nursing of adult patients with medical & surgical conditions musculoskeletal disorders

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  • Nursing of Adult PatientswithMedical & Surgical ConditionsMusculoskeletal Disorders

  • AssessmentScoliosisLateral curvature of the spine

  • AssessmentKyphosisA rounding of the thoracic spineHump-backed appearance

  • AssessmentLoradosisAn increase in the curve at the lumbar region

  • AssessmentBlanching TestCapillary nail refillSignals circulation statusCompress each fingernail or toenail, release the pressure, and note how quickly the pink color returns to the nail bed.Should return to normal color within 2 seconds

  • Diagnostic TestsMyelogramInjection of a radiopaque dye into the subarachnoid space at the lumbar spine to determine the presence of herniated disk or tumors.Assess for allergies to iodine and seafoodOil-based dyeRemoved to prevent meningeal irritation Flat for 12 hours (keeps air space in lower spine)Water-soluble dyeNot removed; absorbed by bodySemi-fowlers position for 8 hours (keeps dye in lower spine)Encourage fluids to assist with absorption of dye

  • Diagnostic TestsNuclear ScanningGiven a low dosage of radioactive isotopesScanner or camera detector is used to record imagesNursing MeasuresWritten consentInforming the patient about radioacive isotopes; will not affect othersFollow instrucitions by nuclear medicine dept.

  • Diagnostic TestsMagnetic Resonance ImagingInvolves the use of magnetism and radio waves to make images of cross sections of the bodyGives detailed picture of fluid filled soft tissue and blood vesselsPatient must remove any metal objectspatients with metal prosthesis (heart valves, othopedic screws) cannot undergo and MRISedatives may be given for anxiety due to claustrophobia

  • Diagnostic TestsComputer Axial Tomography (CAT scan)3-D picture of the structure (Soft tissue & bones)More sensitive than standard x-raysIodine contrast may be usedNursing MeasuresWritten consentAsk about allergies to iodine and seafoodNPO 3-4 hours before testBaseline vital signsRemove jewelry, etc.Teach pt. about procedure

  • Computer Axial Tomography (CAT scan)

  • Diagnostic TestsBone ScanDetects metastatic and inflammatory bone diseaseRadioisotopes administered IV 2-3 hours before testEncourage fluidsA scanning camera is used to reveal the degree of uptakeAreas of uptake may indicate a tumor or other abnormality

  • Diagnostic TestsArthroscopyDirect visualization of a jointexploration of jointdrainage of fluid from the jointremoval of damaged tissue or foreign bodiesInvolves insertion of a large-bore needle into the suprapatellar pouch.Patient may be given a general or local anesthetic Activities may be limited for several days

  • Diagnostic TestsSynovial Fluid AspirationThe puncture of a joint with a needle and the withdrawal of synovial fluidUsed for diagnosis of trauma, systemic lupus, gout, osteoarthritis, and rheumatoid arthritisNormally straw colored, clear, or slightly cloudyAfter proceduresupport extremityjoint rest for 12 hoursice to joint for 24 - 48 hoursassess for s/s of infection

  • Diagnostic TestsElectromyogram (EMG)Insertion of needle electrodes into the skeletal muscles to record the electrical activityMuscles do not produce electrical charge at restUnusual patterns may be observed for neuropathy and myopathy

  • Rheumatoid ArthritisEtiology/PathophysiologyMost serious form of arthritisChronic, systemic diseaseMost common in women of childbearing ageAutoimmune disorder, but may also be geneticAgents that should protect the body attack joint tissuesCan affect lungs, heart, blood vessels, muscles, eyes and skinChronic inflammation of the synovial membrane of the diarthrodial joints (movable)

  • Rheumatoid ArthritisSigns & SymptomsCharacterized by periods of remission and exacerbationMalaiseMuscle weaknessLoss of appetiteGeneralized achingEdema & tenderness of jointsLimited range of motion (morning stiffness)

  • Rheumatoid Arthritis

  • Rheumatoid ArthritisDiagnostic TestsRadiography studies show loss of articular cartilage and change in bone structureLaboratory TestsErythrocyte Sedimentation Rate (ESR)increase indicates inflammationRheumatoid Factor (RF)elevation indicates abnormal serum protein concentrationLatex agglutination testdetects presence of IgM version of rheumatoid factor (anti-IgG antibodies)Synovial fluid aspirationfluid is cloudy, yellow, less viscous and increased protein

  • Rheumatoid ArthritisTreatmentMedicationsSalicylates (Aspirin)Nonsteroidal Anitinflammatory Drugs (NSAIDs)indomethacin (Indocin)ibuprofen (Motrin)naproxen (Naprosyn)piroxicam (Feldene)nabumetone (Relafen)Potent Antiinflammatory Agentsadrenocorticosteroids (prdnisone)phenylbutazone (Butazolidin)Slow-Acting Antiinflammatory Agents (6-12 mo.)hydroxychloroquine (Plaquenil)

