inflammatory disorders. inflammatory disorders of the musculoskeletal system bursitis inflammation...
TRANSCRIPT
Inflammatory Disorders
Inflammatory Disorders of the Musculoskeletal System
• Bursitis• Inflammation of Bursa (fluid filled sac allowing
joint movement)• Usually from trauma or repetitious movement• Appears calcified on X-ray• Treatment
– Rest-Immobilization with heat or cold pack– Anti-inflammatory (NSAIDS) and analgesics– Sometimes injectable steroids and anesthetics into
joint
Inflammatory Disorders of the Musculoskeletal System
• Polymyositis• Inflammation of striated/skeletal muscle• Etiology unknown (possibly autoimmune)• Can affect heart, GI tract, and lungs
Inflammatory Disorders of the Musculoskeletal System
• Arthritis– Most common type of joint disorder– Defined as “inflammation of the joints”– 4 types of arthritis
• Rheumatoid, osteoarthritis, gout and septic (infectious) arthritis
Rheumatoid Arthritis
Etiology/pathophysiology• Most serious form of arthritis• Chronic, systemic disease• Most common in women of childbearing age• Autoimmune disorder, but may also be genetic• May affect lungs, heart, blood vessels, muscles,
eyes, and skin• Chronic inflammation of the synovial membrane of
the diarthrodial joints (movable)
Rheumatoid Arthritis
• Characteristics– Symmetrical joint swelling– Joint swelling rather than bony enlargement
(osteoarthritis)– Permanent deformity as result of inflammatory
process
Rheumatoid Arthritis
• Clinical manifestations/assessment• Characterized by periods of remission and exacerbation
– Exacerbations increased by physical, emotional stress• Muscle weakness• Malaise• Loss of appetite• Generalized aching• Edema and tenderness of joints• Limited range of motion (morning stiffness)
Figure 44-7
(From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.)
Rheumatoid arthritis of hands.
Rheumatoid Arthritis
• Clinical manifestations/assessment– Inflammation, tenderness, swelling of joints– Moderate to severe pain; morning stiffness lasting
longer than 30 min– Joint deformities– Spongy, soft feeling to joints– Low grade temperature, fatigue, weakness– Anorexia, weight loss, anemia
Rheumatoid Arthritis
• Diagnostic tests• Radiography studies show loss of articular cartilage and
change in bone structure• Laboratory tests
– Erythrocyte sedimentation rate (ESR)– Rheumatoid factor (RF)– Latex agglutination test– Synovial fluid aspiration
Rheumatoid Arthritis
• Medical management/Nursing Interventions• Medications• Rest: 8-10 hours of sleep a night• Exercise: Range of motion 2-3 times per day;
balance rest/activity• Heat: Hot packs, heat lamp, and/or hot paraffin• Rehabilitation: splints to prevent deformity • Surgical intervention-joint replacement
Rheumatoid Arthritis
• Goals for Treatment– Control of Disease (Medications)– Pain Relief (Medications, nrsg interventions)– Prolong Joint Function (Physical Therapy)– Slow Progression of Damage (Healthy Lifestyle,
Exercise, Weight Loss)
Ankylosing Spondilitis
– Etiology/pathophysiology• Chronic, progressive disorder of the sacroiliac and
hip joints, the synovial joints of the spine, and the adjacent soft tissues
• Most common in young men• Strong hereditary tendency
– Clinical manifestations/assessment• Pain and stiffness in back; decreased ROM• Elevated temperature; tachycardia; hyperpnea
Ankylosing Spondylitis
– Diagnostic tests• Hemoglobin, hematocrit, ESR, alkaline phosphatase• Radiographic
– Medical management/nursing interventions• Analgesics, NSAIDs• Exercise program: swimming and walking• Surgery: replace fused joints• Maintain spine alignment • Turn, position, and breathing exercises every 2 hours
Degenerative Joint Disease
Osteoarthritis
Osteoarthritis or DJD
• Degenerative Joint Disease- progressive degeneration of joints
• Non-systemic, non-inflammatory• Primary osteoarthritis-cause unknown• Secondary osteoarthritis-caused by trauma,
infection, RA. stress on weight-bearing joints
Osteoarthritis
• Clinical manifestations/assessments– Joint edema, tenderness, instability and deformity– Heberden’s Nodes and Bouchard’s Nodes
• Diagnostic tests– Radiographic studies– Arthroscopy– Arhtrocentesis– Bone Scan
Figure 44-8 Heberden’s Nodes
Heberden’s nodes.
(From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.)
Bouchard’s Nodes
Osteoarthritis
• Medical management/nursing interventions– Exercise balanced with rest – Heat applications– Gait enhancers (walkers, canes, etc.)– Medications-ASA, NSAIDS, steroids– Surgery-osteotomy (bone cut to correct joint
deformity), joint replacement
Nursing Considerations
• Goals: – Encourage patient to maintain ADLs– Adapt to limitations of the disease
• Reminders to older people with cognitive impairment to move, turn, etc.
