Unit II: Activity and Rest Needs- Musculoskeletal System Los Angeles Harbor College Associate Degree Nursing Program Description: After appropriate study and practice, the nursing student will be able to plan and give care to adult patients in an acute hospital setting to meet identified needs; with special emphasis on activity and rest needs due to pain, soft tissue injuries, fractures, bone tumors, amputations, osteomyelitis, osteoporosis, Paget s disease, osteomalacia, lower back pain, common hand and foot disorders and connective tissue disorders. The Roy Adaptation Model and the Nursing Process will be integrated to provide a nursing framework for providing nursing care to patients with adaptation problems relating to activity and rest needs. Estimated time of achievement: Two weeks Objectives: Course Content Learning Activities QSEN Concepts Section 11: Problems Related to Chapter 61: Assessment of Movement and Coordination Musculoskeletal System, pages (Chapters 61-64) 1446-1461 1. Select significant subjective and objective data related to the musculoskeletal system. 2. Select appropriate techniques to use in the physical assessment of the musculoskeletal system. 3. Determine abnormal findings of a physical assessment of the musculoskeletal system. 4. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies of the musculoskeletal system. Table 61-2: Health History Musculoskeletal System, p.1452 Table 61-5: Normal Physical Assessment of the Musculoskeletal System, p. 1455 Table 61-6: Assessment Abnormalities Musculoskeletal System, p. 1456 Table 61-1: Gerontologic Assessment Differences, p1451 Table 61-7: Diagnostic Studies Musculoskeletal System, p. 1457-1459: Standard x- ray, Diskogram, Computed tomography (CT) scan, 1 Case Study Patient Introduction, p. 1451 Subjective Data, p. 1454 Objective Data: Physical Examination, p. 1457 Diagnostic Studies, p. 1460 Online Student Resources: HTTP://evolve.elsevier.com/Lewi s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Patient- Centered Care Gerontologic Considerations: Effects of Aging on Musculoskeletal System, p. 1450 Genetic Risk Alert, p. 1453 Table 61-1: Gerontologic Assessment Differences, p. 1451 Table 61-2: Health History: Musculoskeletal System, p. 1452 Teamwork and Collaboration Discussion Role- Relationship Pattern, p. 1453 Quality Improvement Focused Assessment: Musculoskeletal System, p. 1457 Safety Genetic Risk Alert, p. 1453
5. Differentiate among the etiology, pathophysiology, clinical manifestations, nursing management, and interprofessional care of soft tissue injuries, including strains, sprains, dislocations, subluxations, anterior cruciate ligament, types of fractures, and amputations. 6. Relate the sequential events involved in fracture healing and explain common complications associated with a fracture and fracture healing. 7. Compare closed reduction, cast immobilization, open reduction, and traction in terms of purpose, nursing management, and complications. 8. Describe the types of joint replacement surgery for arthritis and prioritize the preoperative and postoperative management of joint replacement surgery. Myelogram with or without CT, MRI. Bone Mineral Density (BMD) Measurements: Dual energy x- ray absorptiometry (DXA), Radioisotope Studies: Bone scan. Mineral Metabolism: Alkaline phosphate, Calcium, Phosphorus. Serologic Studies: Rheumatoid factor (RF), Uric acid, C- reactive protein (CRP). Markers of muscle injury: Creatine kinase (CK). Invasive Procedures: Arthrocentesis, Arthroscopy, Electromyogram (EMG). Miscellaneous: Duplex venous Doppler Sprains & Strains Fractures Complications of Fx s Hip Fracture Amputation Table 62-4: Manifestations of Fracture, p. 1469 Table 62-5: Complications of Fracture Healing, p. 1470 Table 62-10: Problems Associated with Musculoskeletal Injuries, p. 1478 Table 62-3: Emergency Management Acute Soft Tissue Injury, p. 1464 Table 62-6: Interprofessional Care, p. 1470 Chapter 62: Musculoskeletal Trauma and Orthopedic Surgery, pages 1462-1495 (Sprains & Strains, Fractures, Fracture Complications, Hip Fracture, Amputation) Case Study Periprosthetic Hip Fracture and Revision Arthoplasty, p. 1493 Online Student Resources: HTTP://evolve.elsevier.com/Lewi s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Patient- Centered Care Gerontologic Considerations: Hip Fracture, p. 1484 Gerontologic Considerations: Amputation, p. 1490 Table 62-1: Patient & Caregiver Teaching: Prevention of Musculoskeletal Problems in Older Adults, p. 1463 Table 62-9: Patient & Caregiver Teaching Guide: Cast Care, p. 1477 Table 62-11: Patient & Caregiver Teaching: Hip Replacement, p. 1483 Table 62-14: Patient & Caregiver Teaching: Following Lower Extremity Amputation, p. 1490 Teamwork and Collaboration Ambulatory Care, pp. 1464, 1477, 1484, 1490 Nursing and Interprofessional Management, pp. 1465, 1466, 1467, 2
