Note
Studied by 67 peopleNoteStudied by 8 peopleNoteStudied by 33 peopleNoteStudied by 8 peopleNoteStudied by 11 peopleNoteStudied by 83 peopleModule 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
Musculoskeletal Assessment
History of Present Illness (HPI) / Chief Complaint
Objective
The aim of gathering the HPI or chief complaint is to obtain a clear description of the current problem to ensure appropriate treatment.
Interview Questions
Pain Assessment
Location of pain: Where is the pain located?
Quality of pain: Is it sharp, stabbing, dull, throbbing, continuous?
Time frame: When did the pain start?
Aggravating/Relieving factors: What makes the pain better or worse?
Swelling
Is there swelling present?
Time noticed: When was the swelling first observed?
Progression: Has the swelling increased or decreased?
Stiffness
Location: Where is the stiffness present?
Duration: How long does the stiffness last?
Degree of stiffness: How severe is the stiffness?
Deformity
Has there been any noticeable change in the affected area compared to the uninjured state?
Weakness
Is weakness present?
Degree of weakness: How severe is it?
Progression: Has it increased or improved since the injury?
Instability
Is there instability in the affected area?
Degree of instability: How is the current level of functioning affected?
Loss of Function
Is the affected area unable to function as it did previously?
Color & Temperature Changes
Are there noticeable changes in skin color or temperature over the affected area?
Altered Sensation
Is there any numbness or tingling present?
Associated Symptoms & Medical History
Are there any other symptoms related to the injury?
Relevant past medical history that could impact the injury?
Significant family medical history related to this condition?
Response to Treatment
Has any treatment been attempted?
Assessing Posture
Normal Walking Gait
Assessment
Physical Assessment
Sensation
Pulses
Muscle Tone and Strength
Sensation, Pulses, and Muscle Tone & Strength Assessment
Sensation
Importance:
Evaluation of sensation is a critical indicator of skeletal bone function.
Abnormal sensation (e.g., numbness or tingling) may indicate nerve damage due to pressure, fracture, or injury.
Paresthesia often resolves after treatment is initiated.
Assessment Procedure:
Pinprick test:
Use a paper clip or a specialized instrument to apply a stimulus to the suspected injury area.
Symmetry and equality of sensation are key indicators.
Inability to feel the stimulus may signal sensory nerve damage.
Pulses
Importance:
Pulse assessment indicates the adequacy of blood flow to the extremities, particularly after injury.
Assessment Procedure:
Method:
Use two fingers (avoid the thumb, as it has its own pulse).
Assess for pulse rate, rhythm, depth, and symmetry.
Muscle Tone
Importance:
Muscle tone refers to the normal degree of tension or contraction in relaxed, voluntary muscles.
Abnormal tone may indicate neurological or musculoskeletal issues.
Assessment Procedure:
Ask the patient to relax completely or "go limp."
Move the extremity through full range of motion (ROM).
Expected finding: A mild, even resistance to movement.
Note any abnormal or involuntary movements.
Muscle Strength
Importance:
Muscle strength testing assesses the ability of muscles to resist force and indicates overall muscle function.
Strength testing is particularly useful when assessing weakness.
Assessment Procedure:
Method:
Ask the patient to resist force as you attempt to move their body part against the direction of pull.
Grading Scale (0 to 5):
0: No muscle contraction
1: Trace of muscle contraction
2: Muscle can move without gravity
3: Muscle can move against gravity but not resistance
4: Muscle can move against some resistance
5: Full ROM against resistance (normal strength)
Note:
Compare bilaterally to detect muscle weakness.
Diagnostic Studies
Laboratory Studies
Calcium
Phosphorus
Vitamin D
Hormones
Bone Health and Calcium, Phosphorus, Vitamin D Assessment
Importance of Bone Health
Bones are the major source of calcium in the body.
Adequate calcium levels are essential for bone health and bone integrity.
Low calcium levels increase fracture risk.
Laboratory Assessments for Bone Health
Calcium Levels
Essential for maintaining bone density and bone health.
Low calcium is associated with increased fracture risk.
Phosphorus Levels
Inverse relationship with calcium: As calcium levels rise, phosphorus levels decrease in a healthy individual.
Both calcium and phosphorus are crucial for bone integrity.
