Week 5 Musculoskeletal Voiceover PPT
Musculoskeletal Disorders Overview
Professors: Suparpun Manego, MSN, RN
Chapters: Management of Patients with Musculoskeletal Disorders (Chapter 36), Management of Patients with Musculoskeletal Trauma (Chapter 37), MS ATI Chapters 70, 71, & 72
Extremity Disorders
Common Inflammatory Conditions
Bursitis: Inflammation of the bursa.
Tendonitis: Inflammation of tendons.
Carpal Tunnel Syndrome: Entrapment neuropathy due to median nerve compression at the wrist.
Treatments for Extremity Disorders
Self-Limiting: Many extremity disorders resolve without extensive intervention.
Conservative Measures:
Resting the affected extremities.
Intermittent hot and cold therapy.
Use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).
Corticosteroids for inflammation.
Evidence-Based Practice (EBP) offers quick short-term relief.
Innovative Treatments:
Laser phototherapy.
Radiofrequency ablation.
Extracorporeal shock wave therapy.
Corticosteroid injections (oral or intra-articular).
Acupuncture (may include electrical stimulation).
Use of splints to manage wrist positioning.
Surgical Options: If non-surgical methods fail, open nerve release or endoscopic laser surgery may be required.
Osteomalacia
Definition: Vitamin D deficiency leading to inadequate calcium absorption.
Symptoms: Pain, tenderness, skeletal deformities (smooth kyphosis, bowed legs), waddling gait.
Treatment: Increase vitamin D and calcium intake; encourage sunlight exposure.
Paget’s Disease
Characteristics: Localized rapid bone turnover with unknown origin, leading to high vascularization and weakened structure.
Symptoms: Pathologic fractures due to structural weaknesses.
Management: Focus on pain management with NSAIDs and antiosteoclastic therapy.
Osteoarthritis (Degenerative Joint Disease)
Pathophysiology
Breakdown of articular cartilage, leading to damage beneath the bone and formation of osteophytes (bone spurs).
Results in joint space narrowing and increased joint damage.
Risk Factors
Older age, female gender, obesity, sports participation, labor-intensive jobs, history of injuries, muscle weakness, genetic factors.
Most Significant Modifiable Risk Factor: Obesity.
Signs & Symptoms
Joint pain, stiffness, functional impairment.
Symptoms worsened by movement, relieved by rest.
Short-lived morning stiffness.
Physical exam may show enlarged joints, restricted range of motion (ROM), crepitus, mild inflammation.
Diagnostic Studies
X-rays may reveal osteophytes and joint space narrowing.
Blood tests and joint fluid analysis to rule out autoimmune disorders such as RA.
Medical & Nursing Management
Goals: Decrease pain and stiffness while maintaining/improving mobility.
Recommended interventions: Aerobic exercises, strength training, weight loss, physical and occupational therapy.
Pharmacologic therapy focused on pain control: Acetaminophen, NSAIDs, opioids for severe cases, intra-articular corticosteroids.
Osteoporosis
Definition: Reduced bone mass leading to fragile bones, height loss due to vertebral collapse.
Associated with estrogen withdrawal and increased bone resorption.
Prevention: High calcium and vitamin D intake, weight-bearing exercises.
Osteomyelitis
Definition: Bone infection leading to inflammation, necrosis, and new bone formation.
Symptoms: Swollen, warm, painful bone, often with sepsis signs.
Management: Long-term antibiotics, possible surgical debridement.
Nursing Management for Surgery Patients
Neurovascular Assessment
Essential within first 24 hours to monitor nerves and tissue perfusion.
Elevation of the affected foot aids in pain relief due to edema.
Regular checks for compartment syndrome symptoms: pain, paresthesia, pulse loss.
Postoperative Care
Use of hot/cold therapy, wound care, application of cast/protective device.
Ensure neurovascular checks and maintain comparison with contralateral limb.
Joint Replacement
Procedure: Joint arthroplasty involves removing unhealthy joint structure, commonly in hip, knee, or finger joints.
Indications: Osteoarthritis, rheumatoid arthritis, congenital deformities, trauma-related injuries.
Perioperative Considerations
Risks: Bleeding, VTE, infection, and pain management.
Preventive measures: Use of models like epoetin alfa, pneumatic tourniquets, and careful monitoring of neurovascular status.
Manage pain through comprehensive pre- and postoperative strategies.
Total Hip Arthroplasty
Prevention of Dislocation
Correct positioning and nursing management: keep legs abducted, avoid flexion beyond 90 degrees.
Signs of dislocation: pain, swelling, shortened limb on affected side, abnormal limb positioning.
Total Knee Arthroplasty
Indications & Nursing Management
Joint pain unmanageable through non-surgical methods; severe pain related to joint destruction.
Monitor neurovascular status frequently and manage postoperative complications like infection or limited ROM.
Fracture Management
Types of Fractures
Defined by whether they are open or closed.
Nursing Considerations
Care for both types requires thorough ABCs understanding in terms of neurovascular assessment, infection control, and immobilization practice.
Complications
Compartment Syndrome
Increased internal pressure within muscles leading to decreased perfusion, often requires surgical intervention.
Manifestations include severe pain, shady skin texture, and can lead to severe muscle and nerve damage if untreated.
Fat Embolism Syndrome
Occurs post-trauma, presenting with neurological symptoms and respiratory distress, often requiring cautious intervention.
Amputations
Often due to vascular diseases and trauma; focus on preserving as much limb viability as possible.
Complications include hemorrhage, infection, skin breakdown, and phantom limb pain management.
Conclusion
Assess and manage musculoskeletal disorders and associated treatments effectively to improve patient outcomes.
Questions?
Feel free to contact the instructors for inquiries or clarifications regarding musculoskeletal management.