1.
MUSCULO-SKELETAL SYSTEM Nurse Licensure Examination Review pinoynursing.webkotoh.com

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Review of Anatomy and Physiology <ul><li>The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints </li></ul><ul><li>The primary function of which is to produce skeletal movements </li></ul>

3.
Muscles <ul><li>Three types of muscles exist in the body </li></ul><ul><li>1. Skeletal Muscles </li></ul><ul><ul><li>Voluntary and striated </li></ul></ul><ul><li>2. Cardiac muscles </li></ul><ul><ul><li>Involuntary and striated </li></ul></ul><ul><li>3. Smooth/Visceral muscles </li></ul><ul><ul><li>Involuntary and NON-striated </li></ul></ul>

4.
TENDONS <ul><li>Bands of fibrous connective tissue that tie bones to muscles </li></ul>

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LIGAMENTS <ul><li>Strong, dense and flexible bands of fibrous tissue connecting bones to another bone </li></ul>

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BONES <ul><li>Variously classified according to shape, location and size </li></ul><ul><li>Functions </li></ul><ul><li>1. Locomotion </li></ul><ul><li>2. Protection </li></ul><ul><li>3. Support and lever </li></ul><ul><li>4. Blood production </li></ul><ul><li>5. Mineral deposition </li></ul>

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JOINTS <ul><li>The part of the Skeleton where two or more bones are connected </li></ul>

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CARTILAGES <ul><li>A dense connective tissue that consists of fibers embedded in a strong gel-like substance </li></ul>

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BURSAE <ul><li>Sac containing fluid that are located around the joints to prevent friction </li></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle and joint function </li></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>1. HISTORY </li></ul><ul><li>2. Physical Examination </li></ul><ul><ul><li>Perform a head to toe assessment </li></ul></ul><ul><ul><li>Nurses need to inspect and palpate </li></ul></ul><ul><ul><li>The special procedure is the assessment of joint and muscle movement </li></ul></ul><ul><ul><li>Usually, a tape measure and a protractor are the only instruments </li></ul></ul>

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ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>Gait </li></ul><ul><li>Posture </li></ul><ul><li>Muscular palpation </li></ul><ul><li>Joint palpation </li></ul><ul><li>Range of motion </li></ul><ul><li>Muscle strength </li></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>LABORATORY PROCEDURES </li></ul><ul><li>1. BONE MARROW ASPIRATION </li></ul><ul><ul><li>Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia </li></ul></ul><ul><ul><li>Usual site is the sternum and iliac crest </li></ul></ul><ul><ul><li>Pre-test : Consent </li></ul></ul><ul><ul><li>Intratest : Needle puncture may be painful </li></ul></ul><ul><ul><li>Post-test : maintain pressure dressing and watch out for bleeding </li></ul></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>LABORATORY PROCEDURES </li></ul><ul><li>2. Arthroscopy </li></ul><ul><ul><li>A direct visualization of the joint cavity </li></ul></ul><ul><ul><li>Pre-test : consent, explanation of procedure, NPO </li></ul></ul><ul><ul><li>Intra-test : Sedative, Anesthesia, incision will be made </li></ul></ul><ul><ul><li>Post-test : maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort </li></ul></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>LABORATORY PROCEDURES </li></ul><ul><li>3. BONE SCAN </li></ul><ul><li>Imaging study with the use of a contrast radioactive material </li></ul><ul><li>Pre-test : Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated </li></ul><ul><li>Intra-test : IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning </li></ul><ul><li>Post-test : Increase fluid intake to flush out radioactive material </li></ul>

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ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM <ul><li>LABORATORY PROCEDURES </li></ul><ul><li>4. DXA- Dual-energy XRAY absorptiometry </li></ul><ul><li>Assesses bone density to diagnose osteoporosis </li></ul><ul><li>Uses LOW dose radiation to measure bone density </li></ul><ul><li>Painless procedure, non-invasive, no special preparation </li></ul><ul><li>Advise to remove jewelry </li></ul>

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Common musculoskeletal problems The Nursing Management

