Risk Factors For M/S Problems • 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 • Pain Contractures • Swelling Limited ROM • Redness Joint Stiffness • Myalgia Nodules • Immobility Warmth • Sensory Deficits • Fever • Malaise
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
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 • Scoliosis- done in Health Dept. and school setting at age 10-12. • 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)
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: • 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 • 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 • 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 • 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 • DEPRESSANT EFFECT ON CNS • 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) • CNS side effects (dizziness, drowsiness, weakness) • Flexeril, Skelaxin, Lioresal/central acting • Dantrium/ direct effect on striated muscle
OTCs and Vitamins • Calcium supplements- need 1000mg pre-menopause 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
Heat & Cold Therapy • 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 • Crutches-two, three or four point gait. proper fit and safety. • Walkers-extra support, independence, Pick up or rolling. Weight bearing vs non-weight bearing • Abduction Pillows-prevent internal rotation, adduction and dislocation of new hip joint. • Prosthetic Limbs-immediate <edema, early amb
OTHER SUPPORTIVE THERAPY • Physical Therapy: ROM, Gait/strength, transfers, assisstive devices, treatments • TENS-transcutaneous electrical nerve stimulation-delivers electric current to skin surface over painful region. (by PT) • Massage-pain therapy • Cognitive Therapy-Relaxation, Distraction, Hypnosis, Imagery • 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 • 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 • A. 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.
Fractures • A 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.
Can you identify the different types of fractures and what type of injury caused them?
Edema Color Changes Deformity Parasthesia Pain Limited Movement Crepitation Bruising Bleeding Distal Pulse Pallor Confusion Dyspnea Shock Changes in BP Diaphoresis Fear & Anxiety Concomitant Disease or Other Injuries Assessment: Areas of Concern
Pain Assessment • Pain Scale 0/10 to 10/10 • Location • Quality • Intensity • Duration • Precipitating Factors • Alleviating Factors • Exacerbating Factors
REDUCTION AND IMBOLIZATION • OPEN- surgical correction of bone fracture with use of internal fixation such as wires, screws, pins, plates. More risk for complications. • CLOSED- nonsurgical, manual realignment. anesthesia, immobilization by traction, cast, external fixation, splint or brace.
EXTERNAL FIXATION- metal 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. • INTERNAL FIXATION- surgically inserted at time of realignment. Biologically inert metal devices.
Casts and Splints • Casts are primarily used after a closed reduction of a fracture. Proper technique in handling cast and client is essential. • Two basic types of casts: plaster and synthetic. • Splints are removable devices that are applied to an injured person prior to moving them. • 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 • The exertion of a pulling force utilized to align and immobilize bone fragments. • Also helps to relieve muscle spasms and correct flexion contractures, deformities, and dislocations. • There are 2 types of traction: Skin (Buck’s traction & Russell’s traction) and Skeletal traction.
Care of the Traction Client • SKIN-temporary immobilization, spasms, stabilization. No movement. Body is counterforce. Skin breakdown prevention. • 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 • For Casts- Compartment Syndrome Infection Skin Breakdown • For Traction- Skin Breakdown Orthostatic Hypotension Boredom/Cabin Fever
Complications ……. • For Surgery – Venous thrombosis r/t decreased activity which may lead to clot formation. • Phantom Pain • Aspiration • Fat Embolus • Pneumonia
Complications……. • 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 • A, Wrist structures involved in carpal tunnel syndrome. • 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 • Nsg Considerations
OSTEOMYELITIS • Severe infection of the bone (Staph aureus) • Occurrence reduced by prophylactic use of antibiotics • Blount trauma in males less than 12 yrs old • Diagnosed by bone biopsy, MRI, CT, CBC • Intensive IV antibiotic therapy from 4 weeks to 6 months • Surgical removal of dead bone (Amputation) in advanced cases
Bone Cancer • Multiple Myeloma • Osteogenic Sarcoma • Osteoclastoma • Ewing’s Sarcoma • Metastatic Bone Disease
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. Treatment- Nsg Interventions-