Chronic Musculoskeletal Conditions

Assessment & Management

Quarter 3, Week 8, AY2015-16
Prepared by: Louel Bornie S. Baguio RN, MAN
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Intended learning outcomes:

By the end of this week the students will be able to:
Explain the pathophysiology, prevention and management
of the common chronic musculoskeletal disorders.
Describe the assessment and diagnostic findings for each
disorder.
Use the nursing process as a framework for care of patients
with musculoskeletal disorders.
Discuss the nursing management, and health education
needs of the patient with musculoskeletal disorders.
Develop strategies for critical thinking to deal with difficult
situation
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Characteristics of bone
Support and protect structures of the
body
Provide attachments for muscles,
tendons, and ligaments
Contain tissue in the cavities, which aids
in the formation of blood cells
Assist in regulating calcium and
phosphate concentration
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Types of joints
Type

Description

Amphiarthosis

Cartilaginous joint
Slightly movable

Condyloid

Freely movable
Allows frictionless, painless movement

Diarthrosis

Synovial joint
Ball-and- socket joint

Synarthosis

Fibrous or fixed joint

No movement associated with these joints
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Characteristic of Joints

Allow movement between bones

Formed where two bones join
Surfaces are covered with cartilage
Enclosed in a capsule (Synovial joints)
Contain a cavity filled with synovial fluid
Ligaments hold the bone and joint in the
correct position
Articulation is the meeting point of two or more
bones.
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Range of Motion

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Muscles
Characteristics of muscles
Made up of bundles of muscle fibers
Provide the force to move bones
Assist in maintaining posture
Assist with heat production

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Diagnostic Tests

Radiography
Arthrocentesis
Arthrography
Arthroscopy
Bone Densitometry
Bone scan
biopsy
Electromyography (EMG )
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Fractures
Is a complete or incomplete disruption
in the continuity of bone structure and is
defined according to its type and extent
Occurs when the bone is subjected to
stress greater than it can absorb.
Can cause by direct blows, crushing
force, sudden twisting motion, and
extreme muscle contraction.
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Types of fractures
1. Complete fracture: break across the entire cross-section of the
bone and is frequently displaced
2. Incomplete fracture: (green stick fracture) the break occur through
only part of the cross-sectional of the bone
3. A comminuted fracture: fracture has several bone fragments
4. Closed fracture: simple fracture does not produce a break in the
skin
5. open fracture (compound, complex fracture): is one in which the
skin or mucous membrane wound extends to the fracture bone

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Types of Fractures

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Types of Fractures

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Types of Fractures

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Open fractures are graded as:

Grade I: clean wound less than 1 cm

Grade II: larger wound without extensive soft tissue
damage
Grade III: is highly contaminated, has extensive soft
tissue damage, and is the most severe.
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Clinical Manifestations
Pain or tenderness
loss of muscular function
Deformity of affected area
Shortening of the extremity
Crepitus
Localized edema and ecchymosis
Diagnosis: MRI, Arthroscopy.
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Emergency Management
Immobilize the body part
Splinting: joints distal and proximal to the suspected fracture
site must be supported and immobilized
Assess neurovascular status before and after splinting
Open fracture: cover with sterile dressing to prevent
contamination
Do not attempt to reduce the fracture

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Medical Management
Reduction
Closed
Open

Immobilization: internal or external fixation

Maintaining and restoring function:
-edema
-neurovascular status (circulation, motion & sensation)
-restlessness, anxiety & discomfort.
-Isometric & muscle-setting exercise
-encourage pt. to participate in ADLs
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Intervention for a fracture:

1. Reduction:
Fracture reduction refers to restoration of the fracture
fragments to anatomic alignment and positioning.
Closed reduction: is accomplished by bringing the bone
fragments into anatomic alignment through manipulation and
manual traction.
Traction (skin or skeletal) may be used until the patient is
physiologically stable to undergo surgical fixation.
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Intervention for a fracture:

closed reduction
Traction:
Is the exertion of a pulling force applied in two directions to reduce and
immobilize a fracture
It provides proper bone alignment and reduces muscle spasms.
Interventions:

