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Chapter 27
Musculoskeletal Conditions
Assessment of Musculoskeletal Problems
• Abnormal gait
• Abnormality of structure
• Dysfunction of a limb
• Favoring of one side
• Tremor
• Paralysis
Assessment of Musculoskeletal Problems
(cont.)
• Weakness
• Atrophy of a limb
• Redness; swelling of a joint
• Use of cane, walker, or wheelchair
Physical Examinations of the
Musculoskeletal System
• Shoulder
• Neck
• Elbow
• Wrist
• Finger
• Hip
• Knee
• Ankle
• Toe
Desired Outcomes
• The patient:
– Verbalizes acceptance of realistic body changes.
– Uses effective coping mechanisms.
– Identifies and engages in meaningful activities.
– Is free from depression, withdrawal, and other
complications associated with body image and selfesteem disturbances.
Facilitating Musculoskeletal Function
• A well-balanced diet rich in proteins and minerals
• A minimum of 1500 mg calcium included in the diet daily
for elderly men and women not taking estrogen
– (1000 mg if taking estrogen)
• Weight control
• Activity and exercise
Contributing Factors to Fractures in the
Elderly
• Trauma
• Cancer
• Metastasis to the bone
• Osteoporosis
• Brittle bones of older persons fracture more easily.
• Slower rate of healing
Measures to Prevent Falls
• Avoid risky activities.
• Rise from a kneeling or sitting position slowly.
• Wear safe, properly fitting shoes with a low, broad heel.
• Use hand rails for climbing stairs or rising from the
bathtub.
• Place both feet near the edge of a curb or bus before
stepping up or down.
• Use a night-light in the bathroom and bedroom.
Symptoms of Fractures
• Pain
• Change in the shape or length of a limb
• Abnormal or restricted motion of a limb
• Edema
• Spasm of surrounding tissue
• Discoloration of tissue
• Bone protruding through the tissue
Most Common Fracture Sites
• Neck of the femur
• Colles’ fracture
• Compression fracture of the vertebrae
Factors Contributing to Osteoarthritis
• Disequilibrium between destructive and synthetic
elements
• Stress to the joints
• Obesity
• Genetic factors
• Low vitamin D and C levels
Therapeutic Measures for Osteoarthritis
• Analgesics to control pain
• Rest, heat or ice, ultrasound, and gentle massage
• Splints, braces, and canes
• Cold water fish; other foods high in the essential fatty
acids
• Vitamins A, B, B6, C, and E and zinc, selenium,
niacinamide, calcium, and magnesium
• Weight reduction
Symptoms of Rheumatoid Arthritis
• Fatigue
• Malaise
• Weakness
• Weight loss
• Wasting
• Fever
• Anemia
Patient Education for Rheumatoid
Arthritis
• Knowledge of the disease
• Treatments
• Administration of medications
• Identification of side effects
• Exercise regimens
• Use of assistive devices
• Methods to avoid and reduce pain
Potential Causes of Osteoporosis
• Inactivity or immobility
• Diseases
• Reduction in anabolic sex hormones
• Diet
• Drugs
Problems Associated with Osteoporosis
• Kyphosis and a reduction in height
• Spinal pain
• Bones may fracture more easily
Treatment of Osteoporosis
• Calcium supplements
• Vitamin D supplements
• Progesterone and estrogen
• Anabolic agents
• Fluoride or phosphate
• Synthetic form of calcitonin
• Bisphosphonates
Treatment of Gout
• Reduction of sodium urate through a low-purine diet
• Administration of drugs
• Avoidance of alcohol
• Use of colchicine or phenylbutazone to manage acute
attacks
• Use of vitamin E, folic acid, and eicosapentaenoic acid
(EPA)
• Use of herbs such as yucca and devil’s claw
Podiatric Conditions
• Calluses
• Corns
• Bunions
• Hammer toe
• Plantar fasciitis
• Foot infections
• Ingrown toenails
Patient Teaching for Proper Foot Care
• Keep feet clean and dry.
• Wear safe and proper-fitting shoes.
• Exercise feet.
• Cut nails straight across and even with the top of the toe.
• Seek professional podiatric care for problems.
Nursing Considerations for Pain
Management
• Heat application
• Passive stretching of an extremity
• Avoidance of excessive exercise and musculoskeletal
stress
• Back rubs
• Proper positioning and protection from trauma
• Diversional activities
• Alternative therapies
Measures to Prevent Injury
• Pay attention to the area where one is walking.
• Climb stairs and curbs slowly.
• Use both feet for support as much as possible.
• Use railings and canes for added balance.
• Wear properly fitting, safe shoes for good support.
• Avoid long trousers, nightgowns, or robes.
• Use heat safely.
Promoting Independence
• Use of canes, walkers, and other assistive devices
• Referral to physical and occupational therapists
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).