Professional Documents
Culture Documents
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
Musculoskeletal System
C. MANAGEMENT
Talipes valgus
foot turns out
Talipes varus
foot turns in
A. ASSESSMENT
1. Early detection
2. Straighten all newborn feet to midline as part of
initial assessment
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
4
MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
G. OSTEOGENESIS IMPERFECTA
connective tissue disorder: fragile bone
formation recurring pathologic fractures
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
TYPE 2: A.R.
assoc deafness & dental deformities
No treatment is curative
preventive & safety measures
Growth Hormone
Calcitonin
Biphosponates
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
A. ASSESSMENT
1. persistent fever & rash joint involvement Nursing Diagnosis for Juvenile Rheumatoid Arthritis
2. medical diagnosis Deficient knowledge related to care necessary to
3. Nursing Assessment: control disease symptoms
a. Effect on Individual & Family
b. Self-care Health Teaching for Juvenile Rheumatoid Arthritis
c. Ex: elevated toilet, Velcro strips Active role in treatment
d. Complications Need for follow-up care
e. Ex: slit lamp examinations q6 months Plan & schedule – balance rest & exercise
B. MANAGEMENT
1. - Long term illness RICKETS
a. Exercise disorder in which mineralization of organic matrix is
b. Heat application defective
c. Splinting assoc with Vit D deficiency or resistance
d. Nutrition growing skeleton; defective mineralization both in
e. Medications bones and cartilage
2. Exercise: Rationale – to preserve muscle and joint vs. Osteomalacia – mineralization disorder in adults
function in whom epiphyseal growth plates are closed
a. Daily ROM exercises Bowing deformities, knocked knees
b. Incorporate into dance routine or game Stunting of growth of long bones
c. Family participation Severe muscle weakness
d. Avoid excessive strain on joints
Running A. PATHOPHYSIOLOGY
Jumping 1. Disorders causing alteration of Vit D nutrition or
Prolonged walking metabolism or phosphate wasting
Kicking 2. Hypovitaminosis D
Shortened school day – fatigue easily; 3. Inadequate prod. Vit D3 in skin
start midmorning 4. insufficient dietary supplementation
3. Heat application: 5. inability of small intestine to absorb Vit from diet
4. Rationale – reduces pain & inflammation, increases 6. resistance to effects of Vit D
comfort & motion drugs which interfere w/ Vit D action
a. Warm water soaks 20-30 min 7. anticonvulsants, glucocorticoids
b. Paraffin soaks for finger & wrists alteration in Vit D metabolism
5. Splinting: rarely prescribed because of more 8. Chronic renal failure
effective NSAIDS 9. Intoxication cadmium, lead, expired tetracycline
6. Nutrition: Altered nutrition related to chronic pain
a. GIT irritation – NSAIDS B. SIGN AND SYMPTOMS
b. Plan mealtimes 1. Skeletal deformities – children unable to walk
7. Medications 2. Susceptibility to fractures
c. Tolmetin 3. Weakness & hypotonia
d. Naproxen 4. Growth disturbances
e. Ibuprofen 5. CRANIOTABES: soft calvariae, widening of
f. Celecoxib less GIT irritation sutures