Traction must be continuous to be effective

Skeletal traction is never interrupted
Weights are not removed unless intermittent traction is prescribed.
The patient must be in good body alignment
Ropes must be unobstructed.
Weights must hang freely and not rest on the bed or floor.
Knots in the rope or the footplate must not touch the pulley or the foot of the bed.
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Closed reduction
Skin Traction

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Skeletal Traction

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Types of traction
Skeletal traction: applied
mechanically to the bone with
pins, wires, or tongs (wt.: 25-40 Ib)
Skin traction: using elastic
bandages or adhesive, foam
boot, or sling (Russells skin).
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Intervention for a fracture:

closed reduction

Casts
Plaster or fiberglass casts are used to immobilize bones and joints
into correct alignment after a fracture or injury
Intervention:
Keep the cast and extremity elevated
Allow a wet plaster cast 24 -72 hrs. to dry (synthetic cast needs
20 mints to dry)
Handle a wet plaster cast with the palms of the hands until dry
Turn the extremity every 1-2 hrs., unless contraindicated
A hair dryer can be used
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Closed reduction
Long-Arm and Short-Leg Cast and Common Pressure
Areas

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Open reduction:
Through a surgical approach, the fracture fragments
are anatomically aligned.
Internal fixation devices (metallic pins, wires, screws,
plates, nails, or rods) may be used to hold the bone
fragments in position until solid bone healing occurs.

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Open reduction: Techniques

of Internal Fixation
A. Screws Plate & six
screws for a
transverse/ short
oblique fracture
B. for oblique/ spiral
fracture.
C. Screws for a long
butterfly fragment
D. Plate & six screws for
a short butterfly
fragment
E. Medullary nail for a
segmental fracture
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Open reduction: External

Fixation Devices

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Nursing Management
Patients with closed fractures: teach pt. to
-control edema & pain
-using assistive devices such as crutches, walkerssafely.
Patients with open fractures:
Open fractures require treatment to prevent infection
Tetanus prophylaxis, antibiotics, and cleaning and
debridement of wound
Closure of the primary wound may be delayed to permit
edema, wound drainage, further assessment, and
debridement if needed
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ASSIGNMENT

Please read and discuss the

nursing management for pt. with
closed and open fractures
- Pages:2025, 2033-2035, 2087

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Question
Is the following statement True or False?
Testing for crepitus can produce further tissue damage and
should be avoided.

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Answer
True
Testing for crepitus can produce further tissue damage and
should be avoided.

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Factors enhancing fracture healing:

1.Immobilize of fracture fragments
2.Maximum bone fragment contact
3.Sufficient blood supply
4.Proper nutrition
5.Exercise: wt. bearing for long bone
6.Hormones: growth hormone, thyroid, calcitonin, Vit. D
7.Electric potential across fracture
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Factors inhibiting fracture healing

1.Extensive local trauma, Bone loss, inadequate immobilization
2.Space/tissue between bone fragments, infection
3.Local malignancy, Metabolic bone disease
4.Irradiated bone (radiation necrosis)
5.Avascular necrosis
6.Intra-articular fracture
7.Age
8.Corticosteroids (inhibit the repair rate)

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Complications of Fractures
Early complications:
Shock
Fat embolism syndrome
Compartment syndrome
Delayed complications:
Delayed union, malunion, and nonunion
Avascular necrosis of bone
Reaction to internal fixation devices
Complex regional pain syndrome (CRPS)
Heterotrophic ossification
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Fracture Complications

Early complications:

1. Shock: Hypovolemic or traumatic shock

result from bleeding or from loss of extracellular fluid

Treatment:
1. Restoring blood volume and circulation
2. Relieving patient pain
3. Provide adequate splinting.

