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Musculoskeletal System
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Inflammatory Disorders
PresentationsRheumatoid Arthritis
Ankylosing spondylitis
Osteomyelitis
Bursitis
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Degenerative Disorders
Osteoporosis
Osteoarthritis DJD/Degenerative Joint Disease
Total Joint Arthroplasty
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Osteoporosis
Increased porosity in the bone
Common disorder of bone metabolismDecreased mineral and protein matrix
Bone brittle, fragile
Prone to fractures
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Osteoporosis
10 million people in United States have Osteoporosis
Another 34 million have low bone density, which puts them at risk for Osteoporosis
80% of affected are women
1.5 million fractures occur each year related to Osteoporosis
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Osteoporosis
Silent diseaseNo symptoms of bone lossMay have 50% loss prior to diagnosisMultiple fractures may cause decrease in height
Only diagnosed by BMDBone Mineral Density
PainlessNon-invasivesafe
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Osteoporosis
Risk FactorsSmall bonesAdvanced ageFamily historyPost-menopause with out estrogen replacementEating disordersLow calcium dietInactive activitySmokingIncreased alcohol consumptionUse of corticosteroids or anticonvulsant medications
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Medical-Surgical Management
Pharmacological four medications – EstrogenFosamaxMiacalcinTestosterone
No curePrevention
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Osteoporsis
Diet
Activity
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Nursing Process
AssessmentSubjective Data
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Objective Data
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Dowager’s Hump
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Degenerative Joint Disease/DJDOsteoarthritis
NOT inflammatory
Wear and tear disease
Slow, steady, progressive destruction of the joint
Etiology unknown
Most common form of arthritis
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Osteoarthritis or DJD
SymptomsEarly morning stiffnessPain after physical activityJoint enlargementBouchard’s nodesHeberden’s nodes
Hypertrophic spurs– Distal interphalanges– Hard, painless
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Heberden’s Nodes
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Heberden’s Nodes
Heberden’s nodes.
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Bouchard’s Nodes
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Diagnostic testsRadiographic studies
Arthroscopy
Synovial fluid examination
Bone scans
Osteoarthritis
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Medical management/nursing interventions
Surgery
Osteoarthritis
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Total Joint Arthroplasty
Joint replacement
Replacement of both articular surfaces with in a joint capsule
Hip, knee, shoulder and fingers are most common sites
Replacement consist of metal and polyethylene
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Total Joint Arthroplasty
Older method of cemented in prepared bone is not used as often
New technology uses porous coated cement-less artificial joint component. This allows bone to grow into the joint and less prosthesis failure noted.
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Total Hip Replacement
Replacement of severely damaged hip with an artificial joint
Usually people over 60 years
Severe pain, irreversible damage to hip joints
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Hip Replacement
Potential problems
Dislocation of prosthesis
Excessive wound drainage
Infection
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Following Hip Replacement
Client’s hip and leg to be kept in position of adduction and extension
Knees are apart by abductor pillow or by using foam wedges
Entire leg to be supported when turning side to side
AVOID ACUTE FLEXION OF THE HIP
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Following Hip Replacement
Fracture bed pan should be usedRaised toilet seat in bathroomVital signs, circulation, movement and sensation checks (CMS) to be done frequentlyInspect dressing frequentlyMonitor drainage from portable suction device (JP Drainage) can be as high as 200 -500 cc. With in 48 hours should be less than 30 cc and suction devices can be removed.
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Client Goals after Hip Replacement
Ambulate independentlyOut of bed the night of the surgery or the next dayGait training begins so that client can use crutches or caneFLEXION OF KNEE TO BE AVOIDED No more than 90 degreesNo stair climbing for three months
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Total Knee Replacement
Severe pain and functional disability related to joint destruction
Following knee replacement clients may use CPM continuous passive motion machine which helps increase circulation to operative area and promotes flexibility with in he knee joint.
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Knee Replacement
Following surgery….
Knee to be imoblized
Firm compression dressing
Adjustable soft knee immobilizer
Transfer to chair ok, but NO WEIGHT BEARING is allowed on knee until ordered my MD
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Total knee replacement
SCD – Sequential Compression Device may be used or
TED hose – Anti embolism stocking worn to minimize the development of thrombophlebitis
Rehabilitation starts second day
When patient is sitting knee should be elevated
Weight bearing should start with in 1- 2 days
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Nursing Management
Cough and deep breathe
Use trapeze to raise hips off bed for bedpan use
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NursingAssessment
Nursing Assessment should include…Neurovascular assessment of affected extremity
Incision assessment
Vital signs
Lung sounds
Pedal pulses
Intake and output
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Nursing Assessment
Irritablity
Restlessness
Orientation
Neurovascular assessment for pain, numbness, tingling and paresthesia
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Objective Assessment
Incision assessment forApproximation
Redness
Drainage
Skin color
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Assessment
Other assessmentsTachypnea
Dyspnea
Hypoxia
Crackles and wheezes ( s/s of fat embolism)
Position of affected part
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Care Plans
Divide in to groups and create care plans