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MUSCULOSKELETAL DISORDERS

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Chronic Tophaceous Gout. Hyperuricemia untreated ... Treatment of Gout Attack. Continued. Dietary Management. Drink 3-4 quarts of fluids daily ... – PowerPoint PPT presentation

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Title: MUSCULOSKELETAL DISORDERS


1
MUSCULOSKELETAL DISORDERS
2
  • Osteoporosis
  • Loss of bone mass
  • Increase bone fragility
  • Increase risk of fractures

3
  • Cause of Osteoporosis
  • Low Calcium

4
  • When can you expect a client to have
    Osetoporosis?
  • Age
  • Sex
  • Race
  • Family History

5
  • Who is at risk for Osteoporosis?
  • Calcium deficiencies
  • Skeletal Loss
  • High intake of Sodas
  • Vitamin D Deficiency
  • Smokers
  • Excess ETOH
  • Decrease Estrogen
  • Sedentary Lifestyle
  • Meds
  • Steroids, antacids

6
  • Cardinal Signs of Osteoporosis?
  • Loss of height
  • Curvature of Spine
  • Dowagers Hump
  • Lordosis
  • Low Back Pain

7
  • Treatment of Osteoporosis
  • Biphosphonates
  • Fosamax
  • Actonel
  • Didronel
  • Calcitonin
  • Sodium Flouride
  • Raloxifene (Evista)

8
OSTEOMYELITIS
9
  • True or False
  • Osteomyelitis is an Acute Infection?
  • True or False
  • Osteomyelitis is a Chronic Infection?
  • Osteomyelitis is caused by which of the
    following?
  • Staphylococcus Aureus
  • Fungus
  • Parasite
  • Virus

10
INTRODUCTION
  • Osteomyelitis Bone Infection
  • (Page 1267 Lemone)
  • Acute or Chronic
  • Usually Caused By
  • Staphylococcus Aureus
  • Fungus
  • Parasite
  • Virus

11
(No Transcript)
12
What kind of patient situations have contributed
to the diagnosis of Osteomyelitis?
13
RISK FACTORS
  • Trauma
  • Diabetes
  • Hemodialysis
  • Splenectomy
  • Advanced age
  • ? Immune function
  • Poor circulation

14
CAUSES
  • Direct Contamination
  • Surgical Infection
  • Adjacent Soft Tissue Infection
  • Hematogenous
  • Originating in the blood

15
STAGES OF OSTEOMYELITIS
16
When you see a client with Osteomyelytis, what
does the client usually complain about?
17
MANIFESTATIONS
  • Pain
  • Swelling, redness, warmth
  • Purulent exudate
  • Systemic
  • Fever
  • Chills
  • Nausea
  • Malaise

18
DIAGNOSTIC STUDIES
  • MRI
  • CT
  • Bone Scan
  • Ultrasound
  • Labs
  • Sed Rate
  • WBCs
  • Cultures

19
TREATMENT
  • Medications
  • Antibiotics
  • Pain Management
  • Surgical debridement
  • Amputation

20
Common Nursing Diagnoses for Clients with
Osteomyelitis?
  • Risk for Infection
  • Hyperthermia
  • Impaired physical mobility
  • Acute pain
  • Anxiety
  • Body Image
  • Self Esteem

21
Prevent Osteomyelitis?
  • Risk Factors?
  • Trauma
  • DM
  • PVD
  • SHOES, SOCKS

22
Test Question
  • You have admitted a client with Osteomyelitis.
    What assessment data is essential in the care of
    this client on the first day of admission?
  • Limp in involved extremity
  • Swelling at the involved site
  • Anorexia
  • Chills

23
Arthritis
  • Inflammation of a joint usually accompanied by
    pain swelling and changes in structure
  • Etiology
  • Degenerative Joint Disease
  • Osteoarthritis, Rheumatoid
  • Metabolic disturbances
  • Gout
  • Infection
  • Gonococcus, TB, Pneumonia

24
Osteoarthritis
25
Manifestations
  • Pain
  • Stiffness
  • Redness
  • Swelling
  • Knee effusions
  • Crepitus

26
Diagnostic Tests
  • History and Physical
  • X-rays

27
Treatments
  • Medications
  • Analgesics
  • NSAIDS
  • Steroids-RARE
  • Treatments
  • ROM exercises
  • Rest the joint
  • Assistive devices walker, cane, crutches