Vitamin D Levels
Vitamin D promotes the gastrointestinal absorption of calcium and phosphorus.
Adequate vitamin D is necessary for proper calcium and phosphorus metabolism.
Hormonal Regulation of Calcium and Phosphorus
Calcitonin and Parathyroid Hormone (PTH):
These hormones work together to maintain the equilibrium of calcium and phosphorus in the body.
Estrogen:
Estrogens stimulate osteoblast activity (bone-forming cells).
The decrease of estrogens after menopause increases fracture risk.
Estrogen levels can be assessed primarily through urine analysis.
Clinical Relevance
Calcium and phosphorus levels, along with vitamin D and estrogen assessments, are crucial for evaluating bone health and identifying potential fracture risk.
Monitoring these values regularly can help prevent complications related to osteoporosis and other bone-related disorders.
Imaging Studies
X-ray
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Arthrogram (Joint)
DXA or DEXA Scan (Osteoporosis)
Arthrocentesis
Imaging Studies and Diagnostic Tests for Musculoskeletal Health
X-ray
Purpose:
X-rays are commonly used to visualize injuries or abnormalities in the musculoskeletal system.
They help the practitioner assess the extent of the injury or abnormality for appropriate treatment.
Importance:
Quick, efficient, and non-invasive diagnostic tool.
Often the first step in diagnosing musculoskeletal issues.
Computed Tomography (CT) Scan
Purpose:
A CT scan combines multiple x-ray views from different angles to create cross-sectional images of bones and soft tissues.
The addition of contrast material can highlight blockages or blood vessel abnormalities.
Importance:
Provides detailed images for better assessment of soft tissue and bone abnormalities.
Useful for detecting complex fractures or conditions not clearly visible in a regular x-ray.
Magnetic Resonance Imaging (MRI)
Purpose:
An MRI uses magnetic fields and radio waves to produce high-detail images of internal structures of the body.
Importance:
Often provides greater detail than x-rays or CT scans, especially for soft tissues such as muscles, ligaments, and tendons.
Ideal for assessing conditions like soft tissue damage or joint issues.
Arthrogram
Purpose:
Arthrography is used to evaluate joint pain or progression of joint disease.
A contrast agent (radiopaque dye or air) is injected into the joint cavity to enhance visualization of the joint structures (ligaments, cartilage, tendons, joint capsule).
Importance:
Provides detailed images of joint structures during their range of motion.
If there is a tear in the joint, the contrast agent will leak out, which can be seen on the x-ray.
DEXA (Dual-Energy X-ray Absorptiometry)
Purpose:
DEXA is used for bone densitometry to evaluate bone mineral density (BMD).
It can predict fracture risk and monitor bone density changes, particularly for patients with osteoporosis.
Importance:
Accurate method for monitoring bone density, especially for patients undergoing osteoporosis treatment.
Can evaluate the density of bones in spine, hip, wrist, and total body.
Peripheral DEXA (pDXA) can be used for the forearm, finger, or heel, but it is less accurate for predicting hip or spine fracture risk.
Age-Related Changes
Changes in bone density, posture, and gait (e.g., loss of height, kyphosis)
Age 30: Bone density begins to diminish
Post-Menopause: Accelerates in women due to loss of estrogen
Joint cartilage decreases in mass due to reduced bone mineral content → Thinner joints = Fracture risk
Joints become stiffer and less flexible due to decreased fluid in joint spaces
Connective tissues within ligaments lose water content and become more rigid
Teaching:
Regular weight-bearing exercises
Adequate vitamin D intake
Routine follow-ups with PCP
Reference: Review Table 35-1\
Arthrocentesis (Joint Aspiration)
Purpose:
Arthrocentesis is performed to obtain synovial fluid for diagnostic examination or to relieve pain due to joint effusion (excess fluid in the joint).
The examination of synovial fluid is helpful in diagnosing conditions like septic arthritis and other inflammatory arthropathies.
Additional Purposes:
Diagnose: Hemarthrosis (bleeding into the joint cavity), which indicates trauma or a bleeding disorder.
Relieve Pain: Remove excess fluid from the joint to alleviate discomfort from effusion.
Normal Appearance of Synovial Fluid:
Clear, pale, straw-colored
Scanty in volume
Procedure:
Aseptic Technique:
The procedure is done under aseptic conditions to prevent infection.
