nursing musculoskeletal

Board review

Review of Anatomy and Physiology

The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints

The primary function of which is to produce skeletal movements

The MUSCULAR SYSTEMFUNCTIONS

Movement Posture Support Protection of vital organs Storage of minerals Heat production Propulsion of blood Movement of food in GIT and urine in the ureters

Muscles

Three types of muscles exist in the body1. Skeletal Muscles

Voluntary and striated2. Cardiac muscles

Involuntary and striated3. Smooth/Visceral muscles

Involuntary and NON-striated

Structure of the MuscleEpimysium – outermost layer that

surrounds the muscle.

Perimysium – separate the muscle tissue into small sections.

Endomysium – thin covering of a fascicle

Skeletal Muscles’ Actions a. PRIME MOVERS – muscles whose contractions

actually produces the movement.

b. SYNERGISTS – muscles that contract at the same time as the prime mover, helping it produce the movement so the prime mover can produce a more effective movement.

c. ANTAGONISTS – muscles that relax while the prime mover is contracting.

Different Contractions of the Skeletal Muscles

1. ISOTONIC CONTRACTIONS-- shorten muscle length while maintaining muscle tension generating movement.

2. ISOMETRIC CONTRACTIONS-- tighten the muscle by increasing muscle tension without shortening the muscle.-- does not usually produce direct movement.

3. TWITCH CONTRACTIONS

-- quick, jerky reactions to a single stimulus. -- muscle shortens for a fraction of a second.

4. TETANIC CONTRACTIONS

-- serial, continuous contractions, in which individual contraction can’t be distinguished.

5. TROPPE (Staircase Phenomenon)-- series of increasingly stronger twitch contractions occurring in response to repeated stimuli of constant intensity.

6. FASCICULATION-- abnormal contraction visible through the skin as a slight ripple.-- occurs after neuron destruction

7. CONVULSIONS

-- abnormal, violent rhythmic contractions and relaxations of muscle groups.

TENDONSBands of fibrous connective tissue that

tie bones to muscles

LIGAMENTSStrong, dense and flexible bands of

fibrous tissue connecting bones to another bone

The SKELETAL SYSTEM Variously classified according to shape,

location and size Functions

1. Locomotion

2. Protection

3. Support and lever

4. Blood production

5. Mineral deposition

BONES There are two divisions of the skeleton AXIAL– body upright structure with 80 bones

-- consists of the: skull, vertebral column, and ribs

APPENDICULAR – body appendages with 126 bones

-- consists of the arms, hips and legs

BONES FOUR MAJOR BONE TYPES

1. Long bones – length exceeds breadth and thickness

2. Short bones – equal in main dimensions found mainly on hands and feet

3. Flat bones – primarily made up of cancellous bone tissue

4. Irregular bones – irregular in shape

Difference between Male and Female Skeletons

Male skeletons are larger and heavier than female skeleton

Male pelvis--deep and funnel shaped with narrow pubic arc; female pelvis– shallow, broad, and flaring with wider pubic arc

JOINTSThe part of the Skeleton where two or

more bones are connected

CARTILAGESA dense connective tissue that consists

of fibers embedded in a strong gel-like substance

BURSAESac containing fluid that are located

around the joints to prevent friction

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM

The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle and joint function

1. HISTORY2. Physical Examination

Perform a head to toe assessment Nurses need to inspect and palpate The special procedure is the

assessment of joint and muscle movement

ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM

GaitPostureMuscular palpationJoint palpationRange of motionMuscle strength

LABORATORY PROCEDURES 1. BONE MARROW ASPIRATION

Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia

Usual site is the sternum and iliac crest Pre-test: Consent Intratest: Needle puncture may be painful Post-test: maintain pressure dressing and

watch out for bleeding

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES 2. Arthroscopy

A direct visualization of the joint cavity Pre-test: consent, explanation of

procedure, NPO Intra-test: Sedative, Anesthesia, incision

will be made Post-test: maintain dressing, assist in

ambulation as ordered, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES3. BONE SCAN Imaging study with the use of a contrast radioactive

material Pre-test: Painless procedure, IV radioisotope is

used, no special preparation, pregnancy is contraindicated

Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning

Post-test: Increase fluid intake to flush out radioactive material

LABORATORY PROCEDURES4. DXA- Dual-energy XRAY absorptiometry

Assesses bone density to diagnose osteoporosis

Uses LOW dose radiation to measure bone density

Painless procedure, non-invasive, no special preparation

Advise to remove jewelry

FractureA break in the continuity of the bone

and is defined according to its type and extent

FractureSevere mechanical Stress to bone

bone fractureDirect BlowsCrushing forcesSudden twisting motionExtreme muscle contractionPathologic conditions

