Musculoskeletal Disorders

‡ Sprain ± complete or incomplete tear in the supporting ligaments surrounding joints. ‡ Strain ± overstretching injury to a muscle or tendon.

‡ Sprain ± commonly result from wrenching or twisting motion ‡ Strain ± typically result from excessively vigorous movement in understretched and overstretched muscles and tendons

‡ Sprain ‡ Pain and discomfort ‡ Edema ‡ Decreased joint motion and function ‡ Feeling of joint looseness ‡ Strain ‡ Pain ‡ Edema ‡ Ecchymoses .

4. Administer prescribed medication 2. Provide nursing care for a client who suffer muscle or tendon strain. Provide nursing care for the client who sustain sprain. Provide additional teaching .1. 3.

Displacement of a bone from its normal articulation with a joint

‡ May be congenital ‡ May result from trauma or disease of surrounding joint tissue

‡ ‡ ‡ ‡ ‡ ‡

Pain Visible disruption of joint contour Edema Ecchymoses Impaired joint mobility Change in extremity length and in axis of dislocated bones

Provide teaching . Assist physician in reducing displaced parts as necessary 4. Prevent from further injury 3. Administer prescribed medication 2.1.

Remember ‡ Rest ‡ Ice ‡ Compress ‡ Elevate .


‡ Disruption in the continuity of bone as a result of trauma or various disease process ‡ Highest incidence in males 15-24 years and in elderly persons. women aged 65 years and older .

‡ ‡ ‡ ‡ Direct blow Crushing force Sudden twisting motion Extreme muscle contraction .

cortex on the covade side remain intact .Fractures Complete fractureinvolves a break across the entire cross section of the bone and is frequently displaced from normal position Incomplete fracture ± break occurs through the only part of the cross section of the bone. Closed fracture ± does not produce a break in the skin. Greenstick ± bone bends w/out fracturing across completely. Open fracture ± presence of break in the skin.

caused by a force applied to the site. Compression ± fracture which the bone has been compressed Pathologic ± fracture through an area of diseased bone. Burst ± occurs in a short bone resulting from strong direct pressure. caused by violence forced through the limb.Other fractures Transverse ± fracture that is straight across the bone. . Spiral/ oblique ± fracture twisting around the shaft of the bone.fracture where the fragment are driven into one Crush ± occurs in cancellous bone as result of a compression force. Impacted.

Epiphyseal ± fracture through the epiphysis Compound ± fracture with a surface or open wound.Other fractures Avulsion ± pulling away of a fragmet of bone by a ligament or tendon & its attachment. Include more than one break in the bone. Comminuted ± fracture with more than one fragments .

‡ ‡ ‡ ‡ ‡ ‡ ‡ Pain Loss of function/sensation Deformity Shortening/lenghtening Crepitus (grating sensation) Swelling Discoloration .

‡ ‡ ‡ ‡ Excessive motion on site Soft tissue edema Warmth over injured area Paralysis distal to injury resulting from nerve entrapment ‡ Signs of shock related to severe tissue injury .

or temperature of injured part observe for signs of shock . sensation.Fracture care ‡ ‡ ‡ ‡ ‡ ‡ splinting of fracture preservation of body alignment elevation of body part to limit edema application of cold packs observe for changes in color.

‡ ‡ ‡ ‡ ‡ ‡ Fat embolism Compartment syndrome Nonunion Arterial damage Infection Hemorrhage/ Shock .

serious. potentially life-threatening complication S/Sx: Restlessness mental status changes tachycardia tachypnea hypotension Dyspnea Petechial rash over the upper chest and neck. .Fat emboli .

and function of tissues within that space. viability.Compartment syndrome . ‡ ‡ ‡ ‡ ‡ ‡ S/Sx: increased pain and swelling pain with passive motion inability to move joints loss of sensation pulselessness .increased pressure within a limited anatomic space compromising circulation.