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Fat Embolism Syndrome

Pathophysiology
Bone fracture results in a rise of pressure in the bone
marrow
Fat globules enter the bloodstream
Combine with platelets
Travel throughout the body
Occluding small blood vessels
Causes tissue ischemia
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Fat Embolism Syndrome

Manifestations

Hypoxia, tachycardia, tachypnea, & pyrexia.

edema and hemorrhage in the alveoli
ARDS
Treatment
Intubation and mechanical ventilation
Fluid balance
Corticosteroids
Vasopressor medication
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Compartment Syndrome
develop when tissue perfusion in the muscles less than that
required for tissue viability.
Physiology
Entrapment of the blood vessels limits tissue perfusion
Results in edema within the compartment
Edema causes further pressure
Early Manifestations
Deep Pain which is not controlled by opioids
Normal or decreased peripheral pulse
Later Manifestations
Cyanosis
Paresthesia, paresis
Severe pain

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Cross-Sections of Anatomic Compartments

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Wick Catheter Used to Monitor Compartment

Pressure

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Assessment:
Assess neurovascular function, focus on the five
Ps: pain, paralysis, paresthesia, pallor &
pulslessness.
Treatment
Interventions to alleviate pressure
Removal of the cast
Fasciotomy
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Other early complications:

DVT
PE
DIC

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Delayed Complications
1. Delayed Union: Delay healing, which result from
infection and distraction of bone fragment, poor
nutrition

2. Nonunion: failure of the ends of the fractured bone

to unite, pt. complain of discomfort and abnormal
movement at the fracture site. Managed by internal
fixation or grafting
Result from infection, interposition of tissue
between the bone ends, inadequate immobilization,
excessive space, and impaired blood supply
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Cont.

-Avascular necrosis of the bone:

Bone loses its blood supply & dies.

-Reaction to internal fixation device:
Pain & decreased function
-Complex regional pain syndrome:
Painful SNS problem
-Heterotopic ossification:
Abnormal formation of bone
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Question
Is the following statement True or False?
Avascular necrosis is prolongation of expected healing time
for a fracture.

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Answer
False
Avascular necrosis is death of tissue secondary to poor
perfusion and hypoxemia. Delayed union is prolongation
of expected healing time for a fracture.

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Low Back Pain

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Causes of low back pain

Acute lumbosacral strain

Unstable lumbosacral ligaments & weak muscles
Osteoarthritis of the spine
Spinal stenosis
Intervertebral disk problem
Unequal leg length
Obesity, stress, & depression
Kidney disorders, pelvic problems, retroperitoneal tumors &
abdominal aortic aneurysms
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Pathophysiology
The spinal column----providing maximum protection for the
spinal cord.
The spinal curves absorb vertebral shocks from running &
jumping
The abdominal & thoracic muscles are important in lifting
activities, working to minimize stress on the spinal units.
Disuse weakens these supporting muscular structures.
Obesity, postural problems, structural problems, &
overstretching of the spinal supports may result in back
pain
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Clinical Manifestations

Acute back pain : lasting less than 3 months

Chronic back pain: lasting more than 3 months.
Fatigue
Radiculopathy or sciatica: pain radiating down to leg
(indicate nerve root involvement)
The patients gait, spinal mobility, reflexes, leg length, leg
motor strength,& sensory perception may affected.
P/E: paravertebral muscle spasm, loss of the normal
lumber curve & spinal deformity
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Assessment and diagnostic findings

History and physical exam
General observation, back examination
Neurologic testing (reflexes, sensory impairment, straightleg raising, muscle strength, & muscle atrophy.

