Transcript Musculoskeletal Powerpoint

MUSCULOSKELETAL
SYSTEM
Risk Factors For M/S Problems
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Overweight
Family hx of arthritis
Systemic problems
Occupational risks
Plays contact sports
Exercises less than twice per week
Has poor eyesight
Any problem that would impede ADLs
Key S&S That Suggest M/S Problems
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Pain
Swelling
Redness
Myalgia
Immobility
Sensory Deficits
Fever
Malaise
Contractures
Limited ROM
Joint Stiffness
Nodules
Warmth
Functional Assessment
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Do your
joint/muscle/bone
problems create any
limits on your usual
activities of daily
living?
 Screens for safety of
independent living,
need for HHC, and
quality of life.
 Bathing
 Dressing
 Toileting
 Grooming
 Eating
 Mobility
 Communication
Functional Assessment
 The
functional assessment is important
because it screens for the safety of
independent living, the need for home
health care services, and quality of life.
Self Care Behaviors
 Any
occupational hazards that could affect
the muscles and joints?
 Does your work involve any heavy lifting or
any repetitive motion?
 Do you engage in an exercise program?
 Have you had any recent weight gain?
 Are you taking any medications for
musculoskeletal discomfort?
Orthopedic Screenings
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Scoliosis- done in Health Dept. and
school setting at age 10-12.
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Bone Mineral Density (BMD)- measured by
DEXA (dual energy x-ray absorptiometry)
*T Scores: -1 to -2.5 SD osteopenia
>-2.5
osteoporosis
Diagnostic Tests
 Myelography
 Arthrocentesis
 Arthrogram
 Arthroscopy
 CT
Scan
 Bone Scan
 Magnetic Resonance Imaging
 EMG
Diagnostic Tests
 Erythrocyte
Sedimentation Rate(ESR)
 Complement
 Calcium
 Phosphorus (Alk. Phosphotase)
PHARMACOLOGICAL
THERAPY
ANALGESIC/ANTIINFLAMMATORY
 NSAIDS-5%
of all prescriptions
Nonsteroidal Anitinflammatory Drugs
INDICATIONS: Analgesic, Antiinflammatory,
Anitrheumatic, Antipyretic
ACTION: Inhibition of the arachidonic acid
pathway
Tx : Gout, Bursitis, Fever ,JRA, Osteoarthritis,
Rheumatoid Arthritis, Tendinitis, Mild to Mod.
Pain, ankylosing spondylitis, dysmenorrhea,
migraines
Most common NSAIDS:
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Aspirin/ASA(Salicylate) 3.2-6 g po daily divided q4-6h
 Celebrex(Cox-2 inhibitor) 100-200 mg po once daily
 Vioxx (Cox-2 inhibitior) 12.5-50 mg po once daily
 Ibuprofin(Propionic Acid) (motrin, advil) 1200-3200 mg
po daily divided tid-qid
 Indocin(Acetic Acid) 25-50 mg po bid-tid (max 200 mg)
 Toradol(Pyrrolizine Carboxylic Acid)10 mg po q4-6h
15-60 IV/IM q6-12h
 Nursing implications/side effects and
contraindications. Use of Cytotec????
BIPHOSPHONATES
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Inhibit osteoclast-mediated bone resorption
 Increases BMD and total bone mass
 *Fosamax 5 mg daily or 35 mg/wk prevention
10 mg daily or 75 mg/wk treatment
 *Instructions on administration: AM first thing, full
glass of water, do not eat or drink for 30
minutes, sitting up
These precautions aid in absorption and
decrease GI side effects i.e. gastritis, weight
loss, anorexia, esophageal irritation.
Osteoporosis Drug Therapy
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SERM-selective estrogen receptor modulator
Postmenopausal use-increases BMD by mimicing effect
of estrogen on bone by reducing bone resporption (may
cause leg cramps)
EVISTA (raloxifene) 60mg po qd
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CALCITONIN-hormonal substitute from salmon.
Calcimar IM/SC 100U qd
Miacalcin Nasal Spray 200U qd
CORTICOSTEROIDS
 Intra-articular
Injections: Depo-Medrol
 Systemic: Decadron, Prednisone (PO)
Solu-Cortef (parenteral)
Inhibit syntesis or release of mediators of
Inflammation
Not recommended for long term use
MUSCLE RELAXANTS
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DEPRESSANT EFFECT ON CNS
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Relief of painful muscle spasm /in conjunction with PT
May also reduce rigidity and spasticity in chronic
disorders (cp, ms, parkinson’s, huntington’s chorea)
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CNS side effects (dizziness, drowsiness, weakness)
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Flexeril, Skelaxin, Lioresal/central acting
Dantrium/ direct effect on striated muscle
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OTCs and Vitamins
 Calcium
supplements- need 1000mg premenopause and 1500mg post-menopause
 Vitamin D supplements-must have for
calcium absorption. 400-800IU.