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Nursing Management of common musculo-skeletal problems <ul><li>PAIN </li></ul><ul><li>These can be related to joint inflammation, traction, surgical intervention </li></ul><ul><li>1. Assess patient’s perception of pain </li></ul><ul><li>2. Instruct patient alternative pain management like meditation, heat and cold application, TENS and guided imagery </li></ul>

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Nursing Management <ul><li>PAIN </li></ul><ul><li>3. Administer analgesics as prescribed </li></ul><ul><ul><li>Usually NSAIDS </li></ul></ul><ul><ul><li>Meperidine can be given for severe pain </li></ul></ul><ul><li>4. Assess the effectiveness of pain measures </li></ul>

21.
Nursing Management <ul><li>IMPAIRED PHYSICAL MOBILITY </li></ul><ul><li>1. Instruct patient to perform range of motion exercises, either passive or active </li></ul><ul><li>2. Provide support in ambulation with assistive devices </li></ul><ul><li>3. Turn and change position every 2 hours </li></ul><ul><li>4. Encourage mobility for a short period and provide positive reinforcements for small accomplishments </li></ul>

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Nursing Management <ul><li>SELF-CARE DEFICITS </li></ul><ul><li>1. Assess functional levels of the patient </li></ul><ul><li>2. Provide support for feeding problems </li></ul><ul><ul><li>Place patient in Fowler’s position </li></ul></ul><ul><ul><li>Provide assistive device and supervise mealtime </li></ul></ul><ul><ul><li>Offer finger foods that can be handled by patient </li></ul></ul><ul><ul><li>Keep suction equipment ready </li></ul></ul>

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Nursing Management <ul><li>SELF-CARE DEFICITS </li></ul><ul><li>3. Assist patient with difficulty bathing and hygiene </li></ul><ul><ul><li>Assist with bath only when patient has difficulty </li></ul></ul><ul><ul><li>Provide ample time for patient to finish activity </li></ul></ul>

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Musculoskeletal Modalities <ul><li>Traction </li></ul><ul><li>Cast </li></ul>

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Nursing Management <ul><li>Traction </li></ul><ul><li>A method of fracture immobilization by applying equipments to align bone fragments </li></ul><ul><li>Used for immobilization, bone alignment and relief of muscle spasm </li></ul>

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Traction <ul><li>Skin traction </li></ul><ul><li>Skeletal traction </li></ul>

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Traction <ul><li>Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities </li></ul>

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Nursing Management <ul><li>Traction: General principles </li></ul><ul><li>1. ALWAYS ensure that the weights hang freely and do not touch the floor </li></ul><ul><li>2. NEVER remove the weights </li></ul><ul><li>3. Maintain proper body alignment </li></ul><ul><li>4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot </li></ul>

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Nursing Management <ul><li>Traction: General principles </li></ul><ul><li>5. Observe and prevent foot drop </li></ul><ul><ul><li>Provide foot plate </li></ul></ul><ul><li>6. Observe for DVT, skin irritation and breakdown </li></ul><ul><li>7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide </li></ul>

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Nursing Management <ul><li>CAST </li></ul><ul><li>Immobilizing tool made of plaster of Paris or fiberglass </li></ul><ul><li>Provides immobilization of the fracture </li></ul>

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Nursing Management <ul><li>CAST: types </li></ul><ul><li>Long arm </li></ul><ul><li>Short arm </li></ul><ul><li>Spica </li></ul>

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Casting Materials <ul><li>Plaster of Paris </li></ul><ul><ul><li>Drying takes 1-3 days </li></ul></ul><ul><ul><li>If dry, it is SHINY, WHITE, hard and resistant </li></ul></ul><ul><li>Fiberglass </li></ul><ul><ul><li>Lightweight and dries in 20-30 minutes </li></ul></ul><ul><ul><li>Water resistant </li></ul></ul>

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Nursing Management <ul><li>CAST: General Nursing Care </li></ul><ul><li>1. Allow the cast to dry (usually 24-72 hours) </li></ul><ul><li>2. Handle a wet cast with the PALMS not the fingertips </li></ul><ul><li>3. Keep the casted extremity ELEVATED using a pillow </li></ul><ul><li>4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast </li></ul>

