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



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



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.



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



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.



Osteoporosis

Normal bone





Health Promot ion/Illness Prevent ion

nsure adequate calcium intake.

Avoid sedentary life style.

Continue program of weight-bearing

exercises.



A ssessment

Physical assessment

Psychosocial assessment

Laboratory assessment

Normal labs Radiographic assessment



Drug Therapy

Hormone replacement therapy

Parathyroid hormone

Calcium and vitamin D

Bisphosphonates Selective estrogen receptor

modulators

Calcitonin

Other agents used with varying results



Diet Therapy

Protein

Magnesium

Vitamin K

Trace minerals Calcium and vitamin D

Avoid alcohol and caffeine



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



Others

xercise

Pain management

Orthotic devices



one Tumors

Benign bone tumors (noncancerous):

Chrondrogenic tumors:osteochondroma, chondroma

Osteogenic tumors: osteoid osteoma,osteoblastoma, giant cell tumor

Fibrogenic tumors



Intervent ions

Nondrug pain relief measures

Drug therapy: analgesics, NSAIDs

Surgical therapy: curettage (simple

excision of the tumor tissue), jointreplacement, or arthrodesis



Malignant Bone Tumors

Primary tumors, those tumors thatoriginate in the bone

Osteosarcoma

Ewings sarcoma Chondrosarcoma

Fibrosarcoma

Metastatic bone disease







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



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





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.



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







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



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



Muscular Dystrophies

Clinical Manif estat ion (general)

Progression

Treatment

Nursing Intervent ions



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



Limb girdle dystrophy (Table 53-5, p. 1175)

Limb-girdle muscular dystrophy

What is it

Causes


A ssess

ment Progression

Treatment




Facioscapulohumeral MuscularDystrophy

What is it

Causes


A ssessment

Progression

Treatment




Myotonic (Steinert) Dystrophy

Genet ic Link


A ssessment

Progression

Treatment

Nursing Care

Ch 53: Musculoskeletal Problems (per Amendolair)

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