MUSCULOSKELETAL DISORDERS

1
MUSCULOSKELETALDISORDERS
2

• Osteoporosis
• Loss of bone mass
• Increase bone fragility
• Increase risk of fractures

3

• Cause of Osteoporosis
• Low Calcium

4

• When can you expect a client to have
  Osetoporosis?
• Age
• Sex
• Race
• Family History

5

• Who is at risk for Osteoporosis?
• Calcium deficiencies
• Skeletal Loss
• High intake of Sodas
• Vitamin D Deficiency
• Smokers
• Excess ETOH
• Decrease Estrogen
• Sedentary Lifestyle
• Meds
• Steroids, antacids

6

• Cardinal Signs of Osteoporosis?
• Loss of height
• Curvature of Spine
• Dowagers Hump
• Lordosis
• Low Back Pain

7

• Treatment of Osteoporosis
• Biphosphonates
• Fosamax
• Actonel
• Didronel
• Calcitonin
• Sodium Flouride
• Raloxifene (Evista)

8
OSTEOMYELITIS
9

• True or False
• Osteomyelitis is an Acute Infection?
• True or False
• Osteomyelitis is a Chronic Infection?
• Osteomyelitis is caused by which of the
  following?
• Staphylococcus Aureus
• Fungus
• Parasite
• Virus

10
INTRODUCTION

• Osteomyelitis Bone Infection
• (Page 1267 Lemone)
• Acute or Chronic
• Usually Caused By
• Staphylococcus Aureus
• Fungus
• Parasite
• Virus

11
(No Transcript)
12
What kind of patient situations have contributed
to the diagnosis of Osteomyelitis?
13
RISK FACTORS

• Trauma
• Diabetes
• Hemodialysis
• Splenectomy
• Advanced age
• ? Immune function
• Poor circulation

14
CAUSES

• Direct Contamination
• Surgical Infection
• Adjacent Soft Tissue Infection
• Hematogenous
• Originating in the blood

15
STAGES OF OSTEOMYELITIS
16
When you see a client with Osteomyelytis, what
does the client usually complain about?
17
MANIFESTATIONS

• Pain
• Swelling, redness, warmth
• Purulent exudate
• Systemic
• Fever
• Chills
• Nausea
• Malaise

18
DIAGNOSTIC STUDIES

• MRI
• CT
• Bone Scan
• Ultrasound
• Labs
• Sed Rate
• WBCs
• Cultures

19
TREATMENT

• Medications
• Antibiotics
• Pain Management
• Surgical debridement
• Amputation

20
Common Nursing Diagnoses for Clients with
Osteomyelitis?

• Risk for Infection
• Hyperthermia
• Impaired physical mobility
• Acute pain
• Anxiety
• Body Image
• Self Esteem

21
Prevent Osteomyelitis?

• Risk Factors?
• Trauma
• DM
• PVD
• SHOES, SOCKS

22
Test Question

• You have admitted a client with Osteomyelitis.
  What assessment data is essential in the care of
  this client on the first day of admission?
• Limp in involved extremity
• Swelling at the involved site
• Anorexia
• Chills

23
Arthritis

• Inflammation of a joint usually accompanied by
  pain swelling and changes in structure
• Etiology
• Degenerative Joint Disease
• Osteoarthritis, Rheumatoid
• Metabolic disturbances
• Gout
• Infection
• Gonococcus, TB, Pneumonia

24
Osteoarthritis
25
Manifestations

• Pain
• Stiffness
• Redness
• Swelling
• Knee effusions
• Crepitus

26
Diagnostic Tests

• History and Physical
• X-rays

27
Treatments

• Medications
• Analgesics
• NSAIDS
• Steroids-RARE
• Treatments
• ROM exercises
• Rest the joint
• Assistive devices walker, cane, crutches

28
Surgical Treatment

• Joint Arthroplasty (Reconstruction or
  Replacement)

29
HIP REPLACEMENT
30
Total Knee Replacement
31
Total Joint Replacement

• Candidate selection
• Several devices available
• Significant relief of pain
• Good return to ADL
• OOB in 1 -2 days with PT help
• Best results with PT program for re-strengthening
  muscles
• Post op CPM
• Continuous Passive Motion see next slide

