Musculoskeletal NUR 170 PDF

Musculoskeletal NUR 170  Assessment Observe General ROM Information Gait/ Posture Functional assessment Neurovascular assessment Laboratory ESR X-rays  Osteopo...

Musculoskeletal NUR 170  Assessment Observe General ROM Information Gait/ Posture Functional assessment Neurovascular assessment Laboratory ESR X-rays  Osteoporosis Loss of bone mass which can be caused by multiple factors: Bones – Lack of calcium, Sexual hormones (estrogen/testosterone) Weak Bones OR To keep bones strong, the body destroys old bone cells with osteoclasts. Then makes more bone cells with osteoblasts. Some times these cells do not work as they should. More common in European American / Asian postmenopausal women Additional Risk Factors Treatments and Teaching Older age Sedentary lifestyle Poor health Low calcium and vitamin D intake Excessive alcohol and caffeine Smoking Oral steroid use History of fractures or falls LOOK AT MODIFIABLE RISK FACTORS AND ADDRESS THEM WITH TREATMENTS AND Expected findings Kyphosis of the spine (dowager’s hump) Loss of height (2-3 inches within 20 years) Back pain Compression fractures of spine Diagnostics Since osteoporosis is weak bones – the tests focus on the quality of bones: Dual energy x ray Measure bone mineral density Calcium levels Vit D levels Treatment Calcium Vitamin D Increase fluids Bisphophonates Alendronate (Fosomax) Risedronate (Actonel) Don’t forget about appropriate teaching with these medications  Osteomalacia Bones – Softening of the bone due to lack Weak of calcification due to vitamin D deficiency Bones Osteomalacia How do we test for weak bones? X-rays and imaging Labs can show low calcium, phosphate levels. Also, could be caused by parathyroid issues (parathyroid gland helps control calcium levels) Teaching and treatment for a disorder of with decreased vitamin D and calcium would include?  Osteomyelitis Bones – Severe infection of the bone. Infection of The inflammation can lead to the bone ischemia and necrosis of bone tissue. Risk factors Long-term IV use IV drug use Can also be secondary to other infections – UTI, Peridontal, or other chronic wound S/S of Infection What are the s/s of infection? Now add the s/s of infection of a bone which includes: Bone pain Foot ulcerations Medical management How do we treat infections? Infections of the bone also hurt, so expect pain medication to be part of the treatment regimen Surgery may be required  Fractures Bones – Break in the continuity of the Infection of bone the bone Trauma, twisting, or bone disease Fragments may be displaced, soft tissue can be damaged and leads to inflammation Types Closed Greenstick Comminuted Impacted Complete Incomplete Compression Open Depressed Spiral Risk Factors Cancer Osteoporosis Calcium / Vitamin D deficiency Expected findings Pain due to muscle spasms or tissue damage Decrease in function Deformity Limb shortening Crepitation (grating sensation) Edema Bruising Diagnostics X-ray of the fractured area CT – for complex breaks & soft tissue damage Medical Management Reduction of the fracture Maintaining realignment with immobilization Restoring function Realignment of bone: Close Open Fixation Treatment Traction Casts Skeletal Fiberglass or Plaster Pin Weights Nursing Care and cast care Skin Complications Hemorrhage Compartment syndrome Fat embolism Infection DVT  Amputation Removal of body part by trauma Bones or surgery Above the knee or below the knee, upper extremity amputation LE amputations greater in black populations with diabetes, heart failure, or renal failure. Veterans Complications hemorrhage, infection, phantom limb pain, contractures  Osteoarthritis Progressive loss of cartilage Cartilage Joint pain and loss of function – can lead to immobility and depression Often in people older than 60 Osteoarthritis Cause is unknown Triggered by aging, smoking, obesity, or trauma. Common caused by repetitive motion and stress to the joints. Secondary related to congenital anomalies, trauma, joint sepsis, or metabolic disease (diabetes mellitus). S/S Joint pain Joint effusions Atrophy of skeletal muscle Limited movement Joint enlargement Tests ESR X ray MRI CT Medical Treatment relates to pain management Acetaminophen Lidocaine patch Topical capsaicin cream (OTC) applied to the joints NSAIDS Celebrex Opioids Injections Cortisone, artificial joint fluid Nursing Treatment relates to pain management Non-pharmacological Rest Splint or brace Heat or cold packs Weight control Alternatives (acupuncture, tai chi, etc.) Supplements Glucosamine Chondroitin  Rheumatoid Arthritis Ends in “itis” so you know there is inflammation. Joints Autoimmune Chronic and progressive inflammatory disease which affects connective tissue Affects joints bilaterally Exacerbations and remissions S/S Fatigue Lack of appetite Low-grade fever Muscle and joint stiffness and loss of ROM Red, swollen, painful joints Deformity Diagnostic Tests Rheumatoid factor ESR rate Complete blood count (CBC) Hemoglobin and hematocrit Medical management Goal is to relieve symptoms, maintain function and delay progression Medications NSAIDS Glucocorticoids Biologic response modifiers Disease modifying antirheumatic PT/OT Adequate rest, ice/heat- hot shower in AM for stiffness Rest  Gout Urate crystal deposit in joints and other body tissues. Causes inflammation Joints Primary gout – sodium urate in synovium and other tissues Secondary gout – hyperuricemia caused by disease & other factors Assess kidney function – pts will often have stones Medical