Musculoskeletal Disorders Quiz

Coordinating Care for Patients with Musculoskeletal Disorders

• Objectives include describing epidemiology and risk factors for musculoskeletal disorders, understanding diagnostic results, explaining interprofessional management strategies, designing nursing care plans, coordinating and implementing interprofessional care plans, and ensuring effective communication.
• The musculoskeletal system is the second largest body system, enabling movement, protecting vital organs, producing blood cells, supporting posture, and storing essential minerals.

Assessing Past Medical History & Chief Complaint

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

Physical Assessment

• Key elements include posture, gait, range of motion, sensation, pulse assessment, muscle tone & strength, and skin color/temperature.
• Diagrams depicting normal and abnormal spinal postures (lordosis, kyphosis, flat back, sway back, scoliosis).

Diagnostic Studies

• X-rays, CT scans (with or without contrast), assessment of renal/medication status (metformin), MRI (assessing for claustrophobia), education regarding noise levels, bone density studies/scans, arthrograms, arthroscopies, and arthrocenteses for diagnosis.

Muscular Dystrophy

• Description of muscular dystrophy, including progressive muscle weakness/atrophy, lack of dystrophin, the prevalence in over 50,000 Americans, the most common types (Duchene and Becker), the inheritance pattern (X chromosome link), the possibility of presenting at any age, and the lack of a cure.
• Nine different subgroups of muscular dystrophy, each with its characteristic presentations of locations for pain and muscle weakness.

Muscular Dystrophy: Clinical Manifestations

• Clinical manifestations include progressive muscle weakness, chronic pain, increased fat and scar tissue, calf enlargement, spasms and fractures, poor dentition, deteriorated speech quality, gastrointestinal (GI) dysfunction, difficulty ambulating/frequent falls, scoliosis/lordosis, cardiomyopathy, respiratory compromise, and depression.

Muscular Dystrophy: Diagnosis

• The gold standard is muscle biopsy, serum enzyme tests, and creatinine kinase levels along with chest X-rays, EKGs, CT scans, and genetic testing.

Muscular Dystrophy: Treatment

• Treatment focuses on preventing deterioration, supporting function, pain management, using glucocorticoids (prednisone), anti-inflammatory medications, supplemental drugs, antioxidants, and supportive care & counseling.

Muscular Dystrophy: Nursing Management

• Specific nursing management for muscular dystrophy includes monitoring signs/symptoms, complications, vital signs, labs/imaging results, assisting with activities of daily living (ADLs), range of motion (ROM) and fall precautions, medication administration, and collaboration with physical, occupational, and speech therapists, and family members.

Osteoporosis

• Osteoporosis is a bone disease involving deterioration in bone tissue/density; affecting over 75 million people worldwide, including 1 in 2 women and 1 in 5 men over 50. It affects all ethnicities and is a significant health concern.
• Risk factors include age 50+, female gender, Caucasian/Asian race, sedentary lifestyle, smoking, excessive drinking, decreased calcium/vitamin D intake, steroid use, and anticonvulsants.

Osteoporosis: Clinical Manifestations

• Clinical symptoms include a silent disease (often detected only after a fracture); prevention is key, with potential for spine, hip, and radius fractures, Dowager's hump, loss of height, back pain, pain increasing with activity (and relief with rest), restriction of movement, and fear of falls.

Osteoporosis: Diagnosis

• Diagnosing osteoporosis involves bone mineral density testing via DEXA scans to assess bone mass density. Osteopenia is a situation between 1 and 2.5 points below normal standard deviation, while Osteoporosis is over 2.5 points lower than standard deviation. Ultrasound and quantitative CT scans are also used, and no specific lab tests are needed other than ruling out other conditions.

Osteoporosis: Treatment

• Prevention and screening are crucial for osteoporosis, including weight-bearing exercises, avoiding smoking/alcohol, calcium and vitamin D supplements, sunlight, and pharmacologic interventions like bisphosphonates.
• Complications include falls, prolonged hospitalizations, and death.

Osteoporosis: Nursing Management

• Nursing management focuses on assessment, medication administration, fall prevention, dietary/weight loss counseling, emotional support regarding body image issues, assistance with activities of daily living (ADLs), exercise, and collaboration with home health.

Paget's Disease

• Paget's disease is the second most common bone disease characterized by accelerated bone remodeling. It's most common in males over 50 and its prevalence increases with age, with UK prevalence being high. A genetic component exists, and measles is a possible trigger.

Paget's Disease: Clinical Manifestations

• Paget's disease is initially asymptomatic, but clinical manifestations include pain and deformity and a possible increase in pain during night and with weight-bearing. One notable characteristic is spinal curvature and compression; cortex fissures are another symptom. Other symptoms may include warmth at the site where deformity is present.

Paget's Disease: Complications

• Complications resulting from Paget's disease include fractures, osteosarcoma, hyperparathyroidism, gout, urolithiasis, heart failure, neurologic issues (e.g., deafness), and facial deformities.

Paget's Disease: Diagnosis

• Paget's disease diagnosis relies on identifying 80% asymptomatic patients, conducting a thorough history and physical exam (H&P), bone turnover assessment, imaging such as bone scans that show "hot spots" indicating areas of increased bone turnover, and CT scans/biopsies to rule out osteosarcoma.

