Transcript ecture 12: musculoskeletal system

CHAPTER
18
Lecture Note PowerPoint Presentation
The Musculoskeletal
System
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 1
Explain normal changes in the
musculoskeletal system associated with
aging.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Musculoskeletal System
Components
•
•
•
•
Muscles
Ligaments
Bursae
Joints
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 18-1
Structure of a synovial joint.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Normal Changes of Aging
• Increased complaints of musculoskeletal
pain
• Joint limitations
• Increased development of osteoporosis
and arthritis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 18-2
Normal changes of aging in the musculoskeletal system.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Significant Alterations Causing
Musculoskeletal Changes in Older Adults
•
•
•
•
Human structure
Function
Biochemistry
Genetic patterns
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Skeletal Changes of Aging
• Type 1
– Menopausal bone loss
 Rapid bone loss affecting women in the first 5–10
years after menopause
• Type 2
– Senescent bone loss
 Slower phase affecting both sexes after midlife
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Skeletal Changes of Aging
• Bones become stiffer, weaker, and more
brittle
• Changes in appearance noted after fifth
decade
– Loss of height
– Postural changes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Normal Skeletal Changes of Aging
• Disproportionate size of long bones of arm
and legs
– Seen in eighth and ninth decades
• Kyphosis
• Backward tilt of the head for eye contact
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Normal Muscle Changes of Aging
• Muscle function varies with aging
– Trainable into advanced age
– Regeneration remains normal
• Muscle mass: sarcopenia
• Strength
– Slow decline
– Reduced stamina by age 50
– Decrease of 65% to 85% of mid-twenties
stamina by age 80
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Joint, Ligament, Tendon,
and Cartilage Changes of Aging
• Erosion of joint linings
• Thinning knee cartilage
• Ligaments, tendons, and joint capsules
– Lose elasticity
• Reduced range of motion
• Stiffening of collagen
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 2
Identify risk factors for the older person
related to common musculoskeletal
problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Most common metabolic disease
• Impacts 50% of women during their
lifetime
• 20 million women and 8 million men in the
United States have osteoporosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Risk factors
– Increased age
– Female sex
– White or Asian race
– Positive family history
– Thin body build
– Low calcium intake
– Prolonged immobility
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Risk factors
– Excessive alcohol and caffeine intake
– Stress
– Cigarette smoking
– Long-term use of corticosteroids,
anticonvulsants, or thyroid hormones
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Characterized by low bone mass and
deterioration of bone tissue
– Condition results in compromised bone
strength, increasing the risk of fractures
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Bone strength reflects integration of bone
density and quality
 Bone density is grams of mineral per area or
volume
 Bone quality based on
•
•
•
•
Architecture
Turnover
Damage accumulation
Mineralization
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Bone strength reflects integration of bone
density and quality
 Bone strength cannot be directly measured
 Bone mineral density (BMD)
 Replacement measure for bone strength
 Accounts for 70% of bone strength
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Elder bone loss
 Normal BMD within 1 standard deviation of young
adult mean
 Osteopenia BMD between 1 and 2.5 standard
deviation below the young adult mean
 Osteoporosis BMD is 2.5 standard deviations
below the young adult men
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Decreased bone mass in older persons
 Failure to reach peak bone mass in early
adulthood
 Increased bone resorption
 Decreased bone formation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Reduced BMD
 Highly predictive of spinal and hip fractures
 Osteoporotic fractures affects 1.3 million people
per year in the United States
 Vertebrae fractures affect about 500,000 people
per year
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 18-3
Normal bone compared to osteoporotic bone. A. Normal bone. B. Osteopenia. C.