28
Surgical Treatment
  • Joint Arthroplasty (Reconstruction or
    Replacement)

29
HIP REPLACEMENT
30
Total Knee Replacement
31
Total Joint Replacement
  • Candidate selection
  • Several devices available
  • Significant relief of pain
  • Good return to ADL
  • OOB in 1 -2 days with PT help
  • Best results with PT program for re-strengthening
    muscles
  • Post op CPM
  • Continuous Passive Motion see next slide

32
Continuous Passive Motion
33
Post Op Care Joint Replacement
  • Monitor incision for bleeding
  • Cough, turn, deep breath
  • OOB as ordered
  • Neurovascular checks hourly 12-24 hours (color,
    temp, pulses, capillary refill, movement,
    sensation)
  • Pain management
  • Prevent new hip displacement

34
Post-Op Joint Replacement
  • Nursing Care Plan
  • Pain assessment
  • Position changing with Trapeze
  • Sequential compression
  • Incentive spirometer
  • OOB
  • Abduction pillow for hip replacement
  • Monitor temperature and other VS
  • Surgical site assessment
  • Quadriceps and foot exercises

35
Discharge Teaching
  • Hazards assessment
  • Chronic disease
  • ROM
  • Prevent Overuse/Overstess
  • Pain Management

36
Rheumatoid Arthritis
37
Rheumatoid Arthritis
  • Chronic, Systemic Autoimmune Disease
  • Inflammation of the connective tissue,
  • Inflammation of the joint

38
Sites affected
39
Manifestations of RA
  • Joint symptoms
  • Pain, swelling, stiffness (?in morning)
  • Deformity and muscle atrophy
  • Limited ROM
  • Other Symptoms
  • Fatigue
  • Anorexia
  • Low-grade fever
  • Inflammatory changes of heart and lungs

40
Diagnosis of RA
  • History and physical exam
  • Labs
  • Rheumatoid factors (RF)
  • ESR (Erythrocyte Sedimentation Rate)
  • Synovial fluid exam
  • X-rays
  • Narrowing joint space

41
Treatment of RA
  • NO CURE
  • Goals of Treatment
  • Relieve pain
  • Reduce inflammation
  • Stop or slow joint damage and deformity
  • Improve well-being and ability to function

42
Treatment of RA
  • Medications
  • NSAIDS
  • Steroids (po or intra-articular)
  • Disease-modifying drugs
  • Modify immune system
  • Gold, antimalarial,
  • Modify the autoimmune and inflammatory response
  • Enbrel- Tumor necrosis factor blocker
  • Kineret- Interleukin 1 receptor antagonist
  • Surgery
  • Joint replacement
  • Tendon reconstruction

43
Gout
44
What is Gout?
  • Metabolic disorder
  • Inflammation 2 deposits of uric acid crystals in
    joint
  • Body produces too much uric acid
  • Or
  • Body excretes too little uric acid

45
What is Uric Acid?
  • Uric acid is a waste product formed from the
    breakdown of purines
  • High levels of purines are found in organ meats
    (liver, brains, kidney), anchovies, herring,
    mackerel.
  • Alcohol and some drugs may affect purine
    excretion.

46
Stage 1 Asymptomatic Hyperuricemia
  • Uric acid levels elevated to 9-10 range (normals
    3 6)
  • No symptoms
  • Client may not progress to symptomatic disease

47
Stage 2 Acute Gouty Arthritis
  • Sudden onset, acute pain, redness, swelling
  • Usually hits the big toe, may affect another
    joint
  • Fever, chills
  • Elevated WBC, sed rate
  • Attack lasts hours to weeks
  • 60 have recurrent attack in 1 yr

48
Stage 3 Chronic Tophaceous Gout
  • Hyperuricemia untreated
  • Tophi (urate crystals deposits) develop in
    cartilage, synovial membranes, tendons, soft
    tissues
  • Pain, ulceration, nerve damage
  • Uric acid crystalskidney stones

49
Treatment of Gout
  • Pain
  • Indocin
  • NSAIDS, Narcotics
  • Steroids (po/intra-articular)
  • Interrupt urate crystal formation
  • Colchicine Does NOT alter uric acid levels
  • Inhibit tubular reabsorption of uric acid
  • Probenecid (Benemid)
  • Reduce the production of uric acid
  • Allopurinol (Zyloprim)

50
Treatment of Gout Attack Continued
  • Dietary Management
  • Drink 3-4 quarts of fluids daily
  • Avoid alcohol
  • Sometimes no diet is prescribed
  • Low purine diet
  • Meats, seafood, yeast, beans, peas, lentils,
    oatmeal, spinach, asparagus, cauliflower,
    mushrooms

51
  • Nursing Diagnoses
  • Acute Pain
  • Impaired Physical Mobility

52
Questions?
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