‡ S/Sx: ± fever ± pain ± erythema in the affected area ± tachycardia ± elevated WBC count .caused by the interruption of the integrity of the skin. the infection invades bone tissue.Infection and osteomyelitis .

‡ S/Sx: ‡ pain ‡ decreased sensation Pulmonary Emboli. which results in the death of the bone.caused by immobility precipitated by a fracture ‡ S/Sx: ‡ restlessness and apprehension ‡ Dyspnea ‡ Diaphoresis ‡ ABG changes .interruption in the blood supply to the bony tissue.Avascular necrosis.

provides rigid immobilization of affected body part for support and stability ‡ .Treatment ‡ Splinting.immobilization of the affected part to prevent soft tissue from being damaged by bony parts Casting.

plates.Treatment ‡ Internal fixation. ‡ ‡ .use of metal screws.restoration of the fracture fragments into anatomic alignment and rotation. nails and pins to stabilize reduced fractures Traction Reduction.

moderate carbohydrates (prevent weight gain) ‡ increase fluid intake .Nursing care plan/implementation for clients with Fracture Promote healing and prevent complications ‡ diet: high protein. vitamins (tissue repair). iron.

constipation. change in temperature.Nursing care plan/implementation for clients with Fracture ‡ assess for complications of immobility (pneumonia. decubitus ulcers. osteoporosis) assess casted extremity for presence of foul odor. numbness ‡ . drainage. pulselessness. paleness or blueness. tingling.

Nursing care plan/implementation for clients with Fracture Prevent injury or trauma ‡ avoidance of high-risk activities (sky diving. rollerblading) ‡ avoidance of safety hazards (throw rugs. high impact sports. untreated vision problems) ‡ regular exercise .

Nursing care plan/implementation for clients with Fracture ‡ Provide care related to ambulation with crutches ‡ Provide safety measures related to possible complications following fracture .

.immobilized the fractured extremity .Nursing Management ‡ Administer prescribed medication ‡ Provide care during transfer of the patient .support the affected side.

.‡ Provide client and family teaching .explain prescribed activity restriction .Provide additional teaching .Teach the proper use of assistive devices.


‡ Callus formation: 3 to 4 weeks ‡ Ossification begins within 2 to 3 week up to 3 to 4 months ‡ Progress should be monitored by serial x-rays ± reveals complete bone union .

bone or muscle group using variety of weight and pulley systems .‡ An orthopedic treatment that involves placing tension on a limb.

and immobilize fractures 3. Correct or prevent deformity 4. Increase space between joint surfaces. Decreased muscle spasm 2. . Reduce.1. align.

‡ Straight or Running traction ± involve straight pulling force in one plane. ‡ Balanced suspension traction ± involves exertion of a pull while the limb is supported by hammock or splint .

‡ Skeletal traction ± involves weight applied and attached to metal/pin inserted into bone .‡ Skin traction ± involves weight applied and held to the skin with a Velcro splint.

Buck¶s Extension Traction ± femur & hip fracture Overhead ± fracture of humerus Head halter ± cervical spine affection Pelvic girdle ± lumbosacral affection. herniated nucleus pulposus .

Dunlop¶s Traction ± fractured elbow and humerus .

Halo pelvic ± scoliosis Halo femoral ± severe scoliosis .

Boot leg ± hip and femoral affection .Bryant¶s traction ± femoral fracture. Hip injuries among kids below 3 years old ‡ Buttocks are slightly elevated and clear off the bed.

in ±chest ± severe chest injury with multiple rib fracture .Ninety degrees ± fracture of the femur Stove.

Hammock suspension ± pelvic affection .

Skin Traction ‡ To control muscle spasm ‡ To immobilize an area before surgery .

. humerus. tibia & cervical spine. MOST frequently used in treating fractures of femur. Uses wires. or tongs placed through the bones 2.Skeletal Traction 1. pins.

] ‡ Never release weights unless ordered . ‡ Line of pull is from the first pulley back to the point on the extremity.NURSING FOCUS ‡ Weights must hang freely. ‡ Tie all knots securely. ‡ Skin traction is usually intermittent and skeletal traction is usually continuous.

