musculoskeletal Fall 2011

musculoskeletal Fall 2011 - Musculoskeletal disorders...

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Unformatted text preview: Musculoskeletal disorders disorders Osteoporosis Paget’s Disease Gout Rheumatoid Arthritis Osteoarthritis Joint replacement Hip Fracture Amputation Osteoporosis Osteoporosis Epidemiology Etiology Pathopysiology Osteoporosis: Epidemiology Osteoporosis: Most common bone disease diagnosied 20% of postmenopausal Caucasian women will have it. Another 52% will have low density at the hip. Osteoporosis Osteoporosis Osteoclasts Osteoblasts Remodelling Osteoporosis: Etiology Osteoporosis: Osteoporosis:Linked to these risk factors: Nutritional Deficiencies Endocrine Function Abnormalities Disuse Osteoporosis: Diagnosis Osteoporosis: DEXA scan X­ray Laboratory Tests: Calcium, magnesium, phosphate, Vitamin D, alkaline phosphate. Osteoporosis:Assessment Osteoporosis:Assessment Risk Assessment performed Fractures Spine • • • Kyphosis “Dowager’s Hump” Height Loss Osteoporosis:Nursing Implications Implications Mobility • encourage weight bearing exercise to stimulate bone formation • Strengthen back and abdominal muscles Osteoporosis:Nursing Implications Implications Nutrition Patient/Family teaching Coping Osteoporosis:Nursing Implications: Osteoporosis:Nursing Pharmacology Biphosphonates Hormone replacement Supplements Paget’s Disease Paget’s Epidemiology Etiology Pathophysiology Paget’s Disease: Assessment Paget’s History Physical exam Pain Other findings Paget’s Disease: Diagnostic tests tests ALP (alkaline phosphate) Radiological Exams Paget’s Disease: Nursing Implications Implications Symptom Management Limiting Disability Complication Prevention Gout Gout Epidemiology Etiology Pathophysiology Gout Assessment Gout Pain or Edema in a joint History­Familial? Physical exam­ Tophus Gout: Diagnostic Tests Gout: Laboratory tests: Uric acid, urine albumin, urinary uric acid, sedimentation rate. MRI­ used to identify tophi from tumor Synovial fluid aspiration Renal and cardiovascular evaluation Gout: Nursing Implications Gout: Nutrition Pharmacology Patient/family teaching Joint Disease Joint Rheumatoid Arthritis • • • Systemic Autoimmune Inflammatory Osteoarthritis • Degenerative joint disease • Non­inflammatory Rheumatoid Arthritis Rheumatoid Epidemiology Etiology Pathophysiology Epidemiology/ Etiology Epidemiology/ Affects young to old More women than men Genetic link Age link Causes RA: Pathophysiology RA: RA: Pathophysiology RA: Stage 1­ swelling of the synovial membrane of the joint Stage 2­ rapid cell division and growth on the membrane causes thickening Stage 3­ cells are inflamed. They release enzymes that eat the bone and cartilage RA: assessment RA: Bilateral and symmetrical Early • • • • • • Joint stiffness esp. AM Swelling Pain Fatigue weakness Low grade temp If red, warm, stiff and tender­synovitis Late • Morning stiffness lasts 45­60 min • Effusions in joints • Most joints involved • Cervical spine involvement • Tendon rupture • Systemic complications • Joint deformity RA: Joint Deformity Swan neck Ulnar Deviation Swan neck Ulnar Deviation RA: Joint Deformity RA: Boutonniere deformity RA: Diagnosic tests RA: Serum RF ANA titre ESR C reactive protein Radiological tests: xrays, bone scans Synovial fluid­ straw­colored fluid with an elevated WBC count RA: Nursing Implications RA: Pharmacology Maintain mobility Pain management Coping RA:Pharmacology RA:Pharmacology • • • • NSAIDS OTC/Prescription(combination may be used) Side effects COX­2 inhibitors­recently removed form market. Celebrex is still on market A less common drug used to adjunct therapy is aurothioglucose for inflammation and to slow progress of disease. Not used much anymore because of side effects RA: Pharmacology RA: Synthetic and biological disease modifying antirheumatic drugs (DMARD) • Synthetic DMARD: MTX or methotrexate­ slows progression • Biological DMARD­Enbrel, Remicade, Humira. These drugs reduce erosion and bone damage. Side effect: immunosuppression. RA:Pharmalogoly RA:Pharmalogoly Corticosteriods Steriods are used until the DMARD is at a therapeutic level. Examples of medication used are prednisone RA:Nursing Implications RA:Nursing Rest joint Promote mobility Heat applications Pain management Nutrition Coping Osteoarthritis Osteoarthritis Progressive deterioration and loss of cartilage in one or more joints • Joint pain • Loss of function Weight