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Diagnostic Procedures for Low Back

Pain
X-ray of the spinefracture, dislocation, infection, osteoarthritis, or scoliosis
Bone scan and blood studiesmay disclose infections, tumors, and bone
marrow abnormalities
Computed tomography (CT)obscure soft tissue lesions adjacent to the
vertebral column and problems of vertebral disks
Magnetic resonance imaging (MRI) visualization of the nature and location of
spinal pathology
Electromyogram (EMG) and nerve conduction studiesused to evaluate
spinal nerve root disorders (radiculopathies)
Myelogrampermits visualization of segments of the spinal cord that may have
herniated or may be compressed
Ultrasounduseful in detecting tears in ligaments, muscles, tendons, and soft
tissues in the back
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Medical Management
Management focuses on:
Relief of pain & discomfort
Activity modification
Patient education

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Continue..
Acute low back pain: Nonprescription analgesic agents such as
acetaminophen (Tylenol) and NSAIDs (eg, ibuprofen [Motrin]) and
prescription muscle relaxants (eg, cyclobenzaprine [Flexeril] )
Chronic low back pain: tricyclic antidepressants (eg, amitriptyline
[Elavil) Opioids (eg, morphine), tramadol (Ultram).
Non pharmacologic interventions:
application of superficial heat and spinal manipulation (eg,
chiropractic therapy). Cognitive behavioral therapy (eg,
biofeedback), exercise regimens, spinal manipulation, physical
therapy, acupuncture, massage, and yoga
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Nursing Process: The Care of the Patient

with Low Back PainAssessment
Detailed description of the pain including severity, duration,
characteristics, radiation, associated symptoms such as leg weakness,
description of how the pain occurred, and how the pain has been
managed by the patient
Work and recreational activities
Effect of pain and/or movement limitation on lifestyle and ADLs
Assess posture, position changes, and gait
Physical exam: spinal curvature, back and limb symmetry, movement
ability, DTRs, sensation, and muscle strength
If obese, complete a nutritional assessment
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Diagnoses

Acute pain
Impaired physical mobility
Risk for situational low self-esteem
Imbalanced nutrition

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Planning
Major goals:
relief of pain, improved physical mobility, use of back
conservation techniques and proper body mechanics,
improved self-esteem, and weight reduction.

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Interventions
Pain management
Exercise
Body mechanics
Work modifications
Stress reduction
Health promotion; activities to promote a healthy back
Dietary plan and encouragement of weight reduction
Chart: 68-2 , Chart: 68-3
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Positioning to Promote Lumbar Flexion

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Proper and Improper Standing Postures

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Proper and Improper Lifting

Techniques

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Question
Is the following statement True or False?
Proper standing posture occurs when the abdominal
muscles contract, giving a feeling of upward pull, and the
gluteal muscles contract, giving a downward pull.

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Answer
True
Proper standing posture occurs when the abdominal
muscles contract, giving a feeling of upward pull, and the
gluteal muscles contract, giving a downward pull.

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Common Upper Extremity Problem

Carpal tunnel syndrome

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Carpal Tunnel Syndrome

Median Neuropathy at the Wrist is a medical condition in which the
median nerve is compressed by a thickened flexor tendon sheath,
skeletal encroachment, edema, or a soft tissue mass.
Occurs in women between 30 and 60 years of age.

Manifestations:
Pain
Numbness and tingling
Paresthesia
Weakness a long the median nerve

Tinels sign
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Tinels SignAssessment of Carpal Tunnel Syndrome

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Treatment
Treating any possible underlying disease or condition.
Research findings suggest that intra articular injections of
corticosteroids (eg, methylprednisolone [Medrol]) or oral
corticosteroids (eg, prednisone) are very effective at relieving
symptoms.
Application of wrist splints to prevent hyperextension and
prolonged flexion of the wrist.
Traditional open nerve release or endoscopic laser surgery are
the two most common surgical management.
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Common Foot Problems

Plantar fasciitis
Corn
Callus
Ingrown toenail
Hammer toe
Hallux valgus
Pes cavus: clawfoot
Mortons neuroma
Flatfoot: Pes planus
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Common Foot Deformities

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Nursing Process: Assessment

Surgery is usually performed as an outpatient procedure

Routine outpatient preoperative assessment
Patient knowledge
Neurovascular assessment of the foot
Ambulation and balance
Explore the need for home assistance and the structural
characteristics of the homefor example, distances
required to walk and presence of stairs or steps
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Nursing Process: Diagnoses

Risk for ineffective peripheral tissue perfusion

Acute pain
Impaired physical mobility
Risk for infection

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Nursing Process: The Care of the Patient

Undergoing Foot Surgery: Planning
Major goals may include adequate tissue perfusion, relief
of pain, improved mobility, and absence of complications.

