HA - Module 5 - Comp 2: Musculoskeletal System Reading Guide

Madison College Associate Degree Nursing Program: Nursing Health Alterations Reading Guide

Competency 2: Providing Care for Clients with Alterations in the Musculoskeletal System

Assessment of Musculoskeletal System

• Definition of Osteopenia:
    Osteopenia is defined as a condition characterized by lower than average bone density, which may lead to an increased risk of fractures and osteoporosis.

• Common Lab Tests and Normal Ranges for Musculoskeletal Assessment:   - Calcium levels: Normal range is approximately 8.5-10.5 mg/dL.   - Vitamin D levels (25-hydroxyvitamin D): Normal range is 20-50 ng/mL.   - Phosphorus levels: Normal range is 2.5-4.5 mg/dL.   - Bone turnover markers: Such as alkaline phosphatase (ALP) 30-120 U/L and osteocalcin.

Osteoarthritis (OA)

• What is Osteoarthritis (OA)?
    Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage, causing pain and dysfunction in the affected joints.

• Signs and Symptoms (S/S) of OA:   - Joint pain that worsens with activity and improves with rest.   - Stiffness in the joints, particularly in the morning or after sitting.   - Swelling and tenderness around the joints.   - Decreased range of motion.   - Crepitus (a grating sensation) during joint movement.

• Lab Tests to Diagnose OA:
    - Rheumatoid factor (RF) - typically negative in OA.   - Erythrocyte sedimentation rate (ESR) - may be normal.   - Joint fluid analysis.

• Imaging Tests to Diagnose OA:   - X-rays: show joint space narrowing, subchondral bone sclerosis, and osteophytes.   - MRI: provides detailed images of cartilage and surrounding tissues.

• Nonsurgical Management of OA:
    Non-pharmacologic interventions include weight management, physical therapy, exercise, and the use of assistive devices (e.g., canes).

• Nonpharmacologic Interventions for OA:   - Heat and cold therapies (e.g., hot packs, ice packs).   - Dietary changes to reduce inflammation (e.g., anti-inflammatory diet).   - Acupuncture and massage therapy.

• Surgical Management of OA:
    - Arthroscopy: minimally invasive surgery to clean the joint.   - Osteotomy: re-alignment of bones.   - Total joint arthroplasty (TJA): complete joint replacement surgery.

• Post-op Priorities for a Patient Who Had Total Hip Arthroplasty (THA):
    1. Pain Management:
       - Interventions: Administer analgesics as prescribed; utilize non-pharmacologic methods (e.g., ice therapy).   2. Prevention of Infection:
       - Interventions: Assess surgical site for signs of infection; maintain sterile technique during dressing changes.   3. Mobility and Rehabilitation:
       - Interventions: Encourage early ambulation; assist with physical therapy exercises.

• Patient Teaching About Hip Precautions for a THA:
    - Avoid bending at the waist beyond 90 degrees.   - Do not cross legs while sitting or lying down.   - Use assistive devices as recommended (e.g., reachers).

Osteoporosis

• Definition of Osteoporosis:   Osteoporosis is a systemic skeletal disorder characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to increased fragility and fracture risk.

• Risk Factors for Osteoporosis:
    - Advanced age.   - Female gender (especially post-menopausal women).   - Low body weight.   - Family history of osteoporosis.   - Sedentary lifestyle.   - Smoking and excessive alcohol consumption.

• Signs and Symptoms (S/S) of Osteoporosis:
    - Often asymptomatic until fracture occurs.   - Fractures, especially in the wrist, hip, and spine.   - Decreased height or a stooped posture.

• Bone Mineral Density (BMD) and T-score:
    - BMD: A measurement of the density of minerals (primarily calcium) in bones.   - T-score: A comparison of a person's BMD to the average peak BMD of a healthy 30-year-old.
      - A T-score of -1.0 or above is normal.     - A T-score between -1.0 and -2.5 indicates osteopenia.     - A T-score of -2.5 or lower indicates osteoporosis.

• Imaging Tests to Diagnose Osteoporosis:
    - Dual-energy X-ray absorptiometry (DEXA) scans are standard for diagnosing osteoporosis.

• Nonsurgical Management of Osteoporosis Including Common Medications Used:
    - Medications include bisphosphonates (e.g., alendronate, risedronate), selective estrogen receptor modulators (SERMs), and hormone replacement therapy.

• Nutrition Relation to Osteoporosis Treatment:
    - Adequate intake of calcium (1,200 mg/day) and vitamin D (800-1000 IU/day) is essential for bone health.   - Foods rich in calcium include dairy products, leafy greens, and fortified foods.

• Lifestyle Changes for Osteoporosis Management:
    - Engage in weight-bearing exercises regularly (e.g., walking, jogging).   - Avoid smoking and limit alcohol intake.   - Fall prevention strategies to avoid fractures (e.g., home safety modifications).