Promote self-care within traction limitation . Provide client teaching 5.1. Prevent complications of immobility 2. Promote skin integrity 3. irritation or infection 4. Inspect for signs of skin breakdown.

.Buck¶s extension ‡ simplest form and provides for straight pull on the affected extremity ‡ relieve muscle spasm ‡ immobilize a limb temporarily ‡ Heel is supported off bed to prevent pressure on heel. weight hangs free of the bed. and foot is well away from footboard of bed. and parallel to the bed.

‡ used in the treatment of intertrochanteric fracture of the femur when surgery is contraindicated ‡ Hip is slightly flexed.permits the patient to move freely in the bed .Russel traction .permits flexion of the knee joint. . Pillows may be used under lower leg to provide support and keep the heel free of the bed.

Russell¶s Traction .

or drainage ‡ Patient education ‡ Maintaining the traction ‡ Skin care ‡ Assist in toileting .Nursing Intervention of Patient¶s with Traction  Monitor color. and sensation of the affected extremity ‡ Monitor the insertion sites for redness. motion. swelling.


or pins .‡ A. Internal Fixation ± involves stabilization of reduced fracture with screws. Open reduction ± involves reduction and alignment of fractures through surgical opening ‡ B.

Bone graft ± involves placement of bone tissue for healing. or replacement ‡ D. Arthroplasty ± involves joint repair through small arthroscope .‡ C. stabilization.

Joint replacement ± involve replacement of joint surface with metal or plastic materials . Arthrodesis ± involves immobilization of joint through fusion. ‡ F.‡ E.

femoral.Types of Joint Replacement ‡ 1. Total knee replacement ± involves replacement to tibial. Total hip replacement ± involves replacement of the ball and socket of a severely damaged hip joint ‡ 2. . and patellar joints.

Fasciotomy ± involves removal of muscle fascia.‡ G. Tendon transfer ± involves movement of tendon insertion ‡ H. relieving constriction . Tenotomy ± involves cutting tendons ‡ I.

‡ J. Osteotomy ± involves alignment of bone by removal of a wedge ‡ Purpose of Orthopedic Surgery: ± Reconstruct diseased or injured musculoskeletal structure .

ASSESSMENT ‡ 1. Preoperative assessment ± Elicit the client¶s medical history ± Identify current medication and condition ± Assess nutritional and hydration status ± Assess skin integrity .

‡ 2. Nutritional status ‡ Assess neurovascular status ‡ Assess for joint dislocation ‡ Assess for infection ‡ Assess for thromboembolism ‡ Assess and maintain safety and effectiveness of orthopedic apparatus .respiratory . fluid and electrolyte. Postoperative Assessment ‡ Assess the cardiovascular .

Total Hip Replacement ‡ a plastic surgery that involves removal of the head of the femur followed by placement of a prosthetic implant .

Signs and symptoms necessitating Surgery ‡ ‡ ‡ ‡ ‡ Severe chronic pain Loss of joint mobility Excessive joint destruction Infection in the joint Contractures .


Nursing Management
‡ Teach client how to use crutches ‡ Teach client mechanics of transferring. ‡ Discuss importance of turning and positioning post-op. ‡ Place affected leg in an abducted position and straight alignment following surgery ‡ Prevent hip flexion of more than 90 degrees.

Nursing Management
‡ Apply support stockings ‡ Advise client to avoid external/internal rotation of affected extremity for 6 months to 1 year after surgery ‡ Instruct client to avoid excessive bending, heavy lifting, jogging, jumping ‡ Encourage intake of foods rich in Vitamin C, protein, and iron. ‡ Administer prescribed medications.

‡ ‡ ‡ ‡ ‡ ‡ Infection Hemorrhage Thrombophlebitis Pulmonary embolism Prosthesis dislocation Prosthesis loosening

femoral and patellar joint surfaces are replaced.‡ An implant procedure in which tibial. .