Needle Insertion:
The primary provider inserts a needle into the affected joint.
Aspiration:
The provider aspirates (removes) synovial fluid for analysis.
Medication Injection (Optional):
Anti-inflammatory medications may be injected into the joint after aspiration to reduce inflammation and pain.
Dressing:
A sterile dressing is applied after the procedure to minimize the risk of infection.
Diagnostic Value:
Synovial Fluid Analysis:
Helps identify infections (e.g., septic arthritis).
Can reveal hemarthrosis, indicating bleeding disorders or trauma.
Osteomyelitis
Pathophysiology of Acute and Chronic Osteomyelitis
Overview:
The pathophysiology of acute and chronic osteomyelitis is complex and not completely understood.
The development of the disease is influenced by several factors including virulence of the bacteria, immune status of the patient, underlying health conditions, and the type, location, and vascularity of the bone.
Process of Osteomyelitis Development:
Invasion of Bone and Surrounding Tissue
The process begins with an invasion of the bone and surrounding tissue by bacterial pathogens.
This causes inflammation, which results in increased vascularity and leads to edema.
Thrombus Formation and Ischemia
Within days to weeks, thrombus formation occurs in the vessels, which leads to ischemia and slow necrosis of the affected bone.
The presence of necrotic bone delays the healing process and increases the likelihood of a superimposed infection or abscess.
Cycle of Inflammation and Infection
The continued presence of necrotic bone leads to a cycle of inflammation and infection, which prevents healing.
Clinical Hallmark:
The ultimate clinical hallmark of osteomyelitis is bone necrosis and the development of sinus tracts that connect the bone and skin (as shown in Fig. 53.4).
Types of Osteomyelitis:
Exogenous Osteomyelitis
Causes: Often due to trauma or surgery. The infection spreads through direct inoculation from a fracture or open wound, or via contagious spread from a nearby wound.
Endogenous Osteomyelitis
Causes: This type results from the spread of infection from one part of the body to another. The infection may originate in adjacent soft tissues or joints and then affect the bone.
Spread Mechanism: The infection spreads through indirect inoculation.
Prevalence and Common Pathogens:
Older adults are more commonly affected by contiguous osteomyelitis, which often results from skin infections that spread to the bone.
Common pathogens in contiguous osteomyelitis:
Staphylococcus aureus
Coagulase-negative staphylococci
Aerobic gram-negative bacilli
Polymicrobial or Monomicrobial:
Osteomyelitis in older adults can be either polymicrobial (multiple pathogens) or monomicrobial (single pathogen).
Common scenarios include decubitus ulcers, affected total joint arthroplasties, and vascular insufficiencies.
Prevalence Data:
Contiguous osteomyelitis accounts for approximately 34% of all documented osteomyelitis cases.
Pathophysiology
Invasion of bone and surrounding tissue by bacterial pathogen
Hematogenous: Infection spreads from another area via bloodstream (common in children <1 year)
Contiguous: Occurs from open fractures or trauma (common in adults)
Leads to inflammation and increased vascularity, resulting in edema
Thrombus formation occurs within days to weeks → Ischemia & necrosis
Necrotic bone delays healing → High risk of infection or abscess formation → Increased inflammation and infection
Unfolding Case Study
Patient: R.F., 52-year-old male
Initial Admission (10 months ago):
Admitted to Castro Hospital for COVID-19
Intubated → Extubated → Transferred to Jacob’s Nursing Facility for rehab
Rehab Facility Stay:
Developed sacral wound at Jacob’s Rehab
Received wound treatment
Discharge & Readmission:
Discharged home after 4 months
Developed fever 2 days later
Readmitted to Castro Hospital with a wound infection
Treated with IV antibiotics via PICC line
Current Admission (2.5 months ago):
Admitted to Taylor Nursing Facility
Diagnosed with Stage 4 pressure ulcer (sacrum)
Your Role as an RN:
New grad RN assigned to R.F.’s care
Familiar with his treatment plan after 1 month of care
Assessment Upon Entering the Room
Vital Signs:
Temperature, Pulse, Blood Pressure, Pain
Wound Assessment
Neurovascular Assessment
6 P’s Assessment:
Pain
Pallor
Paresthesia
Paralysis
Pulse
Pressure
Case Study Progress
Current Vital Signs:
BP: 125/82 mmHg
HR: 92 bpm
RR: 18 breaths/min
SpO₂: 95% on RA
Temperature: 100.1°F
Pain Level: 0/10
Mental Status: A&O x3
Next Plan of Action
Administer IV antibiotics as ordered
