This action might not be possible to undo. Are you sure you want to continue?
Musculoskeletal Alterations: Section 1 Infections
Infection of the bone May occur by:
² Extension of soft tissue infections ² Direct bone contamination ² Blood borne spread from other foci of infection ² Most common cause is trauma
70-80% caused by Staphylococcus aureus
Who is at risk?
² Poorly nourished ² Elderly ² Obese ² Impaired immune system ² Chronic illness ² Long term corticosteroid therapy
Bone infections are more difficult to eradicate than soft tissue infections because infected bone becomes walled of
² Natural immune responses are blocked; antibiotics penetrate less
warm. rapid pulse.Osteomyelitis (cont.) Clinical Manifestations: ² Sudden onset with clinical symptoms of septicemia Chills. swollen. general malaise ² Extremity becomes painful. high fever. and tender ² Pulsating pain that intensifies with movement ² Abscess cavity contains dead bone tissue (sequestrum) which does not drain .
Osteomyelitis (cont. irregular cavities. and a raised periosteum or dense bone formations .) Assessment/Diagnostic Methods ² X-rays show soft tissue swelling ² Bone scans or MRI can be done ² Blood studies and blood cultures taken ² Chronic osteomyelitis: x-ray shows large.
) Medical Management Initial goal is to control and arrest the infective process ² Affected area is immobilized. warm soaks ² Blood cultures to identify organism ² IV antibiotic round the clock ² Once infection control³oral antibiotics for up to 3 months ² Surgical debridement with irrigation .Osteomyelitis (cont.
Osteomyelitis (cont. drainage.) Assessment: ² Assess for risk factors ² Observe for guarded movements ² Observe for warmth and swelling. elevated temperature ² Chronic cases may have minimal temperature elevation .
) Nursing Diagnosis: ² Pain related to inflammation and swelling ² Impaired physical mobility associated with pain ² Risk for extension of infection: bone abscess formation ² Deficient knowledge about treatment regimen .Osteomyelitis (cont.
) Planning/Goals Major goals include pain relief and improved mobility. and patient education .Osteomyelitis (cont. control and eliminate infection.
Osteomyelitis (cont.) Nursing Interventions: ² Restrict activity and immobilize ² ROM to joints above and below affected ² Handle with care to avoid pain ² Elevate to decrease swelling ² Administer pain medications and use other pain relief measures ² Monitor neurovascular status ² Encourage ADLs³some restrictions due to weakness of bone .
) ² Monitor response to antibiotics ² Watch for ´super-infectionsµ ² Diet high in protein and vitamin C to help promote healing Patient Education: importance of adhering to therapeutic regimen of antibiotics. and prevention of falls IV equipment instruction .Osteomyelitis (cont.
Medical Surgical Nursing Musculoskeletal Alterations: Section 2 Rheumatic Musculoskeletal Alterations .
peak between 40-60 years of age Women affected 2-3x more than men Believed to be an autoimmune response to unknown antigens .Rheumatoid Arthritis Rheumatoid Arthritis (RA) is an inflammatory disorder that primarily involves the synovial membrane of the joints Occurs between the ages of 30 and 50.
warmth. erythema. and lack of function ² Palpitation of joints reveals spongy or boggy tissue ² Fluid can usually be aspirated from the inflamed joint .Rheumatoid Arthritis (cont) Clinical Manifestations: Determined by the stage and severity of the disease ² joint pain. swelling.
elbows. ankles.Rheumatoid Arthritis (cont) Begins with small joints in hands. cervical spine. hops. bilateral and symmetric Morning stiffness lasts for more than 30 minutes Deformities of the hands and feet result from misalignment and immobilization . wrists and feet Progressively involves knees. shoulders. and TMJ Symptoms are acute in onset.
fatigue. sensory changes ² Raynaud·s phenomenon ² Rheumatoid nodules. non-tender and movable.Rheumatoid Arthritis (cont) Extra-articular features: ² Fever. anemia. weight loss. found in subcutaneous tissue over bony prominences .
extraarticular changes ² Laboratory findings: Rheumatoid Factor (RF) found in 80% of patients ESR elevated RBC and C4 decreased C-reactive Protein (CRP) and antinuclear antibody (ANA) may be + ² Arthrocentesis and x-rays can be performed . joint inflammation.Rheumatoid Arthritis (cont) Assessment and Diagnostic Findings ² Several factors lead to diagnosis of RA Rheumatoid nodules.
