Chapter 43. Care of the Patient with a Musculoskeletal Disorder

Size: px

Start display at page:

Download "Chapter 43. Care of the Patient with a Musculoskeletal Disorder"

Grace Whitehead
6 years ago
Views:

2 Support Protection Movement Mineral storage Hematopoiesis Basic Functions of the Skeletal System All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

3 Divisions of the Skeletal System Axial skeleton Composed of the skull, hyoid bone in the neck, vertebral column, and thorax Appendicular skeleton Composed of the upper extremities, lower extremities, shoulder girdle, and pelvic girdle All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

4 Functions of the Muscular System Muscles are necessary for movement Three vital functions muscles perform when they contract Motion Maintenance of posture Production of heat Contraction also assists in return of venous blood and lymph to the right side of the heart All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

5 Types of Body Movements Flexion Extension Abduction Adduction Rotation Supination Pronation Dorsiflexion Plantar flexion All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

6 Diagnostic Examinations of the Musculoskeletal System X-ray Laminography Scanography Myelogram Nuclear scanning MRI Computed tomography Bone scan Aspiration Synovial fluid aspiration Endoscopic examination All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

7 Rheumatoid Arthritis The most serious form of arthritis Leads to severe crippling Characterized by a chronic inflammation of the synovial membrane (synovitis) of the diarthrodial joints All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7

8 Rheumatoid Arthritis cont d Assessment Subjective Malaise Muscle weakness Loss of appetite Generalized aching Feelings of stiffness (especially in the morning) Objective Joint edema Tenderness Subcutaneous nodules Limitation in ROM Fever All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

9 Rheumatoid Arthritis cont d Medical Management Aimed at Controlling the disease activity Pain relief Prolonging joint function Slowing the progression of the disease All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

10 Osteoarthritis (Degenerative Joint Disease) Nonsystemic, noninflammatory disorder that causes bones and joints to degenerate Most commonly affects the joints of the hand, knee, hip, and cervical and lumbar vertebrae Symptoms include pain and stiffness in the joints (most frequently in the morning) All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

11 Osteoarthritis (Degenerative Joint Disease) cont d Assessment Subjective Pain Stiffness Decreased grip strength Objective Joint edema Tenderness Instability Deformity All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

12 Osteoarthritis (Degenerative Joint Disease) cont d Medical Management Exercise plan Physical therapy Gait enhancers Pain control All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

13 Gouty Arthritis (Gout) Caused by an accumulation of uric acid in the blood Affects men eight times more frequently than women Onset usually occurs at night Excruciating pain and swelling in the affected joint All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13

14 Gouty Arthritis (Gout) cont d Assessment Subjective Pain (most commonly in the great toe) Objective Joint edema Heat Limited joint movement All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

15 Gouty Arthritis (Gout) cont d Medical Management Colchicine Corticosteroids Allopurinol Aspirin All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

16 Nursing Interventions Rheumatoid Arthritis Thorough patient education Administer analgesics as indicated Physical therapy referral Encourage patient to express feelings Hot packs Cold packs All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16

17 Nursing Interventions cont d Osteoarthritis Encourage patient to maintain ADLs Assess for neurovascular impairment Assess gait Provide patient education All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17

18 Osteoporosis A disorder that results in a loss of bone density Can interfere with the mechanical support function of the bone Women between the ages of 55 and 65 years are identified as a high-risk group All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18

19 Osteoporosis cont d Medical Management Calcium supplements Vitamin D supplements Weight-bearing exercises Bone resorption inhibitors Surgical intervention All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19

20 Osteoporosis cont d Healthy Lifestyle Measures Increase milk and dairy intake Increase weight-bearing exercise Limit caffeine intake Avoid drinking cola Avoid smoking All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20

21 Knee Arthroplasty (Total Knee Replacement) Replacement of the knee joint to restore motion, relieve pain, or correct deformity Assess Home medications Allergies Past surgeries Significant medical problems Vital signs Weight All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21

22 Knee Arthroplasty (Total Knee Replacement) cont d Nursing Interventions Monitor and treat pain Turn, cough, and deep breathe Incentive spirometer Monitor fluid status Aid in ambulation as indicated All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22

23 Hip Arthroplasty (Total Hip Replacement) Commonly performed when arthritis involves the head of the femur and acetabulum May also be performed for fractures, tumors, and injuries Assess Orientation Pain Numbness Skin Cough Respiratory effort Incision Urinary output All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23

24 Hip Arthroplasty (Total Hip Replacement) cont d Nursing Interventions Vital signs Intake and output Monitor and treat pain Apply antiembolism devices Provide patient education Turn, cough, deep breathe Neuro checks Maintain bedrest as indicated Encourage ambulation Raised toilet seat All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24

