Interventions for Clients with Musculoskeletal Problems

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

Classification of Osteoporosis Primary osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s. 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. 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. Regional osteoporosis occurs when a limb is immobilized.

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

Assessment Physical assessment Physical assessment Psychosocial assessment Psychosocial assessment Laboratory assessment Laboratory assessment Radiographic assessment Radiographic assessment

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

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

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

Others Exercise Exercise Pain management Pain management Orthotic devices Orthotic devices

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

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 Metabolic disorder of bone remodeling, or turnover; increased resorption of loss results in bone deposits that are weak, enlarged, and disorganized

Paget’s Disease of the Bone Nonsurgical management: calcitonin, selected bisphosphonates, mithramycin Nonsurgical management: calcitonin, selected bisphosphonates, mithramycin Surgical management: tibial osteotomy or partial or total joint replacement 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 A condition caused by the invasion by one or more pathogenic microorganisms that stimulates the inflammatory response in bone tissue Exogenous, endogenous, hematogenous, contiguous Exogenous, endogenous, hematogenous, contiguous

Nonsurgical Management Drug therapy Drug therapy Infection control Infection control Hyperbaric oxygen therapy Hyperbaric oxygen therapy

Surgical Management Sequestrectomy Sequestrectomy Bone grafts Bone grafts Bone segment transfers Bone segment transfers Muscle flaps Muscle flaps Amputation Amputation

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

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

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

Acute Pain; Chronic Pain Interventions include: 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: 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: 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 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.

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

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

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

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

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

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