Osteoporosis.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Reduced BMD
 Hip and wrist fractures affect about 260,000 people
per year
 One in five patients die within 1 year
 One third regain their pre-fracture mobility and
independence level
 Classification
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Primary
 Type 1: menopausal bone loss
• Loss of estrogen results in overproduction of interleukin-6
causing a loss of bone mass
• By age 70, susceptible women have lost 50% of
peripheral cortical bone mass from the long bones
• Increased incidence of vertebral and Colles’ fractures
 Type 2: senescent bone loss
• Decrease in bone formation during remodeling
• Osteoblast formation, bone mineral density, and rate of
formation decrease
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Pathophysiology
– Secondary
 Causes
•
•
•
•
•
•
•
•
Hyperparathyroidism
Malignancy
Immobilization
Gastrointestinal disease
Renal disease
Drugs that cause bone loss
Vitamin D deficiencies
Glucocorticoid drugs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Gender Differences in Bone Density
• Women are at an increase risk for loss of
bone density
– Women accumulate less bone mass than
men
– Women have smaller bones
– Men have more bone mass and bigger,
stronger bones
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Gender Differences in Bone Density
• Hormones impact bone density
– Loss of estrogen at menopause causes loss
in bone density
– Men lose testosterone with aging but decline
is slower; bone density lost at slower rate
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Gender Differences in Bone Density
• Reproductive factors
– Prolonged lactation results in bone density
loss
• Impact of longevity
– Women live longer and have a greater risk for
senescent bone loss
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Trajectory of Bone Loss for Women
• Lower peak bone mass than men
• Less in the “bone bank” because of thinner
bones
• Lose bone mass with lactation
• Rapid withdrawal from “bone bank” during
perimenopause
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Trajectory of Bone Loss for Women
• Longer life span increases risk for
osteoporosis
• Signs/symptoms usually absent
• First sign is often a fracture
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteomalacia
• Metabolic disease
• Inadequate mineralization of formed bone
matrix
• At-risk populations
– Elderly
– Premature infants
– Strict macrobiotic vegetarians
– Multiparous women who have breastfed
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteomalacia
• Risk factors
– Vitamin D deficiency
• Lack of sun exposure
• Poor dietary intake
– Abnormal metabolism of vitamin D
– Phosphate depletion
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteomalacia
• Clinical manifestations
– Bone pain
– Tenderness
– Fractures
– Vertebral collapse
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteomalacia
• Vitamin D metabolism
– Consists of a series of steps
 Step 1: vitamin D manufactured by skin
 Step 2: vitamin D carried to the liver and converted
to calcidiol
 Step 3: calcidiol carried to kidney and converted to
calcitriol
 Step 4: calcitriol stimulates intestinal absorption of
calcium and phosphorus, resulting in
mineralization of the bone
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Paget’s Disease
• Chronic, localized bone disorder
• Normal bone lost and replaced with
abnormal bone
• Affects between 1 and 3 million Americans
• May be asymptomatic
• Pathophysiology
– Increased activity of abnormal osteoclasts
causes formation of new, weak, inferior bone
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Paget’s Disease
• Risk factors
– Viral particles
– Genetics
– Heredity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Paget’s Disease
• Clinical manifestations
– Deep, aching pain
– Muscle spasms
– Bowing of legs
– Gait changes
– Mobility impairments
– Stress fractures
– Kyphosis
– Cord compression
– Paralysis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Most common form of arthritis in the
United States
• Affects 50% of people > age 65
• Leading cause of disability for people over
age 65
• Chronic disease
• Women are affected more than men
• Severity varies
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Nodal disease at middle age associated
with knee OA in 60s and 70s
• Predicts self-care abilities as older adult
• Aging alone does not cause this disease
• Other associated factors for OA
– Obesity
– Overuse of a joint
– Trauma
– Cold climate
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Primary or idiopathic osteoarthritis
– No single, clear cause
– Group of similar disorders
– Involve complex biomedical, biochemical, and
cellular processes
– Changes in several joints as a result of
various causes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Secondary arthritis
– Underlying condition
– Trauma
– Bone disease
– Inflammatory joint disease
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Pathophysiology
– Characterized by progressive erosion of joint
articular cartilage with formation of new bone
in the joint space
– Most commonly involved joints
 Knee
 Hip
 Central joints of cervical and lumbar spine
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Pathophysiology
– Progression
 Cartilage thins, causing loss of protection to
