UNIT VII MUSCULOSKELETAL DISORDERS

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UNIT VII MUSCULOSKELETALDISORDERS

• NS 107
• Intermediate Medical/Surgical
• Nursing

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OSTEOMYELITIS

• Infection of the bone, bone marrow surrounding
  soft tissue.
• Types of infections
• Staphylococcus aureus
• E. Coli
• Staph Epi
• Pseudomonas
• Acute initial infection or an infection
• lt 1 month.
• Chronic gt 1month or infection that has failed to
  respond to antibiotics.

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OSTEOMYELITIS cont.

• Medical treatments includes
• Aggressive antibiotic treatment initially in the
  hospital but may be given at home
• Surgical removal of dead tissue and bone.
• Hyperbaric oxygen therapy

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OSTEOMYELITIS cont.

• Nursing assessment
• Patient hx
• Physical inspection
• Culture results
• CBC
• Pain
• Pulses/circulation/ capillary refill

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OSTEOMYELITIS cont.

• Nursing diagnoses-
• Actual infection
• Alteration in comfort acute pain
• Impaired physical mobility
• Impaired tissue perfusion
• Self-care deficit
• Ineffective therapeutic regimen management
• Knowledge deficit
• Potential for injury

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OSTEOMYELITIS cont.

• Goals
• Satisfactory pain control
• Prevent complications associated with
  osteomyelitis
• Compliance w/treatment plan
• Increase knowledge
• Prevent hazards of immobility

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OSTEOMYELITIS cont.

• Interventions
• Education!!!
• Evaluate medication effectiveness
• Maintain safety
• Maintain sterility w/dressing changes (hospital)

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BONE CANCER

• Types
• Multiple myeloma
• Osteogenic sarcoma
• Osteoclastoma
• Ewings sarcoma
• Metastatic bone disease

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BONE CANCER cont.

• Multiple Myeloma
• Malignant neoplasm of plasma cells
• Widespread infiltration
• Destruction of bone marrow
• Osteolytic lesions throughout the skeleton
• Poor prognosis as usually discovered late, after
  diffuse infiltration of axial skeleton.
• Treatments include
• Chemo
• Bone marrow transplant
• Pain management

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BONE CANCER cont.

• Osteogenic Sarcoma- primary neoplasm of the bone
  that is highly malignant rapid growing and
  metastasis.
• Found in long bones i.e.. Femur, tibia
• Most common tumor affecting children and young
  adults
• Higher incidence in males 10-25 y/o
• Treatments include chemotherapy to reduce tumor
  size and then surgical resection.

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BONE CANCER cont.

• Osteoclastoma
• Affects the cancellous ends of long bones.
• Also known as Giant Cell Tumor
• Aggressive and spreads to lungs
• gt50 recurrence
• Ewings sarcoma
• Common type of neoplasm
• Found in rapidly growing bones.
• Metastisizes quickly to the lungs.

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Metastatic Bone Disease

• Most common type of malignant bone tumor.
• Commonly found due to a fracture.
• May occur years after diagnosis and treatment of
  primary tumor.
• Prognosis depends on the extent of metastasis and
  location.

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BONE CANCER

• Assessment should include
• Inspection
• Palpation
• History
• Subjective data
• Pain, limp, swelling

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BONE CANCER

• Nursing diagnoses
• Alteration in comfort pain
• Disturbed body image
• Impaired physical mobility
• Potential for injury
• Anticipatory grieving
• Anxiety
• Knowledge deficit

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Herniated Intervertebral Disk

• Rupture of the nucleus pulposus.
• Also known as slipped disc.
• Causes include
• Natural degeneration d/t age which leads to
  degenerative disc disease.
• Repeated stress
• Trauma
• Clinical manifestations common site is down the
  sciatic nerve.
• Severe complications include paresthesia, muscle
  weakness, bowel and bladder incontinence.

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Spinal Surgery

• Laminectomy- removal of all or part of
  protruding disc.
• Diskectomy- decompression of nerve root. Can be
  done percutaneously and by laser.
• Spinal fusion- welding of bones together to
  prevent protrusion.