Fracture

TYPES OF FRACTURE1. Complete fracture

Involves a break across the entire cross-section

2. Incomplete fracture The break occurs through only a part of the

cross-section

Fracture

BROAD CLASSIFICATION OFFRACTURE:1. Close or simple fracture

The fracture that does not cause a break in the skin

2. Open or compound fracture The fracture that involves a break in the

Fracture

Classification of Fracture as to Pattern:1. Transverse fracture

The break runs across the bone

2. Oblique fracture The break runs in slanting direction 45 degrees angle

Fracture3. Spiral fracture

The break coils around the bone

4. Longitudinal fracture The break runs parallel to the bone

Classification as to Appearance:Comminuted fracture

Bone splintered into fragments

Impacted fracture When fractured ends of the bone are

pushed into each other

Fracture

FractureCompressed fracture

A condition in which a bone, particularly the vertebra collapses

Depressed fracture Usually occurs in the skull with the broken

bone being driven inward

Greenstick fracture

Fracture

ASSESSMENT FINDINGS 1. Pain or tenderness over the involved area 2. Loss of function 3. Deformity 4. Shortening 5. Crepitus 6. Swelling and discoloration

Fracture

ASSESSMENT FINDINGS

1. PainContinuous and increases in severity Muscle spasm accompanies the

fracture as a reaction of the body to immobilize the fractured bone

Fracture

ASSESSMENT FINDINGS

2. Loss of functionAbnormal movement and pain can

result to this manifestation

Fracture

ASSESSMENT FINDINGS

3. DeformityDisplacement, angulations or rotation of

the fragments causes deformity

Fracture

ASSESSMENT FINDINGS

4. CrepitusA grating sensation produced when the

bone fragments rub each other

FractureDIAGNOSTIC TESTX-ray

Fracture

EMERGENCY MANAGEMENT OF FRACTURE 1. Immobilize any suspected fracture 2. Support the extremity above and below

when moving the affected part from a vehicle 3. Suggested temporary splints- hard board,

stick, rolled sheets 4. Apply sling if forearm fracture is suspected

or the suspected fractured arm may be bandaged to the chest

Fracture

EMERGENCY MANAGEMENT OF FRACTURE

5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination

6. DO NOT attempt to reduce the fracture

Emergency First aid splinting

Fracture

MEDICAL MANAGEMENT 1. Principles of fracture treatment

Reduction of fracture Maintenance of realignment by

immobilization Restoration of function

Fracture 2. Reduction

Closed manipulation using casts or sling Open reduction External fixation Traction

3. Immobilization the most important phase in obtaining union of

fracture fragments.

FractureGeneral Nursing MANAGEMENT For CLOSED FRACTURE 1. Assist in reduction and immobilization 2. Administer pain medication and muscle

relaxants 3. teach patient to care for the cast 4. Teach patient about potential complication

of fracture and to report infection, poor alignment and continuous pain

FractureGeneral Nursing MANAGEMENT For OPEN FRACTURE 1. Prevent wound and bone infection

-Administer prescribed antibiotics-Administer tetanus prophylaxis-Assist in serial wound debridement

2. Elevate the extremity to prevent edema formation

3. Administer care of traction and cast

Fracture

Stages of Bone Healing1. Formation of hematoma

When a bone is fractured, blood extravasates between and around the fragments and the bone marrow.

2. Cellular proliferation Periostal elevation, granulation tissue

containing blood vessels, fibroblasts and osteoblasts

Fracture3. Callus formation

Differentiated tissue bridging the fracture

4. Ossification Final laying down of bone State in which the fracture ends have knit

together

Fracture5. Remodeling

When consolidation is completed, the excess cells are absorbed.