• Medications Used in Osteoporosis Treatment:
    - Bisphosphonates:     - Alendronate (Fosamax): one daily or weekly tablet.     - Risedronate (Actonel): as above.   - Other treatment options include denosumab (Prolia), calcitonin, and teriparatide (Forteo).

Fractures/Sprains/Strains

• Different Classifications of Fractures:
    - Closed (simple) fracture: The skin remains intact.   - Open (compound) fracture: The fracture breaks the skin, increasing infection risk.   - Comminuted fracture: The bone is shattered into multiple fragments.   - Greenstick fracture: Incomplete fracture seen mostly in children.

• Complications of Fractures:
    - Infection (especially in open fractures).   - Nonunion or malunion of the fractured bone.   - Compartment syndrome.   - Fat embolism and deep vein thrombosis (DVT).

• Signs and Symptoms (S/S) of Blood Clot Embolism vs Fat Embolism:
    - Blood clot embolism: Pain, swelling, and warmth in the affected limb; shortness of breath and chest pain if it moves to the lungs.   - Fat embolism: Petechial rash, altered mental status, and respiratory distress within 1-3 days of fracture.

• Priority Nursing Intervention for a Patient with an Acute Fracture:
      - Immobilize the affected limb to prevent further injury and pain.

• Acute Compartment Syndrome (ACS):
    - A condition resulting from increased pressure within a closed muscle compartment, leading to decreased blood flow.   - Assessment: Monitor for 6 P's characteristic of ACS (pain, pallor, pulselessness, paresthesia, paralysis, and pressure).

• Circulation, Motion, and Sensation (CMS) Assessment:
    - Critical for monitoring the neurovascular status of the affected area. It is important to ensure that blood flow is adequate and that the nerves are functioning correctly.

• Different Types of Traction:
    - Skin traction: Utilizes straps and weights to alleviate pressure on the affected limb (e.g., Buck’s traction).   - Skeletal traction: Uses pins and wires inserted into the bone for more significant traction forces.

• Surgical Management for Fractures:
    - Internal fixation (e.g., plates, screws).   - External fixation (e.g., external fixators).

• Nursing Interventions to Prevent Neurovascular Compromise:
    - Regular CMS assessments.   - Monitoring for signs of compartment syndrome.   - Educating patients on positioning to ensure good perfusion.

• Sprain vs Strain and Treatment for Both:
    - Sprain: Injury to ligaments around a joint; treated with RICE (Rest, Ice, Compression, Elevation).   - Strain: Injury to muscles or tendons; treated similarly with rest, ice, and possibly physical therapy for recovery.

Gout

• What is Gout?
    Gout is a type of inflammatory arthritis characterized by sudden and severe pain, redness, and swelling in joints, often affecting the big toe.

• Diagnosis of Gout:
    - Joint fluid test: identification of urate crystals.   - Serum uric acid level assessment (although not definitive).

• Medications Used to Treat Gout:
    - Acute attacks: NSAIDs (e.g., indomethacin) or colchicine.   - Long-term management:allopurinol and febuxostat to decrease uric acid levels.

• Nutrition Therapy Related to Gout:
    - Limit purine-rich foods (e.g., red meat, seafood).   - Encourage increased water intake and maintain a healthy diet rich in fruits and vegetables.   - Avoid alcohol and sugary drinks.

Back Problems

• Signs and Symptoms (S/S) of Back Pain:
    - Dull pain in the lower back.   - Sharp pain that may radiate down the legs.   - Stiffness and limited flexibility.   - Pain that worsens with sitting or standing.

• Measures to Prevent Low Back Pain:
    - Maintain proper body mechanics during lifting and moving.   - Engage in regular physical activity and core-strengthening exercises.   - Use ergonomic furniture and take breaks from prolonged sitting positions.

• Nonsurgical Management of Back Pain:
    - Physical therapy and exercises targeted at strengthening back muscles.   - Medications such as NSAIDs for pain relief.   - Alternative therapies like acupuncture or chiropractic care.

• Surgical Management of Back Pain:
    - Discectomy: removal of herniated disc material.   - Laminectomy: removing part of the vertebra to relieve pressure.   - Spinal fusion: joining two vertebrae to stabilize the spine.

Types of Procedures for Amputation

• Types of Amputation:
    - Major (above-knee or below-knee).   - Minor (digits, toes).

• Complications of Amputations:
    - Infection, delayed wound healing, phantom limb pain, and psychological issues such as depression.

• Diagnostic Assessments Implemented with Amputation:
    - Imaging studies to assess bone and soft tissue conditions (e.g., X-rays, MRIs).
    - Evaluation of vascular status.

• Interventions to Prevent Complications:
    - Regular monitoring of the surgical site for signs of infection.   - Ensure proper stump care and use of prosthetics.   

• Measures to Promote Mobility After Amputation:
    - Initiate early rehabilitation and fitting for prostheses.   - Encourage gradual weight-bearing on the affected limb as tolerated.

• Interventions to Provide Psychological Support:
    - Provide counseling and support services for emotional adjustment.   - Facilitate participation in support groups for amputees.