Musculoskeletal Disorders PDF

COORDINATING CARE FOR PATIENTS WITH MUSCULOSKELETAL DISORDERS Dyana Gallant, BSN, RN ,CMSRN NURS 136 January 27, 2025 Page 1272-1297 OBJECTIVES Describe the epidemiology and risk factors associated with Describe musculoskeletal disorders to inform nursing assessments and...

COORDINATING CARE FOR PATIENTS WITH MUSCULOSKELETAL DISORDERS Dyana Gallant, BSN, RN ,CMSRN NURS 136 January 27, 2025 Page 1272-1297 OBJECTIVES Describe the epidemiology and risk factors associated with Describe musculoskeletal disorders to inform nursing assessments and patient education. Understand diagnostic results that support the confirmation of Understand musculoskeletal disorder diagnoses and guide nursing interventions. Explain the interprofessional management strategies for musculoskeletal Explain conditions,. Design nursing care plans for patients with musculoskeletal disorders, Design incorporating pharmacological treatments, dietary modifications, and lifestyle interventions to optimize outcomes. Coordinate and implement interprofessional care plans for patients Coordinate & undergoing joint replacement surgery, ensuring effective communication Implement and continuity of care. FUNCTIONS OF MUSCULOSKELETAL SYSTEM 2nd largest body system Allow for movement Protection of vital organs Production of blood cells in marrow Support for upright posture & weight-bearing Reservoir for body’s essential minerals Assessing Past Medical History & Chief Complaint Pain Swelling Stiffness Deformity Color/ Loss of Weakness Instability Temperature function changes Numbness & Treatment History of Family Tingling effectiveness injuries history  Physical Assessment Posture Gait Range of Motion Sensation Pulse assessment Muscle tone & strength Skin color/temperature DIAGNOSTIC STUDIES X-ray CT scans with or without contrast Assess renal status Medication status (metformin) MRI Assess for claustrophobia Education regarding noise level Remove metal or any medication patches Bone density studies/scans Arthrogram Arthroscopy Arthrocentesis  Progressive muscle weakness/atrophy Lack of Dystrophin MUSCULAR Multiple types, affecting over 50,000 Americans Most common: Duchene and Becker DYSTROPH More common in men Y The inherited X chromosome link is the only known associated risk factor. Can present at any age No cure Nine different subgroups of Muscular Dystrophy. Each type presents with different locations for pain and muscle weakness.  MUSCULAR DYSTROPHY: CLINICAL MANIFESTATIONS Progressive muscle weakness GI dysfunction Chronic pain (location varies) Difficultyambulating & Increase in fat and scar tissue frequent falls Scoliosis/Lordosis Calf enlargement Cardiomyopathy Spasms & Fractures Respiratory compromise Poor dentation Depression Deteriorated speech quality 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: Prednisone Anti-inflammatory Supplemental medications Anti-oxidants Supportive care and counseling  Monitor signs/symptoms Monitor for complications/deterioration Vital signs – decreased BP & O2, elevated heart rate Muscular Monitor labs/imaging results Dystrophy: Assist with ADLs as needed Nursing ROM & fall precautions Management Medication administration Collaboration with PT, OT, ST and Family Emotional support Nursing management—Evaluating care outcomes: Promote and maintain optimal function and comfort  OSTEOPOROSIS Deterioration in bone tissue/density Most common bone disease Affects over 75 million people worldwide 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 Race (Caucasian/Asian) Sedentary lifestyle Smoking Excessive drinking Decreased calcium & vitamin D intake Steroid use Anticonvulsants OSTEOPOROSIS: CLINICAL MANIFESTATIONS SilentDisease: Typically diagnosed AFTER a fracture Prevention is key Spine, hip, radius common 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 1. DEXA scans w/ 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 1. Lab tests completed to r/o other diseases OSTEOPOROSIS: TREATMENT Preventions & Screening Complications Weight loss Falls Prolonged hospitalization Weight-bearing exercises Death Avoid smoking/alcohol consumption Calcium and Vitamin D supplements Sunlight Pharmacologic interventions (53.5) 1. Bisphosphanates: aldendronate Prevent falls, fractures and death OSTEOPOROSIS: NURSING MANAGEMENT Assessment Nursing management—Evaluating care outcomes Medication administration Identification of risk Fall prevention measures Compliance with medication Maintain healthy lifestyle Encourage healthy diet/weight loss PRN Emotional support for body image issues Assist with ADLs and exercise Collaborate with home health  PAGET’S DISEASE 2nd most common bone disease Accelerated bone remodeling-> 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 & deformity Pain increase at night Painincrease 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 Neuro issues: Deafness Facial deformities PAGET’S DISEASE: DIAGNOSIS 80% asymptomatic Incidental findings H&P Bone turnover Imaging Bone scans *hot spots CT scans and Biopsy r/o osteosarcoma  No effective treatment Goal: Decrease pain and increase functional mobility Non-surgical recommended Calcitonin: not long-term solution PAGET’S DISEASE: Symptomatic: Bisphosphonates MEDICAL 1. Zoledronic acid (Renal Toxic) 2. Calcium and Vitamin D supplements MANAGEMENT Surgical 3. Joint replacement 4. Spinal decompression 5. Osteotomy  Assessment Paget’s Medication administration Disease: Pain management Nursing Hot/Cold therapy Management Collaboration with PT/OT Collaborate home health  OSTEOMYELITIS Inflammation/infection in the bone (Staph Aureus or Gram – Bacili) 1. Spread via bloodstream 2. Trauma/Surgery 3 phases 1. Acute: Less than 2 weeks 2. Subacute: 2 week-3 months 3. Chronic: Greater than 3 months Clinical hallmark: Bone necrosis & sinus tract development Osteomyelitis: Clinical Manifestations Pain unrelieved by rest Swelling Warmth/Tenderness at site Malaise Fever & chills Nausea Erythema  Labs (WBC, ESR, CRP & blood cultures) Bone scan Osteomyelitis: 50% with positive blood cultures Diagnosis CT/MRI Gold standard: Bone biopsy Osteomyelitis: Medical Management Antibiotics 4-6 weeks 1. Penicillins or Cephalosporins 2. Fluoroquinolones 3. Vancomycin (MRSA or allergy) Incision and drainage Surgical debridement Pain management Nutritional/Supplement support Osteomyelitis: Nursing Management Assessment Monitor labs/cultures Antibiotic administration Pain management (Nonpharmacological) Assist with nutritional support Assist with ADLs Maintain safety Collaborate with home health Education SCOLIOSIS Greaterthan 10-degree curvature of the spine Rotation & compression Cause unknown Three categories 1. Neuromuscular 2. Congenital 3. Idiopathic Scoliosis Risk Factors Clinical Manifestations Smoking Sideways curvature of spine Obesity Uneven shoulders Older age One shoulder blade more prominent Heavy labor occupation Uneven waist Sedentary lifestyle Uneven hips Lower educational level Cardiopulmonary compromise if severe 2-3% adolescent idiopathic Scoliosis: Diagnosis & Cobb’s Angle Perpendicular line from upper/lower vertebrae most affected by the curve 10 degree: Scoliosis Greater than 50 degree: Spinal instability Greater than 60 degree: Thoracic compromise-> cardiopulmonary compromise Scoliosis: Medical Management Less than 50-degree curvature Greater than 50-degree curvature Conservative treatment Surgery considered if conservative tx ineffective Thermal therapy Spinal fusion PT/OT Orthotic brace (TLSO) Exercise schedule Pain management 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 Replaced with prosthesis Partial/complete Knee, hip most common 10-15 year joint lifespan Increase in joint replacements secondary to obesity Hospital stay length decreased JOINT REPLACEMENT INDICATIONS Osteoarthritis leading indication Joint destruction Joint dysfunction Joint deformities Immobility Increase in pain/inflammation Muscle spasms Need confirmed with X-rays & MRIs Conservative treatment no longer effective JOINT REPLACEMENT SURGERY Resurfacing of joint along with complete/partial replacement Uncemented approach Hole into bone to allow for bone ingrowth into prosthesis Younger, active population Cemented approach Attach prosthesis to bone Older patients unlikely to require revision Cement=filler between bone/prosthesis resulting in stable fixation Joint Resurfacing JOINT REPLACEMENT SURGERY Traditional 1. 20-30cm longitude incision (less muscle damage) 2. Staples/sutures 3. Semipermeable dressing 4. Drain intra-op to prevent hematoma formation Minimally invasive 5. 10cm or less incision 6. Fast recovery 7. Increase in patient satisfaction 8. Limited surgical visualization JOINT REPLACEMENT COMPLICATIONS Blood loss Hypotension Hypovolemia Wound site infection Dislocation DVT/PE JOINT REPLACEMENT: NURSING MANAGEMENT Vital signs Pain management Neurovascular assessment Incision assessment/care Laboratory assessment Mobilization SCDs & anticoagulation CPM machine if ordered Positioning and turning Education Collaboration with PT & case management JOINT REPLACEMENT – NURSING CONSIDERATIONS Nursing interventions—Actions Nursing interventions—Teaching Administer medication as Preoperative teaching ordered Postoperative teaching Wound care Nursing management—Evaluating Early mobilization care outcomes Ant-embolic stocking Reduction of pain Continuous passive range of Restoration of functional motion machine outcomes Proper positioning and turning schedule HIP REPAIR/ REPLACEMENT KNEE REPAIR/REPLACEMENT