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Nursing Management <ul><li>CAST: General Nursing Care </li></ul><ul><li>5. Petal the edges of the cast to prevent crumbling of the edges </li></ul><ul><li>6. Examine the skin for pressure areas and Regularly check the pulses and skin </li></ul>

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Nursing Management <ul><li>CAST: General Nursing Care </li></ul><ul><li>7. Instruct the patient not to place sticks or small objects inside the cast </li></ul><ul><li>8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses </li></ul>

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Common Musculoskeletal conditions Nursing management

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METABOLIC BONE DISORDERS <ul><li>Osteoporosis </li></ul><ul><li>A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure </li></ul>

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METABOLIC BONE DISORDERS <ul><li>Osteoporosis: Pathophysiology </li></ul><ul><li>Normal homeostatic bone turnover is altered  rate of bone RESORPTION is greater than bone FORMATION  reduction in total bone mass  reduction in bone mineral density  prone to FRACTURE </li></ul>

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METABOLIC BONE DISORDERS <ul><li>Osteoporosis: TYPES </li></ul><ul><li>1. Primary Osteoporosis- advanced age, post-menopausal </li></ul><ul><li>2. Secondary osteoporosis- Steroid overuse, Renal failure </li></ul>

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METABOLIC BONE DISORDERS <ul><li>RISK factors for the development of Osteoporosis </li></ul><ul><li>1. Sedentary lifestyle </li></ul><ul><li>2. Age </li></ul><ul><li>3. Diet- caffeine, alcohol, low Ca and Vit D </li></ul><ul><li>4. Post-menopausal </li></ul><ul><li>5. Genetics- caucasian and asian </li></ul><ul><li>6. Immobility </li></ul>

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METABOLIC DISORDER <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Low stature </li></ul><ul><li>2. Fracture </li></ul><ul><ul><li>Femur </li></ul></ul><ul><li>3. Bone pain </li></ul>

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METABOLIC DISORDER <ul><li>LABORATORY FINDINGS </li></ul><ul><li>1. DEXA-scan </li></ul><ul><ul><li>Provides information about bone mineral density </li></ul></ul><ul><ul><li>T-score is at least 2.5 SD below the young adult mean value </li></ul></ul><ul><li>2. X-ray studies </li></ul>

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METABOLIC DISORDER <ul><li>Medical management of Osteoporosis </li></ul><ul><li>1. Diet therapy with calcium and Vitamin D </li></ul><ul><li>2. Hormone replacement therapy </li></ul><ul><li>3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST </li></ul><ul><li>4. Moderate weight bearing exercises </li></ul><ul><li>5. Management of fractures </li></ul>

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METABOLIC DISORDER <ul><li>Osteoporosis Nursing Interventions </li></ul><ul><li>1. Promote understanding of osteoporosis and the treatment regimen </li></ul><ul><li>Provide adequate dietary supplement of calcium and vitamin D </li></ul><ul><li>Instruct to employ a regular program of moderate exercises and physical activity </li></ul><ul><li>Manage the constipating side-effect of calcium supplements </li></ul>

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METABOLIC DISORDER <ul><li>Osteoporosis Nursing Interventions </li></ul><ul><li>Take calcium supplements with meals </li></ul><ul><li>Take alendronate with an EMPTY stomach with water </li></ul><ul><li>Instruct on intake of Hormonal replacement </li></ul>

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METABOLIC DISORDER <ul><li>Osteoporosis Nursing Interventions </li></ul><ul><li>2. Relieve the pain </li></ul><ul><li>Instruct the patient to rest on a firm mattress </li></ul><ul><li>Suggest that knee flexion will cause relaxation of back muscles </li></ul><ul><li>Heat application may provide comfort </li></ul><ul><li>Encourage good posture and body mechanics </li></ul><ul><li>Instruct to avoid twisting and heavy lifting </li></ul>

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METABOLIC DISORDER <ul><li>Osteoporosis Nursing Interventions </li></ul><ul><li>3. Improve bowel elimination </li></ul><ul><li>Constipation is a problem of calcium supplements and immobility </li></ul><ul><li>Advise intake of HIGH fiber diet and increased fluids </li></ul>

