Nursing For Adults - Muscolskeltal Part 1.

Kyphosis

Curve outward

Lordosis

Curved inward

lower back a pronounced curve

Scoliosis

Curves sideways

S or C shape from behind

General bone health ingredients

Active Vitamin D - Needed for absorption of calcium

PTH - regulates bone / calcium and phosphorus levels

Calcitonin - lowers blood calcium levels

Thyroid hormone and cortisol - graves disease long term steroid use

Growth hormone - stimulate bone growth and remodeling

TnE - stimulate osteoblasts and inhibits osteoclasts

Bone healing

Hema Toma formation (1-5)

Inflammatory phase (5-11)

Reparative phase (days 11-28)

Remodeling phase (6 weeks and onward)

joint types

Synovial

Saddle

Joint Capsule

Ligaments

Synovial - free moving hinge

Saddle - pivot joints (radius / ulna)

Joint Capsule ( lined by synovium, prevents bone surface form touching one another)

Ligaments - connects articulating bones together

Bursa - filed with synovial fluid, facilitates movement of tendons and muscles.

Muscle Strength : Hypertrophy and atrophy

Hypertrophy

- increase in size of muscle fibers

Atrophy

- loss of muscle mass and strength

- occurs with bed rest and immobility

- prevent with isometric exercises

aging considerations of musculoskeletal

Peak bone mass - early 40s

Osteoporosis

Osteoarthritis

Contracture

Effusion

Crepitus

MS assessment

NV assessment including the 6 ps (pain, pallor, pulse, paresthesia, paralysis, poikilothermic)

Arthrography

Arthroscopy

Arthrocentesis

Acute back pain

asd3 months

Aging change related, disc of spinal cord become irregular shaped and densest

Disk protrusion (herniation)

Acute back pain clinical manifestations

Radiculopathy

Sciatica

Absence = muscular

Acute back pain Tx

Usually self limiting 4 weeks (rest, analgesics, stress reeducation, relaxation)

Pharmacologic

(NO opioid's, OTC NSAIDS)

Non-Pharmacological

(heat / col, acupuncture, massage, biofeedback, body mechanics, change position)

Acute back pain improve mobility

Slow and easy

body posture

in bed: no prone, curled, log roll

Lumbar support

Core exercise

Avoid jarring activates

Plantar fasciitis

inflammation of foot fascia

Severe heal pain in morning

Localized to medial heel

Diminished with stretching

Plantar fasciitis management

Stretching exercises orthotic devices

Weight loss

NSAIDS

Unresolved = bone spurs

Osteoporosis what is happening

Reduced bone density = progressively porous bones = fracture easily under stress

Compression fractures can occur EX : thoracic / lumbar / neck / trochanteric of femur, colles fracture of wrist.

Osteoporosis risk factors

Female, small frames, loss of estrogen

Nutrition - need adequate calories / nutrients, calcium and vitamin D.

Weight bearing exercises - immobility

Gerontological risk factors - prevalence increased with age, lowered calcium absorption excreted more readily, reduced sun exposure.

Osteoporosis how will client present

Loss of height

Kyphosis / dowagers hump

Compression fractures of spine

Protruding abdomen

breathing difficulties

Osteoporosis Tx

Anticatabolic Meds - alendronate and risedronate

Hormone therapy - estrogen / progesterone

Monoclonal antibody - densumab

Anabolic - teriparatide and abalopratide

Calcium supplements

Carbonate

Citrate

Gluconate

Lactate

Vitamin D supplements

cholecalciferol,

ergocalciferol

Calcitriol

Weight bearing exercises for osteoporosis

Stress signals osteoblasts to stimulate bone formation

Increase bone density

Sunlight for osteoporosis

UVB rays interact with cholesterol in skin cells

Body processes this into activate vitamin D

Allows for increased absorption of calcium

Allows body to naturally produce vitamin D it needs

Osteomyelitis : Three common mechanisms

Extension of soft tissue infection

Direct bone constipation

Hematogenous spread from other sites of infection

Three common : Risk factors

Age

Impaired immune system

Trauma / open fractures

Inject drugs

Chronic illness

Orthopedic hardware

Long term corticosteroid therapy

Immunosuppressive agents

Osteomyelitis : what is happening

Infection --> inflammation --> thrombus ---> ischemia and bone necrosis

infection to adjacent soft tissues / joints

prompt treatment

Dealed treatment = dead bone, does not drain = abscess formation = new bone forms around dead bone = recurring abscesses

Osteomyelitis : how will the client present

*Pain over infected bones

Painful, swollen, extremely tender

Spread from nearby infection = slow onset / sepsis

Osteomyelitis : Acute

May take 14 Days

Elevated, WBC, leukocytes, ESR and CRP

Osteomyelitis : Chronic

ESR / WBC normal

Anemia of chronic disease

Osteomyelitis : chronic vs acute

Chronic is presence of dead

Osteomyelitis : medical treatment

Based on blood cultures

hydration / balanced diet, correction anemia

Immobilize affected area

Osteomyelitis : pharma logical treatment

Hospiltiazed --> antibiotic around clock

6 weeks acute, chronic longer

after controlled = oral antibiotics up to 3 months

Surgery if chronic (debridement)

Osteomyelitis : prevention

postpone elective surgery

Prophylactic surgies before during and after

remove catheters

treat local infections

Special care for PTs with DM

Bone tumors Nursing management

Monitor VS and NV

Assess blood loss

Monitor For complications

Elevate extremity

Reposition

Nutrition

Hydration

Hypercalcemia

Benign Bone tumors

most common

Slow growing

Osteochondroma

Malignant bone tumors

Osteosarcoma, chondrosarcoma, Ewing sarcoma

Osteosarcoma, most common / fatal

Prognosis based on metasis

Pain edema, limited joint / limb motion, pain on weight bearing, weight loss

Chemo Surgery