Module 10: Altered Musculoskeletal Function

Notes

• Don’t go too deep, only really taking care of the patient NURSING MANAGEMENT

• Study the case study, pp with notes

• hormones ( ONLY estrogen)

Actual PP

• During the assessment

  • Pain, weakness, instability, altered sensation, temperature, altered sensation

• Scolosis

• GAIT assessment

• Dx: Caclcium, phosphorus, vitamin D, hormones ( ONLY estrogen)

  • Imaging Study: XR, computed tomography, MRI, Arthrogram ( joint), DEXA scan ( osteoporosis)

• Arthrocentesis

  • Clinical procedure where fluid is aspirated from the joint

  • Done for dx tests and pain relief, and the most common reason is to diagnose gout, arthritis, and synovial infection

  • Inject corticosteroid for pain relief

  • Worried about infection

  • Sterile dressing and keep it on

  • Pain is an expected finding

• Age-related changes

  • At age 30, bone density begins to down

  • In women, estrogen and menopausal accelerates bones

  • Joints are stiffer and less flexible

  • Teaching, regular weight bearing exercise, take vitamin D supplements

• Osteomyelitis

  • Pathophysiology: Invasion of bone and surrounding tissue by bacterial pathogens

  • Hematogenous: Infectious spread from another area to the body via the bloodstream

  • Continguous: Result of an open fracture or trauma to the bone

  • Bone infections are worse than tissue infections

  • Radioactive isotop goes to the area of inflammation and infections and lights up when there are infection

  • The gold standard is bone biopsy

    • ESR, WBC, Blood culture, C reastive protein, bone scan for acute osteomyeltis

  • Tx: Give antibiotic 4-6 weeks, surgical debridement

    • Complication: Sepsis and amputation

• Scoliosis: Curvature of the spine more than 10 degrees

  • Causes is unknown

  • Clinical mani: sideways curve, uneven shoulders, uneven waist, one hip high, and cardiopulmonary compromise with severe scoliosis ( when the heart can grow correlty)

  • Referred to as a C curve and S curve

  • Management

    • Thermal therapy, PT/OT, progressive exercise, bracing, TLS braces ( like a vest)( prevent spine from worsening but doestn correct), steel rodes in the back

    • Surgical management only for severe scoliosis

  • Nursing intervention

    • Pain management, thermal

• Bone Tumors

  • Primary Tumors -

    • Osteosarcoma: most common and fatal

      • The best treatment is cutting off the limp

      • Chondrosarcoma. Ewing sarcoma, fibrosarcoma

    • Soft tissue sarcomas

      • Liposarcoma, fibrosarcoma of soft tissue, rhabdomyosarcoma

  • The prognosis depends on the type and whether the tumor has metastasized

  • Bone Tumor - Metastatic ( Secondary)

    • More common than primary bone tumors

    • Common primary sites that metastasize: kidneys, prostate, lung, breast, ovary, thyroid

    • Metatic tumors are more frequently found in the skull, spine, pelvis, femur, and humerus, involving one or more bones

    • Treatment is palliative care

  • Medical and Nursing Management of Bone Tumors

    • Medical management

      • Primary: Surgical excision, radiation therapy, chemo

      • Secondary: Palliative

    • Nursing Management

      • Monitoring and managing complications

        • Delay wound healing

        • Infection

        • Hypercalcemia

      • Patient and family education regarding diagnosis, disease process, and treatment

Case Studies

• R.F. had pressure ulcers and recurrent

• You would check

  • For pressure ulcer, vitals, pain, wound assessment, 6 P: pain, pallor, parensthesia, paralysis, pulse, pressure

  • Antibiotics can be started with a pressurized bulb in an outpatient setting and inserted into the PIV

    • When there are two infections, they will need two antibiotics

    • High-calorie diet prioritizing protein

    • Proper wound care and management

  • Priority nursing problem

    • Impaired physical mobility

    • Impaired skin impairment

    • Acute/chronic pain

Group Activity

• Group 1: Osteoporosis

  • Patho: rate of bone absorption accelerate as the rate of bone formation decrease which decrease bone mass and bones becomes more porous and brittle