bearing joints most affected Osteoarthritis Osteoarthritis Epidemiology Etiology Pathophsiology OA: pathophysiology OA: OA: assessment OA: Pain and stiffness • Lasts for ~ 30min after inactivity • Early related to activity • Late pain with rest and activity Crepitus • Grating sensation caused by irregular cartilage Enlarged joints­osteophyte formation Joint effusions­ fluid around joint Spinal involvement OA: presentation OA: Heberden’s nodes OA: presentation OA: Bouchard’s nodes OA: diagnosis OA: X­ray to visualize joint changes CT scan for vertebral involvement OA: Nursing Implications OA: Maintain Joint mobility Minimize pain Nutrition Pharmacology Surgery OA: Pain and Immobility Pain management Rest joint Hot/cold applications Weight control OA: Pain and Immobility OA: Exercise: PT and OT programs Preventing further damage slows progression and minimizes pain OA: nutrition OA: Supplements:provide relief from stiffness and pain • Chondrotin • Glucosamine Vitamin Deficiencies • Vitamin D may have a role in preventing or treating OA OA: Pharmacology OA: Analgesics: Tylenol for pain control NSAIDS: Motrin, Advil, Naprosyn, COX­2 inhibitors. Side Effects???? Opoids­ Tramadol, oxycontin, morphine, diluadid Steroid injections Arthritis: Client Education Arthritis: Avoid positions of deviation and stress Use larger/stronger joints Distribute weight over many joints rather than a few Change positions frequently Avoid repetitious motions Modify chores to avoid stress on joints Arthritis: Client Education Arthritis: Maintain good posture and body alignment Maintain normal weight Use assistive devices if needed Avoid tasks that cause pain Develop organizing and pacing techniques Joint Replacement Joint (Arthroplasty) Used in arthritis treatment when response to other methods of treatment are unsuccessful The most common joints treated surgically are hips and knees Joint replacement Joint Indications • Used in OA, RA, congenital abnormalities, trauma, avascular necrosis Contraindications • • • Any infection Advanced osteoporosis Severe inflammation Elective • Autologous blood transfusion Surgical Replacement Surgical THR Post-op care THR (total hip replacement) Vital signs Pain control­PCA or epidural Neuro­vascular status­ on affected side. Lovenox Incision­ assess dressing, drainage, presence of drain(amt of bleeding) Position­abduction pillow to prevent dislocation THR: Discharge Planning THR: • Physical Therapy­OOB post­op day 1. Use walker/crutches until full wt bearing • Home Care­Is patient safe enough to go home? PT/ RN provide visits in the home • DME­ medical equipment: walker, cane,bedside commode • Rehab setting­ SNF placement­Daily PT TKA TKA (total knee replacement) Vital signs Dressing­ compression dressing Neurovascular assessment­ Lovenox CPM machine­provides ROM to knee Pain­ PCA TKR: DISCHARGE PLANNING TKR: Physical therapy­ Knee immobilizer in place. ROM exercises. CPM machine Home care­ PT/RN visits DME­ walker, CPM , Bedside commode. Rehab Setting­SNF with daily PT Hip Fracture Hip Very common in older adults 200,000 hip fractures occur annually Two types of fractures: Intracapsular­ involves femoral neck Excacapsular­ involves trochanter area of hip Hip Fracture Hip Risk Factors Increasing age Gender Ethnicity Mental status Nutritional deficits Low body weight Medications Environmental Hazards Tobacco/Alcohol Use Hip Fracture: Treatment Hip ORIF­ open reduction and internal fixation with plates or screws Hemiarthroplasty­Femoral head implant is cemented to the bone Total hip replacement Hip Fracture: Post-Op Care Hip Patient comfort­ Hemodynamic stability­ Electrolyte and fluid status­ Prevent complications Hip Fracture: Discharge Planning Planning Physical therapy­ begins post­op day one. Gait training and weight bearing instruction Hip precautions­DME? Home Care­ Is the home safe? Is the patient safe? Family support?? Pain management Rehab setting/SNF Amputations Amputations Definition: Causes: Amputation: Assessment Amputation: PMH Circulation Sensory Integument Pain Diagnostic Testing Diagnostic Doppler studies Arteriography Venography Plethysmography CBC, serum electrolytes Types of Amputation Types Closed Amputation Open Amputation Nursing management of the client with an amputation client Psychosocial needs Pain Limb care Client Education Client Inspect limb Skin Care Pain management Exercise Coping strategies ...
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