Compact bone is being formed

Average period for firm union of various bones are as follows:

Clavicle Radius-ulna Metacarpals Femur Fibula Phalanges Humerus Lower 3rd radius Tarsals Metatarsals

3-4 weeks6-13 weeks4 weeks12 weeks12-14 weeks3 weeks6 weeks4 weeks6-8 weeks5-6 weeks

FractureFRACTURE COMPLICATIONS

●Early●1. Shock2. Fat embolism3. Compartment syndrome4. Infection 5. DVT

FractureFRACTURE COMPLICATIONSLate1. Delayed union2. Avascular necrosis3. Delayed reaction to fixation devices4. Complex regional syndrome5. Heterotrophic ossification

FractureFRACTURE COMPLICATIONS: Fat

EmbolismOccurs usually in fractures of the long

bonesFat globules may move into the blood

stream because the marrow pressure is greater than capillary pressure

Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs

EmbolismOnset is rapid, within 24-72 hoursASSESSMENT FINDINGS1. Sudden dyspnea and respiratory

distress2. tachycardia3. Chest pain4. Crackles, wheezes and cough

EmbolismNursing Management1. Support the respiratory functionRespiratory failure is the most common

cause of deathAdminister O2 in high concentrationPrepare for possible intubation and

ventilator support

EmbolismNursing Management2. Administer drugsCorticosteroidsDopamineMorphine

Fracture FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 3. Institute preventive measures Immediate immobilization of fracture Minimal fracture manipulation Adequate support for fractured bone during

turning and positioning Maintain adequate hydration and electrolyte

balance

FractureEarly complication: Compartment

syndromeA complication that develops when

tissue perfusion in the muscles is less than required for tissue viability

FractureEarly complication: Compartment syndromeASSESSMENT FINDINGS1. Pain- Deep, throbbing and UNRELIEVED

pain by opiodsPain is due to reduction in the size of the

muscle compartment by tight castPain is due to increased mass in the

compartment by edema, swelling or hemorrhage

FractureEarly complication: Compartment syndromeASSESSMENT FINDINGS2. Paresthesia- burning or tingling sensation3. Numbness 4. Motor weakness5. Pulselessness, impaired capillary refill

time and cyanotic skin

FractureEarly complication: Compartment

syndromeMedical and Nursing management1. Assess frequently the neurovascular

status of the casted extremity2. Elevate the extremity above the

level of the heart3. Assist in cast removal and

FASCIOTOMY

Strains

Excessive stretching of a muscle or tendon

Nursing management 1. Immobilize affected part 2. Apply cold packs initially, then heat

packs 3. Limit joint activity 4. Administer NSAIDs and muscle

relaxants

Sprains

Excessive stretching of the LIGAMENTS

Nursing management 1. Immobilize extremity and advise rest 2. Apply cold packs initially then heat packs 3. Compression bandage may be applied to

relieve edema 4. Assist in cast application 5. Administer NSAIDS

Dislocation Displacement of a bone from its normal joint

position to the extent that articulating surface partially lose contact.

CAUSES Trauma Disease Congenital condition

DislocationSIGNS AND SYMPTOMS

Burning pain Deformity Stiffness and loss of joint function Moderate or severe edema around the joint

Dislocation NURSING MANAGEMENT

To lessen swelling, elevate the affected extremity.

Assess affected extremity for signs for neurovascular problems.

Give pain medications as ordered by the doctor.

Provide appropriate care if patient is immobilized.

Encourage patient to exercise.

Common musculoskeletal problems

The Nursing Management

Nursing Management of common musculo-skeletal problems

PAIN These can be related to joint inflammation,

traction, surgical intervention 1. Assess patient’s perception of pain 2. Instruct patient alternative pain

management like meditation, heat and cold application, TENS and guided imagery

Nursing Management

PAIN3. Administer analgesics as prescribed4. Assess the effectiveness of pain

measures

Nursing ManagementIMPAIRED PHYSICAL MOBILITY 1. Instruct patient to perform range of motion

exercises, either passive or active 2. Provide support in ambulation with

assistive devices 3. Turn and change position every 2 hours 4. Encourage mobility for a short period and

provide positive reinforcements for small accomplishments

Nursing ManagementSELF-CARE DEFICITS1. Assess functional levels of the patient2. Provide support for feeding problems

Place patient in Fowler’s position Provide assistive device and supervise meal

time Offer finger foods that can be handled by

patient Keep suction equipment ready

Nursing Management

SELF-CARE DEFICITS3. Assist patient with difficulty bathing

and hygiene Assist with bath only when patient has

difficulty Provide ample time for patient to finish

activity

Musculoskeletal Modalities

TractionCast

Nursing Management

TractionA method of fracture immobilization by

applying equipments to align bone fragments

Used for immobilization, bone alignment and relief of muscle spasm

Nursing Management

TRACTION It is the act of pulling or drawing which

is associated with counter traction. Traction means that a pulling force is applied to a body part or extremity while a counter traction pulls in the opposite direction.