Table 62-7: Emergency Management Fractured Extremity, p. 1474 Table 62-8: Nursing Assessment Fracture, p. 1475 Table 62-13: Interprofessional Care Amputation, p. 1487 Table 62-9: Patient & Caregiver Teaching Cast Care, p. 1477 Table 62-11: Patient & Caregiver Teaching Hip Replacement, p. 1483 Table 62-14: Patient & Caregiver Teaching Following Lower Extremity Amputation, p. 1490 1468 Teamwork & Collaboration: Caring for the Patient With a Cast or Traction, p. 1471 Evidence- Based Practice Evidence- Based Practice: Translating Research Into Practice Do Physical Activity Exercises Decrease Sport Injuries?, p. 1476 Safety Discussion Health Promotion, pp. 1463, 1475, 1488 Safety Alert, pp. 1462,1480 Table 62-3: Emergency Management: Acute Soft Tissue Injury, p. 1464 Table 62-7: Emergency Management: Fractured Extremity, p. 1474 Informatics/Nursing Judgment Informatics in Practice: Web- Based Knee and Hip Replacement Community, p. 1477 9. Describe the etiology, pathophysiology, clinical manifestations, nursing management, interprofessional care, including surgical therapy, and nursing management of osteoporosis, osteomyelitis, and acute/chronic low back pain (including intervertebral disc disease). Osteoporosis Osteomyelitis Acute/Chronic Low Back Pain Table 63-2: Nursing Assessment - Osteomyelitis, p. 1499 Table 63-5: Nursing Assessment Low back pain, p. 1503 Table 63-7: Chapter 63: Musculoskeletal Problems, pages 1496-1516 Case Study Metastatic Bone Tumor/Pathologic Fracture, p. 1514 Teamwork and Collaboration/Professional Identity Discussion Muscular Dystrophy, p. 1501 Online Student Resources: Patient- Centered Care Genetic Link, p. 1502 Gerontologic Considerations: Foot Problems, p. 1510 Gerontologic Considerations: Metabolic Bone Diseases, p. 1514 Table 63-6: Patient & Caregiver Teaching: Low Back Problems, p. 1504 Table 63-10: Patient & Caregiver Teaching: Neck Exercises, p. 1508 Genetics in Clinical Practice: Duchenne and Becker Muscular Dystrophy (MD), p. 1502 3
Manifestations of Lumbar Disc Herniation, p. 1505 Table 63-12: Risk Factors for Osteoporosis, p. 1511 Table 63-8: Interprofessional Care Intervertebral Disc Disease, p. 1506 HTTP://evolve.elsevier.com/Lewi s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Diagnostic & Laboratory Exams Cultural & Ethnic Health Disparities: Osteoporosis, p. 1511 Gender Differences: Osteoporosis, p. 1511 Safety Drug Alerts, pp. 1498, 1513 Safety Alert, pp. 1502, 1514 Table 63-12: Risk Factors for Osteoporosis, p. 1511 Table 63-13: Interprofessional Care Osteoporosis, p. 1512 Table 63-6: Patient & Caregiver Teaching Low Back Problems, p. 1504 10. Compare and contrast the sequence of events leading to joint destruction in osteoarthritis and rheumatoid arthritis. 11. Differentiate among the etiology, pathophysiology, clinical manifestations, nursing management and interprofessional care, including surgical therapy of osteoarthritis, rheumatoid arthritis, gout, and systemic Lupus Erythematosus (SLE). Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout Systemic Lupus Erythematosus (SLE) Table 64-5: Stages of Rheumatoid Arthritis, p. 1526 Table 64-6: Comparison of Rheumatoid Arthritis and Osteoarthritis, p. 1526 Table 64-7: Diagnostic Criteria for Rheumatoid Arthritis, p. 1528 Table 64-9: Nursing Assessment Rheumatoid Arthritis, p. 1530 Chapter 64: Arthritis and Connective Tissue Diseases, pages 1517-1552 Case Study Rheumatoid Arthritis, p. 1549 Managing Multiple Patients, p. 1552 Online Student Resources: HTTP://evolve.elsevier.com/Lewi s/medurg Resource Books: Latest Edition of: Drug Guide Clinical Nursing Skills and Techniques Nursing Concepts Patient- Centered Care Genetic Link, p. 1526 Gerontologic Considerations: Arthritis, p. 1532 Table 64-4: Patient & Caregiver Teaching: Joint Protection and Energy Conservation, p. 1524 Table 64-10: Patient & Caregiver Teaching: Protection of Small Joints, p. 1531 Table 64-13: Patient & Caregiver Teaching: Prevention and Early Treatment of Lyme Disease, p. 1535 Table 64-17: Patient & Caregiver Teaching: Systemic Lupus Erythematosus, p. 1542 Gender Differences: Osteoarthritis (OA), p. 1518 4