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METABOLIC DISORDER <ul><li>Osteoporosis Nursing Interventions </li></ul><ul><li>4. Prevent injury </li></ul><ul><li>Instruct to use isometric exercise to strengthen the trunk muscles </li></ul><ul><li>AVOID sudden jarring, bending and strenuous lifting </li></ul><ul><li>Provide a safe environment </li></ul>

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Juvenile rheumatoid Arthritis <ul><li>Definition: </li></ul><ul><ul><li>AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause </li></ul></ul><ul><ul><li>SYSTEMIC chronic disorder of connective tissue </li></ul></ul><ul><ul><li>Diagnosed BEFORE age 16 years old </li></ul></ul>

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Juvenile rheumatoid Arthritis <ul><li>PATHOPHYSIOLOGY : unknown </li></ul><ul><li>Affected by stress, climate and genetics </li></ul><ul><li>Common in girls 2-5 and 9-12 y.o. </li></ul>

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Juvenile rheumatoid Arthritis Poor prognosis Very Good prognosis Anorexia, anemia, fatigue Five or more joints Less than 4 joints Five or more joints Weight Bearing joints IRIDOCYCLITIS Salmon-pink rash Morning joint stiffness and fever MILD joint pain and swelling FEVER Polyarticular Pauci-articular Systemic JRA

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JRA <ul><li>Symptoms may decrease as child enters adulthood </li></ul><ul><li>With periods of remissions and exacerbations </li></ul>

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JRA <ul><li>Medical Management </li></ul><ul><li>ASPIRIN and NSAIDs- mainstay treatment </li></ul><ul><li>Slow-acting anti-rheumatic drugs </li></ul><ul><li>Corticosteroids </li></ul>

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JRA <ul><li>Nursing Management </li></ul><ul><li>Encourage normal performance of daily activities </li></ul><ul><li>Assist child in ROM exercises </li></ul><ul><li>Administer medications </li></ul><ul><li>Encourage social and emotional development </li></ul>

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JRA <ul><li>Nursing Management </li></ul><ul><li>During acute attack: </li></ul><ul><li>SPLINT the joints </li></ul><ul><li>NEUTRAL positioning </li></ul><ul><li>Warm or cold packs </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS </li></ul><ul><li>The most common form of degenerative joint disorder </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS </li></ul><ul><li>Chronic, NON-systemic disorder of joints </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Pathophysiology </li></ul><ul><li>Injury, genetic, Previous joint damage, Obesity , Advanced age  Stimulate the chondrocytes to release chemicals  chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Risk factors </li></ul><ul><li>1. Increased age </li></ul><ul><li>2. Obesity </li></ul><ul><li>3. Repetitive use of joints with previous joint damage </li></ul><ul><li>4. Anatomical deformity </li></ul><ul><li>5. genetic susceptibility </li></ul>

62.
DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Assessment findings </li></ul><ul><li>1. Joint pain </li></ul><ul><li>2. Joint stiffness </li></ul><ul><li>3. Functional joint impairment limitation </li></ul><ul><li>The joint involvement is ASYMMETRICAL </li></ul><ul><li>This is not systemic, there is no FEVER, no severe swelling </li></ul><ul><li>Atrophy of unused muscles </li></ul><ul><li>Usual joint are the WEIGHT bearing joints </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Assessment findings </li></ul><ul><li>1. Joint pain </li></ul><ul><li>Caused by </li></ul><ul><ul><li>Inflamed synovium </li></ul></ul><ul><ul><li>Stretching of the joint capsule </li></ul></ul><ul><ul><li>Irritation of nerve endings </li></ul></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Assessment findings </li></ul><ul><li>2. Stiffness </li></ul><ul><li>commonly occurs in the morning after awakening </li></ul><ul><li>Lasts only for less than 30 minutes </li></ul><ul><li>DECREASES with movement </li></ul><ul><li>Crepitation may be elicited </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Diagnostic findings </li></ul><ul><li>1. X-ray </li></ul><ul><li>Narrowing of joint space </li></ul><ul><li>Loss of cartilage </li></ul><ul><li>Osteophytes </li></ul><ul><li>2. Blood tests will show no evidence of systemic inflammation and are not useful </li></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Medical management </li></ul><ul><li>1. Weight reduction </li></ul><ul><li>2. Use of splinting devices to support joints </li></ul><ul><li>3. Occupational and physical therapy </li></ul><ul><li>4. Pharmacologic management </li></ul><ul><ul><li>Use of PARACETAMOL, NSAIDS </li></ul></ul><ul><ul><li>Use of Glucosamine and chondroitin </li></ul></ul><ul><ul><li>Topical analgesics </li></ul></ul><ul><ul><li>Intra-articular steroids to decrease inflam </li></ul></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Nursing Interventions </li></ul><ul><li>1. Provide relief of PAIN </li></ul><ul><ul><li>Administer prescribed analgesics </li></ul></ul><ul><ul><li>Application of heat modalities. ICE PACKS may be used in the early acute stage!!! </li></ul></ul><ul><ul><li>Plan daily activities when pain is less severe </li></ul></ul><ul><ul><li>Pain meds before exercising </li></ul></ul>

