Ch 53: Musculoskeletal Problems (per Amendolair)
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Transcript of Ch 53: Musculoskeletal Problems (per Amendolair)
8/8/2019 Ch 53: Musculoskeletal Problems (per Amendolair)
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Chapter 53
Interventions for Clients withMusculoskeletal Problems
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Osteoporosis
Metabolic disease =demineralization results indecreased density and subsequent fractures
Osteopenia (low bone mass), which occurs whenthere is a disruption in the bone remodelingprocess
Causes: When bone is subject to reduced mechanical loading as
a result of bed rest or immobilization
The presence of reduced sex hormone (menopause infemales)
Presence of excess corticosteriods usually given astreatment for a variety of conditions such as arthritis orasthma
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Classificat ion of Osteoporosis
Generalized osteoporosis occurs mostcommonly in postmenopausal women and menin their 60s and 70s.
Secondary osteoporosis results from anassociated medical condition such ashyperparathyroidism, long-term drug therapy,long-term immobility.
Regional osteoporosis occurs when a limb is
immobilized.
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Vertebral body. Osteoporotic vertebral body (right)
shortened by compression fractures compared
with a normal vertebral body. Note that the
osteoporotic vertebra has a characteristic loss of
horizontal trabeculae and thickened vertical
trabeculae.
From Cotran RS, Kumar V, Collins T: Robbins pathologic basis of disease, ed 6,
Philadelphia, 1999, Saunders
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Figure 37-11. Mechanism of loss
of trabecular bone in women
and trabecular thinning in men.
Bone thinning predominates inmen because of reduced bone
formation. Loss of connectivity
and complete trabeculae
predominates in women
Figure 37-12. Bone loss in men
and women. Absolute
amount of bone resorbed
on the inner bone surface,and formed on the outer
bone surface is more in
men than women during
aging.
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Osteoporosis
Normal bone
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Health Promot ion/Illness Prevent ion
nsure adequate calcium intake.
Avoid sedentary life style.
Continue program of weight-bearing
exercises.
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A ssessment
Physical assessment
Psychosocial assessment
Laboratory assessment
Normal labs Radiographic assessment
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Drug Therapy
Hormone replacement therapy
Parathyroid hormone
Calcium and vitamin D
Bisphosphonates Selective estrogen receptor
modulators
Calcitonin
Other agents used with varying results
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Diet Therapy
Protein
Magnesium
Vitamin K
Trace minerals Calcium and vitamin D
Avoid alcohol and caffeine
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Fall Prevent ion
Hazard-free environment
High-risk assessment through programssuch as Falling Star protocol
Hip protectors that prevent hip fracturein case of a fall
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Others
xercise
Pain management
Orthotic devices
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one Tumors
Benign bone tumors (noncancerous):
Chrondrogenic tumors:osteochondroma, chondroma
Osteogenic tumors: osteoid osteoma,osteoblastoma, giant cell tumor
Fibrogenic tumors
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Intervent ions
Nondrug pain relief measures
Drug therapy: analgesics, NSAIDs
Surgical therapy: curettage (simple
excision of the tumor tissue), jointreplacement, or arthrodesis
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Malignant Bone Tumors
Primary tumors, those tumors thatoriginate in the bone
Osteosarcoma
Ewings sarcoma Chondrosarcoma
Fibrosarcoma
Metastatic bone disease
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A cute Pain; Chronic Pain
Interventions include:
Treatment aimed at reducing the sizeor removing the tumor
Drug therapy; chemotherapy Radiation therapy
Surgical management
Promotion of physical mobility with
ROM exercises
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A nt icipatory Grieving
Interventions include:
Active listening
Encouraging client and family to
verbalize feelings Making appropriate referrals
Helping client and others to cope withthe loss and grieving
Promoting the physician-clientrelationship
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Potent ial f or Fractures
Interventions
Nonsurgical management: radiationtherapy and strengthening exercises.
Surgical management: replace asmuch of the defective bone aspossible, avoid a second procedure,and return client to a functioning statewith a minimum of hospitalization and
immobilization.
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Scoliosis
Changes in muscles and ligaments on theconcave side of the spinal column
Congenital, neuromuscular, or idiopathic
in type Assessment: complete history, pain
assessment, observation of posture
Interventions: exercise, weightreduction, bracing, casting, surgery
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Progressive Muscular Dystrophies
At least nine types of muscular dystrophiesidentified; categorized as slowly or rapidlyprogressive
Diagnosis often difficult
Management
Supportive, making client as comfortable aspossible
Prednisone, immunosuppressive agents,
anabolic steroids
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Muscular Dystrophies: Adults
Four type f ound in adult s
Becker
Limb-girdle
Faci
osc
apulohumeral Myotonic
Pathophysiology
Poor blood f low
Disturbance in nerve-muscle interact ion Loss of cell membrane integrity as a result of
increased enzyme act ivity
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Muscular Dystrophies
Clinical Manif estat ion (general)
Progression
Treatment
Nursing Intervent ions
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Becker Muscular Dystrophy (Table 53-5, p. 1175)
What is it
Causes
Clinical Manif estat ions
A ssessment
Progression
Treatment
Nursing Considerat ions
nd BMD)
On thecover:Both AndrewS oto, s hown h ere with Freckles , and hi s old erbroth erJu lian, hav e receiv ed diagno ses of Duc h enn emuscular dy s trophy. Th eyliv e in Tucs on, Ariz., withth eir par ent s , Lup eand Tim.Dear F ri end s
Whatar eDuc h enn e and B ecke r Mu sc u lar D y s trophi es?
What c a u ses D u c h enn e and B ecke r m u sc u lar dy s trophi es?
Whathapp en s
to th evol u ntary m u sc l es of s om eon ewith D MD orB MD?Whatt es t s ar eu sed to diagno se D MD
and B MD?
What c an be
don e to tr eat D MD orB MD?
Inwhatoth er way s do D MD
and B MD
aff ec tth ebody ?C an
s p ec ialdi et s or exer c i ses
h elp in D MD
and B MD?
How do famili es and c hildr enadju s t to D MD or B MD?T h eMu sc l e-F i ber Mem bran eD o es it Ru nin th e F amily ?MDA'sSear c h for Tr eatm ent s
&C u r es MDA
i s Her e to Help Y o u
Inth e early s tag es ,
D u c h enn e and B ecke r MD
aff ec tth es ho u ld erand u pp erarm
m u sc l es and th e m u sc l es of th e hip s and
thigh s . Th esew ea k n esses
l ead to diffi c u lty in ri s ing from th e floor, c lim bing
s tair s , maintaining balan ce and rai s ing th e
arm s .Whatar eD u c h enn e and B ecker
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Limb girdle dystrophy (Table 53-5, p. 1175)
Limb-girdle muscular dystrophy
What is it
Causes
Clinical Manif estat ions
A ssess
ment Progression
Treatment
Nursing Considerat ions
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Facioscapulohumeral MuscularDystrophy
What is it
Causes
Clinical Manif estat ions
A ssessment
Progression
Treatment
Nursing Considerat ions