Transcript Interventions for Clients with Musculoskeletal Problems

Interventions for Clients with
Musculoskeletal Problems
Osteoporosis
Metabolic disease, in which bone
demineralization results in decreased
density and subsequent fractures
 Osteopenia (low bone mass), which
occurs when there is a disruption in
the bone remodeling process

Classification of
Osteoporosis
Primary osteoporosis occurs most
commonly in postmenopausal
women and men in their 60s and
70s.
 Secondary osteoporosis results from
an associated medical condition such
as hyperparathyroidism, long-term
drug therapy, long-term immobility.
 Regional osteoporosis occurs when a
limb is immobilized.

Health Promotion/Illness
Prevention
Ensure adequate calcium intake.
 Avoid sedentary life style.
 Continue program of weight-bearing
exercises.

Assessment
Physical assessment
 Psychosocial assessment
 Laboratory assessment
 Radiographic assessment

Drug Therapy
Hormone replacement therapy
 Parathyroid hormone
 Calcium and vitamin D
 Bisphosphonates
 Selective estrogen receptor
modulators
 Calcitonin
 Other agents used with varying
results

Diet Therapy
Protein
 Magnesium
 Vitamin K
 Trace minerals
 Calcium and vitamin D
 Avoid alcohol and caffeine

Fall Prevention
Hazard-free environment
 High-risk assessment through
programs such as Falling Star
protocol
 Hip protectors that prevent hip
fracture in case of a fall

Others
Exercise
 Pain management
 Orthotic devices

Osteomalacia
Softening of the bone tissue
characterized by inadequate
mineralization of osteoid
 Vitamin D deficiency, lack of sunlight
exposure
 Similar, but not the same as
osteoporosis
 Major treatment: vitamin D from
exposure to sun and certain foods

Paget’s Disease of the Bone

Metabolic disorder of bone remodeling, or
turnover; increased resorption of loss
results in bone deposits that are weak,
enlarged, and disorganized
Paget’s Disease of the Bone
Nonsurgical management: calcitonin,
selected bisphosphonates,
mithramycin
 Surgical management: tibial
osteotomy or partial or total joint
replacement

Osteomyelitis
A condition caused by the invasion by
one or more pathogenic
microorganisms that stimulates the
inflammatory response in bone tissue
 Exogenous, endogenous,
hematogenous, contiguous

Nonsurgical Management
Drug therapy
 Infection control
 Hyperbaric oxygen therapy

Surgical Management
Sequestrectomy
 Bone grafts
 Bone segment transfers
 Muscle flaps
 Amputation

Bone Tumors

Benign bone tumors (noncancerous):
– Chrondrogenic tumors:
osteochondroma, chondroma
– Osteogenic tumors: osteoid osteoma,
osteoblastoma, giant cell tumor
– Fibrogenic tumors
Interventions
Nondrug pain relief measures
 Drug therapy: analgesics, NSAIDs
 Surgical therapy: curettage (simple
excision of the tumor tissue), joint
replacement, or arthrodesis

Malignant Bone Tumors

Primary tumors, those tumors that
originate in the bone
– Osteosarcoma
– Ewing’s sarcoma
– Chondrosarcoma
– Fibrosarcoma
– Metastatic bone disease
Acute Pain; Chronic Pain

Interventions include:
– Treatment aimed at reducing the size or
removing the tumor
– Drug therapy; chemotherapy
– Radiation therapy
– Surgical management
– Promotion of physical mobility with
ROM exercises
Anticipatory Grieving

Interventions include:
– Active listening
– Encouraging client and family to
verbalize feelings
– Making appropriate referrals
– Helping client and others to cope with
the loss and grieving
– Promoting the physician-client
relationship
Disturbed Body Image

Interventions include:
– Recognize and accept the client’s view
of body image alteration.
– Establish and maintain a trusting nurseclient relationship.
– Emphasize the client’s strengths and
remaining capabilities.
– Establish realistic mutual goals.
Potential for Fractures

Interventions
– Nonsurgical management: radiation
therapy and strengthening exercises.
– Surgical management: replace as much
of the defective bone as possible, avoid
a second procedure, and return client to
a functioning state with a minimum of
hospitalization and immobilization.
Phalen’s maneuver for detection of carpal
tunnel syndrome
Carpal Tunnel Syndrome
Common condition; the median nerve
in the wrist becomes compressed,
causing pain and numbness
 Common repetitive strain injury via
occupational or sports motions
 Nonsurgical management: drug
therapy and immobilization
 Possible surgical management

Hand Disorders
Dupuytren's contracture—slowly
progressive contracture of the
palmar fascia resulting in flexion of
the fourth or fifth digit of the hand
 Ganglion—a round, cystlike lesion,
often overlying a wrist joint or
tendon

Disorders of the Foot
Hallux valgus
 Hammertoe
 Morton’s neuroma
 Tarsal tunnel syndrome
 Plantar fasciitis
 Other problems of the foot

Scoliosis
Changes in muscles and ligaments on
the concave side of the spinal column
 Congenital, neuromuscular, or
idiopathic in type
 Assessment: complete history, pain
assessment, observation of posture
 Interventions: exercise, weight
reduction, bracing, casting, surgery

Osteogenesis Imperfecta
Rare genetic disorder in which the
bones are fragile and fracture easily,
resulting in bone deformity
 Clinical manifestations: poor skeletal
development
 Treatment: palliative; client’s life
span is often shortened
 Steroids, calcium, vitamin C, and
possibly sodium fluoride

Progressive Muscular
Dystrophies
At least nine types of muscular
dystrophies identified; categorized as
slowly or rapidly progressive
 Diagnosis often difficult
 Management

– Supportive, making client as
comfortable as possible
– Prednisone, immunosuppressive agents,
anabolic steroids