Administer analgesic therapy as prescribed
Provide training for safe movement with activities
Provide nutritional support
Implement and adhere to turn schedule to prevent further skin breakdown
Priority Nursing Problems
Impaired Skin Integrity
Acute/Chronic Pain
Impaired Physical Mobility
Imbalanced Nutrition: Less Than Body Requirements
Risk for Sepsis
Risk for Disturbed Body Image
Osteomyelitis Diagnosis
Laboratory Tests:
WBC count (elevated in infection)
Erythrocyte Sedimentation Rate (ESR) (indicates inflammation)
C-reactive Protein (CRP) (marker of acute infection)
Blood Cultures (identify causative organism)
Imaging Studies:
Bone Scan (detects acute osteomyelitis)
Bone Biopsy (Gold Standard) for definitive diagnosis
Erythrocyte Sedimentation Rate (ESR)
Overview:
The Erythrocyte Sedimentation Rate (ESR) is a blood test that measures the rate at which red blood cells (erythrocytes) settle at the bottom of a test tube over a period of time (usually one hour).
It is a nonspecific test that can help detect inflammation in the body.
Significance of ESR:
Increased ESR: A higher-than-normal ESR indicates inflammation, which may be caused by conditions like:
Infections
Autoimmune diseases
Chronic inflammatory conditions
ESR is often used to monitor the progress of conditions such as:
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Polymyalgia rheumatica
Normal ESR Values:
Normal ESR levels can vary depending on age, sex, and the laboratory conducting the test.
Typical reference ranges:
Men: 0-15 mm/hr
Women: 0-20 mm/hr
Children: 0-10 mm/hr
Bone Scan
Overview:
A Bone Scan is a nuclear medicine test used to examine the bones for abnormalities or conditions.
It involves the injection of a small amount of radioactive isotopes into the bloodstream. These isotopes are absorbed by bones, and special imaging is used to observe any areas of abnormal activity.
Purpose of a Bone Scan:
Bone scans are often used to detect:
Infections in the bones (osteomyelitis)
Bone fractures that are not visible on X-ray
Cancer that has spread to the bone (metastatic bone disease)
Bone pain of an unknown origin
Arthritis or other inflammatory conditions affecting the bones
Procedure:
A small amount of radioactive material is injected into the bloodstream through an intravenous (IV) line.
The material is absorbed by the bones, and after a short waiting period (typically 2-4 hours), images are taken using a gamma camera.
Areas of abnormal bone metabolism (such as inflammation or infection) will appear brighter in the images.
Advantages of Bone Scans:
Sensitive: Bone scans are highly sensitive for detecting bone-related issues and can identify problems that may not be visible on traditional X-rays.
Early Detection: The test can detect early changes in bone health, making it useful for monitoring the progression of conditions or evaluating treatment effectiveness.
Limitations:
Non-specific: A bone scan can indicate the presence of a problem, but it cannot provide a definitive diagnosis. Further tests (like biopsy or MRI) may be needed to confirm the condition.
Radiation Exposure: As with all nuclear medicine tests, a bone scan involves some exposure to radiation, although the amount is generally low.
Treatment of Osteomyelitis
Medical Management
IV Antibiotic Therapy (4-6 weeks regimen)
Surgical Management
Surgical Debridement and Incision to remove infected or necrotic tissue and bone
Potential Complications
Sepsis
Amputation
Scoliosis
Definition
Curvature of the spine greater than 10 degrees
Cause: Unknown
Commonly classified as: “C” or “S” curve
Clinical Manifestations
Sideways curve in the spine
Uneven shoulders
One shoulder blade more prominent than the other
Uneven waist
One hip higher than the other
Severe scoliosis: May cause cardiopulmonary compromise
Management
Medical Management
Thermal therapy – Reduces pain, promotes comfort, and assists with spinal flexibility
Physical Therapy (PT)/Occupational Therapy (OT)
Progressive exercise regimen
Pain management
Bracing – Helps prevent progression of the curvature
Surgical Management
Spinal Instrumentation and/or Spinal Fusion
Steel rods placed on either side of the spine to straighten the curve
Nursing Interventions – Actions
Administer pain medication as ordered
Maintain orthotic device (e.g., brace)
Apply thermal therapy as prescribe
Nursing Interventions for Musculoskeletal Pain Management
1. Administer Pain Medication as Ordered
Rationale: Adequate pain management is essential in helping the patient achieve maximal functional mobility.
