UNIT VII MUSCULOSKELETAL DISORDERS
NS 107 Intermediate Medical/Surgical Nursing
OSTEOMYELITIS • Infection of the bone, bone marrow & surrounding soft tissue.
– Types of infections:
• • • • Staphylococcus aureus E. Coli Staph Epi Pseudomonas
– Acute: initial infection or an infection < 1 month. Chronic: > 1month or infection that has failed to respond to antibiotics.
OSTEOMYELITIS cont.’ • Medical treatments includes
– Aggressive antibiotic treatment initially in the hospital but may be given at home – Surgical removal of dead tissue and bone. – Hyperbaric oxygen therapy
OSTEOMYELITIS cont.’ • Nursing assessment
– Patient hx – Physical inspection – Culture results – CBC – Pain – Pulses/circulation/ capillary refill
OSTEOMYELITIS cont.’ • Nursing diagnoses– Actual infection – Alteration in comfort: acute pain – Impaired physical mobility – Impaired tissue perfusion – Self-care deficit – Ineffective therapeutic regimen management – Knowledge deficit – Potential for injury
OSTEOMYELITIS cont.’ • Goals:
– Satisfactory pain control – Prevent complications associated with osteomyelitis – Compliance w/treatment plan – Increase knowledge – Prevent hazards of immobility
OSTEOMYELITIS cont.’
• Interventions:
– Education!!! – Evaluate medication effectiveness – Maintain safety – Maintain sterility w/dressing changes (hospital)
BONE CANCER • Types:
– Multiple myeloma – Osteogenic sarcoma – Osteoclastoma – Ewing’s sarcoma – Metastatic bone disease
BONE CANCER cont.’ • Multiple Myeloma
– Malignant neoplasm of plasma cells
• • • • Widespread infiltration Destruction of bone marrow Osteolytic lesions throughout the skeleton Poor prognosis as usually discovered late, after diffuse infiltration of axial skeleton. • Treatments include:
– Chemo – Bone marrow transplant – Pain management
BONE CANCER cont.’
• Osteogenic Sarcoma- primary neoplasm of the bone that is highly malignant; rapid growing and metastasis.
– Found in long bones i.e.. Femur, tibia – Most common tumor affecting children and young adults – Higher incidence in males 10-25 y/o – Treatments include chemotherapy to reduce tumor size and then surgical resection.
BONE CANCER cont.’ • Osteoclastoma
– Affects the cancellous ends of long bones. – Also known as “Giant Cell Tumor” – Aggressive and spreads to lungs – >50% recurrence
• Ewing’s sarcoma
– Common type of neoplasm – Found in rapidly growing bones. – Metastisizes quickly to the lungs.
Metastatic Bone Disease • Most common type of malignant bone tumor.
– Commonly found due to a fracture. – May occur years after diagnosis and treatment of primary tumor. – Prognosis depends on the extent of metastasis and location.
BONE CANCER • Assessment should include:
– Inspection – Palpation – History – Subjective data
• Pain, limp, swelling
BONE CANCER • Nursing diagnoses
– Alteration in comfort: pain – Disturbed body image – Impaired physical mobility – Potential for injury – Anticipatory grieving – Anxiety – Knowledge deficit
Herniated Intervertebral Disk • Rupture of the nucleus pulposus.
– Also known as “slipped disc”. – Causes include
• Natural degeneration d/t age which leads to degenerative disc disease. • Repeated stress • Trauma
– Clinical manifestations: common site is down the sciatic nerve.
• Severe complications include: paresthesia, muscle weakness, bowel and bladder incontinence.
Spinal Surgery • Laminectomy- removal of all or part of protruding disc. • Diskectomy- decompression of nerve root. Can be done percutaneously and by laser. • Spinal fusion- welding of bones together to prevent protrusion.
Nursing Management • • • • Pain control Maintaining alignment Prevention of infection Prevent hazards of immobility
– What are they?
• Prevent post-op complications
Osteomalacia
• Vitamin D deficiency results in bone decalcification and softening.
– Malformation = RICKETS – Fractures are common w/delayed healing. Causes include: – Lack of ultraviolet rays. – GI malabsorption – Extensive burns – Chronic diarrhea – Pregnancy – Kidney disease – Medications such as Dilantin
Paget’s Disease • Excessive bone resorption and replacement of normal bone marrow w/fibrous connective tissue.
– Bone is larger and weaker. – Fracture may be 1st indication of disease. – Complications may include bone malignancies previously discussed. – No cure, only supportive therapies. – Heredity is linked.
Nursing Management of Osteomalacia & Paget’s • Nursing diagnosis
– Risk for injury – PAIN – Impaired physical mobility – Self-care deficit – Disturbed body image – Impaired walking
Nursing Management of Osteomalacia & Paget’s cont.’ • Plan of care:
– Keep them safe
• Patient education • PT Evaluation • Supportive walking aids
– Adequate pain relief – Prevent further bone loss
• Education on safety and nutrition
Comparing Osteo & Rheumatoid Arthritis • Osteoarthritis
– Slowly progressive
• Begins young
• Rheumatoid
– Slowly progressive: insidious – Degenerative – Unknown cause – Immune response most likely
• Damage & thickening to synovial membranes. • Erosion of bone • Destruction of cartilage • Granulation formation within joints causing scaring, joint laxity, sublimation and contractures, deformities.
– Degenerative – Idiopathic cause unknown (primary) – Immune response
• Formation of new joint tissue as cartilage is destroyed.
– Bone outgrowth – Subarticular bone cysts – Hyperplasia and inflammation
Rheumatoid Arthritis • Effects multiple organs • Morning stiffness worse later in the day • Diagnosis made by
– Pt history – + Rheumatoid factor – Other labs studies: Erythrocyte sedimentation rate(ESR), Antinuclear antibody(ANA), CBC – Synovial fluid biopsy
Rheumatoid Arthritis • Collaborative therapy (63-7)
– Drug therapy – Surgery – Heat and cold – Use of assistive devices – Nutritional counseling – Therapeutic exercise – Apherisis
• Review the careplan on pg 1730-31
Septic Arthritis
• Infection of or to the joint cavity which travels throughout the body via the bloodstream.
– More common than you may think. – Think of those with decreased resistance.
• Anyone immunosuppressed like:______ • Diabetics • Debilitated individuals
– Staph Aureus is most common bug. – Can cause death or joint destruction.
Septic Arthritis • Nursing Assessment
– Inspection of joints – Palpation – Manipulation of suspected site – Vital signs – Lab data – Subjective data: pain assessment and patient history (can also be objective)
Septic Arthritis • Goal: prevent complications and promote health and wellness • Interventions to include:
– Medication administration – Monitoring joint inflammation and pain – Immobilization of affected joint – ROM exercises – Patient education – Maintain & monitor aseptic technique
Lyme Disease • Spirochetal infection transmitted by an infected deer tick
– No person-to-person transmission. – Summer months – “Great imitator” – Untreated infection can lead to arthritis, Bell’s Palsy, severe headaches. – Early treatment with antibx has good prognosis.
Connective Tissue Disorders • Systemic lupus erythematosus • Ankylosing spondklitis • Systemic sclerosis- fibrotic, degenerative
and inflammatory changes in the skin, blood vessels, synovium, skeletal muscle, and internal organs (63-17).
– CREST syndrome
• Calcinosis =painful deposits of calcium in the skin • Raynaud’s phenomenon= blood flow with cold or stress • Esophageal dysfunction= difficulty swallowing d/t scaring • Sclerodatyly= tightening of the skin of fingers and toes • Telangiectasia= red spots