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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1

Care of the Patient with a Musculoskeletal Disorder

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2

Overview of Anatomy and Physiology

Function of the bones SupportProtectionMovementMineral storageHemopoiesis

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 3

Functions of the musclesMotionMaintenance of postureProduction of heat

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4

Rheumatoid arthritisEtiology/pathophysiology

Autoimmune disorder, but may also be geneticChronic inflammation of the joints

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Rheumatoid arthritisClinical manifestations

Characterized by periods of remission and exacerbationGeneralized achingEdema and tenderness of jointsLimited range of motion (morning stiffness)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 6

Rheumatoid arthritis of hands.

(From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.)

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7

Rheumatoid arthritisRheumatoid arthritisLaboratory tests

•Erythrocyte sedimentation rate (ESR)

•Rheumatoid factor (RF)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8

Rheumatoid arthritisTreatment

Medications:potent antiinflammatory agentsslow-acting antiinflammatory agents exercise: range of motion 2-3 times

per dayHeat: Hot packs, heat lamp, and/or

hot paraffinRehabilitation

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 9

OsteoarthritisOsteoarthritisDegenerative joint disease

Non-inflammatory Bones and joints wear out

• Caused by trauma, infections, previous fractures, rheumatoid arthritis, stress on weight-bearing joints

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10

Osteoarthritis Medical management/nursing interventions

Heat applicationsGait enhancers (canes, walkers, etc.)Medications

• Salicylates (aspirin), NSAIDs(Motrin), steroids (cortisone)

Surgery• Joint replacement

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11

Gout Gout Etiology/pathophysiologyaccumulation of uric acid in the

bloodineffective metabolism of purinesPrimary: hereditary factorsAffects men more frequently than

women

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13

Less consumption of meat products that have high purine content, such as beef, pork and lamb, as do organs like liver, kidney, and brain, along with gravy enriched with meat extracts. Avoid alcohol

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14

GoutGoutClinical manifestations/assessment

Excruciating painEdemaInflammation (most common in the

great toe)Diagnostic tests

Serum and uric acid level

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 15

Gout Gout Medical management/nursing

interventionsMedications

• Colchicine, indomethacin (Indocin), corticosteroids, allopurinol(Zyloprim)

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16

OsteoporosisOsteoporosisEtiology/pathophysiology

Reduction of bone massPorous and brittle bones

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18

All women are generally at risk for developing osteoporosis due to hormonal changes that occur at menopause. (Hormones control when bone tissue is broken down to access stored calcium

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19

Osteoporosis Diagnostic tests

Radiography studiesMedical management/nursing

interventionsCalcium supplements, vitamin DWeight-bearing exercisesEstrogen, FosamaxDiet: milk and dairy products

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20

FibromyalgiaFibromyalgia syndromesyndrome (FMS)Etiology/pathophysiologyChronic Musculoskeletal pain

syndromeUnknown etiology

Clinical manifestations/assessment

Widespread pain & tendernessMuscle tension in the shoulders, low

back, hips Tension headache

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21

Fibromyalgia syndrome Diagnostic testsNo specific laboratory or radiographic

tests diagnose FMSMedical management/nursing interventionsPatient education and reassuranceTricyclic antidepressantsExerciseRelaxation techniques

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22

Surgical Interventions for Total Knee or Total Hip Replacement

Knee arthroplasty (total knee replacement)Replacement of the knee jointRestore motion of the joint, relieve pain, or

correct deformityHip arthroplasty (total hip replacement)Replacement of the hip joint

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23

Figure 44-11

A, Tibial and femoral components of total knee prosthesis. B, Total knee prosthesis in place.

(From Phipps, W.J., Monahan, F.D., Sands, J.K., Marek, J.F., Neighbors, M. [2003]. Medical-surgical nursing: health and illness perspectives. [7th ed.]. St. Louis: Mosby.)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 24

Figure 44-14

Hip arthroplasty (total hip replacement).

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25

FracturesFracturesFracture of the hipMost common type of fractureClinical manifestations/assessment

Severe pain at siteInability to move the leg voluntarily

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 26

Figure 44-16

Fractures of the hip.

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Fracture of the hipDiagnostic testRadiographic examination

Medical management/nursing interventionsBuck’s traction until surgerySurgical repair

• Internal fixation• Neufeld nail and screws• Prosthetic implants

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 28

Fracture of the hip Postoperative interventions

• Maintain leg abduction• Limit weight-bearing on affected

side• Chairs and commode seats should

be raised to prevent flexion of hip beyond 60 degrees

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 29

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 30

Fracture of the vertebraeEtiology/pathophysiologyDiving accidentsBlows to the head or bodyOsteoporosisMetastatic cancerMotorcycle and car accidents

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 31

Fracture of the vertebrae Clinical manifestations/assessment

Pain at site of injuryPartial or complete loss of mobility or sensationEvidence of fracture/fracture dislocation on x-ray

Medical management/nursing interventionsStable injuries

• Pain medication, muscle relaxants• Back support, brace, or cast

Unstable fractures• Traction, open reduction

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 32

Fracture of the PelvisEtiology/pathophysiologyFalls, automobile accidents, crushing accidents

Clinical manifestations/assessmentUnable to bear weight without discomfort

Medical management/nursing interventionsBedrest—More severe fractures may require surgery

and/or spica or body cast

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 33

Traumatic Injuries

Contusion: A blow or blunt force which causes local bleeding under the skinSprains: Wrenching or hyperextension of

a joint Strains: Microscopic muscle tears as a

result of overstretching muscles and tendons

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 34

Traumatic Injuries

Contusions, sprains, whiplash, strainsMedical management/nursing interventionsElevate injured areaCold compresses for 15-20 minutes

intermittently for 12-36 hoursWarm compresses for 15-30 minutes four

times a day after 24 hours

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 35

Traumatic Injuries

Carpal tunnel syndromeCarpal tunnel syndromeEtiology/pathophysiologyCompression of the median nerve between

the carpal ligament and other structuresPredisposing factors

• Occupations involving repetitious motions of the fingers and hands

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 36

A, Wrist structures involved in carpal tunnel syndrome. B,Decompression of median nerve.

(From Thompson, J.M., et al. [2002]. Mosby’s clinical nursing. [5th ed.]. St. Louis: Mosby.)

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 37

Traumatic Injuries

Carpal tunnel syndrome Clinical manifestations/assessment Burning pain or tingling in the handsInability to grasp or hold small objectsEdema of the hand, wrist, or fingers

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 38

KyphosisA rounding of the thoracic spineHump-backed appearance

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 39

ScoliosisLateral curvature of the spine

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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 40

LordosisAn increase in the curve at the lumbar region