Nursing Management

TRACTION Purposes of Traction

1.Traction is often used in the treatment of fractured extremities

To lessen muscle spasm To reduce fracture To provide immobilization To maintain alignment

Nursing ManagementTRACTION2. Traction is also used to correct, lessen or prevent

deformities as in the case of arthritis patients with flexion contraction.

3. Prior to total hip surgery, surgeons may apply skeletal traction in an attempt to stretch muscles to obtain more working space.

4. Lessens muscle spasm in back pain

Nursing Management

Traction: General principles 1. patient’s position must be supine 2. avoid friction 3. allow the weights to hang freely 4. apply traction continuously 5. there should be an adequate counter

traction 6. line of pull must be in line with deformity

Nursing Management

Traction: What to watch out for?1. Impaired circulation in the extremities2. Observe for DVT, skin irritation and

breakdown3. Signs of infection

Provide pin care4. Deformity like foot drop

Provide foot board

TractionSkin traction

Application of a pulling force to the skin from where it is transmitted to the muscles and then to the bones

Uses adhesive and non-adhesive type of materials

TractionSkeletal traction

The pulling force is applied directly to the bone using pins and wires such as Kirshner’s wire, Steinman’s pin, Vinki’s skull retractor and crutch field tongs.

Manual traction Pulling force is applied by hands of the

operator

Application of skeletal traction…

Traction Equipments for Balanced Skeletal Traction

Thomas splint Pearson’s attachment Rest splint 5 slings (different sizes) 5 safety pins Cord pulleys

TractionEquipments cont’n

Weight traction and suspension weight bag Steiman’s pin holder Kirshner’s wire holder Overhead trapeze Foot board Balkan frame