Paget's Disease: Medical Management

• There is no effective cure for Paget's; management addresses symptoms. Non-surgical approaches include calcitonin and symptomatic bisphosphonates (zoledronic acid, others—renal toxicity) along with calcium and vitamin D supplements. Surgical approaches may include joint replacement, spinal decompression, and osteotomy.

Paget's Disease: Nursing Management

• Nursing interventions associated with Paget's Disease include assessment, medication administration, pain management, hot/cold therapy, collaborating with PT/OT, and home health, as well as patient education.

Osteomyelitis

• Osteomyelitis involves inflammation/infection in the bone, often caused by bacteria such as Staph Aureus or Gram-negative bacilli that spread via the bloodstream or from trauma/surgery.
• Osteomyelitis has three phases: acute (less than 2 weeks), subacute (2-3 months), and chronic (over 3 months).
• A key characteristic is bone necrosis and sinus tract development.

Osteomyelitis: Clinical Manifestations

• Clinical symptoms of osteomyelitis include pain that is not relieved by rest, swelling, warmth/tenderness at the site, malaise, fever/chills, and possible nausea/erythema.

Osteomyelitis: Diagnosis

• Diagnostic tools for osteomyelitis include lab tests (WBC, ESR, CRP, blood cultures), bone scans, CT/MRI, and the definitive gold standard, bone biopsy.

Osteomyelitis: Medical Management

• Treatment primarily involves antibiotics, typically penicillins or cephalosporins, often for 4-6 weeks, along with possible fluoroquinolones or vancomycin (if MRSA or allergy). Surgical intervention may include incision and drainage, and surgical debridement; pain management, and nutritional/supplement support.

Osteomyelitis: Nursing Management

• Nursing management for osteomyelitis includes monitoring lab tests/cultures, administering antibiotics, providing pain management (non-pharmacological options), assisting with ADLs, monitoring safety, and collaborating with home health and educating the patient and family.

Scoliosis

• Scoliosis is characterized as a curvature of the spine greater than 10 degrees, accompanied by rotation and compression. It has three main categories: neuromuscular, congenital, and idiopathic (cause unknown).

Scoliosis: Risk Factors

• Possible risk factors for scoliosis include smoking, obesity, older age, heavy labor occupations, sedentary lifestyles, and lower educational levels; there is also a reported 2–3% prevalence in adolescent idiopathic cases.

Scoliosis: Clinical Manifestations

• Clinical signs of scoliosis include spinal curvature, uneven shoulders, a prominent shoulder blade on one side, uneven hips and waist, and possible cardiopulmonary compromise (if severe).

Scoliosis: Diagnosis

• Scoliosis diagnosis involves evaluating the spine to identify the degree and location of the curvature. A particular measure is the Cobb's angle, which assesses the degree of spinal curvature, with different levels of spinal instability associated with different levels of curvature.

Scoliosis: Medical Management

• Treatment strategies for scoliosis depend on the degree of curvature: patients with less than 50 degrees typically receive conservative treatment (e.g., thermal therapy, physical/occupational therapy, exercise schedules, pain management). More severe curvatures (over 50 degrees) may require surgical intervention such as spinal fusion involving placement of an orthotic brace or TLSO.

Scoliosis: Nursing Management

• Nursing interventions focus on patient monitoring for cardiopulmonary compromise, pain management, fall prevention, assistive devices (e.g., braces), maintaining exercise/activity levels, thermal therapy, and patient education.

Joint Replacement Surgery

• Total joint replacement (arthroplasty) involves removing the damaged area of bone and replacing it with a prosthesis. Partial or complete joint replacement (knee or hip) is common, often with patients experiencing a 10–15-year lifespan following surgery. Increases in joint replacement rates often result from increasing trends in obesity. Average hospital stay time following joint replacements is often decreased.

Joint Replacement: Indications

• Surgical indications involve conditions such as osteoarthritis, joint destruction, impaired joint function, mobility problems, increased pain/inflammation, muscle spasms, and when non-surgical conservative treatment methods are ineffective.

Joint Replacement: Surgical Approaches

• Two primary approaches are used: cemented (attaching the prosthesis to bone with cement) and uncemented (allowing for bone ingrowth onto the prosthesis). Uncemented methods tend to be preferred in younger and more active populations since bone will integrate into the replacement piece.

Joint Replacement: Types of Surgery

• Different surgical approaches, including traditional methods with larger incisions and minimally invasive methods using smaller incisions, are used with varied levels of muscle damage. Traditional procedures typically involve 20–30cm incisions, whereas minimally invasive approaches often result in incisions of less than 10cm.

Joint Replacement: Complications

• Potential complications following joint replacement surgery include blood loss, hypotension, hypovolemia, wound site infection, dislocation, deep vein thrombosis (DVT)/pulmonary embolism (PE).

Joint Replacement: Nursing Management

• Patient evaluations include vital signs, pain management, neurovascular assessments, wound care, lab testing, range-of-motion exercises, positioning protocols, the use of devices (e.g., sequential compression devices, CPM), education, and collaboration with physical/occupational therapists, and other associated medical staff.

Hip and Knee Repair/Replacement

• These are specific procedures requiring consideration within the context of musculoskeletal care.

Miscellaneous/General

• Pages 1 and 2 detail the subject matter of the presentation, while pages 3–42 contain detailed medical information about various conditions.