Rheumatoid Arthritis (cont) Medical Management Includes education. includes new COX-2 inhibitors. and referral to community agencies for support ² Early RA: Medical management includes therapeutic doses of salicylates or NSAIDs. penicillamine Occupational and physical therapy Reconstructive surgery and corticosteroids . gold. a balance of rest and exercise.
Corticosteroids may stimulate appetite and cause weight gain Low dose antidepressant medications to promote adequate sleep and manage pain . weight loss.Rheumatoid Arthritis Advanced RA: (cont) ² Immunosuppressive agents such as methotrexate and cyclophosphamide RA patients frequently experience anorexia. and anemia.
swelling.Rheumatoid Arthritis Assessment: (cont) ² Assess patient·s self-image ² Assess joints by inspecting palpating. and redness ² Assess joint mobility. and muscle strength . and inquiring about tenderness. ROM.
Rheumatoid Arthritis Planning and Goals (cont) ² Goals include pain relief ² Relief of fatigue ² Optimal functional mobility ² Independence in ADLs ² Improved sleep ² Absence of complications .
Rheumatoid Arthritis (cont) Nursing Interventions: ² Pain relief measures ² Relief of fatigue ² Increasing mobility ² Improving sleep ² Monitoring for potential complications ² Increase knowledge of disease ² Promoting self-care .
Systemic Lupus Erythematosus (SLE) Chronic inflammatory autoimmune collagen disease resulting from disturbed immune regulation that causes an exaggerated production of autoantibodies .
SLE (cont) Pathophysiology ² Brought on by some combination of genetic.or drug-induced SLE ² Some foods (alfalfa sprouts) have been implicated ² Usual onset during childbearing years . hormonal and environmental factors ² Certain medications have been implicated in chemical.
the body produces antibodies against its own cells Formed antigen-antibody complexes can suppress the body·s normal immunity and damage tissues Pt·s with SLE can produce antibodies against many tissue components: red blood cells. lymphocytes or any organ or tissue in the body . platelets.Pathophysiology cont In autoimmunity. neutrophils.
SLE Susceptibility Genetic predisposition Stress Streptococcal or viral infections Exposure to sunlight or UV light Immunization Pregnancy Abnormal estrogen metabolism .
Drugs that spark SLE Procainamide Hydralazine Isoniazid Methyldopa Anticonvulsants Penicillins. and oral contraceptives (less common) . sulfa drugs.
SLE (cont) Clinical Manifestations ² Onset is insidious or acute ² SLE can go undiagnosed for many years ² Clinical course is one of exacerbations and remissions ² Multisystem features Nephritis. cardiopulmonary disease. rashes. evidence of systemic inflammation .
depression . morning stiffness Integumentary system: ² Butterfly rash across bridge of nose and cheeks ² Lesions can be provoked by sunlight or artificial UV light Cardiovascular ² Pericarditis Other: ² Pleuritis or pleural effusions ² Renal involvement.SLE (cont) Musculoskeletal System: ² Arthralgias and arthritis. joint swelling. HTN.
thrombocytopenia. leukopenia. lymphopenia.SLE (cont) Diagnostic Studies ² ² ² ² Complete history Analysis of blood work No specific lab work confirms SLE Other diagnostic immunologic tests support but do not confirm the diagnosis. and an elevated ESR ² Women may report irregular menstruation ² 90% have joint involvement that resembles RA ² 40% have Raynaud·s phenomenon . Anemia.