 Glucosamine-role in synthesis of new
cartilage. Found in mucoproteins.
 Chondroitin-component of cartilage
NONPHARMACOLOGICAL
THERAPY
Heat & Cold Therapy
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Cold Therapy-After an injury, ice packs should be
applied for 20 minutes out of every hour for the first 24
hours. Reduces swelling. Trauma, surgery, arthritis.
Heat therapy (such as heating pads, hot tub baths etc.) are
helpful in treating pain, stiffness and muscle spasms.
Whirlpool baths, ultrasound, paraffin wax (by PT)
DO NOT use in areas of radiation therapy, bleeding (with
heat), poor circulation, decreased sensation.
Cover heat or cold source with towel to prevent burns.
Assistive Devices
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Crutches-two, three or four point gait. proper fit
and safety.
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Walkers-extra support, independence, Pick up or
rolling. Weight bearing vs non-weight bearing
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Abduction Pillows-prevent internal rotation,
adduction and dislocation of new hip joint.
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Prosthetic Limbs-immediate <edema, early amb
OTHER SUPPORTIVE THERAPY
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Physical Therapy: ROM, Gait/strength, transfers, assisstive devices,
treatments
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TENS-transcutaneous electrical nerve stimulation-delivers electric current to
skin surface over painful region. (by PT)
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Massage-pain therapy
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Cognitive Therapy-Relaxation, Distraction, Hypnosis, Imagery
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RICE –REST, ICE, COMPRESSION, ELEVATION
Trauma
 Trauma
accounts for a significant portion
of medical associated with the
musculoskeletal tissues. Injuries occur in
all age groups.
 One
in five emergency department visits is
associated with musculoskeletal trauma.
Trauma
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Contusion- A bruise without an external break in
the skin.
 Strain- A “pull” in a muscle, ligament, or tendon
caused by excessive stretch.
 Sprain- A partial or full tearing off or away
(avulsion) of one or more ligaments, tendon, or
portions of bone in & around a joint.
 Dislocation- Displacement of a part, usually a
bone from its normal anatomic position within a
joint.
DISLOCATION OF THE HIP
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Normal.
 B. Subluxation
(partial
dislocation).
 C. Dislocation.
TYPES OF HIP FRACTURE
INTERNAL FIXATION DEVICES
A. Femoral head
endoprosthesis.
 B. Type of hip
compression screw
with side plate.
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Fractures
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fracture is a dicontinuity or a break in the
bone.
 A fractured bone can no longer maintain
its normal length unless the two fragment
impact into each other.
 Usually there will be shortening of the
tissues around the fractured bone d/t
muscle contractions and spasms.
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Can you identify
the different
types of
fractures and
what type of
injury caused
them?
Explain the difference between
these fractures.
Assessment: Areas of Concern
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Edema
Color Changes
Deformity
Parasthesia
Pain
Limited Movement
Crepitation
Bruising
Bleeding
Distal Pulse
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Pallor
 Confusion
 Dyspnea
 Shock
 Changes in BP
 Diaphoresis
 Fear & Anxiety
 Concomitant Disease or
Other Injuries
Pain Assessment
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Pain Scale 0/10 to 10/10
Location
Quality
Intensity
Duration
Precipitating Factors
Alleviating Factors
Exacerbating Factors
REDUCTION AND IMBOLIZATION
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OPENsurgical correction of bone fracture
with use of internal fixation such as
wires, screws, pins, plates.
More risk for complications.
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CLOSEDnonsurgical, manual realignment.
anesthesia, immobilization by traction,
cast, external fixation, splint or brace.
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EXTERNAL FIXATIONmetal pins inserted into bone and attached to
external rods.
for traction, complex fractures, limb lengthening.
signs of infection: pain, redness, tenderness,
exudate at pin site. Pin care ½ hydrogen
peroxide with normal saline.
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INTERNAL FIXATIONsurgically inserted at time of realignment.
Biologically inert metal devices.
Casts and Splints
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Casts are primarily used after a closed reduction
of a fracture. Proper technique in handling cast
and client is essential.
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Two basic types of casts: plaster and synthetic.
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Splints are removable devices that are applied
to an injured person prior to moving them.
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Splints are also used in a more long-term
manner to prevent joint deformities and to
maintain functional and structural alignment.
Common casts used in treatment of
disorders of the musculoskeletal system
Traction
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The exertion of a pulling force utilized to align
and immobilize bone fragments.
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Also helps to relieve muscle spasms and correct
flexion contractures, deformities, and
dislocations.