‡ Assess the neurovascular status of the leg ‡ Immobilize knee in extension with a firm compression dressing and an adjustable splint or long leg cast ‡ Elevate on pillows ‡ Apply ice to control edema and bleeding ‡ Encourage active flexion of the foot every hour when patient is awake ‡ Drainage: 1st 8 hrs. = 200 ml ‡ After 48 hrs = less than 25 ml .

Types: ‡Below the knee (BKA) .

. .Phantom limb pain described as a cramp or uncomfortable sensation .phantom limb pain.the pain is a real sensation and should not be dismissed as illusionary.disappears with time .Amputation of a Lower Extremity ‡ surgical removal of a lower limb or part of the limb.10% of patients experience uncomfortable sensations. .

2. Monitor for bleeding. Notify surgeon ASAP. 3. Have clamps available at bedside. Elevate the foot of the bed if hemorrhage is suspected. 4.1. 5. Apply pressure directly over the area of bleeding. .

Complications of Amputation ± Infection ± Wound necrosis ± Phantom limb pain ± Contractures ± Skin breakdown .

then q 2 hours for 1st 24 hours.‡ Monitor vital signs q 15 min until stable. ‡ Keep the stump elevated for 1st 24 hours to prevent edema ‡ After 48 hours DO NOT elevate with pillows BUT rather elevate the foot of the bed. . then q 4 hours.

‡ Encourage to do active ROM of extremity to strengthen muscles and inhibit contractures.To prevent contractures: ‡ Place patient in a prone position for 15 minutes. ‡ Maintain on low-Fowler¶s or flat position after AKA . four times per day. (especially AKA) after 24-48 hrs to stretch the muscles and prevent flexion contracture of hip ‡ Have patient lie in a supine position with the knee in extension (especially BKA).

place a pillow under the abdomen and stump and keep the legs close together to prevent abduction ‡ Support stump with pillow for first 24 hours. place rolled bath blanket along outer aspect to prevent outward rotation.‡ In prone position. ‡ Encourage exercises to prevent thromboembolism ‡ Encourage patient to ambulate using correct crutchwalking techniques .

‡ Crutch ‡ Cane ‡ Walker .


Caring for Patient with .

. ‡Bones become fragile and prone to fracture.‡A disease characterized by exaggerated loss of bone mass and changes in microarchitecture of the bone tissue that compromise bone quality.

Characteristics of Osteoporosis ³Silent": most patients are unaware of osteoporosis until the first bone fracture occurs. hormone secretion drops drastically during menopause and this accelerates bone loss. It is more common in females than males: in women. .

8. hyperthyroidism or some reproductive disorders. 6. 7.These factors increase your risk of developing osteoporosis: 1. 4. 2. such as steroids and thyroid hormone . 5. Prolonged use of certain medications. 3. Heredity factors Early menopause in women Drinking too much coffee and strong tea Cigarette smoking and alcoholism Low calcium intake Lack of exercise Some diseases. such as rheumatoid arthritis.


smoking & caffeine intake .Health history includes questions concerning: ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Occurrence of osteoporosis Family history Previous Fractures Dietary consumption of calcium Exercise patterns Onset of menopause Use of corticosteroids Alcohol.


Reviewing and evaluating a patient's: ‡ ‡ ‡ physical condition. lifestyle & daily living habits 2.1. Measuring Bone Density .

Other medications: ‡ Alendronate ‡ Calcitonin . Balance diet rich in CALCIUM & VITAMIN D 2. Regular weight-bearing EXERCISES 3.1. Hormone replacement therapy (HRT) with ESTROGEN & PROGESTERONE 4.

.Prevention of osteoporosis begins from childhood as it is important that you maximize your peak bone mass before the age of 35 years.

.Sufficient intake of calcium Adequate weight-bearing exercises.

Home safety to prevent falls and fractures. .Maintain a healthy lifestyle.

To maintain bone mass. . postmenopausal women may need adequate hormone replacement therapy according to a doctor's advice.