SLE (cont) Pharmacologic Therapy ² NSAIDs and corticosteroids ² Topical corticosteroids for cutaneous manifestations ² Immunosuppressive agents for most serious forms of SLE .
SLE (cont) Nursing Interventions ² Generally the same as those for patients with rheumatic disease and address: Fatigue Impaired skin integrity Disturbed body image Knowledge deficit .
Characterized by a progressive loss of joint cartilage. Risk Factors: female genetic pre-disposition Obesity Mechanical joint stress Trauma Congenital and developmental disorders Inflammatory joint diseases Endocrine and metabolic diseases .Osteoarthritis (Degenerative Joint Disease) Osteoarthritis (OA) is the most common joint disorder.
or obesity Obesity increases the pain and discomfort of the disease OA peaks between the fifth and sixth decades of life .trauma.OA (cont) Classified as: ² Primary (idiopathic) ² Secondary (related to risk factors): most commonly -. congenital deformity.
knees. stiffness.OA (cont) Clinical Manifestations: ² Pain. cervical and lumbar spine) ² Bony nodes may be present (painless) Heberden·s nodes: distal joints Bouchard·s nodes: proximal joints . and functional impairment ² Stiffness is most common in the morning³lasts less than 30 minutes ² Functional impairment is related to pain ² Aching during weather changes ² ´gratingµ of joint during motion ² Most often occurs in weight bearing joints (hips.
OA (cont) Assessment and diagnosis: ² X-ray shows narrowing of joint space and osteophytes (spurs) at the joint margins ² Serum studies are not useful ² No laboratory test is specific for osteoarthritis Medical Management: ² Focuses on slowing and treating symptoms³ no treatment available that stops the degenerative joint process .
NSAIDs COX-2 inhibitors Topical analgesics New therapeutic approaches .OA (cont) Prevention: ² Weight reduction ² Prevention of injuries ² Perinatal screening for congenital hip disease Pharmacologic Therapy ² ² ² ² Acetaminophen.
weight reduction. joint rest ² Orthotic devices ² Isometric and postural exercises ² OT and PT Surgical Management ² Joint replacement .OA (cont) Conservative Measures ² Heat.
OA (cont) Nursing Management ² Manage pain ² Optimize functional ability ² Assist with weight loss strategies ² Encourage use of assistive devices for ambulation ² Patient safety .
or heredity .Gout A heterogeneous group of conditions related to a defect of purine metabolism and resulting hyperuricemia Pathophysiology ² Over secretion of uric acid or renal deficit in excreting or combination of both ² May be due to starvation. excessive intake of purine rich foods.
Gout Primary gout usually occurs in men over age 30 and post-menopausal women who take diuretics Intermittent Between attacks patient may be symptom free for years .
diet. medication ² Abrupt onset occurs at night ² Early attacks go away spontaneously ² May be months or years before the next attack . alcohol.Gout (cont) Clinical Manifestations ² Four stages Asymptomatic hyperuricemia² urate levels rise but don·t produce symptoms Acute gouty arthritis ² Most common early sign ² Metatarsophalangel joint of the big toe ² Acute attack triggered by trauma.
Gout (cont) Hyperuricemia ² Few people develop clinically apparent urate crystal deposits ² Development of gout is directly related to duration an magnitude of hyperuricemia Tophi ² Chalky deposits of sodium urate ² Associated with frequent and severe inflammatory episodes ² High uric acid concentrations associated with tophi ² Found in various places Risk for urolithiasis .
tophi. joint destruction treated after the acute inflammatory process ² Uricosuric agents to correct hyperuricemia ² Colchicine or NSAIDs ² Allopurinol³limited due to risk of toxicity .Gout (cont) Medical Management ² Hyperuricemia.
Gout (cont) Nursing Management ² Restrict consumption of foods high in purines (organ meats. anchovies. sardines. sweetbreads) ² Avoid alcohol ² Maintain normal body weight ² Pain management ² Instruction to continue medications to maintain effectiveness .
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.