management Elevate feet Medications The three clinical stages Asymptomatic hyperuricemia Acute gouty arthritis Chronic tophaceous Interventions Acute Chronic NSAIDs allopurinol (zyloprim) reduces Colchicine uric acid Interventions Nutritional therapy Fluids Limit proteins Alkaline foods Avoid trigger foods Low purine diet Low purine diet No organ meats, shellfish, oily fish Excessive alcohol and starvation diets cause attacks. Increase fluids  Post procedure: Position correctly Neurovascular assessment Wound care: S/S infection Total Joint Wear elastic stockings or SCDs Replaceme nt Surgical management Total joint arthroplasty or replacement Contraindications to surgery Infection Advanced osteoporosis Uncontrolled diabetes or hypertension Prior to joint replacement Medications Discontinue NSAIDs for 1 week Anticoagulant before surgery Epoetin alfa to prevent post-surgical anemia Blood donation After Surgery Infection Venous thromboembolism Anemia Neurovascular compromise Hip dislocation Prevent with abductor pillow, adaptive devices Rehabilitation Community based Care Usually managed at home, but can also be at LTC facility Home care management Health teaching Health care resources Home care nurse or aide Physical therapist / Occupational therapist The Arthritis Foundation  Herniated Disk Spinal stenosis Osteoporosis NSAIDS, creams, PT, weight reduction Back Pain Surgery – assess for complications Prevention is best – push rather than pull, no twisting, avoid staying in any position for long periods  Carpal tunnel syndrome Median nerve in wrist is compressed Repetitive activities Nerve Damage S/S numbness, paresthesia, decreased fine movements Treatments: NSAIDs, splint, ergonomics Surgery: cuts or uses laser Elevate for swelling, no heavy  Sprains and strains Rest – immobilize the joint Ice – Intermittently for 24-48 hrs Compress-24-48 hours Sports Elevate – decreases swelling Injuries Assume injured area is fractured until x- ray confirms Perform neurovascular assessment distal to injury  Used to prevent further injury Promote healing and circulation Reduce pain Correct a deformity Immobilizat Can include: braces, casts, ion Devices immobilizer/splint, traction, internal or external fixation, orthopedic shoes and boots  Used to prevent further injury Promote healing and circulation Reduce pain Correct a deformity Casts and Can include: braces, casts, Splints immobilizer/splint, traction, internal or external fixation, orthopedic shoes and boots Sprain and Strain RICE Rest – immobilize the joint above and below injury Ice – intermittently for 24-48 hours Compression – 24-48 hours (ace wrap) Elevate – decreases swelling Do not move patient until spinal cord injury is determined. Assume injured area is fractured until x-ray confirmation Perform neurovascular assessment distal to injury Immobilization Devices Used to prevent further injury Promote healing and circulation Reduce pain Correct a deformity Can include: braces, casts, immobilizer/splint, traction, internal or external fixation, orthopedic shoes and boots Casts and Splits Neurovascular checks should be performed hourly x 24 hours Your finger should be able to be inserted between cast and skin Infection can happen underneath casts due to poor skin integrity, if skin is already damaged a window can be cut into cast Decreased perfusion can also occur from cast being too tight Educate patients to not put anything inside the cast, report “hot spots” inside cast as they could be signs of Casts Fiberglass Most commonly used Lighter and stronger than plaster Dry within 30 minutes Plaster Heavy and can take 24-72 hours to completely dry Not water resistant Traction Pulling force to part of the body to provide reduction of fracture, alignment, and rest. Also used to decrease muscle spasms and to prevent or correct deformity and tissue damage Classifications Running Pulling force is one direction and body weight acts as countertraction If the bed or the patient is moved it can alter the traction Balanced Suspension Provides countertraction so the pulling for of traction is not altered with movement Types Skin Buck’s Traction – used for hip and proximal femur fractures using Velcro Boot and 5-10 pounds of weigh along with pulley system Skeletal Traction Screws are surgically inserted directly into the bone Allow for longer traction time and heavier weights (15-30 pounds) This type of traction aids in bone realignment but impairs patient mobility Pin Care is very important Skin Traction Skeletal Traction Traction Important Reminders Weights should not be removed or rest on the ground without MD orders Weights should freely hang at all times Skin assessment at minimum of every 8 hours – if possible remove belt/boot to inspect the skin during this time Inspect all components of traction system a minimum of every 8-12 hours – all ropes, knots, pulleys, and weights for loosening, fraying, and positioning Pin Site Care Is used with skeletal traction and external fixation Pin Care prevents and monitors for signs and symptoms of infection Look for drainage or redness assessing color, amount, and odor Check for pins that may have become loose Look for tenting of skin at the pin site (skin is rising up on pin) Pins are usually cleaned with chlorhexidine but are based upon provider preference Pin care is completed usually once per shift or 1-2 times per day, each facility will have it’s own protocol or more frequently if infection is suspected Use one cotton swab for each pin to prevent cross-contamination