ETIOLOGY ‡ Result from trauma or secondary infection. ‡ Blood-borne (hematogenic) osteomyelitis is common children ‡ Chronic illness ‡ Long term corticosteroid therapy .


heat.Clinical Manifestations ‡ ‡ ‡ ‡ ‡ ‡ ‡ Localized bone pain Tenderness. and edema Guarding of the affected area Restricted movement Systemic symptom Purulent drainage malaise .

Aureus) ‡ Radiograph and bone scan .Lab/ Dx Findings ‡ WBC count reveals leukocytosis ‡ ESR is elevated ‡ Blood cultures identifies the causative agent (Staph.

Administer prescribed medication 2. Prepare client for surgical treatment 5. Protect the affected extremity from further injury and pain 3. wet soaks 20 min several times a day . Provide additional teaching 6.Nursing Management 1. May apply warm. Promote healing and tissue growth 4.

degenerative joint disease characterized by variable changes in weight-bearing joint.-a slowly progressive. -Also known as Degenerative Joint Disease/ Hyperthropic Arthritis .

‡ Associated with ‡ Obesity ‡ Aging (>50yr) ‡ Trauma ‡ Genetic predisposition ‡ Congenital abnormalities .


‡ Pain and muscle spasm. aggravated by use relieved by rest ‡ Limited motion ‡ Joint grating with movement ‡ Flexion contractures ‡ Joint tenderness ‡ Presence of Heberden¶s nodes or Bouchard¶s nodes ‡ Weight loss ‡ Cold intolerance .

‡ Radiographs may reveal a narrowing of joint space .


Administer prescribed medication 2.1. Position the client to prevent flexion deformity 4.Plan activities that promote optimal function and independence . Provide nonpharmacologic comfort measures 3.

Provide referrals . Prepare the client fro surgical treatment as indicated 7. Refer to physical and occupational therapy 6.5.

Medication Aspirin ‡ inhibits cyclooxygenase enzyme. analgesic. antipyretic action ‡ inhibit platelet aggregation in cardiac disorders . it diminishes the formation of prostaglandins ‡ anti-inflammatory.

nausea.Adverse effects: ‡ GI: Epigastric distress. can cause respiratory depression . and vomiting ‡ Blood: inhibition of platelet aggregation and a prolonged bleeding time ‡ Respiratory: In toxic doses.

‡ Hypersensitivity ‡ Reye¶s syndrome: Acute encephalopathy following a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver .

Toxicity: (mild or severe) ‡ Mild salicylism: nausea. vomiting. delirium. mental confusion. convulsions. coma. respiratory and metabolic acidosis and death from respiratory failure. dizziness. headache. . hallucinations. and tinnitus ‡ Severe salicylism: restlessness. marked hyperventilation.

analgesic.and antipyretic acitivity ‡ use for chronic treatment of rheumatoid and osteoarthritis ‡ less GI effects than aspirin ‡ reversible inhibitors of the cyclooxygenases and inhibit the synthesis of prostaglandins .Ibuprofen ‡ anti-inflammatory.

tinnitus and dizziness .Adverse effects: ‡ GI: dyspepsia to bleeding ‡ CNS: headache.

analgesic and antipyretic acitivity ‡ inhibits cyclooxygenase enzyme ‡ more potent than aspirin as an antiinflammatory agent .Indomethacin ‡ anti-inflammatory.

vomiting. diarrhea and abdominal pain ‡ CNS: frontal headache. vertigo. dizziness. light-headedness. and mental confusion ‡ Hypersensitivity reaction .Adverse effects: ‡ *dose-related ‡ GI: nausea. anorexia.

swelling ‡ medications as prescribed.Nursing Management Promote comfort: reduce pain. spasms. ‡ Heat to reduce muscle spasm ‡ Cold to reduce swelling and pain . inflammation.

splints to maintain proper alignment Position: elevate extremity to reduce swelling Promote independence ‡ ‡ . bed rest on firm mattress.‡ Prevent contractures: exercise.