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DEGENERATIVE JOINT DISEASE <ul><li>OSTEOARTHRITIS: Nursing Interventions </li></ul><ul><li>2. Advise patient to reduce weight </li></ul><ul><ul><li>Aerobic exercise </li></ul></ul><ul><ul><li>Walking </li></ul></ul><ul><li>3. Administer prescribed medications </li></ul><ul><ul><li>NSAIDS </li></ul></ul>

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Rheumatoid arthritis <ul><li>A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more women (ages 35-45) than men </li></ul>

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Rheumatoid arthritis <ul><li>FACTORS: </li></ul><ul><li>Genetic </li></ul><ul><li>Auto-immune connective tissue disorders </li></ul><ul><li>Fatigue, emotional stress, cold, infection </li></ul>

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Rheumatoid arthritis <ul><li>Pathophysiology </li></ul><ul><li>Immune reaction in the synovium  attracts neutrophils  releases enzymes  breakdown of collagen  irritates the synovial lining  causing synovial inflammation edema and pannus formation and joint erosions and swelling </li></ul>

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Rheumatoid arthritis <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. PAIN </li></ul><ul><li>2. Joint swelling and stiffness- SYMMETRICAL, Bilateral </li></ul><ul><li>3. Warmth, erythema and lack of function </li></ul><ul><li>4. Fever , weight loss, anemia , fatigue </li></ul><ul><li>5. Palpation of join reveals spongy tissue </li></ul><ul><li>6. Hesitancy in joint movement </li></ul>

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Rheumatoid arthritis <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>Joint involvement is SYMMETRICAL and BILATERAL </li></ul><ul><li>Characteristically beginning in the hands, wrist and feet </li></ul><ul><li>Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement, diminishes as the day progresses </li></ul>

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Rheumatoid arthritis <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>Joints are swollen and warm </li></ul><ul><li>Painful when moved </li></ul><ul><li>Deformities are common in the hands and feet causing misalignment </li></ul><ul><li>Rheumatoid nodules may be found in the subcutaneous tissues </li></ul>

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Rheumatoid arthritis <ul><li>Diagnostic test </li></ul><ul><li>1. X-ray </li></ul><ul><ul><li>Shows bony erosion </li></ul></ul><ul><li>2. Blood studies reveal (+) rheumatoid factor, elevated ESR and CRP and ANTI-nuclear antibody </li></ul><ul><li>3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory proteins </li></ul>

76.
Rheumatoid arthritis <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>1. Therapeutic dose of NSAIDS and Aspirin to reduce inflammation </li></ul><ul><li>2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid </li></ul><ul><li>3. For advanced cases- arthroplasty, synovectomy </li></ul><ul><li>4. Nutritional therapy </li></ul>

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Rheumatoid arthritis <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>GOLD THERAPY: </li></ul><ul><li>IM or Oral preparation </li></ul><ul><li>Takes several months (3-6) before effects can be seen </li></ul><ul><li>Can damage the kidney and causes bone marrow depression </li></ul>

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Rheumatoid arthritis <ul><li>Nursing MANAGEMENT </li></ul><ul><li>1. Relieve pain and discomfort </li></ul><ul><li>USE splints to immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE DEFORMITY </li></ul><ul><li>Administer prescribed medications </li></ul><ul><li>Suggest application of COLD packs during the acute phase of pain, then HEAT application as the inflammation subsides </li></ul>