  • Rheumatoid ArthritisRest8-10 hours of sleep a night; 2 hour nap during dayExerciseRange of motion 2-3 times per dayprevents joints from freezing and muscles from weakeningHeatHot packs, heat lamp, and/or hot paraffinRelaxes and soothes musclesRehabilitationHelp pt. to adapt to physical limitaions and promoting normal daily activities

  • Rheumatoid ArthritisPrognosisRemissions and exacerbations are commonDisease normally progresses to include joint deformity, extensive muscle atrophy, soft tissue lesions, bone and cartilage destruction, and fibrous or bony ankylosis (fixed joints)

  • Ankylosing SpondylitisEtiology/PathophysiologyChronic, progressive disorder of the sacroiliac and hip joints, the synovial joints of the spine, and the adjacent soft tissues.Most common in young menStrong hereditary tendency

  • Ankylosing SpondylitisSigns & SymptomsLow back pain and stiffnesssciatica pain lasts for a few days then subsidesworse when standingMay also affect joints in the neck, jaw, shoulders, knees, and hipsDecreased ROMElevated temperatureTachycardiaHyperpnea

  • Ankylosing Spondylitis

  • Ankylosing SpondylitisDiagnostic TestsHemoglobin and HematocritLow due to anemiaESRelevated due to inflammationSerum alkaline phosphatase elevated due to immobilizationRadiographicreveals sacroiliac joint and intervertebral disk inflammation with bony erosion and joint space fusion

  • Ankylosing SpondylitisTreatmentAnalgesicsNSAIDsExercise programswimming and walkingSurgeryreplace fused jointsMaintain spine alignmentfirm mattressbed boardback braceBreathing exercisesTurn and position every 2 hours

  • Ankylosing SpondylitisPrognosisChronic diseaseLasts about 20 years leaving permanent damage

  • Degenerative Joint Disease (Osteoarthritis)Etiology/PathophysiologyNonsystemic, noninflammatory disorder that progressively causes bones and joints to degeneratePrimaryCause is unknownSecondaryCaused by trauma, infections, previous fractures, rheumatoid arthritis, stress on weight-bearing joints.

  • Degenerative Joint Disease (Osteoarthritis)

  • Degenerative Joint Disease (Osteoarthritis)Signs & SymptomsJoint edema, tenderness, instability, and deformityHeberdens Nodesnodules on the sides of the distal joints of fingers

    Bouchards Nodesnodules on the proximal joints of fingers

  • Degenerative Joint Disease (Osteoarthritis)

  • Degenerative Joint Disease (Osteoarthritis)Diagnostic TestsRadiographic studiesArthroscopySynovial fluid examinationBone scans

  • Degenerative Joint Disease (Osteoarthritis)TreatmentExercise balanced with restHeat applicationsGait enhancers (canes, walkers, etc.)MedicationsSalicylates (aspirin)NSAIDs (Motrin)Steriods (cortisone)SurgeryOsteotomyJoint replacement

  • Degenerative Joint Disease (Osteoarthritis)PrognosisChronic disease that ultimately causes permanent destruction of affected cartilage and underlying bone.

  • Gout (Gouty Arthritis)Etiology/PathophysiologyMetabolic disease resulting from an accumulation of uric acid in the bloodCaused by an ineffective metabolism of purinesPrimaryhereditary factorsSecondaryuse of certain drugs, complication of other diseases, or idiopathicAffects men more frequently than womenDoes not occur before puberty in the male or before menopause in the female

  • Gout (Gouty Arthritis)Signs & SymptomsExcruciating painEdemaInflammationMost common in the great toeTophicalculi deposits

  • Gout (Gouty Arthritis)

  • Gout (Gouty Arthritis)Diagnostic TestsSerum and uric acid levelsComplete blood countESRRadiography studiesreveal cysts Synovial fluid aspirationcontain urate crystals

  • Gout (Gouty Arthritis)TreatmentMedicationscolchicine decreases uric acidphenylbutazone (Butazolidin)indomethacin (Indocin)antiinflammatorycorticosteroidsallopurinol (Zyloprim)decreased the production of uric acid sulfinpyrazone (Anturane)increases secretion of uric acid by the kidneys

  • Gout (Gouty Arthritis)Encourage fluid intakeat least 2000 cc/dayMonitor intake and outputBed rest and joint immobilizationDietAvoid high purine foodsorgan meatsanchoviesyeastherringmackerelscallops

  • Gout (Gouty Arthritis)PrognosisSigns and symptoms are usually recurrentCan progress to destructive joint changes

  • OsteoporosisEtiology/PathophysiologyReduction of bone massMost common in women ages 55-65possibly related to lack of estrogenContributing FactorsImmobilizationUse of steroidsHigh intake of caffeineDiet low in calciumSmokingExcessive protein in dietSedentary lifestyle

  • Osteoporosis Magnification of:Healthy Bone Bone with Osteoporosis

  • OsteoporosisSigns & SymptomsBackacheespecially in the thoracic and lumbar regionsworse with sitting, standing, coughing, sneezing, and strainingBones porous and brittlepathological or spontaneous fracturesDowagers humpsp

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