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There are 2 types of traction: Skin (Buck’s
traction & Russell’s traction) and Skeletal
traction.
Care of the Traction Client
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SKIN-temporary immobilization, spasms,
stabilization. No movement. Body is
counterforce. Skin breakdown prevention.
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SKELETAL-free falling weights, ropes taught,
pin assess and care, free movement. Need
trapeze, rope and weight assess. essential.
Amputation
 The
removal of all or part of a specific
tissue or organ. Musculoskeletal tissues
are frequently amputated because of
crush injuries, severe sepsis, malignant
tumors, or gangrene.
 Assessment/Areas of Concern Nsg
Considerations-
Complications
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Casts- Compartment Syndrome
Infection
Skin Breakdown
 For
Traction- Skin Breakdown
Orthostatic Hypotension
Boredom/Cabin Fever
Complications …….
Surgery – Venous thrombosis r/t
decreased activity which may lead to clot
formation.
 Phantom Pain
 Aspiration
 Fat Embolus
 Pneumonia
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Complications…….
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For Fractures – Fat embolism- This is a serious
circulatory condition characterized by the
blocking of an artery by an embolus of fat that
entered the circulatory system after the fracture
of a long bone or, less commonly, after a
traumatic injury to adipose tissue or to a fatty
liver.
Conditions/Diseases/Disorders
 Bursitis-
Inflammation of the bursa (small
sac or cavity surrounding or near a joint).
Typically involves the shoulder, elbow,
knee, and hip.
 Treatment Nursing
Interventions
Carpal Tunnel Syndrome
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A, Wrist structures
involved in carpal
tunnel syndrome.
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B, Decompression of
median nerve.
Conditions/Diseases/Disorders
Paget’s Diseases- A metabolic bone disorder of
unknown etiology and which normally affects
older people. This process causes an increased
and irregular formation of the bone due to
irregular osteoclast and osteoblast activity.
Deformities & bony enlargement often occur.
 Treatment
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Nsg Considerations
OSTEOMYELITIS
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Severe infection of the bone (Staph aureus)
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Occurrence reduced by prophylactic use of antibiotics
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Blount trauma in males less than 12 yrs old
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Diagnosed by bone biopsy, MRI, CT, CBC
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Intensive IV antibiotic therapy from 4 weeks to 6 months
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Surgical removal of dead bone (Amputation) in advanced
cases
Bone Cancer
 Multiple
Myeloma
 Osteogenic Sarcoma
 Osteoclastoma
 Ewing’s Sarcoma
 Metastatic Bone Disease
GERIATRIC
considerations
Conditions/Diseases/Disorders
 Osteoporosis-
A condition of overall
reduction in the bone mass or density in
which bone reabsorption has outstripped
bone formation, thereby upsetting the
normal balance.
 Treatment
 Nursing
Interventions
Conditions/Diseases/Disorders
 Osteoarthritis-
AKA osteoarthrosis- a
degenerative condition of the articular
cartilage primarily within the major weight
bearing joints although other joints can
also be affected.
TreatmentNsg Interventions-
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Joints most frequently
involved in
osteoarthritis.
PEDIATRIC
considerations
Pediatric Problems
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Scoliosis- Lateral curvature of the spine. A
common abnormality of childhood. Causes
include congenital malformations, spastic
paralysis, and unequal leg length.
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Kyphosis- An abnormal condition of the vertebral
column that is characterized by increased
convexity in the curvature of the thoracic spine.
It may be caused by rickets or tuberculosis of
the spine. Adolescent kyphosis is usually selflimiting and often undiagnosed.
Pediatric Problems
 Muscular
Dystrophy- A group of
genetically transmitted diseases
characterized by progressive atrophy of
symmetric groups of skeletal muscles
without the involvement of neural tissue.
There is a loss of strength with increasing
disability and deformity.
Congenital Hip Dysplasia
 The
abnormal placement and
development of the head of the femur and
acetabulum resulting in the dysfunction of
the hip.
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is more common in female babies (6:1).
 The
left hip is more commonly affected
than the right hip.
Legg-Perthes Disease
A
disease of the femoral head in which
either the cartilage or the femoral head
itself develops avascular necrosis.
 Treatment
 Nsg
Implications
 CLUB
FOOT-complex deformity of the
ankle and foot including inversion,
eversion, .plantar or dorsiflexion. 1-2 births
in 1000. boys 2x girls.
50% bilateral. Goal: correction of
deformity:
manual manipulation/Serial Casting q12wks.
Surgical: pinning and tendon release.
PSYCHOSOCIAL INTEGRITY
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Assess for :
Self esteem disturbance
Loss of independence
Body image disturbance
Role performance disturbance
Social isolation
Impaired physical mobility