Muscular Dystrophy and Osteoporosis Quiz

Coordinating Care for Patients with Musculoskeletal Disorders

• Objectives: Describe epidemiology and risk factors of musculoskeletal disorders to inform nursing assessments and patient education; understand diagnostic results to confirm diagnoses and guide interventions; explain interprofessional management strategies for musculoskeletal conditions; design nursing care plans incorporating pharmacological treatment, dietary modifications and lifestyle interventions to optimize outcomes; coordinate and implement interprofessional care plans for patients undergoing joint replacement surgery, ensuring effective communication and continuity;

Functions of the Musculoskeletal System

• Second largest body system
• Allows for movement
• Protects vital organs
• Produces blood cells in bone marrow
• Supports upright posture and weight-bearing
• Reservoir for essential body minerals

Assessing Past Medical History & Chief Complaint

• Key aspects to assess include pain, swelling, stiffness, deformity, weakness, instability, loss of function, color/temperature changes, numbness/tingling, treatment effectiveness, history of injuries, and family history.

Physical Assessment

• Includes posture, gait, range of motion, sensation, pulse assessment, muscle tone and strength, and skin color/temperature. Visual aids demonstrate normal and abnormal postures including Lordosis, Kyphosis, Flat back and Scoliosis

Diagnostic Studies

• X-rays: scans with or without contrast, renal and medication status assessment (e.g., metformin)
• CT scans: with or without contrast, assess renal and medication status (e.g., metformin)
• MRI: assess for claustrophobia, education regarding noise levels, remove metal and medication patches, bone density studies/scans, arthrograms, arthroscopy, arthrocentesis

Muscular Dystrophy

• Progressive muscle weakness/atrophy
• Lack of dystrophin
• Multiple types affecting over 50,000 Americans
• Most common types: Duchenne and Becker
• More common in males
• Inherited X chromosome link is the only known risk factor
• Can present at any age
• No cure

Muscular Dystrophy: Clinical Manifestations

• Progressive muscle weakness
• Chronic pain (location varies)
• Increase in fat and scar tissue
• Calf enlargement
• Spasms and fractures
• Poor dentation
• Deteriorated speech quality
• GI dysfunction
• Difficulty ambulating and frequent falls
• Scoliosis or Lordosis
• Cardiomyopathy
• Respiratory compromise
• Depression

Muscular Dystrophy: Diagnosis

• Gold standard: Muscle biopsy
• Serum enzymes
• Creatinine kinase levels
• Chest X-rays
• EKGs
• CT scans
• Genetic testing

Muscular Dystrophy: Treatment

• Prevention of deterioration
• Support to maintain function
• Pain management
• Glucocorticoids (e.g., Prednisone)
• Anti-inflammatory medications
• Supplemental medications
• Antioxidants
• Supportive care and counseling

Muscular Dystrophy: Nursing Management

• Monitor signs and symptoms
• Monitor for complications and deterioration
• Monitor vital signs (possible decreased BP & O2 and elevated heart rate)
• Monitor labs and imaging results
• Assist with ADLs as needed
• ROM and fall precautions
• Medication administration
• Collaboration with PT, OT, ST, and family
• Emotional support
• Evaluating care outcomes; promote and maintain optimal function and comfort

Osteoporosis

• Deterioration in bone tissue density
• Most common bone disease worldwide
• Affects over 75 million people globally
• 1 in 2 women and 1 in 5 men over age 50
• Affects all ethnicities
• Major health concern

Osteoporosis: Risk Factors

• Age 50+
• Female > Male
• Caucasian/Asian race
• Sedentary lifestyle
• Smoking
• Excessive alcohol consumption
• Decreased calcium and vitamin D intake
• Steroid use
• Anticonvulsants

Osteoporosis: Clinical Manifestations

• Silent disease: Typically diagnosed after a fracture
• Prevention is key
• Spine, hip, or radius common fracture sites
• Dowager's hump
• Loss of height
• Back pain
• Pain increased with activity, relieved with rest
• Restriction of movement
• History and fear of falls

Osteoporosis: Diagnosis

• Bone mineral density testing (DEXA scans with T scores)
• Osteopenia (low bone mass): Between 1 and 2.5 points lower than standard deviation
• Osteoporosis: Greater than 2.5 points lower than standard deviation
• Ultrasounds
• Quantitative CT scans
• No specific lab tests (other lab tests may be completed to rule out other diseases)

Osteoporosis: Treatment

• Prevention and screening (weight loss, weight-bearing exercises, avoid smoking/alcohol, calcium and vitamin D supplements, sunlight)
• Complications (falls, prolonged hospitalization, death)
• Treatment plan includes (medication, healthy diet, calcium and vitamin D, exercise, preventing falls)

Osteoporosis: Nursing Management

• Assessment
• Medication administration
• Fall prevention measures
• Encourage healthy diet/weight loss (PRN)
• Emotional support for body image issues
• Assist with ADLs and exercise
• Collaborate with home health

Paget's Disease

• Second most common bone disease
• Accelerated bone remodeling leading to abnormal structures
• Males age 50+
• Prevalence increases with age
• Most common in UK
• Genetics involved
• Measles potential trigger

Paget's Disease: Clinical Manifestations

• Initially asymptomatic
• Pain and deformity
• Pain increased at night
• Pain increased with weight-bearing
• Spinal curvature and compression
• Cortex fissures
• Warmth to site of deformity

