Interventions for Clients with Musculoskeletal Problems

1. Interventions for Clients with Musculoskeletal Problems

2. 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

3. Osteoporosis

4. 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.

5. Health Promotion/Illness Prevention • Ensure adequate calcium intake. • Avoid sedentary life style. • Continue program of weight-bearing exercises.

7. Assessment • Physical assessment • Psychosocial assessment • Laboratory assessment • Radiographic assessment

9. Drug Therapy • Hormone replacement therapy • Parathyroid hormone • Calcium and vitamin D • Bisphosphonates • Selective estrogen receptor modulators • Calcitonin • Other agents used with varying results

10. Diet Therapy • Protein • Magnesium • Vitamin K • Trace minerals • Calcium and vitamin D • Avoid alcohol and caffeine

11. 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

12. Others • Exercise • Pain management • Orthotic devices

13. 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

14. Osteomalacia

16. 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

17. Paget’s Disease of the Bone • Nonsurgical management: calcitonin, selected bisphosphonates, mithramycin • Surgical management: tibial osteotomy or partial or total joint replacement

18. 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

20. Nonsurgical Management • Drug therapy • Infection control • Hyperbaric oxygen therapy

21. Surgical Management • Sequestrectomy • Bone grafts • Bone segment transfers • Muscle flaps • Amputation

22. Bone Tumors • Benign bone tumors (noncancerous): • Chrondrogenic tumors: osteochondroma, chondroma • Osteogenic tumors: osteoid osteoma, osteoblastoma, giant cell tumor • Fibrogenic tumors

23. Bone Tumors

24. Interventions • Nondrug pain relief measures • Drug therapy: analgesics, NSAIDs • Surgical therapy: curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis

25. Malignant Bone Tumors • Primary tumors, those tumors that originate in the bone • Osteosarcoma • Ewing’s sarcoma • Chondrosarcoma • Fibrosarcoma • Metastatic bone disease

26. 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

27. 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

28. Disturbed Body Image • Interventions include: • Recognize and accept the client’s view of body image alteration. • Establish and maintain a trusting nurse-client relationship. • Emphasize the client’s strengths and remaining capabilities. • Establish realistic mutual goals.

29. 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.

30. Phalen’s maneuver for detection of carpal tunnelsyndrome

31. 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

32. Carpal Tunnel Syndrome

33. 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

34. Disorders of the Foot • Hallux valgus • Hammertoe • Morton’s neuroma • Tarsal tunnel syndrome • Plantar fasciitis • Other problems of the foot

37. 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

38. 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

39. 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

40. Progressive Muscular Dystrophies