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.