    • Lack of estrogen

  • Risk Factors: Females, smoker. ,emp[aiise, sedentary lifestyle

  • Diagnostic test: Bone biopsy, x ray, CT scan, dexa scan( loss of bone density and measure boen density, decrease vitamin D3 and increase of PTH

  • Nursing Intervnetion/ Teaching:

    • Improtance of CA and vitamin D

    • Medication regime and side effect

    • Fall injury precuations

      • Clutter syndrome

      • Use of assistive device

    • Smoking

    • ROM excervicse

    • tHERMAL THERAP

  • Tx: Smoking cessation, PT/OT, thermal therapy, assisted device, pain control, low impact aerobic, muscle strengthens exercise,e calcium rich diet, reduction and internal fixation for fraction, jyponosis

• Group 2: Fracture/ Traction ( NO TYPES OF FRACTURES)

  • Fractures Physiology: disruption of continuity of bone classified by type of every and is subjected to excessive stress. Can harm surround tissues leading to swelling, mucle/ joint hemorrhage, dislocation, rupture tendons

  • Diagnostic Test for fracture: X-ray, CT scan

  • Prone to osteomylitis

    • Non surgical: NSAID, topical anesthetics, corticostieord, opioids

      • Pain management: monitor for infection

      • Reinforce education: Non weight bearing exercise, use of assistive devices

      • Wound care ( debridement)

    • Surgical: bone graft, internal fixation, etenral fixation

      • Nursing management monitor for infection

  • Possible complication of fraction

    • Shock, infections, DVT, never blood vessel damage, loss of muscle due to immbolity and joint stiffness

      • Bone marrow can cause PE since its such as big vessel

  • Nusing Intervnetion

    • Asssess vital signs, deformity, discoloration, numberness, pain

    • Action: stabailze use with splint, adminster pain med and antiinflammatory, ice packs, prepare for x-ray

  • Traction

    • Skin: Tractions applied to just the skin to stabilize a fraction and control muscle spasm and no more than 4.5-8 lbs involve velcro, straps, and boot

    • Skeletal: use for continuous reaction, inbolbes passing a pin or wire through the bone to mobilize the position

    • Emergency: Never remove traction unless a life threatening situation

• Group 3: Sprain/ Strain

  • Strains: Injury a msucel or a tendon ( msucel to bone)

    • Risk: Overweight/ obese. body proper mechanics

    • RICE: Rest , OCE, COMPRESS, ELEVATE

    • Complication: decrease mobility, chroni pain, nerve damage

    • Cinoartment syndrome ( Tissue damage): pressures builds up in muscle, restricting blood and causing tissue damage ( necrosis)

      • Can happen in sprain, strains, fractures

      • When the wrap is to tight causing acculamation of pressure so you have to assess the top and bottom

      • Faciostom would be the treatment

  • Sprains: Injurty to a ligament connects ( bone to bone)

    • Assessmetn: 6 P: pallor, pain, parasthesia, pulse, paralysis, pressure

    • Initial management: RICE

    • Swelling: doppler ultrasouns/pulses, temp, joint above R below injury site x-ray

    • Pathophysio: Muslce or tendon, stretch beyond capacity that result in damage and tear

      • S/S pain swelling brusing, erythema

    • Bo weight bearing on ankle important, thermotherapy , RICE, ACE wraps ( base of the toes and around the ankle

      • Check for circulation

• Group 4: Amputation

  • Preparation

    • Evalaution of the neuro and function of the affected leg and the non effected level as well

    • Dietatician for post op care

    • Making sure all labs and medication arent influencing the outomc of these surgery

  • Post op team

    • PT, Dietacian, therapy

  • Prone positioning is important since they can develop contractions at the hip

  • AT RISK FOR BLEEDING

• Group 5: Rhyematoid Arrthritis

  • REST REST REST

  • Autoimmune disorder

  • Stress will reactivate the autoimmune response

  • Bilateral

• Group 6: Osteoarthritis