May be localized to a single joint or more. and fever. May be exacerbated by exercise. Finger joints may become affected. Ulnar deviation General Weight loss. Feels better after exercise. may not be swollen.Rheumatoid Pain Early morning stiffness which gets better as the day progresses. but may be painful. Joints Typical deformity is symmetrical (bilateral) with swelling. Osteoarthritis Stiffness worsens during the day. fatigue. .

Rheumatoid arthritis ‡ chronic systemic inflammatory disease ‡ destruction of connective tissue and synovial membrane within the joints ‡ weakens and leads to dislocation of the joint and permanent deformity .

Risk Factors: ‡ exposure to infectious agents ‡ fatigue ‡ stress .

Diagnostic tests ‡ Elevated ESR ‡ Mild leukocytosis ‡ Anemia ‡ Positive RF .

muscle atrophy. tenderness.Signs and Symptoms ‡ inflammation. and decreased range of motion ‡ spongy. soft feeling in the joints ‡ low grade fever. and stiffness of the joints ‡ moderate to severe pain and morning stiffness lasting longer than 30 minutes ‡ joint deformities. fatigue and weakness .

weight loss.Signs and Symptoms ‡ anorexia. and anemia ‡ elevated ESR. and positive RF ± Nonreactive: 0-39 IU/ml (CRP) ± Weakly reactive: 40-79 IU/ml (CRP) ± Reactive: greater than 80 IU/ml (CRP) ‡ X-ray showing joint deterioration .

Rheumatoid Arthritis .

Rheumatoid Arthritis .

anti-inflammatory ‡ Gold salts .Medication ‡ Salicylates (acetylsalicylic acid ) ‡ NSAIDs ‡ Corticosteroids.

Gold salts ‡ ‡ ‡ ‡ slow-acting.use in the treatment of RA that does not respond to salicylates or other NSAID therapy . rather they can only prevent further injury . anti-inflammatory agents Gold sodium thiomalate.these drugs cannot repair existing damage. Aurothioglucose. Auranofin .

‡ Adverse effects:
‡ dermatitis of the skin or of the mucous membranes ‡ proteinuria and nephrosis

‡ Gold salts should be avoided in patients suffering from hepatic or renal disease, pregnancy. ‡ Serious Toxicity: Dimercaprol

‡ Hot and Cold packs to affected joints ‡ Surgical Procedures: synovectomy, arthrotomy, arthrodesis, arthroplasty

Nursing Management
Prevent or correct deformities ‡ ‡ ‡ ‡ bed rest daily ROM exercises heat and/or pain medication increase oral fluid intake at least 1500 mL to prevent renal calculi

A metabolic disease marked by urate crystal deposits in joints throughout the body. .

Higher incidence in men .Age (>50yr) .Linked to a genetic deficit in purine metabolism ..

Signs and Symptoms ‡ ‡ ‡ ‡ ‡ extreme pain swelling erythema of the involved joints fever tophi .


joint swelling and inflammation ‡ Intolerance to the weight of bed linen over the affected joint ‡ Pruritus or skin ulceration ‡ Signs of renal involvement .‡ sudden attacks. usually at night ‡ Pain.

Arthrocentesis reveals urate crystal in synovial fluid ‡ 2. . Serum uric acid level is increased ‡ 3.‡ 1. Radiographs may show joint damage in advanced disease.

.a purine analog .reduces the production of uric acid by competitively inhibiting uric acid biosynthesis which are catalyzed by xanthine oxidase.Treatment ‡ Allopurinol .

Allopurinol .Effective in the treatment of primary hyperuricemia of gout and hyperuricemia secondary to other conditions (malignancies). ‡ Adverse effects: hypersensitivity reactions. nausea and diarrhea .

‡ Does not prevent the progression of gout but have a suppressive. prophylactic effect reducing the frequency of acute attacks and relieves pain.Colchicine ‡ Effective for acute attacks of gouty arthritis pain ‡ Reduces inflammation in the joint. ‡ Anti-inflammatory activity alleviating pain within 12 hours .

vomiting. alopecia . abdominal pain.Colchicine ‡ Adverse effects: nausea. diarrhea. aplastic anemia. agranulocytosis.