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Interventions
Neurovascular assessment is vital
Assess swelling and neurovascular status every 12 hours for
the first 24 hours
Instruct patient to assess for edema, and neurovascular status

Reliving pain
Elevate foot
Use of intermittent ice packs
Medications; oral analgesics
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Interventions
Improving mobility
Instruction in weight-bearing restrictions as
prescribed
Use of assistive devices (crutches or walker)
Measures to assure patient safety

Measures to prevent infection

Wound or pin care
Keep dressing clean and dry
Signs and symptoms of infections

Patient teaching
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Question
What is pes cavus?
A. Flexion deformity of the interphalangeal joint that may
involve several toes.
B. Deformity in which the great toe deviates laterally.
C. Common disorder in which the longitudinal arch of the
foot is diminished.
D. Foot with an abnormally high arch and a fixed equinus
deformity of the forefoot.
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Answer
D

Hammer toe is flexion deformity of the interphalangeal joint

that may involve several toes. Hallux valgus is a deformity
in which the great toe deviates laterally. Pes planus is a
common disorder in which the longitudinal arch of the foot
is diminished. Pes cavus is a foot with an abnormally high
arch and a fixed equinus deformity of the forefoot.
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ASSIGNMENT

As a group, discuss patient

education related to self care
after foot surgery
- Page: 2062, chart: 68-6

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Metabolic Bone Disorder

Osteoporosis

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Osteoporosis

Osteoporosis is the most prevalent bone disease in the world.

More than 10 million Americans have osteoporosis and an additional 33.6
million have osteopenia, the precursor to osteoporosis.
The consequence of osteoporosis is bone fracture.
It is projected that 1 of every 2 Caucasian women and 1 of every 5 men will
have an osteoporosis-related fracture (National Osteoporosis Foundation
[NOF], 2008).
The costs incurred from treating osteoporosis-related fractures in the United
States are estimated at $20 billion annually

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Osteoporosis: Pathophysiology

Is characterized by a reduction in the total bone mass and

a changes in bone structure which increases the tendency
for fracture.
The rate of bone resorption is greater than the rate of bone
formation, resulting in a reduced total bone mass.
The bones become porous, brittle, and fragile
Result in compression fractures of the thoracic and lumber
spine, hip fractures, and colles fracture of the wrist

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Osteoporosis:
Pathophysiology
The gradual collapse of a vertebra may be asymptomatic; it is
observed as progressive kyphosis. With the development of
kyphosis (ie, dowagers hump), there is an associated loss of
height.
Loss of bone mass over time due to Aged-related loss:
Decreased calcitonin, decreased estrogen ( which prevent bone
breakdown), parathyroid hormone increases with age result in
increase bone Resorption
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Progressive Osteoporosis Bone Loss and Compression

Fractures

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Typical Loss of Height Associated With Osteoporosis and

Aging

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Osteoporosis
Client may be asymptomatic until the bones become fragile and a
minor injury or movement causes fracture.

Types
Primary
Postmenopausal women
In men later in life
Risk factors: decrease Ca. intake, deficient estrogen, sedentary life

Secondary
result of medications or other conditions and diseases that affect bone metabolism.
Specific disease states (eg, celiac disease, hypogonadism) and medications (eg,
corticosteroids, antiseizure medications)

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Prevention
Follow a balanced diet high in calcium and vitamin D throughout
life
Use calcium supplements to ensure adequate calcium intake:
take in divided doses with vitamin D
Regular weight bearing exercises: walking
Weight training stimulates bone mineral density (BMD)
See Chart 68-8

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Risk factors for Osteoporosis