Goal: To reduce pain levels, allowing the patient to participate in physical therapy and other rehabilitation activities.
2. Maintain Orthotic Device
Rationale: Orthotic devices, such as a TCO (Thoraco-Colo-Lumbo-Orthosis) or TLSO (Thoracolumbosacral Orthosis), may be used with or without spinal instrumentation to support the spine, improve posture, and provide pain relief.
Goal: To maintain proper alignment and minimize strain on the musculoskeletal system, aiding in comfort and recovery.
3. Apply Thermal Therapy as Ordered
Rationale: Thermal therapy, which includes hot and/or cold treatments, has been shown to reduce pain and increase functionality.
Hot therapy (e.g., heating pads, warm compresses) is often used to relax muscles and increase blood flow.
Cold therapy (e.g., ice packs) helps to reduce inflammation and numb the area.
Goal: To provide relief from pain and stiffness, promoting healing and comfort.
Bone Tumors – Malignant (Primary)
Types of Primary Bone Tumors
Osteosarcoma – Most common and most fatal
Chondrosarcoma
Ewing Sarcoma
Fibrosarcoma
Soft Tissue Sarcomas
Liposarcoma
Fibrosarcoma of soft tissue
Rhabdomyosarcoma
Prognosis: Depends on the type and whether metastasis has occurred
Bone Tumors – Metastatic (Secondary)
More common than primary bone tumors
Common primary sites that metastasize to bone:
Kidney
Prostate
Lung
Breast
Ovary
Thyroid
Most frequently affected bones:
Skull
Spine
Pelvis
Femur
Humerus
Often affects more than one bone (polyostotic)
Treatment
Palliative care – Focused on symptom management
Goal: Relieve pain and improve quality of life
Osteoporosis
Pathophysiology
Rate of bone resorption accelerates while bone formation decreases → Decreased bone mass
Bones become more porous and brittle
Lack of estrogen contributes to bone loss
Risk Factors
Gender: Female
Lifestyle: Sedentary lifestyle, smoking
Other Factors: Emphysema
Diagnostic Tests
Bone Biopsy
X-ray
CT Scan
DEXA Scan (Measures bone density)
Lab Tests:
↓ Vitamin D3
↑ Parathyroid Hormone (PTH)
Nursing Interventions & Teaching
Importance of Calcium and Vitamin D intake
Medication regimen and potential side effects
Fall Injury Precautions:
Keep environment clutter-free
Use of assistive devices
Range of Motion (ROM) exercises
Smoking cessation
Thermal therapy for pain relief
Treatment (Tx)
Smoking cessation
Physical Therapy (PT) / Occupational Therapy (OT)
Thermal Therapy
Use of assistive devices
Pain control
Low-impact aerobic and muscle-strengthening exercises
Calcium-rich diet
Reduction and internal fixation for fractures
Kyphosis management
Fracture & Traction
Fracture Pathophysiology
Disruption of bone continuity due to excessive stress
Can harm surrounding tissues, leading to:
Swelling
Muscle/joint hemorrhage
Dislocation
Ruptured tendons
Diagnostic Tests for Fracture
X-ray
CT scan
High risk for osteomyelitis
Treatment Approaches
Non-Surgical Management
Pain Management:
NSAIDs
Topical anesthetics
Corticosteroids
Opioids
Wound care (e.g., debridement)
Reinforce education:
Non-weight-bearing exercises
Use of assistive devices
Surgical Management
Bone grafting
Internal fixation
External fixation
Nursing Management
Monitor for infection
Assess for complications:
Shock
Infection
DVT (Deep Vein Thrombosis)
Nerve & blood vessel damage
Muscle loss due to immobility
Joint stiffness
Risk for Pulmonary Embolism (PE) due to bone marrow entering circulation
Nursing Interventions
Assess:
Vital signs
Deformity
Discoloration
Numbness
Pain
Actions:
Stabilize fracture using splints
Administer pain medications & anti-inflammatory drugs
Apply ice packs
Prepare for X-ray
Traction
Types of Traction
Skin Traction
Used to stabilize fractures & control muscle spasms
Applied externally using:
Velcro, straps, boots
Weight limit: 4.5–8 lbs
Skeletal Traction
Used for continuous traction
Involves passing a pin or wire through the bone to mobilize position
Emergency Consideration
🚨 Never remove traction unless in a life-threatening situation 🚨
Sprain & Strain
Strain
Definition: Injury to a muscle or tendon (muscle to bone)