• Weight reduction if obesity a problem• Splint support – check for fit and potential
pressure areas
Nursing Considerations
• If long-term anti-inflammatory med use: stool guiac and/or emesis guiac
• Gait enhancers – for safety – Rubber tips on ends of mobility devices – walkers,
canes– Proper size– Pt. knowledge re: use
Gout• Metabolic disease resulting from excessive uric
acid in blood; urate crystals deposit in joints
• Caused by ineffective metabolism of purines• Primary cause: heredity; disorder of purine metabolism• Secondary cause: certain drugs, complication of
other disease, idiopathic
• More men than women, not before puberty in men, not before menopause in women
Gout
• Clinical manifestations– Excruciating pain– Edema of joints; low grade temp; pruritis– Inflammation (most often in great toe)– Tophi (hard, fairly large irregular shaped deposits
in skin)• Diagnostic Tests
– CBC, ESR, Serum uric acid– X ray, arthrocentesis
Gout
• Medical management/nursing interventions– Medications: Colchicine, phenylbutazone (Butazolidin),
indomethacin (Indocin), corticosteroids, allopurinol (Zyloprim), sulfinpyrazone (Anturane)
– Encourage fluid intake: greater than 2000cc/day!– Monitor I&O
– Bedrest and joint immobilization during acute attacks
– Diet-avoid foods high in purines (wine, cheese, organ meats)
Osteomyelitis• Local or generalized infection of the bone and
bone marrow
• Staphylococci are the most common cause
• Introduced through trauma (injury or surgery) or via the bloodstream from another site in body to bone
• Bacteria invade the bone and degeneration occurs
Osteomeylitis
• Most common cause– Bacterial infection from open fracture
• Also from infected teeth, tonsils, or URI• Common organisms
– Staphylococus aureaus– Pseudomonas– E. Coli
Osteomyelitis
Osteomyelitis
Osteomyelitis
• Clinical manifestations– Persistent, severe and increasing bone pain– Wound draining purulent fluid– S/S of infection-fever, tachycardia, tachypnea– Edema of affected area
• Diagnostic tests– Radiographic studies; bone scan– CBC, ESR, cultures of blood and drainage
Osteomyelitis
• Medical management/nursing interventions– Broad spectrum antibiotic therapy– Surgical removal of necrotic bone– Absolute rest of affected area– Wound care: irrigation of area with H2O2 or antibiotic
solution and cover with sterile dressing– Drainage and secretion precautions– Diet: high in calories protein and vitamins
Fibromyalgia
• Etiology/pathophysiology• Musculoskeletal chronic pain syndrome• Fatigue and sleep disturbances• Multiple tender points-back of head, upper
back of head and neck, upper chest, elbows, hips and knees
• Unknown etiology, more common in women than in men
Fibromyalgia
• Clinical manifestations/assessment– Generalized aching– Irritable bowel syndrome– Tension headache– Paresthesia of upper extremities– Sensation of edematous hands
Fibromyalgia
• Diagnostic tests– No specific diagnostic tests can diagnose FMS
• Medical management/nursing interventions– Patient education and reassurance– Tricyclic antidepressants– Exercise– Relaxation techniques
Lyme Disease
– Caused by bacterium Borrelia burgdoferi; transmitted to humans by bite of blacklegged tick
– – Symptoms include: fever, HA, characteristic rash
called erythema migrans
– If not treated, can spread to joints, heart and nervous system
Lyme Disease
• Diagnosis based on symptoms, physical findings (e.g. rash) and possibility of exposure to infected ticks
• Treatment involves several weeks of antibiotics
• Prevention: insect repellant, remove ticks promptly, pest management
Other Musculoskeletal Disorders
OSTEOPOROSIS
• Reduction of bone mass• Most common: women ages 55-65• Contributing Factors:
– Immobilization– Steroids– High intake caffeine– Diet low in calcium, high in protein– Smoking– Sedentary lifestyle
OSTEOPOROSIS
• Hormonal influence– Postmenopausal osteoporosis
• Poss. related to estrogen deficiency– Influences bone resorption and sensitivity to
parathyroid hormone - i.e. parathyroid hormone weakens the bone by increasing calcium movement from bone into extracellular fluid.
OSTEOPOROSIS
• Clinical Manifestations– Backache– Porous and brittle bones– Dowager’s hump
• Subjective Data: lifestyle pracitices; pain c/o• Objective Data: observable deformities; gait
impairment; inability to maintain erect posture
OSTEOPOROSIS
• Medical Management– Lab work: serum calcium, phosphorus, alkaline
phosphatase; CBC; BUN, Cr., UA; liver and thyroid function– Bone Mineral Density (BMD) Test– Medication/supplements: (See p. 129 Table 4-6)
• Calcium Supplements, Vitamin D• Weight bearing exercises• Estrogen, Biphosphanates (Fosamax, Boniva)• Parathyroid hormone
– Diet: milk, dairy; limit caffeine, low animal protein (red meat) and low sodium
OSTEOPOROSIS
• Medications:– Biphosphonates: (Fosamax, Actonel, Boniva)
• Taken after arising in A.M. with full glass of water• No eating or drinking for 30 min. after taking med• Remain upright for 30 min. after taking med
– Estrogen Receptor Modulator (Evista)• Mimic effect of estrogen on bone by reducing bone resorption
– Teriparatide (Forteo)• Stimulates new bone formation• Used to treat osteoporosis in men and post menopausal
women at high risk for fx.
OSTEOPOROSIS
• Treatment Dowager’s Hump:– Surgical Interventions
• Kyphoplasty: a balloon is used to separate the vertebrae then bone cement is injected to fill the space
• Vertebroplast: bone cement is injected between the vertebrae without separating the vertebrae