underlying bone; subchondral bone becomes
irritated leading to degeneration
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Manifestations
– Joint pain
 During activity
 Relieved by rest
– Morning stiffness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoarthritis
• Manifestations
– Joint involvement
 Initially asymmetrical
 Bony appearance of joints
 Crepitus
 Range of motion deficit
 Muscle weakness
 Heberden’s nodes: distal interphalangeal joint
 Bouchard’s nodes: proximal interphalangeal joint
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Most prevalent inflammatory arthritis
– Incidence increases up to age 80
– Women affected more than men by a 3:1 ratio
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Pathophysiology
 Chronic syndrome, characterized by symmetrical
inflammation of peripheral joints
 Unknown cause
 Unknown environmental factors trigger an
autoimmune response
 Genetic predisposition
 Long-term exposure to offending antigen converts
normal antibodies into autoantibodies
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Manifestations
 Course of RA
• Slow and insidious
• Acute process affecting several joints
 Primary RA clinical manifestations
•
•
•
•
Tenderness and limitation of movement
Disabling morning stiffness
Marked pain in joints (primarily in upper extremities)
Joints will have severe redness, swelling, and warmth
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Manifestations
 Commonly affected joints
•
•
•
•
•
•
Hands
Elbows
Shoulders
Knees
Ankle
Feet
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Manifestations
 Nonspecific systemic symptoms (may occur weeks
or months before joint symptoms)
•
•
•
•
Fatigue
Malaise
Weight loss
Fever
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Manifestations
 Symptoms cause
• Severe pain on movement
• Limitation of movement
• Disrupted sleep pattern
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Rheumatoid arthritis (RA)
– Systemic and nonarticular manifestations
 Rheumatoid nodules
 Episcleritis and scleritis
 Pleurisy with effusion
 Pericarditis and myocarditis
 Renal involvement
 Felt’s syndrome
 Vasculitis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Gout
– Statistics
 Most common inflammatory joint disease in men
over age 25
 Peak onset in men 40–50 years of age
 In women, it occurs after menopause
– Pathophysiology
 Linked to purine metabolism and kidney function
 Urate crystals deposit in peripheral joint resulting in
pain, inflammation, and destruction
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Gout
– Predisposing factors
 Family history
 High-purine diet
 Obesity
 Drug use
• ASA
• Alcohol
 Decreased renal function
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Gout
– Clinical manifestations: first signs
 Acute pain
 Mild attack: few weeks
 Severe attack: several weeks
 General malaise
 Fever
 Chills accompany painful joint symptoms
 WBC and ESR elevations
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Gout
– Chronic gout (tophaceous gout)
 Occurs 3 to 40 years after initial attack
 Persistent aching joints
 Soreness
 Morning stiffness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Inflammatory Joint Disease
• Gout
– Urate crystal deposits (tophi)
 Cartilage
 Synovial membranes
 Tendons
 Soft tissue
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pseudogout (or Calcium
Pyrophosphate Deposition Disease)
• A form of arthritis
• Caused by the formation of calcium
pyrophosphate-dihydrate crystals in large
joints
• Mechanism of disease not fully understood
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Tendonitis and Bursitis
• Acute pain in joint with soft tissue injury
• Potential causes
– Repetitive injuries
– Aging
– Sports
– Occupational injuries
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Tendonitis and Bursitis
• Bursitis
– Irritation of subcutaneous tissue and
inflammation of underlying bursae
– May develop at pressure points
– Characterized by aching pain with movement
• Tendonitis
– Inflammation of the tendon sheath
– Associated with significant pain and reduction
in mobility
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Falls and the Older Person
• Most occur in home during normal routines
• Leading cause of accidental death
• 7th leading cause of death in persons over
age 65
• Fall-related deaths increase with age
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Falls and the Older Person
• National Center for Injury Prevention and
Control (NCIPC, 2006) Statistics
– Cost of falls over 19 billion
– Costs expected to rise to over 43.8 billion in
2020
– More than 1:3 people over age 65 sustain a
serious fall
– Among older adults, falls are most common
cause of injury deaths
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Falls and the Older Person
• National Center for Injury Prevention and
Control (NCIPC, 2006) Statistics
– Nearly 85% of deaths from falls in 2004
among people 75 and older
– Among older adults, majority of fractures
caused by falls
– Osteoporotic fractures of hip, spine, and
forearm most common fall-related injuries
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Falls and the Older Person
• National Center for Injury Prevention and
Control (NCIPC, 2006) Statistics
– Risk of aging increase likelihood of hip
fracture
– Of all fall-related fractures, hip fractures cause