g. Rofecoxib 6. RACHITIC ROSARY: prominence of
h. NSAIDS: reduce/control pain & inflammation costochondral junctions
6-8 wks
Health teachings:
GIT irritation (w/
meals)
Give even if w/o pain
to exert anti-
inflammatory action
i. SAARDs (Slow Acting Anti-Rheumatic drugs)
j. DMARDs (Disease Modifying Anti-Rheumatic
drugs)
Ex. Gold salts, Penicillamine,
Hydroxychloroquinine
k. Cytotoxic Drugs: side effects
Cyclophosphamide
Chlorambucil
Methotrexate
l. Steroids
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
7. HARRISON’S GROOVE: indentation of lower family history = 30% but no specific inheritance
ribs at site of attachment of diaphragm pattern
5x more girls > boys
Peak incidence 8-15 y/o
Most marked during pre-puberty (rapid growth)
C. TREATMENT
1. Vit D2 (Ergocalciferol) 800-4000 IU
2. Vit D3 (Cholecalciferol) (0.02-0.1 mg) daily for 6-
12 wks followed by 200-600 IU daily
3. Calcium supplements Uneven Shoulders
Curve in Spine
Uneven hips
COMMON HEALTH PROBLEMS OF THE ADOLESCENT A. ASSESSMENT
1. Bra straps adjusted to unequal length
2. Difficulty buying jeans
I. SCOLIOSIS 3. Skirts & dresses hang unevenly
lateral curvature of spine 4. Bend forward
may involve all or only a portion of SC 5. Scoliometer: reading >7° ≈ 20°
may be functional (2°) or structural (1° deformity) 6. PPT
I. FUNCTIONAL SCOLIOSIS 7. Chest Xray
II. STRUCTURAL SCOLIOSIS
B. MANAGEMENT
I. FUNCTIONAL SCOLIOSIS 1. Scoliosis (Long term)
compensatory mechanism related to unequal leg 2. <20° = no treatment; close observation until 18y/0
length, EOR constantly tilt head sideways 3. >20° = conservative non-surgical treatment, body
pelvic tilt related to unequal leg length & head brace, traction
tilt spinal deviation 4. >40° = surgery, spinal fusion
C shaped curve - little change in shape of 5. Bracing > 20° - 40° skeletally immature
vertebrae 6. Milwaukee brace (Thoracolumbar support)
THERAPEUTIC MANAGEMENT of Functional 7. worn under clothing
Scoliosis 8. worn 23H/day
1. correct the difficulty causing spinal curvature 9. at night Charleston Bending brace
2. unequal leg length (as is to medial malleolus) 10. Milwaukee Brace
3. shoe lift
4. correct EOR
5. maintain good posture
6. sit-ups, pushups, swimming
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
A. ASSESSMENT
11. Braces 14 ½ y/o ♀ 1. usually taller children (rapid bone growth)
16 ½ y/o ♂ 2. pain & swelling at tumor site
3. History of recent trauma not the cause
12. Halo Traction 4. Pathologic fracture
5. Diagnostic biopsy
6. ↑ alkaline phosphatase fm rapidly growing bone cells
7. Metastatic workup
CBC, UA
CXR
Chest CT Scan
Bone scan
C. NURSING MANAGEMENT
I. OSTEOGENIC SARCOMA 1. Post-op: swelling disrupting neurologic & circulatory
malignant tumor of long bone involving rapidly function
growing bone tissue 2. proper position
more commonly in boys > girls 3. monitor
common sites Capillary refill < 5s
Distal femur (40-50%) (-) numbness & tingling
Proximal tibia (20%) Warm, pink
Proximal humerus (10-15%) 4. Post-op: Phantom Pain Syndrome
History of radiation 5. Nerve trunks continue to report pain
Early metastasis 2° to ↑vascularity of bones 6. Need analgesics!