Promote measures to prevent exacerbations. Provide client teaching .1. Provide measures to promote comfort and reduce pain 4. 3. Administer prescribed medication 2.

Caring for Patient with .

? .What is ‡ Osteomalacia involves softening of the bones caused by a deficiency of vitamin D or problems with the metabolism of this vitamin.

‡ In children. the condition is called rickets and is usually caused by a deficiency of vitamin D . .

Malabsorption of vitamin D . Inadequate exposure to sunlight (ultraviolet radiation) 3. Inadequate dietary intake of vitamin D 2. the condition is usually caused by: 1.‡ In adult.

Side effects of medications used to treat seizures . Hereditary or acquired disorders of vitamin D metabolism 2. 3. . Kidney failure and acidosis .‡ Other conditions: 1. PO4 depletion associated with low dietary intake or kidney disease 4.

‡ Risk factors are related to the causes. there is an increased risk for those who tend to remain indoors and who avoid milk because of lactose intolerance ‡ The incidence is 1 in 1000 people. . ± In the elderly.

Carpopedal spasms 3. Bowing of legs 4. numbness around the mouth & of extremities 2. Decrease in height/ Spinal Deformities (i. KYPHOSIS) .e. especially in the hips ‡ muscle weakness ‡ symptoms associated with low calcium 1.‡ diffuse bone pain . Waddling or limping GAIT 5.

and walking.‡ In children. . and the development of bowlegs or knock-knees. symptoms of rickets include: ² delayed sitting. pain when walking. crawling.

Bone biopsy: (+) increase in osteoid 2.1. Low serum calcium & phosphate levels 6. Elevated ALP (Alkaline Phosphatase) . 3. Low serum vitamin D level 5. Studies of the vertebrae: (+) compression fx 4. Bone X-ray or CT scan of lumbosacral spine shows demineralization.

Adequate dietary intake of dairy products that are fortified with vitamin D 2. Adequate exposure of the body to sunlight .1.

and phosphorus .‡ Oral supplements of vitamin D . calcium.

.‡ Large doses of Vitamin D with exposure to sunlight may be indicated in people with intestinal malabsorption .

‡ Monitoring of blood levels of phosphorus and calcium may be indicated with some underlying conditions. ‡ Braces or surgery to correct deformities .

4. 2. 3.‡ ‡ ‡ Protrusion of the nucleus of the disk into the fibrous ring of the disk with subsequent nerve compression May occur in any portion of the vertebral column Signs & Symptoms 1. Pain Sensory changes Loss of reflex Muscle weakness .


Cervical         Pain/ Stiffness ± head. neck & upper extremities Paresthesia. numbness Weakness Low back pain radiating to the buttocks and leg Postural deformity of the spine (+) Straight-Leg Raise test Weakness & Asymmetric reflexes Sensory loss 2.1. Lumbar Nursing Alert: Perform repeated assessments of sensorimotor functions/ reflexes to determine progression of condition .

Anti-inflammatory drugs. Relaxation techniques . Use of bed boards under the mattress 3. and narcotic analgesics 2. Bed rest ± supine or low fowler¶s or side lying position with slight knee flexion and pillows between knees. Moist heat application 5.Alleviating pain 1. 4. muscle relaxants.

Signs & Symptoms: ‡ ‡ ‡ ‡ Abnormal lateral deviation of spine Unleveled shoulder Asymmetric waistline Prominent scapula Complications: ‡ Related to respiratory problems due to decreased lung expansion as a result of severe curvature of the spine .