Paget's Disease: Complications

• Fractures
• Osteosarcoma
• Hyperparathyroidism
• Gout
• Urolithiasis
• Heart failure
• Neurological issues (e.g., deafness)
• Facial deformities

Paget's Disease: Diagnosis

• 80% asymptomatic
• Incidental findings
• History and physical examination
• Bone turnover
• Imaging (e.g., bone scans—revealing "hot spots", CT scans, biopsy to rule out osteosarcoma)

Paget's Disease: Medical Management

• No effective treatment, goal is to decrease pain and increase functional mobility
• Non-surgical is recommended
• Calcitonin (not a long-term solution)
• Symptomatic treatment: Bisphosphonates (e.g., zoledronic acid - renal toxic), calcium and vitamin D supplements
• Surgical treatment: Joint replacement, spinal decompression, osteotomy

Paget's Disease: Nursing Management

• Assessment
• Medication administration (including monitoring)
• Pain management (non-pharmacological)
• Assist with nutritional support
• Assist with Activities of Daily Living (ADLs)
• Maintain safety
• Collaborate with home health
• Education

Osteomyelitis

• Inflammation/infection in the bone (e.g., Staph Aureus or Gram-negative bacilli)
• Spread via bloodstream or trauma/surgery
• Three phases: acute (<2 weeks), subacute (2-3 months), chronic (>3 months)
• Clinical hallmark: bone necrosis and sinus tract development

Osteomyelitis: Clinical Manifestations

• Pain unrelieved by rest
• Swelling
• Warmth/tenderness at site
• Malaise
• Fever and chills
• Nausea
• Erythema

Osteomyelitis: Diagnosis

• Labs (WBC, ESR, CRP, blood cultures)
• Bone scan
• 50% with positive blood cultures
• CT/MRI
• Gold standard: bone biopsy

Osteomyelitis: Medical Management

• Antibiotics (4-6 weeks): Penicillins, Cephalosporins, Fluoroquinolones, Vancomycin (if MRSA or allergy)
• Incision and drainage
• Surgical debridement
• Pain management
• Nutritional/Supplement support

Osteomyelitis: Nursing Management

• Assessment
• Monitor labs/cultures
• Antibiotic administration
• Pain management (non-pharmacological)
• Assist with nutritional support
• Assist with ADLs
• Maintain safety
• Collaborate with home health
• Education

Scoliosis

• Greater than 10-degree curvature of the spine
• Rotation and compression
• Cause unknown
• Three categories: neuromuscular, congenital, idiopathic

Scoliosis: Risk Factors

• Smoking
• Obesity
• Older age
• Heavy labor occupation
• Sedentary lifestyle
• Lower educational level
• 2-3% adolescent idiopathic

Scoliosis: Clinical Manifestations

• Sideways curvature of spine
• Uneven shoulders
• One shoulder blade more prominent
• Uneven waist
• Uneven hips
• Cardiopulmonary compromise in severe cases

Scoliosis: Diagnosis

• Cobb's angle: Perpendicular line from upper/lower vertebrae most affected by curvature
• 10 degrees: Scoliosis
• Greater than 50 degrees: Spinal instability
• Greater than 60 degrees: Thoracic compromise—potential cardiopulmonary compromise

Scoliosis: Medical Management

• Less than 50 degrees of curvature: Conservative treatment (thermal therapy, PT/OT, exercise schedule, pain management)
• Greater than 50 degrees of curvature: Surgery, Spinal fusion, orthotic brace (e.g., TLSO)

Scoliosis: Nursing Management

• Monitor for cardiopulmonary compromise
• Pain management
• Fall prevention
• Assist with orthotic device
• Maintain level of activity/exercise
• Thermal therapy
• Education

Joint Replacement Surgery

• Total joint replacement (arthroplasty): removal of damaged area of bone and replacement with prosthesis
• Common sites: Knee and Hip
• Increased incidence secondary to obesity
• Reduced hospital stay length

Joint Replacement Indications

• Osteoarthritis (leading indication)
• Joint destruction
• Joint dysfunction
• Joint deformities
• Immobility
• Increase in pain/inflammation
• Muscle spasms
• Conservative treatment no longer effective
• Confirmed with X-rays and MRIs

Joint Replacement Surgery (Types)

• Uncemented approach: hole in bone to allow ingrowth into prosthesis
• Younger, active population
• Cemented approach: attach prosthesis to bone
• Older patients, less likely to need revision

Joint Replacement Surgery: Traditional vs Minimal Invasive

• Traditional: 20-30cm incision, staples/sutures, semipermeable dressings, intra-operative drainage to prevent hematoma
• Minimal invasive: 10cm or less incision, faster recovery, increased patient satisfaction, less muscle damage

Joint Replacement Complications

• Blood loss
• Hypotension
• Hypovolemia
• Wound site infection
• Dislocation
• DVT/PE

Joint Replacement: Nursing Management

• Monitor vital signs
• Pain management
• Neurovascular assessment
• Incision assessment/care
• Laboratory assessment
• Mobilization
• SCD's and anticoagulation
• CPM machine (if ordered)
• Positioning and turning
• Education
• Collaboration with PT and case management

Joint Repair Considerations

• Nursing interventions (pre and post-operative teaching, administer medications, wound care, early mobilization, anti-embolic stocking, CPM, positioning/turning , educational resources)
• Nursing management (evaluate care outcomes, reduce pain, restoration of functional outcomes)

Hip Repair/Replacement

• Procedure for repairing or replacing a damaged hip joint.

Knee Repair/Replacement

• Procedure for repairing or replacing a damaged knee joint.