Osteoarthritis and Fracture Management Quiz

Musculoskeletal Overview

• Presented by: Cydnee Seneviratne PhD, RN, Twyla Ens BSN, RN, Shelley Deboer MN, RN, Catherine Fox MN, RN, and Kaleigh McCartney MN, RN
• Focuses on nursing management of pharmacotherapeutic regimes for individuals and their families across the lifespan experiencing chronic musculoskeletal disorders.
• Lecture objectives include identifying safe and effective nursing management, nursing outcomes, and interventions related to chronic musculoskeletal disorders.

Osteoarthritis

• Pathophysiology: Characterized by joint space narrowing, loss of cartilage, bone spur formation (osteophytes), and synovial inflammation.
• Classifications: Diagnosed through clinical presentations with common images.
• Collaborative Care: Management focuses on managing pain and inflammation, preventing disability, and maintaining/improving joint function. Non-pharmacological interventions are foundational, with drug therapy serving as an adjunct.
• Diagnosis: X-ray, CT, and MRI are diagnostic tools, with MRI and CT allowing for earlier diagnosis compared to X-rays.
• Interventions: Heat and cold applications, nutritional therapy, exercise, and complementary therapies (yoga, massage, acupuncture) are crucial, followed by medications. Long-term interventions might include arthroscopic surgery for removing debris.

Osteoarthritis: Medications

• Acetaminophen: Maximum dose of 4 grams per day.
• Topical agents: Capsaicin or diclofenac diethylamine (Voltaren Emulgel).
• NSAIDs: Examples include Celebrex (celecoxib), Voltaren (diclofenac), ibuprofen, indomethacin, ketoprofen, ketorolac, meloxicam, nabumetone, paroxen, piroxicam, and sulindac; used as disease progresses.
• Antibiotics: Doxycycline or minocycline.
• Corticosteroids: Methylprednisolone acetate, triamcinolone, dexamethasone, hydrocortisone sodium succinate, methylprednisolone sodium succinate, prednisone, and triamcinolone.
• Disease-Modifying Antirheumatic Drugs (DMARDs): Methotrexate, sulphasalazine, leflunomide, and D-penicillamine.
• Gold compounds: Oral aurano-fin, parenteral gold, and sodium aurothiomalate.
• Antimalarials: Hydroxychloroquine.
• Immuno-suppressants: Azathioprine and cyclophosphamide.
• JAK inhibitors: Tofacitinib.
• Biological and Targeted Therapies: Tumor necrosis factor inhibitors, interleukin-1 receptor antagonist, interleukin-6 receptor antagonist.

Osteoporosis

• Definition: Low bone density and deterioration of bone tissue.
• Prevalence: 1 in 3 Canadian women and 1 in 5 Canadian men experience fractures due to osteoporosis.
• Risk factors: Age over 50, gender.
• Prevention: Supplementation with calcium (1200 mg daily for women over 50) and Vitamin D (800-2000 units daily for adults over 50 and high risk young adults). Exercise with weight-bearing activities is essential for bone mass maintenance.
• Medications:
  • Bisphosphonates: Alendronate (didrocal), etindronate disodium with calcium carbonate (Didrocal), risedronate, sodium demipentahydrate (actonel), zoledronic acid (actonel DR).
  • SERMS: Raloxifene and tamoxifen.
  • Calcitonin and Teriparatide: Stimulates bone formation.
  • Denosumab: Prevents bone resorption.
• Mechanism of Action (for mentioned medications)

Musculoskeletal Trauma & Injuries

• Sprains/Strains: Edema, decreased function, bruising, and pain are common symptoms. Management of these is by the RICE method
• Dislocations/Subluxations: Deformity, pain, tenderness, and loss of function/swelling.
• Carpal Tunnel Syndrome: Preventative care is essential, includes wrist splints, special keyboards, and corticosteroids injections, surgical options are available.
• Rotator Cuff Injuries: Acute or chronic issues require rest, ice, heat, NSAIDS, and corticosteroids. Physiotherapy. Surgical interventions may be necessary.
• Meniscus Issues: Management includes RICE, NSAIDs, corticosteroids, and possibly surgery.
• Anterior Cruciate Ligament (ACL) Injury: A positive Lachman test and MRI diagnosis may indicate associated conditions. Reconstruction surgery, including allograft or autograft, is a common intervention. Rehabilitation is crucial for knee functionality, taking 6-8 months.
• Fractures: Realignment of bone fragments is a primary goal. Immobilization with casts, splints, or surgical fixation (internal fixation, pins) is typical.

