1. Chapter 27 Musculoskeletal Conditions

2. Assessment of Musculoskeletal Problems Abnormal gait Abnormality of structure Dysfunction of a limb Favoring of one side Tremor Paralysis

3. Assessment of Musculoskeletal Problems (cont.) Weakness Atrophy of a limb Redness; swelling of a joint Use of cane, walker, or wheelchair

4. Physical Examinations of the Musculoskeletal System Shoulder Neck Elbow Wrist Finger Hip Knee Ankle Toe

5. Desired Outcomes The patient: –Verbalizes acceptance of realistic body changes. –Uses effective coping mechanisms. –Identifies and engages in meaningful activities. –Is free from depression, withdrawal, and other complications associated with body image and self- esteem disturbances.

6. Facilitating Musculoskeletal Function A well-balanced diet rich in proteins and minerals A minimum of 1500 mg calcium included in the diet daily for elderly men and women not taking estrogen –(1000 mg if taking estrogen) Weight control Activity and exercise

7. Contributing Factors to Fractures in the Elderly Trauma Cancer Metastasis to the bone Osteoporosis Brittle bones of older persons fracture more easily. Slower rate of healing

8. Measures to Prevent Falls Avoid risky activities. Rise from a kneeling or sitting position slowly. Wear safe, properly fitting shoes with a low, broad heel. Use hand rails for climbing stairs or rising from the bathtub. Place both feet near the edge of a curb or bus before stepping up or down. Use a night-light in the bathroom and bedroom.

9. Symptoms of Fractures Pain Change in the shape or length of a limb Abnormal or restricted motion of a limb Edema Spasm of surrounding tissue Discoloration of tissue Bone protruding through the tissue

10. Most Common Fracture Sites Neck of the femur Colles’ fracture Compression fracture of the vertebrae

11. Factors Contributing to Osteoarthritis Disequilibrium between destructive and synthetic elements Stress to the joints Obesity Genetic factors Low vitamin D and C levels

12. Therapeutic Measures for Osteoarthritis Analgesics to control pain Rest, heat or ice, ultrasound, and gentle massage Splints, braces, and canes Cold water fish; other foods high in the essential fatty acids Vitamins A, B, B 6, C, and E and zinc, selenium, niacinamide, calcium, and magnesium Weight reduction

13. Symptoms of Rheumatoid Arthritis Fatigue Malaise Weakness Weight loss Wasting Fever Anemia

14. Patient Education for Rheumatoid Arthritis Knowledge of the disease Treatments Administration of medications Identification of side effects Exercise regimens Use of assistive devices Methods to avoid and reduce pain

15. Potential Causes of Osteoporosis Inactivity or immobility Diseases Reduction in anabolic sex hormones Diet Drugs

16. Problems Associated with Osteoporosis Kyphosis and a reduction in height Spinal pain Bones may fracture more easily

17. Treatment of Osteoporosis Calcium supplements Vitamin D supplements Progesterone and estrogen Anabolic agents Fluoride or phosphate Synthetic form of calcitonin Bisphosphonates

18. Treatment of Gout Reduction of sodium urate through a low-purine diet Administration of drugs Avoidance of alcohol Use of colchicine or phenylbutazone to manage acute attacks Use of vitamin E, folic acid, and eicosapentaenoic acid (EPA) Use of herbs such as yucca and devil’s claw

19. Podiatric Conditions Calluses Corns Bunions Hammer toe Plantar fasciitis Foot infections Ingrown toenails

20. Patient Teaching for Proper Foot Care Keep feet clean and dry. Wear safe and proper-fitting shoes. Exercise feet. Cut nails straight across and even with the top of the toe. Seek professional podiatric care for problems.

21. Nursing Considerations for Pain Management Heat application Passive stretching of an extremity Avoidance of excessive exercise and musculoskeletal stress Back rubs Proper positioning and protection from trauma Diversional activities Alternative therapies

22. Measures to Prevent Injury Pay attention to the area where one is walking. Climb stairs and curbs slowly. Use both feet for support as much as possible. Use railings and canes for added balance. Wear properly fitting, safe shoes for good support. Avoid long trousers, nightgowns, or robes. Use heat safely.

23. Promoting Independence Use of canes, walkers, and other assistive devices Referral to physical and occupational therapists

24. Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).