nursing musculoskeletal
TRANSCRIPT
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.
Different Contractions of the Skeletal Muscles
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.
Different Contractions of the Skeletal Muscles
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.
Different Contractions of the Skeletal Muscles
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
ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
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
ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
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
ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
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
skin
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
FractureFRACTURE COMPLICATIONS: Fat
EmbolismOnset is rapid, within 24-72 hoursASSESSMENT FINDINGS1. Sudden dyspnea and respiratory
distress2. tachycardia3. Chest pain4. Crackles, wheezes and cough
FractureFRACTURE COMPLICATIONS: Fat
EmbolismNursing Management1. Support the respiratory functionRespiratory failure is the most common
cause of deathAdminister O2 in high concentrationPrepare for possible intubation and
ventilator support
FractureFRACTURE COMPLICATIONS: Fat
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
METABOLIC BONE DISORDERS
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
METABOLIC BONE DISORDERS
Osteoporosis: TYPES1. Primary Osteoporosis- advanced
age, post-menopausal2. Secondary osteoporosis- Steroid
overuse, Renal failure
METABOLIC BONE DISORDERS
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
DEGENERATIVE JOINT DISEASE
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
DEGENERATIVE JOINT DISEASE
OSTEOARTHRITIS: Risk factors1. Increased age2. Obesity3. Repetitive use of joints with previous
joint damage4. Anatomical deformity5. genetic susceptibility
DEGENERATIVE JOINT DISEASE
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
DEGENERATIVE JOINT DISEASE
OSTEOARTHRITIS: Assessment findings
1. Joint painCaused by
Inflamed synovium Stretching of the joint capsule Irritation of nerve endings
DEGENERATIVE JOINT DISEASE
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
DEGENERATIVE JOINT DISEASE
OSTEOARTHRITIS: Diagnostic findings1. X-rayNarrowing of joint spaceLoss of cartilageOsteophytes2. Blood tests will show no evidenceno evidence of
systemic inflammation and are not useful
DEGENERATIVE JOINT DISEASE
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
DEGENERATIVE JOINT DISEASE
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
DEGENERATIVE JOINT DISEASE
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
Rheumatoid arthritis
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
Rheumatoid arthritis
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
Rheumatoid arthritis
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
Rheumatoid arthritis
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
Rheumatoid arthritis
MEDICAL MANAGEMENT1. Therapeutic dose of NSAIDS and
Aspirin2. Chemotherapy with methotrexate,
antimalarials, gold therapy and steroid3. For advanced cases- arthroplasty,
synovectomy4. Nutritional therapy
Rheumatoid arthritis
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