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Assessment and diagnostic

findings
Routine X-ray
Diagnosed by dual-energy x-ray absorptiometry (DXA), which provides information
about BMD at the spine and hip.
Lab. Studies: Serum Ca, Serum phosphate, urine calcium excretion, ESR
Medical Management:
Adequate balanced diet rich in calcium and Vit D
Regular weight bearing exercise promotes bone formation
Pharmacological therapy: Hormonal replacement therapy ( look for side effect of
estrogen and progesterone replacement therapy which result in cancers thus
frequent breast examination is recommended )
Alendronate alternative to Hormonal replacement therapy: inhibiting osteoclast
function and dcreases bon loss
Calcitonin: suppress bone loss

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Pharmacologic Therapy
Bisphosphonates
Alendronate: Fosamax
Risedronate: Actonel
Ibandronate: Boniva

Selective estrogen modulators (SERMs): Evista

Cacitonin
Teriparatide: Forteo
Also need adequate amounts of calcium and vitamin D
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Question
How long does a patient taking bisphosphonates need to
stay upright after administration?
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 120 minutes
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Answer
C
Biphosphonates are administered on arising in the morning
with a full glass of water on an empty stomach and the
patient must stay upright for 3060 minutes.

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Nursing Process: The Care of the

Patient with Osteoporosis: Assessment

Occurrence of osteopenia and osteoporosis

Family history
Previous fractures
Dietary consumption of calcium
Exercise patterns
Onset of menopause
Use of corticosteroids as well as alcohol, smoking, and
caffeine intake
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Nursing Process: Diagnoses

Deficient knowledge about the osteoporotic process and
treatment regimen
Acute pain related to fracture and muscle spasm
Risk for constipation related to immobility or development
of ileus (intestinal obstruction)
Risk for injury: additional fractures related to osteoporosis

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Nursing Process: Planning

The major goals for the patient may include knowledge

about osteoporosis and the treatment regimen, relief of
pain, improved bowel elimination, and absence of
additional fractures.

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Interventions

Promoting understanding of osteoporosis and the

treatment regimen
Relieving pain
Improving bowel elimination
Preventing injury

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Musculoskeletal Infections
Osteomyelitis

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Osteomyelitis
Osteomyelitis is an infection of the bone that results in
inflammation, necrosis, and formation of new bone.
Osteomyelitis is classified as:
Hematogenous osteomyelitis (ie, due to bloodborne spread of
infection)
Contiguous-focus osteomyelitis, from contamination from bone
surgery, open fracture, or traumatic injury (eg, gunshot wound).
Osteomyelitis with vascular insufficiency, seen among patients with
diabetes and peripheral vascular disease, most commonly affecting
the feet.
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Osteomyelitis
Deep sepsis after arthroplasty may be classified as
follows:
Stage 1, acute fulminating: occurring during the first 3
months after orthopedic surgery; frequently
associated with hematoma, drainage, or superficial
infection
Stage 2, delayed onset: occurring between 4 and 24
months after surgery
Stage 3, late onset: occurring 2 or more years after
surgery, usually as a result of hematogenous spread
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Osteomyelitis
Pathophysiology:
Staphylococcus aureus causes over 50% of bone infection
Process of infection (inflammation, edema, thrombosis of
the blood vessels result in ischemia with bone necrosis,
which may progress to form bone abscess
Clinical manifestations: chills, high fever, rapid pulse, pain,
swollen area, and tenderness and drainage
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Assessment and diagnostic Findings:

X-ray (shows soft tissue swelling, later bone
decalcification and necrosis),
MRI,
Lab test (leukocytosis, and ESR),
wound and blood culture

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Cont..

Prevention: treat all sources of infection, Aseptic surgery,

Prophylactic antibiotics, Aseptic postoperative care.
Medical management:

Pharmacological therapy: Intravenous antibiotic according

to the wound cultures.
Surgical management: expose the bone surgically to
remove infected and necrotic materials and irrigating the
area with normal saline, direct application of antibiotics
surgical (dbridement).
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Nursing Process: Osteomyelitis

Assessment
Risk factors
Signs and symptoms of infection localized pain edema,
erythema, fever, drainage
Note: With chronic osteomyelitis fever may be low grade and
occur in afternoon or evening
Signs and symptoms of adverse reactions and complications
of antibiotic therapy including signs and symptoms of
superinfections
Ability to adhere to prescribed therapeutic regimen antibiotic therapy
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Nursing Process: Diagnoses

Acute pain
Impaired physical mobility
Risk for extension of infection: bone abscess
formation
Deficient knowledge

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Nursing Process: Planning

Major goals may include relief of pain, improved

physical mobility, within therapeutic limitations,
control and eradication of infection, and knowledge
of therapeutic regimen.