the greatest number of deaths
– After a hip fracture, 1:4 older people are in an
institution for at least one year; many never
return home
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Falls and the Older Person
• Fall prevention
– Key goal of gerontological nursing practice
– Goals
 Recognition of at-risk persons
 Identify and correct risk factors
 Improve balance, gait, mobility, and functional
independence
 Reduce or eliminate environmental factors
contributing to fall risk
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hip Fracture
• Responsible for approximately 390,000
hospital admissions
• 95% of hip fractures in older adults caused
by falls
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Hip Fracture
• Causes
– Low-energy trauma
– Home environment unsafe
– History of falls
– Unable to bear weight
• Hip fractures include upper third of femur
– Intracapsular
– Extracapsular
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Hip Fracture
• Assessment
– Injured leg shortened
– Externally rotated
– Extreme pain prevents movement
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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LEARNING OUTCOME 3
List nursing diagnoses of older persons
related to common musculoskeletal
problems.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Impaired Physical Mobility Related to Stiffness, Pain,
Joint Contractures, and Decreased Muscle Strength
• The state in which an individual
experiences a limitation of ability for
independent physical movement
• Major defining characteristics
– Inability to purposefully move within the
physical environment
– Limited range of motion
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Impaired Physical Mobility Related to Stiffness, Pain,
Joint Contractures, and Decreased Muscle Strength
• Minor defining characteristics
– Decreased muscle strength
– Reduced muscle control
– Inability to sit unsupported
– Impaired coordination
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Other Nursing Diagnoses
• Acute Pain related to progression of
inflammation
• Chronic Pain related to joint abnormalities
• Fatigue related to pain and systemic
inflammation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Other Nursing Diagnoses
• Body Image Disturbance related to chronic
illness, joint deformities, impaired mobility
• Ineffective Coping related to personal
vulnerability in a situational crisis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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LEARNING OUTCOME 4
Discuss the pharmacological management and
nursing responsibilities related to the older person
with common musculoskeletal problems, including
osteoporosis, osteomalacia, Paget’s disease,
osteoarthritis, rheumatoid arthritis, gout,
pseudogout, and hip fractures.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities
• Aging and pharmacology
– Aging is associated with altered drug
metabolism
– Increased drug toxicities with aging
– Patients take increasing amounts of
medications with aging
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities
• Interventions to reduce complications
– Complete history and physical
– Baseline function tests
– Dosages based upon age and renal function
– Serum testing to assess for signs of toxicity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoporosis
• Preserves or increases bone density
• Decreases rate of bone resorption
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoporosis
• Classifications and special considerations
– Bisphosphonates
 Zoledronic acid (Reclast)
• Administered yearly by IV
• Increases bone strength
• Reduces fractures of hips, spine, wrists, arms, legs, and
ribs
• Side effects include hypocalcemia, headache, dizziness,
peripheral edema, musculoskeletal pain, and possible
osteonecrosis of the jaw
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoporosis
• Classifications and special considerations
– Selective estrogen receptor modulators
(SERMs)
 Provide benefits of estrogen without the
disadvantages
 Raloxifene approved for postmenopausal
prevention and treatment of osteoporosis in
women
 Less effective than bisphosphonates
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoporosis
• Classifications and special considerations
– Calcitonin
 Safe but less effective
 Decreases spinal fractures by up to 33%
– Hormone replacement therapy (HRT)
 No longer approved by the FDA for treatment of
osteoporosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Paget’s Disease
• Deformities, symptoms, and joint changes
are often irreversible
• Bisphosphonates and calcitonin
– Goal is to relieve pain
– Prevent progression of deformities
– Bisphosphonates
 Actonel
 Foxamax
 Aredia
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteomalacia
• Goal of treatment is to rematerialize the
bone
• Treatment is determined by the cause
• Vitamin D replacement
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoarthritis
• No available therapies to slow or halt
progression
• Therapies directed at pain relief and
minimizing functional disability
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoarthritis
• Analgesics
– Topical agents
 Capsaicin
•
•
•
•
Nonprescription availability
Applied 2–4 times per day
May cause heat or burning
May take 4–6 weeks to achieve pain relief