79.
Rheumatoid arthritis <ul><li>Nursing MANAGEMENT </li></ul><ul><li>2. Decrease patient fatigue </li></ul><ul><li>Schedule activity when pain is less severe </li></ul><ul><li>Provide adequate periods of rests </li></ul><ul><li>3. Promote restorative sleep </li></ul>

80.
Rheumatoid arthritis <ul><li>Nursing Management </li></ul><ul><li>4. Increase patient mobility </li></ul><ul><li>Advise proper posture and body mechanics </li></ul><ul><li>Support joint in functional position </li></ul><ul><li>Advise ACTIVE ROME </li></ul>

81.
Rheumatoid arthritis <ul><li>Nursing Management </li></ul><ul><li>5. Provide Diet therapy </li></ul><ul><li>Patients experience anorexia, nausea and weight loss </li></ul><ul><li>Regular diet with caloric restrictions because steroids may increase appetite </li></ul><ul><li>Supplements of vitamins, iron and PROTEIN </li></ul>

82.
Rheumatoid arthritis <ul><li>6. Increase Mobility and prevent deformity: </li></ul><ul><li>Lie FLAT on a firm mattress </li></ul><ul><li>Lie PRONE several times to prevent HIP FLEXION contracture </li></ul><ul><li>Use one pillow under the head because of risk of dorsal kyphosis </li></ul><ul><li>NO Pillow under the joints because this promotes flexion contractures </li></ul>

83.
Hot versus Cold ACUTE ATTACK After acute attack Use to control inflammation and pain Use to RELIEVE joint stiffness, pain and muscle spasm Cold HOT

84.
Gouty arthritis <ul><li>A systemic disease caused by deposition of uric acid crystals in the joint and body tissues </li></ul><ul><li>CAUSES: </li></ul><ul><li>1. Primary gout- disorder of Purine metabolism </li></ul><ul><li>2. Secondary gout- excessive uric acid in the blood like leukemia </li></ul>

87.
Gouty arthritis <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Severe pain in the involved joints, initially the big toe </li></ul><ul><li>2. Swelling and inflammation of the joint </li></ul><ul><li>3. TOPHI- yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty appearance </li></ul><ul><li>4. PODAGRA </li></ul>

88.
Gouty arthritis <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>5. Fever, malaise </li></ul><ul><li>6. Body weakness and headache </li></ul><ul><li>7. Renal stones </li></ul>

89.
Gouty arthritis <ul><li>DIAGNOSTIC TEST </li></ul><ul><li>Elevated levels of uric acid in the blood </li></ul><ul><li>Uric acid stones in the kidney </li></ul>

90.
Gouty arthritis <ul><li>Medical management </li></ul><ul><li>1. Allupurinol- take it WITH FOOD </li></ul><ul><ul><ul><ul><ul><li>Rash signifies allergic reaction </li></ul></ul></ul></ul></ul><ul><li>2. Colchicine </li></ul><ul><ul><ul><li>For acute attack </li></ul></ul></ul>

91.
Gouty arthritis <ul><li>Nursing Intervention </li></ul><ul><li>1. Provide a diet with LOW purine </li></ul><ul><li>Avoid Organ meats, aged and processed foods </li></ul><ul><li>STRICT dietary restriction is NOT necessary </li></ul><ul><li>2. Encourage an increased fluid intake (2-3L/day) to prevent stone formation </li></ul><ul><li>3. Instruct the patient to avoid alcohol </li></ul><ul><li>4. Provide alkaline ash diet to increase urinary pH </li></ul><ul><li>5. Provide bed rest during early attack of gout </li></ul>

92.
Gouty arthritis <ul><li>Nursing Intervention </li></ul><ul><li>6. Position the affected extremity in mild flexion </li></ul><ul><li>7. Administer anti-gout medication and analgesics </li></ul>

93.
Fracture <ul><li>A break in the continuity of the bone and is defined according to its type and extent </li></ul>

94.
Fracture <ul><li>Severe mechanical Stress to bone  bone fracture </li></ul><ul><li>Direct Blows </li></ul><ul><li>Crushing forces </li></ul><ul><li>Sudden twisting motion </li></ul><ul><li>Extreme muscle contraction </li></ul>