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Interventions

Reliving pain
Immobilization
Elevation
Handle with great care and gentleness
Administer prescribed analgesics

Improving physical mobility

Activity is restricted
Gentle ROM to joints above and below the affected part
Participation in ADLs within limitations
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Interventions

Controlling the infectious process

Promote good nutrition
Encourage adequate hydration
Administer and monitor antibiotic therapy

Patient and family teaching

Long-term antibiotic therapy and management of home IV
administration
Mobility limitations
Safety and prevention of injury
Follow-up care
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Rheumatic Disorder
Rheumatoid arthritis
Osteoarthritis

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Rheumatic Arthritis
RA is an autoimmune disease
of unknown origin that affects
1% of the population worldwide,
with a female to- male ratio
between 2:1 and 4:1.
The autoimmune reaction
primarily occurs in the synovial
tissue
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Pathophysiology and Associated Physical

Signs of Rheumatoid Arthritis

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Clinical Manifestations
Joint pain, swelling, warmth, erythema, and lack of function
are classic symptoms in the morning.
Palpation of the joints reveals spongy or boggy tissue.
The onset of symptoms is usually acute. Symptoms are
usually bilateral and symmetric.
Deformities of the hands and feet are common in RA.
fever, weight loss, fatigue, anemia and lymph node
enlargement.
Rheumatoid nodules
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Patient Assessment and

Diagnostic Findings
Health history: include onset of and evolution of symptoms,
past health history, and contributing factors
Functional assessment
Arthrocentesis

X-rays, bone scans

Tissue biopsy

Blood studies: ESR elevated, C reactive protein and

antinuclear antibody (ANA) test results may also be positive
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Medical management

Early Rheumatoid Arthritis

Moderate, Erosive Rheumatoid Arthritis
Persistent, Erosive Rheumatoid Arthritis
Advanced, Unremitting Rheumatoid Arthritis
-Nutrition Therapy

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Nursing Management
Monitoring and Managing Potential Complications
Promoting Home and Community-Based Care
Teaching Patients Self-Care
Continuing Care

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ASSIGNMENT

Please read and discuss the

medical & nursing management
for pt. with Rheumatoid Arthritis
- Pages: 1643-1646

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http://www.arthritis.ae
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Degenerative Joint Disease:

Osteoarthritis

Is a marked by progressive deterioration of the articular

cartilage
It causes bone buildup and the loss of articular cartilage
in peripheral and axial joints
It affects the weight bearing joints and joints that
receive the greatest stress (hips, knees, lower vertebral
column, and hands )
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Characteristic Degenerative Changes:

Degradation

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Osteoarthritis
(Degenerative Joint Disease)

The causes of primary osteoarthritis is not known

Risk factors:

Previous joint damage

Aging
Obesity
Genetic changes

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Clinical Manifestations

pain, stiffness, and functional impairment.

Stiffness, experienced in the morning or after awakening,
usually lasts less than 30 minutes and decreases with
movement.
Assessment and Diagnostic Findings:
Physical assessment
X ray
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Medical Management

Constructive treatment measures: patient

education
Pharmacologic therapy
Surgical management
-osteotomy
-arthroplasty
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Nursing Management
Non-pharmacologic interventions are used first and
continued with pharmacologic agents.
Pain management
Weight loss and exercise
Open discussion regarding the use of complementary
and alternative therapies

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ASSIGNMENT

Discuss the medical & nursing

management for pt. with
Osteoarthritis
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