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoarthritis
• Analgesics
– Systemic oral agents
 Acetaminophen (Tylenol)
•
•
•
•
A first-line therapy for OA
Up to 4 g/day may be administered
Higher doses may cause liver damage
Ceiling effect: higher doses will not increase analgesic
benefit
• Used alone or as an adjunct to NSAIDs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoarthritis
• Analgesics
– NSAIDs
 Most common treatment for pain and inflammation
of OA
– COX-2 inhibitors
 Considered safe for GI tract
 Side effects include renal impairment
– Adjuvant agents
– Intra-articular agents
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing
Responsibilities for Osteoarthritis
• Analgesics
– Corticosteroids valuable for synovial
inflammation
– Hyaluronic acid
 Normal component of the joint for lubrication and
nutrition
 Decreased pain for longer periods than other intraarticular therapies
 Administered in series of three to five injections
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Rheumatoid Arthritis
• Corticosteroids: prednisone
– Reduce inflammation
– Improve fatigue, pain, and joint swelling
– Long-term adverse effects include
osteoporosis, cataracts, hypertension, and
increased risk of infection
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Rheumatoid Arthritis
• NSAIDs
– High dosages are needed to relieve
inflammation and may cause toxic side effects
such as gastrointestinal bleeding,
gastrointestinal perforation, and renal failure
– COX-2 inhibitors
 Considered safer for gastrointestinal tract
 Associated with renal impairment
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Rheumatoid Arthritis
• Disease-modifying antirheumatic drugs
(DMARDs)
– Often an alternative for the patient who has
used low-dose steroids without relief for
several months
– May take weeks or months to demonstrate
pain relief
– Studies indicate most successful when
implemented early in disease process
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Rheumatoid Arthritis
• Disease-modifying antirheumatic drugs
(DMARDs)
– Examples
 Immunosuppressive agents
 Methotrexate
 Antimalarial (hydroxychloroquine)
 Sulfasalazine
 Gold compounds (aurothioglucose)
 Cytotoxic agents (azathioprine, cyclophosphamide,
and cyclosporine)
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Acute Gout and Chronic Gout
• Gout
– NSAIDs
– Oral colchicines loading
– Intra-articular
– Systemic steroids
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Acute Gout and Chronic Gout
• Pseudogout
– NSAIDs
– Short course of oral corticosteroids
– Intra-articular corticosteroids for large joint
involvement
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Acute Gout and Chronic Gout
• Chronic gout
– Colchicines
 Decrease inflammation
 May be given long term to reduce repeated attacks
of gout
 Maximum dose lowered for elderly
 Liver, renal, and bone marrow toxicity
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacology and Nursing Responsibilities
for Acute Gout and Chronic Gout
• Chronic gout
– Allopurinol, probenemid, and sulfinpyrazone
 Prevent long-term complications by lowering
serum uric acid blood level
 Probenemid and sulfinpyrazone are uricosuric
agents
 Allopurinol is a uric acid synthesis inhibitor that
lowere formation of uric acid; more versatile than
uricosurics and safe at all levels of renal function
 Goal therapy to decrease serum urate levels to </=
6.5 mg/day
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Pharmacological Treatment of
Bursitis
•
•
•
•
Treatment depends upon the cause
Infections will require antibiotic therapy
Corticosteroid injection
NSAIDs
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 5
Discuss the nonpharmacological management of
the older person with common musculoskeletal
problems, including osteoporosis, osteomalacia,
Paget’s disease, osteoarthritis, rheumatoid
arthritis, gout, pseudogout, and hip fractures.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Bone mineral density test
– Dual energy X-ray absorptiometry (DEXA)
 Patient lies on table
 Machine passes over body part being tested
 Minimal radiation exposure
 Results measured in standard deviations
 Problems
• Older adults have bone changes due to arthritis
complicating results
• Cutoffs to determine diagnosis are arbitrary and must be
considered with other factors
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Bone and joint radiography
– Basic imaging technology
– Used to diagnose and stage rheumatic
disease and diagnose fractures
– Not sensitive enough to diagnose bone
mineral density
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Computerized tomography
– Uses an X-ray machine rotating 180 degrees
around body part
– Able to view inflammation and degeneration
not visible on a routine X-ray
– Shows occult fractures and articular damage
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Magnetic resonance imaging (MRI)
– Uses large magnet and radio waves to
produce energy field that can be transferred
to a visual image
– Does not show calcification or bone
mineralization
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Bone scan
– Detects skeletal trauma and disease
– Determines the amount of the matrix the bone
“takes up” of a bone-seeking radioactive
isotope
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Electrolytes