Table 64-14: Diagnostic Criteria for Systemic Lupus Erythematosus, p. 1540 Table 64-16: Nursing Assessment Systemic Lupus Erythematosus, p. 1541 Table 64-2: Interprofessional Care - Osteoarthritis, p. 1520 Table 64-8: Interprofessional Care - Rheumatoid Arthritis, p. 1528 Table 64-12: Interprofessional Care - Gout, p. 1533 Table 64-15: Interprofessional Care - Systemic Lupus Erythematosus, p. 1540 Table 64-10: Patient & Caregiver Teaching Protection of Small Joints, p. 1531 Table 64-17: Patient & Caregiver Teaching Systemic Lupus Erythematosus, p. 1542 Diagnostic & Laboratory Exams Gender Differences: Gout, p. 1533 Cultural & Ethnic Health Disparities: Arthritis and Connective Tissue Disorders, p. 1525 Genetics in Clinical Practice: Ankylosing Spondylitis, p. 1536 Teamwork and Collaboration Ambulatory Care, pp. 1524, 1531, 1542 Interprofessional Care, pp. 1519, 1528, 1533, 1537, 1540, 1543, 1547 Nutritional Therapy, pp. 1529, 1534 Nursing Management: Fibromyalgia, p. 1548 Myofascial Pain Syndrome, p. 1546 Evidence- Based Practice Table 64-5: Stages of Rheumatoid Arthritis, p. 1526 Table 64-7: Diagnostic Criteria for Rheumatoid Arthritis, p. 1528 Table 64-13: Patient & Caregiver Teaching: Prevention and Early Treatment of Lyme Disease, p. 1535 Table 64-14: Diagnostic Criteria For Systemic Lupus Erythematosus, p. 1540 Complementary & Alternative Therapies: Acupuncture, p. 1523 Complementary & Alternative Therapies: Glucosamine and Chondroitin, p. 1523 Safety Drug Alerts, pp. 1529, 1545 5
Drug Therapy List Chapter 62 Chapter 63 Chapter 64 Non- steroidal anti- inflammatory drugs (NSAIDs) Antibiotic therapy cefazolin, vancomycin Analgesics nonopioid/opioid morphine, hydromorphone (Dilaudid) Muscle relaxants cyclobenzaprine (Flexeril), methocarbamal (Robaxin) Stool softeners/laxatives Docusate sodium (Colace), polyethylene glycol (Miralax) Anticoagulants warfarin (Coumadin) Low- molecular weight heparin enoxaparin (Lovenox), dalteparin (Fragmin) Factor Xa inhibitor fondaparinux (Arixtra), rivaroxaban (Xarelto), apixaban (Elquis) Antibiotic therapy cephalexin, cefazolin, cefoxitin, gentamicin, tobramycin, penicillin, vancomycin, ciprofloxacin (Cipro) Non- steroidal anti- inflammatory drugs (NSAIDs) Corticosteroid oral/epidural injections prednisone Analgesics nonopioid/opioid morphine, hydromorphone (Dilaudid) Muscle relaxants cyclobenzaprine (Flexeril), methocarbamal (Robaxin) Stool softeners/laxatives Docusate sodium (Colace), polyethylene glycol (Miralax) Antidepressants Duloxetine (Cymbalta) Antiseizure Gabapentin (Neurontin) Biphosphonates Analgesics nonopioid acetaminophen (Tylenol) Salicylates aspirin Non- steroidal anti- inflammatory drugs (NSAIDs) ibuprofen (Advil), naproxen (Aleve), indomethacin (Indocin), meloxicam (Mobic), celecoxib (Celebrex) Antibiotics doxycycline (Vibramycin), Topical analgesics capsaicin cream, diclofenac sodium (Volatren gel) Corticosteroids intraarticular injections methylprednisolone acetate (Depo- Medrol), triamcinolone (Aristospan) Corticosteroids systemic hydrocortisone (Solu- Cortef), methylprednisolone (Solu- Medrol), dexamethasone, prednisone, triamcinolone 6
Tetanus and diphtheria prophylaxis alendronate (Fosamax) Selective estrogen receptor modulator raloxifene (Evista) Antigout colchicine (Colcrys), allopurinol (Zyloprim), febuxostat (Uloric), Disease- modifying antirheumatic drugs (DMARDs) methotrexate (Trexall), sulfasalazine (Azulfidine) Gold compounds parenteral: gold sodium thiomalate aurothioglucose; oral: auranofin (Ridaura) Antimalarial Hydroxychloroquine (Plaquenil) Immunosuppressants azathioprine (Imuran), mofetil (Cellcept) JAK (Janus Kinase) inhibitor tofacitinib (Xeljanz) Biologic Response Modifiers (Biologics, Immunotherapy) Tumor necrosis factor inhibitors infliximab (Remicade), adalimumab (Humira) Interleukin- 1 receptor antagonist anakinra (Kineret) 7
Interleukin- 6 receptor antagonist tocilizumab (Actemra) T cell activation inhibitor abatacept (Orencia) B cell depleting agent rituximab (Rituxan) Topical immunomodulators Tacrolimus (Prograf) 8
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