Risk Factors
Overweight/obesity
Poor body mechanics
Pathophysiology
Muscle or tendon is stretched beyond its capacity → Leads to damage and tearing
Signs & Symptoms
Pain
Swelling
Bruising
Erythema
Complications
Decreased mobility
Chronic pain
Nerve damage
Compartment Syndrome (Tissue Damage)
Increased pressure in muscle compartment → Restricted blood flow → Tissue necrosis
Occurs in: Sprains, strains, fractures
Cause: Wrapping too tightly → Pressure builds up
Assessment: Check top & bottom of the wrap
Treatment: Fasciotomy (surgical decompression)
Initial Management – RICE
Rest
Ice
Compress
Elevate
Sprain
Definition: Injury to a ligament (connects bone to bone)
Assessment – 6 P’s
Pallor
Pain
Paresthesia
Pulse
Paralysis
Pressure
Initial Management
RICE
ACE wraps (starting from base of toes and wrapping around ankle)
Diagnostic Tests
Doppler ultrasound (to check circulation & pulses)
Temperature assessment
X-ray (to assess for fractures)
Nursing Considerations
No weight-bearing on ankle (if injured)
Thermotherapy (heat/cold therapy)
Check circulation frequently
Amputation
Preoperative Preparation
Evaluate neurovascular and functional status of the affected limb
Assess circulation of the unaffected limb
Evaluate nutritional status and develop a postoperative nutritional care plan
Consult with dietitian & metabolic nutrition support team
Identify concurrent health conditions and treat them to optimize surgical outcomes
Psychosocial Considerations
Grief response due to permanent body alteration, body image changes, and mobility loss
Professional counseling & support services to help cope post-amputation
Postoperative Assessment
Monitor for infection
Assess incision, dressing, and drainage
Watch for skin breakdown (due to immobilization & pressure)
Monitor for bleeding at the surgical site
Assess residual limb tissue perfusion
Postoperative Care & Interventions
Positioning
Elevate the leg on a pillow above heart level for first 23 hours
Place the patient in a prone position for 20 minutes to prevent hip flexion contracture
Pain Management
Administer analgesics and prescribed medications
For phantom limb pain:
Change position
Apply a light sandbag to the residual limb
Use alternative methods (e.g., distraction techniques, TENS unit to reduce phantom pain)
Wound Healing & Limb Care
Handle the limb gently
Shape the residual limb to reduce swelling and prepare for prosthetic fitting
Psychosocial Support & Coping
Encourage expression of feelings in a supportive atmosphere
Help the patient work through grief and adjust to body image changes
Mobility & Safety
Assist the patient in regaining physical mobility
Monitor and manage potential complications
Educate the patient on mobility aids & self-care
Rheumatoid Arthritis (RA)
Pathophysiology
Chronic inflammatory disorder
Inflammation thickens the synovial membrane → Leads to vascular fibrous tissue formation
Bone erosion occurs, causing:
Decreased joint motion
Loss of ligament elasticity
Prolonged morning stiffness (lasts longer than an hour) due to synovial fluid becoming less effective
Patient Education
Medication adherence
Regular lab testing
Monitor for:
Side effects → Notify doctor if severe
Signs of infection & bleeding
Folic acid supplementation (especially with methotrexate therapy)
Increase ROM exercises to decrease stiffness & increase strength
Avoid excessive exercise (may exacerbate the condition)
Non-Pharmacological Management
Physical Therapy (PT)
Thermal therapy (heat/cold application)
Range of Motion (ROM) exercises
Stretching
Use of splints & braces
Complications
Increased risk of heart disease
Inflammation of heart & lung tissue
Scleritis (eye inflammation)
Vasculitis (inflammation of blood vessels)
Osteoporosis
Anemia
Kidney problems
Increased risk of cancer
Self-Care Recommendations
Practice relaxation techniques
Maintain a balanced diet
Attend regular check-ups
Engage in low-impact exercise
Osteoarthritis (OA)
Pathophysiology
Degenerative joint disease causing cartilage deterioration
Common symptoms:
Right knee pain after activity
Crepitus (grating sensation during movement)
Swelling of the affected joint (e.g., right knee)
Common Physical Findings
Bouchard’s Nodes: Small bony growths in the proximal interphalangeal (PIP) joints
Heberden’s Nodes: Small bony growths in the distal interphalangeal (DIP) joints
Medical Management
Tylenol (Acetaminophen) is prescribed because OA is not a severe inflammatory disease
Helps manage pain and improve activity tolerance
Lifestyle Changes
Weight loss to reduce stress on joints
Physical therapy (PT)
Thermal therapy (heat/cold application)
Patient Education
Weight reduction → Reduces pressure on joints
Use of assistive devices (e.g., cane, walker)
Balanced diet
Engage in low-impact, weight-bearing activities
Avoid prolonged periods of standing
Complications
Pain progression
Reduced range of motion (ROM)
Joint deformities
Increased fall risk
Possible need for surgical intervention
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
Rvaluate the nuerovasulcar and function status of the limb and ciruclary of the functions of uneffect limb
Evaluate nutritonasl stsuts and deveope a post op plan for nutritional care
Consult with dietation and metbolci neutrion support team
Idenfity concurrent health problems and treat so patient in best condition withstand surgical prodcuere
Pyschosocial: Grief response to permanent body alteration and body image function and mobitliy
Professional counseling and support service to help cop post ampuistion
Post op assessment
Infecitno is important to look for
Monitior incision, dressing and drainage
Skin break down related to immbolziation and pressure
Monitor for bleeding and surgical site
Assess redifual luimbs tissue perform
Thigns to do
Leg elevated on pillow above the heart for 23 hours
Then prone position for 20 minutes to prevent hip felxion contraction
Meds region and cardiac check
Phantom pain
Interventions
Releive pain by admisntering anafeisc and other med
Change pstion, putting light sand bag on residula lime
Alternative methods: Distraions, TENS unit to reduce phantom pain
Promtoem would healting
Handle limb gently and residual lium shaping
For amputation involves reducing swelling
Resovluing greift and enchangin bady image
Encoryage expression of feeling, supportive admostpers
Focus on safety and mobliyu
Assit pt to achieve ephysuical mobilyi u
Monitor and amange potential complication and educate patient
Group 5: Rhyematoid Arrthritis
Pathophysiology: Chronicn inflation disorder where the inflammation causes synvoimal memebran to thikcen leading to vacualr fribros tissue and finally bone erosion occurs decrease joint motions and ligament elasticity
Prologn morning stiffest is a symptoms due to the synovla fluid become less effective and last longe than an hour
Pt education
Meddcaion adherence
Regular labs testing
Sidded effect and notify doctor
Sings of infection and bleeding
Folic acid supplement
Increase ROM decrease stiffness and increase strength
Too much exercise will exacerbate eth condition
Non pharmacological
PT, thermal, ROM, stretching, splint , braces
Complication
risk of hear disease
Inflmamation of the hear and lung tissue
Scleritis
Vaculitis
Osteoprosis
anemia
Kidney problem s
Risk of cancer
Self care
Relaxation, maintain balance diet, attend regular check ups, low impact exercise
Group 6: Osteoarthritis
Degeernative joint disease causing caritlafge deteration
Right knee pain after activity
Creperis
Swlling of the R knee
Bouchard nodes: Small bony gowths interphalagerla promxima
Henerdens Nodes: Small bony gorwgt intergeal distal
Tyleon prescribe ebacuase this si not a severe inflammamtore disease which helps to manage pain and tolerate active
Lifestyle chasne
Weight loss, pt , thermal tehapy
Education: Weight rudetion, pressure on joints, assisted drives, diet, low wiehgt bearing activity , avoid long perion of standing
Complication: Pain progression, reduce ROM, joint deformitis, Increase fall risk and need fo surgery
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