TractionDifferent Kinds of Traction

1. Halo – femoral traction Skin Severe scoliosis

2. Head-halter traction Skin Several cervical sprains, cervical strains, mild

cervical trauma, Pott’s disease

TractionDifferent Types of Traction

3. Dunlop traction Skin Supracondylar fracture of the humerus

4. Buck’s traction Skin (adhesive tape) Injuries to the hip and femur bone

TractionDifferent Types of Traction

5. Halo-pelvic traction Skin Scoliosis

6. Pelvic traction Skin (non-adhesive) Low back pain

Traction

Different Types of Traction

7. Cotrel Skin (combination of head halter and pelvic

traction) Scoliosis

8. Pelvic traction Skin (non-adhesive) Low back pain, lumbar affection

TractionDifferent Types of Traction9. Bryant’s traction

Skin (adhesive tape) Femur fracture, congenital hip dislocation in

infants less than 6 years old

10. Boot cast traction Skin Hip and femur fracture, post poliomyelitis with

residual paralysis

Traction

Different Types of Traction11. 90-90 lower extremity traction

Skin or skeletal Displaced femoral fracture

12. Stove-in Chest Skin Severe chest injury with multiple fracture

TractionDifferent Types of Traction12. Balance skeletal traction

Skeletal Femoral affectation

13. Side arm traction (90-90 upper extremity traction) Skeletal or skin Supracondylar fracture of the humerus

Traction

14. Crutchfield Tong and halo traction Skeletal Cervical fracture or subluxation

14. Russel traction Skin (adhesive) fracture of femur

Head-halter traction

Skull traction

Dunlop traction

Pelvic traction

Acetabular traction

Buck’s Traction And Russel’sTraction

BRACESBanjo Splint

Peripheral nerve injury

Bilateral Long Leg Brace Polio

Chair Back Brace Lumbo-sacral affectation

BRACESCock-up Splint

Wrist drop

Dennis Brown Splint Congenital clubfoot or talipes

Finger Splint Fractured digits

BRACES Forester Brace

Cervico-thoraco-lumbar spine affectation

Jewette Brace Lower thoracic and upper lumbar affectation

Milwaukee Brace Scoliosis T9 and above

BRACESL-S Corset

Thoraco-lumbar affectation

Philadelphia brace

L-S Corset

8 Figure Brace

Velpeau Brace

Nursing Management

CAST Immobilizing tool made of plaster of

Paris or fiberglassProvides immobilization of the fracture

Nursing Management

CAST: types

1. Long arm

2. Short arm

3. Spica

Casting MaterialsPlaster of Paris

Drying takes 1-3 days If dry, it is SHINY, WHITE, hard and

resistantFiberglass

Lightweight and dries in 20-30 minutes Water resistant

Nursing Management

CAST: General Nursing Care1. Allow the cast to dry (usually 24-72

hours)2. Handle a wet cast with the

PALMS not the fingertips3. Keep the casted extremity

ELEVATED using a pillow4. Turn the extremity for equal

drying. DO NOT USE DRYER for plaster cast

Nursing Management

CAST: General Nursing Care5. Petal the edges of the cast to

prevent crumbling of the edges6. Examine the skin for

pressure areas and Regularly check the pulses and skin

Nursing Management

CAST: General Nursing Care7. Instruct the patient not to

place sticks or small objects inside the cast

8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses

Different Kinds of Cast

Common Musculoskeletal conditions

Nursing management

METABOLIC BONE DISORDERS

OsteoporosisA disease of the bone characterized by

a decrease in the bone mass and density with a change in bone structure

Osteoporosis: PathophysiologyNormal homeostatic bone turnover is

altered rate of bone RESORPTION is greater than bone FORMATION reduction in total bone mass reduction in bone mineral density prone to FRACTURE

Osteoporosis: TYPES1. Primary Osteoporosis- advanced

age, post-menopausal2. Secondary osteoporosis- Steroid

overuse, Renal failure

RISK factors for the development of Osteoporosis

1. Sedentary lifestyle 2. Age 3. Diet- caffeine, alcohol, low Ca and Vit D 4. Post-menopausal 5. Genetics- caucasian and asian 6. Immobility

METABOLIC DISORDER

ASSESSMENT FINDINGS1. Low stature2. Fracture

Femur3. Bone pain

METABOLIC DISORDER

LABORATORY FINDINGS1. DEXA-scan

Provides information about bone mineral density

T-score is at least 2.5 SD below the young adult mean value

2. X-ray studies

METABOLIC DISORDER

Medical management of Osteoporosis 1. Diet therapy with calcium and Vitamin D 2. Hormone replacement therapy 3. Biphosphonates- Alendronate, risedronate

produce increased bone mass by inhibiting the OSTEOCLAST

4. Moderate weight bearing exercises 5. Management of fractures

METABOLIC DISORDEROsteoporosis Nursing Interventions1. Promote understanding of osteoporosis and

the treatment regimen Provide adequate dietary supplement of

calcium and vitamin D Instruct to employ a regular program of

moderate exercises and physical activity Manage the constipating side-effect of

calcium supplements

METABOLIC DISORDER

Osteoporosis Nursing InterventionsTake calcium supplements with mealsTake alendronate with an EMPTY

stomach with water Instruct on intake of Hormonal

replacement

METABOLIC DISORDER

Osteoporosis Nursing Interventions

2. Relieve the pain Instruct the patient to rest on a firm

mattress Suggest that knee flexion will cause

relaxation of back muscles Heat application may provide comfort Encourage good posture and body

mechanics Instruct to avoid twisting and heavy lifting

METABOLIC DISORDER

Osteoporosis Nursing Interventions3. Improve bowel eliminationConstipation is a problem of calcium

supplements and immobilityAdvise intake of HIGH fiber diet and

increased fluids

METABOLIC DISORDER

Osteoporosis Nursing Interventions4. Prevent injury Instruct to use isometric exercise to

strengthen the trunk musclesAVOID sudden jarring, bending and

strenuous liftingProvide a safe environment

DEGENERATIVE JOINT DISEASE

OSTEOARTHRITISThe most common form of degenerative

joint disorder

OSTEOARTHRITIS: Pathophysiology Injury, genetic, Previous joint

damage, Obesity, Advanced age Stimulate the chondrocytes to release chemicals chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening

OSTEOARTHRITIS: Risk factors1. Increased age2. Obesity3. Repetitive use of joints with previous

joint damage4. Anatomical deformity5. genetic susceptibility

OSTEOARTHRITIS: Assessment findings 1. Joint pain 2. Joint stiffness 3. Functional joint impairment The joint involvement is ASYMMETRICAL This is not systemic, there is no FEVER Usual joint are the WEIGHT bearing joints