25 Postoperative Care for the Patient Who Had a Fractured Hip Open Reduction and Internal Fixation (ORIF) Assess patient s ability to understand instructions and limitations Assist patient to dangle feet at bedside on first postoperative day Turn patient every 2 hours Prop with pillows between legs or under the back to maintain position Assist with range-of-motion exercises to maintain muscle strength If a stable plate and screw fixation is used to repair the fractured hip, the patient should not bear weight for 6 weeks to 3 months to protect the fracture site A telescoping nail fixation allows minimal to partial weight-bearing during the first 6 weeks to 3 months All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 25

26 Hip Prosthetic Implant Teaching for patients who had a fractured hip and received a hip prosthetic implant (hemiarthroplasty) includes the following: Avoid hip flexion beyond 60 degrees for approximately 10 days Avoid hip flexion beyond 90 degrees for 2 to 3 months Avoid adduction of the affected leg beyond midline for 2 to 3 months Maintain partial weight-bearing status for approximately 2 to 3 months Avoid positioning on the operative side in bed Maintain abduction of the hip by using a wedge-shaped foam bolster or pillows arranged in a wedge; this will require nursing assistance All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26

27 Physiology of Bone Healing When a fracture occurs, there is bleeding at the site A clot forms at the ends of the fractured bone The hematoma becomes organized and a fibrin network is created Osteoblasts enter the fibrous areas A callus forms Collagen strengthens and calcium deposits increase Remodeling occurs All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27

29 Complications of Fractures cont d Compartment Syndrome Pathologic condition Caused by Arterial vessel compression Reduced blood supply to an extremity May result from a tight cast or dressing Irreversible muscle ischemia can occur within 6 hours Paralysis and sensory loss follow All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 29

30 Complications of Fractures cont d Compartment Syndrome Assessment Subjective data Pain complaints, most frequently when moving hand or foot Usually deep, unrelenting, poorly localized pain Pain unrelieved by analgesics Pain may be accompanied by numbness or tingling Objective data Unable to flex fingers or toes Cool extremity Thready or absent pulses Paleness in extremity Cool extremity All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 30

31 Complications of Fractures cont d Compartment Syndrome Medical Management Prompt intervention is necessary A fasciotomy is indicated All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 31

32 Complications of Fractures cont d Compartment Syndrome Nursing Interventions Assess and control pain Keep limb at a level no higher than the heart Apply cold packs Remove constricting material All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 32

33 Complications of Fractures cont d Fat Embolism Pulmonary fat embolism involves the embolization of fat tissue within the pulmonary capillaries Fat embolism is rare Can be life-threatening, as fat occludes the pulmonary artery This leads to brain hypoxia and tissue death All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 33

34 Complications of Fractures cont d Fat Embolism Assessment Subjective data Mental status Orientation Irritability Chest pain Muscle weakness Objective data Tachypnea Dyspnea Hypoxemia Crackles Wheezes All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 34

35 Complications of Fractures cont d Fat Embolism Nursing Interventions Assess ABGs Careful support when repositioning Reposition as little as possible Monitor I&O Monitor fluid status Assess daily weights All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 35

37 Traction cont d Nursing Interventions Keep body in proper alignment Keep weights off floor Assess pin sites as indicated All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 37

40 Bone Cancer Tumors of the bone may be primary or secondary They may be benign or malignant All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 40

43 Bone Cancer cont d Medical Management Larger tumors may require surgery Radiation Chemotherapy Possible amputation All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 43

44 Bone Cancer cont d Nursing Interventions Monitor vital signs Assess and treat pain Provide cast care Assist with ADLs as needed Consult PT Consult OT Provide patient education All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 44

45 Phantom Pain Pain felt in the missing extremity as if it were still present May be frightening to the patient Phantom pain occurs because the nerves that register pain in the amputated area continue to send a message to the brain This is a common finding All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 45

46 Lordosis, Scoliosis, Kyphosis Lordosis is an increase in the curve at the lumbar spine region that throws the shoulders back Scoliosis is a lateral (or S) curvature of the spine Kyphosis is a rounding of the thoracic spine All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 46

Car a e e o f o th f e th e Pati Pa e ti n e t n wi w th i th a Mus u c s u c l u o l s o k s e k l e e l t e al a l Dis i o s r o de d r

Car a e e o f o th f e th e Pati Pa e ti n e t n wi w th i th a Mus u c s u c l u o l s o k s e k l e e l t e al a l Dis i o s r o de d r Care of the Patient with a Musculoskeletal Disorder 1 Slide 1 Overview of Anatomy and Physiology Function of the bones Support Protection Movement Mineral storage Hemopoiesis Slide 2 Functions of the muscles