 Calcium
• Normal range: 8.8 to 10.2 mg/dL
• Increased in Paget’s disease with bone fractures and
immobility
• Decreased in osteoporosis and osteomalacia
 Phosphorus
• Normal range: 2.3–3.7 mg/dL
• Increased in bone fractures and healing states
• Decreased in osteomalacia
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Serum uric acid (SUA)
 Diagnosis of gout made when SUA found in tissue
or synovial fluid
 Higher levels associated with an attack of gout
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Rheumatoid factor (RF)
 An antibody that binds to the Fc fragment of
immunoglobulin G
 Negative in early stages of disease
 Elevations in titers (> 1.320) predicts an increase
in severity of symptoms and greater disability and
extra-articular disease
 Elevated in patients with liver disease, lung
disease, and other conditions
 Not diagnostic for RA but can confirm diagnosis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Acute-phase reactants
 Proteins that increase in response to acute and
chronic inflammation
 C-reactive protein
 Erythrocyte sedimentation rate
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Alkaline phosphatase
 An enzyme associated with bone activity
 Normal values: men, 45–115 U/L; women, 30–100
U/L
 Values increase after age 50
 Values elevated with Paget’s disease
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Diagnostic Tests Used in the Management
of Musculoskeletal Disorders
• Blood serum tests
– Synovial fluid analysis
 Fluids are withdrawn from a joint capsule and
analyzed
 Appearance, volume, and cellular contents are
analyzed
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Lifestyle Changes
•
•
•
•
•
Increase exercise
Weight loss
Eat healthy diets
Eliminate alcohol and caffeine intake
Smoking cessation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Healthy People 2010
(www.health.gov/healthypeople)
• Nation’s goals and objectives for improved
health
• Includes an objective for arthritis
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Nonpharmacological treatment of
osteoporosis
– Assessment of risk factors
– Education
 Prevention
 Lifestyle changes
 Diet
 Exercise
 Risk factor modification
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• National Osteoporosis Foundation
recommendations
– Provide education to all women concerning
risk factors
– BMD testing for any women who has had a
fracture
– BMD testing for any women under 65 who
has any risk factors for disease development
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Osteoporosis
• Lifestyle modification activities to prevent
or treat osteoporosis
– Diet with adequate calcium and vitamin D
– Encourage weight-bearing exercise
– Reduce or eliminate smoking
– Reduce or eliminate consumption of
beverages containing alcohol, caffeine, and
phosphorus
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment of
Osteomalacia
• Space activities to conserve energy
• Monitor safety measures for the home
• Evaluate home hazards
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment of
Paget’s Disease
• Evaluate diet
• Increase exercise
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment of
Osteoarthritis
• Education about disease process
• Weight reduction
• Exercise to promote pain relief and
stiffness
• General and specific rest as needed
• Canes, crutches, and walkers to protect
joints
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment of
Osteoarthritis
• Use of assistive technology to help with
functional ability
• Surgical intervention as needed
• Apply heat to painful joints
• Use of cold applications
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment for
Rheumatoid Arthritis
•
•
•
•
Reduction of joint stress
Maintenance of joint function
Promotion of independence
Management of fatigue
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment for
Rheumatoid Arthritis
• Teaching guidelines
– Refer to local Arthritis Foundation
– Visit government Websites
– Caution concerning advertisements for
treatments
– Exercise
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment for
Rheumatoid Arthritis
• Teaching guidelines
– Avoid positions of deformity
– Rest painful joints
– Weight loss
– Assistive devices
– Scheduled rest periods
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment for
Gout and Pseudogout
•
•
•
•
•
•
•
Rest joint during attacks
Increase fluid intake
Apply cold
Avoid heat if inflammation present
Avoid high purine foods
Avoid alcoholic beverages
Maintain healthy weight
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment for
Bursitis
• Exercise affected area
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nonpharmacological Treatment to Prevent
Falls and Fall-Related Injuries
• Assess for risk factors
• Assess functional mobility
• Education regarding how to recover from a
fall
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 6
Explain the nursing management principles
related to the nursing care of older patients
with arthritis.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Management Principles
• Assessment
• Pain assessment and control
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Surgical Intervention
• Type of surgical procedure depends on
– Type of injury
– Patient’s condition
– Preexisting orthopedic conditions
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.