Interventions for Clients with Musculoskeletal Problems

Osteoporosis Metabolic disease, in which bone demineralization results in decreased density and subsequent fractures Osteopenia (low bone mass), which occurs when there is a disruption in the bone remodeling process S&P

Osteoporosis

Classification of Osteoporosis Primary osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s. Secondary osteoporosis results from an associated medical condition such as hyperparathyroidism, long-term drug therapy, long-term immobility. Regional osteoporosis occurs when a limb is immobilized.

Health Promotion/Illness Prevention Ensure adequate calcium intake. Avoid sedentary life style. Continue program of weight-bearing exercises. S&P

Assessment Physical assessment Psychosocial assessment Laboratory assessment Radiographic assessment

Drug Therapy Hormone replacement therapy Parathyroid hormone Calcium and vitamin D Bisphosphonates Selective estrogen receptor modulators Calcitonin Other agents used with varying results

Diet Therapy Protein Magnesium Vitamin K Trace minerals Calcium and vitamin D Avoid alcohol and caffeine

Fall Prevention Hazard-free environment High-risk assessment through programs such as Falling Star protocol Hip protectors that prevent hip fracture in case of a fall S&P

Others Exercise Pain management Orthotic devices

Osteomalacia Softening of the bone tissue characterized by inadequate mineralization of osteoid Vitamin D deficiency, lack of sunlight exposure Similar, but not the same as osteoporosis Major treatment: vitamin D from exposure to sun and certain foods S&P

Osteomalacia

Paget’s Disease of the Bone Metabolic disorder of bone remodeling, or turnover; increased resorption of loss results in bone deposits that are weak, enlarged, and disorganized S&P

Paget’s Disease of the Bone Nonsurgical management: calcitonin, selected bisphosphonates, mithramycin Surgical management: tibial osteotomy or partial or total joint replacement

Osteomyelitis A condition caused by the invasion by one or more pathogenic microorganisms that stimulates the inflammatory response in bone tissue Exogenous, endogenous, hematogenous, contiguous

Nonsurgical Management Drug therapy Infection control Hyperbaric oxygen therapy

Surgical Management Sequestrectomy Bone grafts Bone segment transfers Muscle flaps Amputation

Bone Tumors Benign bone tumors (noncancerous): Chrondrogenic tumors: osteochondroma, chondroma Osteogenic tumors: osteoid osteoma, osteoblastoma, giant cell tumor Fibrogenic tumors

Bone Tumors

Interventions Nondrug pain relief measures Drug therapy: analgesics, NSAIDs Surgical therapy: curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis S&P

Malignant Bone Tumors Primary tumors, those tumors that originate in the bone Osteosarcoma Ewing’s sarcoma Chondrosarcoma Fibrosarcoma Metastatic bone disease

Acute Pain; Chronic Pain Interventions include: Treatment aimed at reducing the size or removing the tumor Drug therapy; chemotherapy Radiation therapy Surgical management Promotion of physical mobility with ROM exercises

Anticipatory Grieving Interventions include: Active listening Encouraging client and family to verbalize feelings Making appropriate referrals Helping client and others to cope with the loss and grieving Promoting the physician-client relationship

Disturbed Body Image Interventions include: Recognize and accept the client’s view of body image alteration. Establish and maintain a trusting nurse-client relationship. Emphasize the client’s strengths and remaining capabilities. Establish realistic mutual goals.

Potential for Fractures Interventions Nonsurgical management: radiation therapy and strengthening exercises. Surgical management: replace as much of the defective bone as possible, avoid a second procedure, and return client to a functioning state with a minimum of hospitalization and immobilization. S&P

Phalen’s maneuver for detection of carpal tunnel syndrome

Carpal Tunnel Syndrome Common condition; the median nerve in the wrist becomes compressed, causing pain and numbness Common repetitive strain injury via occupational or sports motions Nonsurgical management: drug therapy and immobilization Possible surgical management S&P

Carpal Tunnel Syndrome

Hand Disorders Dupuytren's contracture—slowly progressive contracture of the palmar fascia resulting in flexion of the fourth or fifth digit of the hand Ganglion—a round, cystlike lesion, often overlying a wrist joint or tendon S&P

Disorders of the Foot Hallux valgus Hammertoe Morton’s neuroma Tarsal tunnel syndrome Plantar fasciitis Other problems of the foot

Scoliosis Changes in muscles and ligaments on the concave side of the spinal column Congenital, neuromuscular, or idiopathic in type Assessment: complete history, pain assessment, observation of posture Interventions: exercise, weight reduction, bracing, casting, surgery S&P

Osteogenesis Imperfecta Rare genetic disorder in which the bones are fragile and fracture easily, resulting in bone deformity Clinical manifestations: poor skeletal development Treatment: palliative; client’s life span is often shortened Steroids, calcium, vitamin C, and possibly sodium fluoride S&P

Progressive Muscular Dystrophies At least nine types of muscular dystrophies identified; categorized as slowly or rapidly progressive Diagnosis often difficult Management Supportive, making client as comfortable as possible Prednisone, immunosuppressive agents, anabolic steroids S&P

Progressive Muscular Dystrophies