Lungs – 25% brain, other bones
Chronic cough
Dyspnea
Chest pains COMMON HEALTH PROBLEMS OF ADULT
Leg pains
A. PATHOPHYSIOLOGY
1. Phagocytosis produces enzymes within joint
2. Enzymes break down collagen
1. Edema
2. Proliferation of synovial membrane
3. Pannus formation
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
II. GOUT
Stages of Gout
a. Asymptomatic Hyperuricemia
b. Acute Gouty Arthritis
c. Intercritical Gout
d. Chronic Tophaceous Gout
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
F. SURGICAL MANAGEMENT
1. use of heat
2. weight reduction
3. joint rest
4. avoidance of joint overuse
5. orthostatic devices (splints, braces)
6. isometric and postural exercises
7. aerobic exercises
8. OcTherap and PhysTher
9. Osteotomy- to alter the force distribution of the
joint
10. Arthroplasty- to replace diseased joint
C. PATHOPHYSIOLOGY compnonents
11. Viscosupplemetation-reconstitution of joint fluid
viscosity using hyaluronic acid
Genetic and Mechanical Previous joint
hormonal injury damage 12. (Hyalgan, Synvise Rx)
factors 13. Tidal Lavage of Knee – stimulate production of
Others synoviocytes
14. Approximately 6 months pain relief
Chondrocyte response G. NURSING MANAGEMENT
1. Pain management
Release of cytokines 2. Optimizing functional ability
3. Pt referral
4. Lifestyle changes
Stimulation, production and release of proteolytic 5. Planning daily activities
enzymes, metalloproteases, collagensase
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
I. FRACTURE
FRACTURE- break in the continuity of bone and
adjacent structures
soft tissue edema
hemorrhage into muscles and joints
joint dislocation
ruptured tendons
severed nerves
damaged blood vessels
body organ damage secondary to force or fracture
fragments A. CLINICAL MANIFESTATIONS
1. pain
Types of fractures 2. loss of function, abnormal movement
1. Complete break across entire cross section of bone 3. deformity: displacement, angulation, rotation,
(displacement) swelling – VISIBLE or PALPABLE
2. Open, Compound, Complex skin or muscle 4. shortening- 2.5-5cm r/t contraction of muscles
extends thru fractured bone 5. crepitus – grating sensation
a. Grade I clean wound <1cm 6. swelling and discoloration
b. Grade II larger wound without extensive soft
tissue damage B. MANAGEMENT
c. Grade III highly contaminated OPEN FRACTURE
d. Compressed – bone has been compressed 1. cover wound with a clean / sterile dressing
(ie. Vertebral fractures) 2. do not attempt to reduce fracture
3. Depressed- fragments driven inwards 3. ASSESS NEUROVASCULAR STATUS DISTAL
e. (ie. Skull and facial bones) TO INJURY
4. Epiphyseal- fracture thru epiphysis
5. Impacted- bone fragment is driven thru another C. MEDICAL MANAGEMENT
bone fragment 1. Reduction “setting the bone”
6. Pathologic- occurs thru an area of diseased bone 2. restore the fracture fragments to anatomical
7. Stress- results from repeated loading without bone alignment and rotation
and muscle recovery OPEN
8. Incomplete (greenstick) break thru only part of CLOSED
cross section of bone 3. early Fracture reduction, gentle manipulation
9. Transverse-fracture straight across the bone 4. Nursing consideration written consent / analgesia
10. Closed (simple)- no break in skin
CLOSED REDUCTION
-bring bone fragments into apposition (ends in
contact) via
a. manipulation
b. traction and counter traction (thru patients
weight and bed position)
c. splint or cast
d. x-rays
e. traction (skin or skeletal) for fracture
reduction/ for fracture immobilization
PRINCIPLES OF TRACTION
1. traction must be continuous to be effective
2. skeletal muscle traction is never interrupted
3. do not remove weights unless intermittent is
prescribed
11. Oblique occur at an angle across the bone (less 4. eliminate any factor that reduces effective pull or
stable than transverse) alter resultant line of pull
12. Comminuted one that produces several bone good body alignment in center of bed
fragments ropes unobstructed
13. Spiral fracture that twists around shaft of bone weights should hang free
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MS Abejo
Medical and Surgical Nursing
Musculoskeletal Disorder
Prepared: Mark Fredderick Abejo RN, MAN
LEVEL OF AMPUTATION
1. circulation
2. functional usefulness (prosthesis)
COMPLICATIONS OF AMPUTATION
1. hemorrhage
2. infection
3. skin break down
4. phantom limb: r/t severing of peripheral nerves
5. joint contracture: r/t positioning and protective
flexion withdrawal pattern associated with pain and
muscle imbalance
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MS Abejo