Musculoskeletal Fractures

• Surgical Procedures: Open reduction, closed reduction, external fixation.
• Hip Fractures: Common in elderly related to osteoporosis; 70-90% caused by osteoporosis, 95% result from a fall. 10% die within the 1st month and 30% within 1 year. Internal fixation devices and hip replacements (partial or total) may be required.
• Facial/Pelvic Fractures: Facial fractures need a patent airway and, concurrent-c-spine injury assessment. Pelvic fractures have high mortality, damage to abdominal/GI/GU organs is a concern.
• Intervention & Collaborative Care: Assessment for pain and other symptoms. Stabilization of the fracture. Recovery depends on condition severity, proper treatment, and factors like osteoporosis.

Complications of Fractures

• Infection: Especially in open fractures and soft tissue injuries.
• Bone malunion/nonunion: Incomplete or improper healing of the fracture.
• AVascular Necrosis: Loss of blood supply to the bone.
• Compartment syndrome: Increased pressure in a muscle compartment resulting from restrictive dressings, splints, or premature closure of fascia. Signs include pain, tingling, paleness, loss of function and diminished pulse.
• Deep Vein Thrombosis (DVT)
• Fat Embolism: A significant complication and can be life threatening. Early recognition is crucial.
• Traumatic or hypovolemic shock

Musculoskeletal Assessment

• Comprehensive assessment crucial for accurate diagnosis and interventions.
• Includes color, warmth, sensation, movement, pain, pallor, pulse, paresthesia, and paralysis

Postoperative Care

• Monitoring: The status of vital signs, breathing, pain, and wound are essential. Regular assessments of renal function.
• Special Needs: Provide the patient with proper support, pain management, and wound care. Monitor for complications such as infection or DVT.

Enhanced Recovery After Surgery (ERAS) Protocol

• Standardized care to speed up the healing process after surgery and aid in faster recovery.
• Focuses on strategies to shorten hospital stays, reduce hospital-acquired complications and includes strategies related to nutrition, mobility, and pain control

Musculoskeletal Complications:

• Osteomyelitis: An infection of the bone. Collaborative care includes intravenous antibiotics, pain control, and surgical debridement.
• Back Pain: Common musculoskeletal issues. Acute pain may require limited bed rest, NSAIDs, or muscle relaxants. Chronic pain necessitates treatment of the underlying issue, weight reduction, and exercise.

Pediatric Musculoskeletal Conditions

• Kyphosis: Excessive outward curvature of a portion of the spine (hump back).
• Lordosis: Excessive inward curvature of a portion of the spine (sway back).
• Scoliosis: Abnormal lateral curvature of the spine.
• Spina Bifida: A birth defect associated with either the spinal cord or meninges.
• Cerebral Palsy: A disorder resulting from occurring in the development of the brain leading to muscle tone and coordination issues.

Muscular Dystrophy

• DMD (Duchenne Muscular Dystrophy): Common form of muscular dystrophy, characterized by gradual degeneration of muscle fibers and affects lifespan.

Neural Tube Defects

• Anencephaly: Most severe NTD where both hemispheres of the brain are absent; incompatible with life.
• Encephalocele: Herniation of brain and meninges through a skull defect. Usually due to prenatal insufficiency of neural tube closing.
• Spina Bifida: A complex birth defect involving incomplete closure of the spine.

Specific Surgical Procedures (with particular focus):

• Total hip and hip resurfacing: Procedures for repairing or replacing damaged joints in the hip to alleviate pain, limit mobility issues and restore functionality.