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Fracture <ul><li>TYPES OF FRACTURE </li></ul><ul><li>1. Complete fracture </li></ul><ul><ul><li>Involves a break across the entire cross-section </li></ul></ul><ul><li>2. Incomplete fracture </li></ul><ul><ul><li>The break occurs through only a part of the cross-section </li></ul></ul>

97.
Fracture <ul><li>TYPES OF FRACTURE </li></ul><ul><li>1. Closed fracture </li></ul><ul><ul><li>The fracture that does not cause a break in the skin </li></ul></ul><ul><li>2. Open fracture </li></ul><ul><ul><li>The fracture that involves a break in the skin </li></ul></ul>

99.
Fracture <ul><li>TYPES OF FRACTURE </li></ul><ul><li>1. Comminuted fracture </li></ul><ul><ul><li>A fracture that involves production of several bone fragments </li></ul></ul><ul><li>2. Simple fracture </li></ul><ul><ul><li>A fracture that involves break of bone into two parts or one </li></ul></ul>

100.
Fracture <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Pain or tenderness over the involved area </li></ul><ul><li>2. Loss of function </li></ul><ul><li>3. Deformity </li></ul><ul><li>4. Shortening </li></ul><ul><li>5. Crepitus </li></ul><ul><li>6. Swelling and discoloration </li></ul>

101.
Fracture <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Pain </li></ul><ul><li>Continuous and increases in severity </li></ul><ul><li>Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone </li></ul>

102.
Fracture <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>2. Loss of function </li></ul><ul><li>Abnormal movement and pain can result to this manifestation </li></ul>

103.
Fracture <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>3. Deformity </li></ul><ul><li>Displacement, angulations or rotation of the fragments Causes deformity </li></ul>

104.
Fracture <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>4. Crepitus </li></ul><ul><li>A grating sensation produced when the bone fragments rub each other </li></ul>

105.
Fracture <ul><li>DIAGNOSTIC TEST </li></ul><ul><li>X-ray </li></ul>

106.
Fracture <ul><li>EMERGENCY MANAGEMENT OF FRACTURE </li></ul><ul><li>1. Immobilize any suspected fracture </li></ul><ul><li>2. Support the extremity above and below when moving the affected part from a vehicle </li></ul><ul><li>3. Suggested temporary splints- hard board, stick, rolled sheets </li></ul><ul><li>4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest </li></ul>

107.
Fracture <ul><li>EMERGENCY MANAGEMENT OF FRACTURE </li></ul><ul><li>5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination </li></ul><ul><li>6. DO NOT attempt to reduce the facture </li></ul>

108.
Fracture <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>1. Reduction of fracture either open or closed, Immobilization and Restoration of function </li></ul><ul><li>2. Antibiotics, Muscle relaxants and Pain medications </li></ul>

109.
Fracture <ul><li>General Nursing MANAGEMENT </li></ul><ul><li>For CLOSED FRACTURE </li></ul><ul><li>1. Assist in reduction and immobilization </li></ul><ul><li>2. Administer pain medication and muscle relaxants </li></ul><ul><li>3. teach patient to care for the cast </li></ul><ul><li>4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain </li></ul>

110.
Fracture <ul><li>General Nursing MANAGEMENT </li></ul><ul><li>For OPEN FRACTURE </li></ul><ul><li>1. Prevent wound and bone infection </li></ul><ul><li>Administer prescribed antibiotics </li></ul><ul><li>Administer tetanus prophylaxis </li></ul><ul><li>Assist in serial wound debridement </li></ul><ul><li>2. Elevate the extremity to prevent edema formation </li></ul><ul><li>3. Administer care of traction and cast </li></ul>

111.
Fracture <ul><li>FRACTURE COMPLICATIONS </li></ul><ul><li>Early </li></ul><ul><li>1. Shock </li></ul><ul><li>2. Fat embolism </li></ul><ul><li>3. Compartment syndrome </li></ul><ul><li>4. Infection </li></ul><ul><li>5. DVT </li></ul>

