Chapter 27Musculoskeletal Conditions

Chapter 27Musculoskeletal Conditions

Assessment of Musculoskeletal ProblemsAssessment of Musculoskeletal Problems

• Abnormal gait

• Abnormality of structure

• Dysfunction of a limb

• Favoring of one side

• Tremor

• Paralysis

Assessment of Musculoskeletal Problems (cont.)Assessment of Musculoskeletal Problems (cont.)

• Weakness

• Atrophy of a limb

• Redness; swelling of a joint

• Use of cane, walker, or wheelchair

Physical Examinations of the Musculoskeletal SystemPhysical Examinations of the Musculoskeletal System

• Shoulder

• Neck

• Elbow

• Wrist

• Finger

• Hip

• Knee

• Ankle

• Toe

Desired OutcomesDesired 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.

Facilitating Musculoskeletal FunctionFacilitating 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

Contributing Factors to Fractures in the ElderlyContributing 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

Measures to Prevent FallsMeasures 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.

Symptoms of FracturesSymptoms 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

Most Common Fracture SitesMost Common Fracture Sites

• Neck of the femur

• Colles’ fracture

• Compression fracture of the vertebrae

Factors Contributing to OsteoarthritisFactors Contributing to Osteoarthritis

• Disequilibrium between destructive and synthetic elements

• Stress to the joints

• Obesity

• Genetic factors

• Low vitamin D and C levels

Therapeutic Measures for OsteoarthritisTherapeutic 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, B6, C, and E and zinc, selenium, niacinamide, calcium, and magnesium

• Weight reduction

Symptoms of Rheumatoid Arthritis Symptoms of Rheumatoid Arthritis

• Fatigue

• Malaise

• Weakness

• Weight loss

• Wasting

• Fever

• Anemia

Patient Education for Rheumatoid ArthritisPatient 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

Potential Causes of OsteoporosisPotential Causes of Osteoporosis

• Inactivity or immobility

• Diseases

• Reduction in anabolic sex hormones

• Diet

• Drugs 

Problems Associated with OsteoporosisProblems Associated with Osteoporosis

• Kyphosis and a reduction in height

• Spinal pain

• Bones may fracture more easily

Treatment of OsteoporosisTreatment of Osteoporosis

• Calcium supplements

• Vitamin D supplements

• Progesterone and estrogen

• Anabolic agents

• Fluoride or phosphate

• Synthetic form of calcitonin

• Bisphosphonates

Treatment of GoutTreatment 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

Podiatric ConditionsPodiatric Conditions

• Calluses

• Corns

• Bunions

• Hammer toe

• Plantar fasciitis

• Foot infections

• Ingrown toenails

Patient Teaching for Proper Foot Care 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.

Nursing Considerations for Pain ManagementNursing 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

Measures to Prevent InjuryMeasures 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.

Promoting IndependencePromoting Independence

• Use of canes, walkers, and other assistive devices

• Referral to physical and occupational therapists

SourceSource

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