Nursing Implementation 1. Monitor progression of the curvature 2. Prepare the child and parents for the use of a brace if prescribed ± usually worn from 16 to 23 hours a day ± inspect the skin for signs of redness or breakdown ± keep the skin clean and dry. avoiding lotions and powders ± advise the child to wear soft nonirritating clothing under the brace .


to maintain alignment ‡ instruct in activity restrictions ‡ instruct the child to roll from a side-lying position to a sitting position. avoid twisting movements ‡ logroll the child when turning.Nursing Implementation Prepare the child and parents for surgery if prescribed. and assist with ambulation . Postoperative: ‡ maintain proper alignment.

most commonly affecting the skull. pelvic bones and vertebrae ‡ Primary bone resorption followed by bone formation ‡ Diseased bone is highly vascularized but structurally weak ‡ More common in the adult (>50 y/o) ‡ Male > female . tibia.Paget's Disease of Bone ‡ Localized rapid bone turnover. femur.

Clinical Manifestations ‡ ‡ ‡ ‡ ‡ ‡ bowing of femur and tibia enlargement of the skull cranial nerve compression respiration distress pain high cardiac output failure .

elevated Bone scan .Diagnostics ‡ ‡ ‡ ‡ X-rays Serum alkaline phosphatase.elevated Serum calcium.

Nursing Management ‡ Prevent pathological fractures ‡ Control pain ‡ Administer drugs as prescribed .

with Paget's disease and exposure to radiation ‡ Exhibits a moth-eaten pattern of bone destruction.Bone Tumors Osteosarcoma ‡ Most common primary bone tumor ‡ Occurs between 10-25 years of age. proximal tibia and proximal humerus . ‡ Most common sites: metaphysis of long bones especially the distal femur.


Clinical Manifestations
‡ local signs ± pain ( dull, aching and intermittent in nature), swelling, limitation of motion ‡ systemic symptoms: malaise, anorexia, and weight loss

confirms the diagnosis X-ray MRI Bone Scan .Diagnostics ‡ ‡ ‡ ‡ Biopsy.

Medical Management ‡ Radiation ‡ Chemotherapy ‡ Surgical management ± amputation ± limb salvage procedures .

‡ Promote coping skills and self esteem ‡ Assess for potential complications (infection.Nursing Management ‡ Promote understanding of the disease process and treatment regimen ‡ Promote pain relief ‡ Prevent pathologic fracture. complications of immobility). .

Nursing Management ‡ ‡ ‡ ‡ Provide care for client with amputation Observe for signs of bleeding Elevate stump on pillow for 24-40 hrs Turn patient to prone position for short time first post-op day then 2-3x daily .

Nursing Management ‡ Encourage exercise as soon as possible (1st or 2nd post-op day) ‡ Dangle and transfer patient to wheelchair and back within 1st or 2nd day post-op. crutch walking started as soon as patient feels sufficiently strong ‡ Apply lanolin to dry skin .

or hip socket. of the pelvis. ‡ Congenital or develop after birth .Other Musculoskeletal Disorders Dysplasia of the Hip ‡ condition in which the head of the femur is improperly seated in the acetabulum.


Implementation: ‡ Splinting of the hips with Pavlik harness to maintain flexion and abduction and external rotation (neonatal period) . which allows the femoral head to be displaced from the acetabulum upon manipulation.Assessment Neonates: laxity of the ligaments around the hip.


Limited range of motion in the affected hip. apparent short femur on the affected side (Galleazzi sign. Allis sign) . d. c. b. Asymmetric abduction of the affected hip when the child is placed supine with the knees and hips flexed.Assessment Infants beyond the newborn period: a. Asymmetry of the gluteal and thigh skinfolds when the child is placed prone and the legs are extended against the examining table.

Spica Cast .

1st & 2nd fingers affected=Tinel Sign( tingling sensation when inner wrist is percussed) .CARPAL TUNNEL SYNDROME: ‡ It occurs when the median nerve at the wrist is compressed ‡ ASSESSMENT: ‡ Pain ‡ Numbness ‡ Paresthesia ‡ Thumb.

Management: ‡ ‡ ‡ ‡ Wrist splinting Avoid repetitive wrist movement Carpal canal cortisone injection Surgical release of tendon sheat .

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