Musculoskeletal System

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Musculoskeletal System
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Inflammatory Disorders

• Presentations
• Rheumatoid Arthritis
• Ankylosing spondylitis
• Osteomyelitis
• Bursitis

3
Degenerative Disorders

• Osteoporosis
• Osteoarthritis DJD/Degenerative Joint Disease
• Total Joint Arthroplasty

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Osteoporosis

• Increased porosity in the bone
• Common disorder of bone metabolism
• Decreased mineral and protein matrix
• Bone brittle, fragile
• Prone to fractures

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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

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Osteoporosis

• Silent disease
• No symptoms of bone loss
• May have 50 loss prior to diagnosis
• Multiple fractures may cause decrease in height
• Only diagnosed by BMD
• Bone Mineral Density
• Painless
• Non-invasive
• safe

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Osteoporosis

• Risk Factors
• Small bones
• Advanced age
• Family history
• Post-menopause with out estrogen replacement
• Eating disorders
• Low calcium diet
• Inactive activity
• Smoking
• Increased alcohol consumption
• Use of corticosteroids or anticonvulsant
  medications

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Medical-Surgical Management

• Pharmacological four medications
• Estrogen
• Fosamax
• Miacalcin
• Testosterone
• No cure
• Prevention

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Osteoporsis

• Diet
• Activity

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Nursing Process

• Assessment
• Subjective Data

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• Objective Data

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Dowagers Hump
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Degenerative Joint Disease/DJDOsteoarthritis

• NOT inflammatory
• Wear and tear disease
• Slow, steady, progressive destruction of the
  joint
• Etiology unknown
• Most common form of arthritis

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Osteoarthritis or DJD

• Symptoms
• Early morning stiffness
• Pain after physical activity
• Joint enlargement
• Bouchards nodes
• Heberdens nodes
• Hypertrophic spurs
• Distal interphalanges
• Hard, painless

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Heberdens Nodes
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Heberdens Nodes
Heberdens nodes.
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Bouchards Nodes
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Osteoarthritis

• Diagnostic tests
• Radiographic studies
• Arthroscopy
• Synovial fluid examination
• Bone scans

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Osteoarthritis

• Medical management/nursing interventions
• Surgery

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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

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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.

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Total Hip Replacement

• Replacement of severely damaged hip with an
  artificial joint
• Usually people over 60 years
• Severe pain, irreversible damage to hip joints

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Hip Replacement

• Potential problems
• Dislocation of prosthesis
• Excessive wound drainage
• Infection

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Following Hip Replacement

• Clients 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

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Following Hip Replacement

• Fracture bed pan should be used
• Raised toilet seat in bathroom
• Vital signs, circulation, movement and sensation
  checks (CMS) to be done frequently
• Inspect dressing frequently
• Monitor 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.

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Client Goals after Hip Replacement

• Ambulate independently
• Out of bed the night of the surgery or the next
  day
• Gait training begins so that client can use
  crutches or cane
• FLEXION OF KNEE TO BE AVOIDED
• No more than 90 degrees
• No stair climbing for three months

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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.

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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

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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

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Nursing Management

• Cough and deep breathe
• Use trapeze to raise hips off bed for bedpan use

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NursingAssessment

• Nursing Assessment should include
• Neurovascular assessment of affected extremity
• Incision assessment
• Vital signs
• Lung sounds
• Pedal pulses
• Intake and output

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Nursing Assessment

• Irritablity
• Restlessness
• Orientation
• Neurovascular assessment for pain, numbness,
  tingling and paresthesia

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Objective Assessment

• Incision assessment for
• Approximation
• Redness
• Drainage
• Skin color

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Assessment

• Other assessments
• Tachypnea
• Dyspnea
• Hypoxia
• Crackles and wheezes ( s/s of fat embolism)
• Position of affected part

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Care Plans

• Divide in to groups and create care plans