32
Continuous Passive Motion
33
Post Op Care Joint Replacement

• Monitor incision for bleeding
• Cough, turn, deep breath
• OOB as ordered
• Neurovascular checks hourly 12-24 hours (color,
  temp, pulses, capillary refill, movement,
  sensation)
• Pain management
• Prevent new hip displacement

34
Post-Op Joint Replacement

• Nursing Care Plan
• Pain assessment
• Position changing with Trapeze
• Sequential compression
• Incentive spirometer
• OOB
• Abduction pillow for hip replacement
• Monitor temperature and other VS
• Surgical site assessment
• Quadriceps and foot exercises

35
Discharge Teaching

• Hazards assessment
• Chronic disease
• ROM
• Prevent Overuse/Overstess
• Pain Management

36
Rheumatoid Arthritis
37
Rheumatoid Arthritis

• Chronic, Systemic Autoimmune Disease
• Inflammation of the connective tissue,
• Inflammation of the joint

38
Sites affected
39
Manifestations of RA

• Joint symptoms
• Pain, swelling, stiffness (?in morning)
• Deformity and muscle atrophy
• Limited ROM
• Other Symptoms
• Fatigue
• Anorexia
• Low-grade fever
• Inflammatory changes of heart and lungs

40
Diagnosis of RA

• History and physical exam
• Labs
• Rheumatoid factors (RF)
• ESR (Erythrocyte Sedimentation Rate)
• Synovial fluid exam
• X-rays
• Narrowing joint space

41
Treatment of RA

• NO CURE
• Goals of Treatment
• Relieve pain
• Reduce inflammation
• Stop or slow joint damage and deformity
• Improve well-being and ability to function

42
Treatment of RA

• Medications
• NSAIDS
• Steroids (po or intra-articular)
• Disease-modifying drugs
• Modify immune system
• Gold, antimalarial,
• Modify the autoimmune and inflammatory response
• Enbrel- Tumor necrosis factor blocker
• Kineret- Interleukin 1 receptor antagonist
• Surgery
• Joint replacement
• Tendon reconstruction

43
Gout
44
What is Gout?

• Metabolic disorder
• Inflammation 2 deposits of uric acid crystals in
  joint
• Body produces too much uric acid
• Or
• Body excretes too little uric acid

45
What is Uric Acid?

• Uric acid is a waste product formed from the
  breakdown of purines
• High levels of purines are found in organ meats
  (liver, brains, kidney), anchovies, herring,
  mackerel.
• Alcohol and some drugs may affect purine
  excretion.

46
Stage 1 Asymptomatic Hyperuricemia

• Uric acid levels elevated to 9-10 range (normals
  3 6)
• No symptoms
• Client may not progress to symptomatic disease

47
Stage 2Acute Gouty Arthritis

• Sudden onset, acute pain, redness, swelling
• Usually hits the big toe, may affect another
  joint
• Fever, chills
• Elevated WBC, sed rate
• Attack lasts hours to weeks
• 60 have recurrent attack in 1 yr

48
Stage 3Chronic Tophaceous Gout

• Hyperuricemia untreated
• Tophi (urate crystals deposits) develop in
  cartilage, synovial membranes, tendons, soft
  tissues
• Pain, ulceration, nerve damage
• Uric acid crystalskidney stones

49
Treatment of Gout

• Pain
• Indocin
• NSAIDS, Narcotics
• Steroids (po/intra-articular)
• Interrupt urate crystal formation
• Colchicine Does NOT alter uric acid levels
• Inhibit tubular reabsorption of uric acid
• Probenecid (Benemid)
• Reduce the production of uric acid
• Allopurinol (Zyloprim)

50
Treatment of Gout AttackContinued

• Dietary Management
• Drink 3-4 quarts of fluids daily
• Avoid alcohol
• Sometimes no diet is prescribed
• Low purine diet
• Meats, seafood, yeast, beans, peas, lentils,
  oatmeal, spinach, asparagus, cauliflower,
  mushrooms

51

• Nursing Diagnoses

• Acute Pain
• Impaired Physical Mobility

52
Questions?