Musculoskeletal System

Inflammatory Disorders

PresentationsRheumatoid Arthritis

Ankylosing spondylitis

Osteomyelitis

Bursitis

Degenerative Disorders

Osteoporosis

Osteoarthritis DJD/Degenerative Joint Disease

Total Joint Arthroplasty

Osteoporosis

Increased porosity in the bone

Common disorder of bone metabolismDecreased mineral and protein matrix

Bone brittle, fragile

Prone to fractures

Osteoporosis

10 million people in United States have Osteoporosis

Another 34 million have low bone density, which puts them at risk for Osteoporosis

80% of affected are women

1.5 million fractures occur each year related to Osteoporosis

Osteoporosis

Silent diseaseNo symptoms of bone lossMay have 50% loss prior to diagnosisMultiple fractures may cause decrease in height

Only diagnosed by BMDBone Mineral Density

PainlessNon-invasivesafe

Osteoporosis

Risk FactorsSmall bonesAdvanced ageFamily historyPost-menopause with out estrogen replacementEating disordersLow calcium dietInactive activitySmokingIncreased alcohol consumptionUse of corticosteroids or anticonvulsant medications

Medical-Surgical Management

Pharmacological four medications – EstrogenFosamaxMiacalcinTestosterone

No curePrevention

Osteoporsis

Diet

Activity

Nursing Process

AssessmentSubjective Data

Objective Data

Dowager’s Hump

Degenerative Joint Disease/DJDOsteoarthritis

NOT inflammatory

Wear and tear disease

Slow, steady, progressive destruction of the joint

Etiology unknown

Most common form of arthritis

Osteoarthritis or DJD

SymptomsEarly morning stiffnessPain after physical activityJoint enlargementBouchard’s nodesHeberden’s nodes

Hypertrophic spurs– Distal interphalanges– Hard, painless

Heberden’s Nodes

Heberden’s Nodes

Heberden’s nodes.

Bouchard’s Nodes

Diagnostic testsRadiographic studies

Arthroscopy

Synovial fluid examination

Bone scans

Osteoarthritis

Medical management/nursing interventions

Surgery

Osteoarthritis

Total Joint Arthroplasty

Joint replacement

Replacement of both articular surfaces with in a joint capsule

Hip, knee, shoulder and fingers are most common sites

Replacement consist of metal and polyethylene

Total Joint Arthroplasty

Older method of cemented in prepared bone is not used as often

New technology uses porous coated cement-less artificial joint component. This allows bone to grow into the joint and less prosthesis failure noted.

Total Hip Replacement

Replacement of severely damaged hip with an artificial joint

Usually people over 60 years

Severe pain, irreversible damage to hip joints

Hip Replacement

Potential problems

Dislocation of prosthesis

Excessive wound drainage

Infection

Following Hip Replacement

Client’s hip and leg to be kept in position of adduction and extension

Knees are apart by abductor pillow or by using foam wedges

Entire leg to be supported when turning side to side

AVOID ACUTE FLEXION OF THE HIP

Following Hip Replacement

Fracture bed pan should be usedRaised toilet seat in bathroomVital signs, circulation, movement and sensation checks (CMS) to be done frequentlyInspect dressing frequentlyMonitor drainage from portable suction device (JP Drainage) can be as high as 200 -500 cc. With in 48 hours should be less than 30 cc and suction devices can be removed.

Client Goals after Hip Replacement

Ambulate independentlyOut of bed the night of the surgery or the next dayGait training begins so that client can use crutches or caneFLEXION OF KNEE TO BE AVOIDED No more than 90 degreesNo stair climbing for three months

Total Knee Replacement

Severe pain and functional disability related to joint destruction

Following knee replacement clients may use CPM continuous passive motion machine which helps increase circulation to operative area and promotes flexibility with in he knee joint.

Knee Replacement

Following surgery….

Knee to be imoblized

Firm compression dressing

Adjustable soft knee immobilizer

Transfer to chair ok, but NO WEIGHT BEARING is allowed on knee until ordered my MD

Total knee replacement

SCD – Sequential Compression Device may be used or

TED hose – Anti embolism stocking worn to minimize the development of thrombophlebitis

Rehabilitation starts second day

When patient is sitting knee should be elevated

Weight bearing should start with in 1- 2 days

Nursing Management

Cough and deep breathe

Use trapeze to raise hips off bed for bedpan use

NursingAssessment

Nursing Assessment should include…Neurovascular assessment of affected extremity

Incision assessment

Vital signs

Lung sounds

Pedal pulses

Intake and output

Nursing Assessment

Irritablity

Restlessness

Orientation

Neurovascular assessment for pain, numbness, tingling and paresthesia

Objective Assessment

Incision assessment forApproximation

Redness

Drainage

Skin color

Assessment

Other assessmentsTachypnea

Dyspnea

Hypoxia

Crackles and wheezes ( s/s of fat embolism)

Position of affected part

Care Plans

Divide in to groups and create care plans