OSTEOARTHRITIS: Assessment findings

1. Joint painCaused by

Inflamed synovium Stretching of the joint capsule Irritation of nerve endings

OSTEOARTHRITIS: Assessment findings

2. Stiffness commonly occurs in the morning after commonly occurs in the morning after

awakeningawakening Lasts only for less than 30 minutes DECREASES with movement

OSTEOARTHRITIS: Diagnostic findings1. X-rayNarrowing of joint spaceLoss of cartilageOsteophytes2. Blood tests will show no evidenceno evidence of

systemic inflammation and are not useful

OSTEOARTHRITIS: Medical management 1. Weight reduction 2. Use of splinting devices to support joints 3. Occupational and physical therapy 4. Pharmacologic management

Use of NSAIDS Use of Glucosamine and chondroitin Topical analgesics

OSTEOARTHRITIS: Nursing Interventions

1. Provide relief of PAIN Administer prescribed analgesics Application of heat modalities Plan daily activities when pain is less

severe Pain meds before exercising

OSTEOARTHRITIS: Nursing Interventions

2. Advise patient to reduce weight Aerobic exercise Walking

3. Administer prescribed medications NSAIDS

Rheumatoid arthritisA type of chronic systemic inflammatory

arthritis affecting more women than men

Rheumatoid arthritis

Pathophysiology Immune reaction in the synovium

attracts neutrophils releases enzymes breakdown of collagen irritates the synovial liningcausing synovial inflammation edema and pannus formation and joint erosions

ASSESSMENT FINDINGS 1. PAIN 2. Joint swelling and stiffness-

SYMMETRICAL 3. Warmth, erythema and lack of

function 4. Fever, weight loss, anemia, fatigue 5. Palpation of join reveals spongy tissue 6. Hesitancy in joint movement

ASSESSMENT FINDINGSJoint involvement is SYMMETRICAL

and BILATERALCharacteristically beginning in the

hands, wrist and feetJoint STIFFNESS occurs early morning,

lasts MORE than 30 minutes, not relieved by movement

ASSESSMENT FINDINGSJoints are swollen and warmPainful when movedDeformities are common in the hands

and feet causing misalignment Rheumatoid nodules may be found in

the subcutaneous tissues

Diagnostic test 1. X-ray

Shows bony erosion

2. Blood studies reveal (+) rheumatoid factor, elevated ESR and CRP

3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing WBC and inflammatory proteins

MEDICAL MANAGEMENT1. Therapeutic dose of NSAIDS and

Aspirin2. Chemotherapy with methotrexate,

antimalarials, gold therapy and steroid3. For advanced cases- arthroplasty,

synovectomy4. Nutritional therapy

Nursing MANAGEMENT

1. Relieve pain and discomfort USE splints to immobilize the affected

extremity during acute stage of the disease and inflammation

Administer prescribed medications Suggest application of COLD packs during

the acute phase of pain, then HEAT application as the inflammation subsides

Rheumatoid arthritisNursing MANAGEMENT2. Decrease patient fatigue Schedule activity when pain is less severe Provide adequate periods of rests3. Promote restorative sleep4. Increase patient mobility Advise proper posture and body mechanics Support joint in functional position Advise ACTIVE ROME

Gouty arthritisA systemic disease caused by

deposition of uric acid crystals in the joint and body tissues

CAUSES:1. Primary gout- disorder of Purine

metabolism2. Secondary gout- excessive uric acid

in the blood caused by other diseases

Gouty arthritisASSESSMENT FINDINGS1. Severe pain in the involved joints,

initially the big toe2. Swelling and inflammation of the joint3. TOPHI- yellowish-whitish, irregular

deposits in the skin that break open and reveal a gritty appearance

4. PODAGRA

Gouty arthritis

ASSESSMENT FINDINGS5. Fever, malaise6. Body weakness and headache7. Renal stones

Gouty arthritis

DIAGNOSTIC TESTElevated levels of uric acid in the bloodUric acid stones in the kidney

Gouty arthritisMedical management1. Allupurinol2. Colchicine

Gouty arthritisNursing Intervention1. Provide a diet with LOW purine Avoid Organ meats, aged and processed

foods2. Encourage an increased fluid intake3. Instruct the patient to avoid alcohol4. Provide alkaline ash diet to increase

urinary pH5. Provide bed rest during early attack of gout

Gouty arthritis

Nursing Intervention

6. Position the affected extremity in mild flexion

7. Administer anti-gout medication and analgesics

nursing musculoskeletal

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