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Nursing Management

• Pain control
• Maintaining alignment
• Prevention of infection
• Prevent hazards of immobility
• What are they?
• Prevent post-op complications

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Osteomalacia

• Vitamin D deficiency results in bone
  decalcification and softening.
• Malformation RICKETS
• Fractures are common w/delayed healing.
• Causes include
• Lack of ultraviolet rays.
• GI malabsorption
• Extensive burns
• Chronic diarrhea
• Pregnancy
• Kidney disease
• Medications such as Dilantin

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Pagets Disease

• Excessive bone resorption and replace-ment of
  normal bone marrow w/fibrous connective tissue.
• Bone is larger and weaker.
• Fracture may be 1st indication of disease.
• Complications may include bone malignancies
  previously discussed.
• No cure, only supportive therapies.
• Heredity is linked.

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Nursing Management of Osteomalacia Pagets

• Nursing diagnosis
• Risk for injury
• PAIN
• Impaired physical mobility
• Self-care deficit
• Disturbed body image
• Impaired walking

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Nursing Management of Osteomalacia Pagets
cont.

• Plan of care
• Keep them safe
• Patient education
• PT Evaluation
• Supportive walking aids
• Adequate pain relief
• Prevent further bone loss
• Education on safety and nutrition

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Comparing Osteo Rheumatoid Arthritis

• Osteoarthritis
• Slowly progressive
• Begins young
• Degenerative
• Idiopathic cause unknown (primary)
• Immune response
• Formation of new joint tissue as cartilage is
  destroyed.
• Bone outgrowth
• Subarticular bone cysts
• Hyperplasia and inflammation

• Rheumatoid
• Slowly progressive insidious
• Degenerative
• Unknown cause
• Immune response most likely
• Damage thickening to synovial membranes.
• Erosion of bone
• Destruction of cartilage
• Granulation formation within joints causing
  scaring, joint laxity, sublimation and
  contractures, deformities.

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Rheumatoid Arthritis

• Effects multiple organs
• Morning stiffness worse later in the day
• Diagnosis made by
• Pt history
• Rheumatoid factor
• Other labs studies Erythrocyte sedimentation
  rate(ESR), Antinuclear antibody(ANA), CBC
• Synovial fluid biopsy

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Rheumatoid Arthritis

• Collaborative therapy (63-7)
• Drug therapy
• Surgery
• Heat and cold
• Use of assistive devices
• Nutritional counseling
• Therapeutic exercise
• Apherisis
• Review the careplan on pg 1730-31

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Septic Arthritis

• Infection of or to the joint cavity which travels
  throughout the body via the bloodstream.
• More common than you may think.
• Think of those with decreased resistance.
• Anyone immunosuppressed like______
• Diabetics
• Debilitated individuals
• Staph Aureus is most common bug.
• Can cause death or joint destruction.

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Septic Arthritis

• Nursing Assessment
• Inspection of joints
• Palpation
• Manipulation of suspected site
• Vital signs
• Lab data
• Subjective data pain assessment and patient
  history (can also be objective)

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Septic Arthritis

• Goal prevent complications and promote health
  and wellness
• Interventions to include
• Medication administration
• Monitoring joint inflammation and pain
• Immobilization of affected joint
• ROM exercises
• Patient education
• Maintain monitor aseptic technique

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Lyme Disease

• Spirochetal infection transmitted by an infected
  deer tick
• No person-to-person transmission.
• Summer months
• Great imitator
• Untreated infection can lead to arthritis, Bells
  Palsy, severe headaches.
• Early treatment with antibx has good prognosis.

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Connective Tissue Disorders

• Systemic lupus erythematosus
• Ankylosing spondklitis
• Systemic sclerosis- fibrotic, degenerative and
  inflammatory changes in the skin, blood vessels,
  synovium, skeletal muscle, and internal organs
  (63-17).
• CREST syndrome
• Calcinosis painful deposits of calcium in the
  skin
• Raynauds phenomenon ?blood flow with cold or
  stress
• Esophageal dysfunction difficulty swallowing d/t
  scaring
• Sclerodatyly tightening of the skin of fingers
  and toes
• Telangiectasia red spots