112.
Fracture <ul><li>FRACTURE COMPLICATIONS </li></ul><ul><li>Late </li></ul><ul><li>1. Delayed union </li></ul><ul><li>2. Avascular necrosis </li></ul><ul><li>3. Delayed reaction to fixation devices </li></ul><ul><li>4. Complex regional syndrome </li></ul>

113.
Fracture <ul><li>FRACTURE COMPLICATIONS: Fat Embolism </li></ul><ul><li>Occurs usually in fractures of the long bones </li></ul><ul><li>Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure </li></ul><ul><li>Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs </li></ul>

114.
Fracture <ul><li>FRACTURE COMPLICATIONS: Fat Embolism </li></ul><ul><li>Onset is rapid, within 24-72 hours </li></ul><ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Sudden dyspnea and respiratory distress </li></ul><ul><li>2. tachycardia </li></ul><ul><li>3. Chest pain </li></ul><ul><li>4. Crackles, wheezes and cough </li></ul><ul><li>5. Petechial rashes over the chest, axilla and hard palate </li></ul>

115.
Fracture <ul><li>FRACTURE COMPLICATIONS: Fat Embolism </li></ul><ul><li>Nursing Management </li></ul><ul><li>1. Support the respiratory function </li></ul><ul><li>Respiratory failure is the most common cause of death </li></ul><ul><li>Administer O2 in high concentration </li></ul><ul><li>Prepare for possible intubation and ventilator support </li></ul>

116.
Fracture <ul><li>FRACTURE COMPLICATIONS: Fat Embolism </li></ul><ul><li>Nursing Management </li></ul><ul><li>2. Administer drugs </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Dopamine </li></ul><ul><li>Morphine </li></ul>

117.
Fracture <ul><li>FRACTURE COMPLICATIONS: Fat Embolism </li></ul><ul><li>Nursing Management </li></ul><ul><li>3. Institute preventive measures </li></ul><ul><li>Immediate immobilization of fracture </li></ul><ul><li>Minimal fracture manipulation </li></ul><ul><li>Adequate support for fractured bone during turning and positioning </li></ul><ul><li>Maintain adequate hydration and electrolyte balance </li></ul>

118.
Fracture <ul><li>Early complication: Compartment syndrome </li></ul><ul><li>A complication that develops when tissue perfusion in the muscles is less than required for tissue viability </li></ul>

119.
Fracture <ul><li>Early complication: Compartment syndrome </li></ul><ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. Pain- Deep, throbbing and UNRELIEVED pain by opiods </li></ul><ul><li>Pain is due to reduction in the size of the muscle compartment by tight cast </li></ul><ul><li>Pain is due to increased mass in the compartment by edema, swelling or hemorrhage </li></ul>

120.
Fracture <ul><li>Early complication: Compartment syndrome </li></ul><ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>2. Paresthesia- burning or tingling sensation </li></ul><ul><li>3. Numbness </li></ul><ul><li>4. Motor weakness </li></ul><ul><li>5. Pulselessness, impaired capillary refill time and cyanotic skin </li></ul>

121.
Fracture <ul><li>Early complication: Compartment syndrome </li></ul><ul><li>Medical and Nursing management </li></ul><ul><li>1. Assess frequently the neurovascular status of the casted extremity </li></ul><ul><li>2. Elevate the extremity above the level of the heart </li></ul><ul><li>3. Assist in cast removal and FASCIOTOMY </li></ul>

122.
Strains <ul><li>Excessive stretching of a muscle or tendon </li></ul><ul><li>Nursing management </li></ul><ul><li>1. Immobilize affected part </li></ul><ul><li>2. Apply cold packs initially, then heat packs </li></ul><ul><li>3. Limit joint activity </li></ul><ul><li>4. Administer NSAIDs and muscle relaxants </li></ul>

123.
Sprains <ul><li>Excessive stretching of the LIGAMENTS </li></ul><ul><li>Nursing management </li></ul><ul><li>1. Immobilize extremity and advise rest </li></ul><ul><li>2. Apply cold packs initially then heat packs </li></ul><ul><li>3. Compression bandage may be applied to relieve edema </li></ul><ul><li>4. Assist in cast application </li></ul><ul><li>5. Administer NSAIDS </li></ul>

124.
End of Musculoskeletal