Nur 105 Module i
description
Transcript of Nur 105 Module i
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MUSCULOSKELETAL SYSTEM
MODULE I
NURSING 105: ADULT NURSING
Myrna Williamson, MSN, RN, OCN
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In the very young…
• The skeleton is composed of mostly cartilage and is therefore, pliable with a decreased incidence of bone fractures and breakage in childhood
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Mature Bone
• Rigid connective tissue consisting of cells;– Collagen– Calcium– Phosphate
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SKELETON
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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SKELETON
• AXIAL PORTION– Cranium– Vertebrae– Ribs
• APPENDICULAR PORTION– Limbs– Shoulders – Hips
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ANATOMY & PHYSIOLOGY REVIEW
• Structure & Function – Skeletal System
• Bone Formation, Maintenance, Healing
– Articular System• Joints – synarthrosis, amphiarthrosis, & diarthrosis
– Skeletal Muscle System• Contraction• Tone• Actions• Exercise, Disuse, & Repair
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Bone Cells
Osteogenic CellsOsteoblastsOsteocytesOsteoclasts
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Bone Formation & Maintenance
• Ossification• Resorption &
Formation– Local stress– Vit. D– Parathyroid hormone– Calcitonin– Blood supply
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TYPES OF BONES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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SPONGY BONE
• Located in the ends of long bones and the center of flat and irregular bones
• Can withstand forces applied in many directions
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DENSE (COMPACT) BONE
• Covers spongy bone
• Cylinder around a central marrow cavity
• Can withstand force predominantly in one direction
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SPONGY BONE AND COMPACT BONE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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FUNCTIONS OF BONE
• Framework• Support• Movement• Shape• Maintain Position• Attachment of
Muscles
• Protects Organs• Storage• Hematopoiesis• Remodeling• Reformation• Movable Joints
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CHARACTERISTICS OF JOINTS
• Allow the movement between bones
• Formed where two bones join
• Surfaces are covered with cartilage
• Enclosed in a capsule
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Classification of Joints
• A-C; Synarthrotic (immovable) & amphiarthrotic (slightly movable) joints.
• D-E: Diarthrodial (freely movable) joints
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Types of Diarthrodial Joints
• Hinge• Ball &
Socket• Pivot• Condyloid• Saddle• Gliding
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SYNOVIAL JOINT
From Applegate E: The Anatomy and Physiology Learning System, ed. 2, Philadelphia, 2000, W.B. Saunders.
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SYNOVIAL JOINT OF THE KNEE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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ANTERIOR VIEW OF MAJOR MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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POSTERIOR VIEW OF MAJOR MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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SKELETAL MUSCLE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.
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Neuromuscular Junction
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CHARACTERISTICS OF MUSCLES
• Made up of bundles of muscle fibers
• Provide the force to move bones
• Assist in maintaining posture
• Assist with heat production
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4 Steps of Muscle Contraction
• Excitation
• Coupling
• Contraction
• Relaxation
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Body Movements
• Flexion• Extension• Abduction• Adduction• Rotation• Circumduction• Supination
• Pronation• Inversion• Eversion• Protraction• Retraction
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Age Related Changes of Musculoskeletal System
• Bones• Muscles• Joints• Ligaments
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Nursing Assessment
• Health History– Initial Interview
– Assessment Data• Pain• Altered Sensations
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Nursing Assessment
• Physical Assessment– Posture– Gait– Bone Integrity– Joint Function– Muscle Strength & Size– Skin– Neurovascular Status
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RISK FACTORS
• Autoimmune disorders
• Calcium deficiency
• Degenerative conditions
• Falls
• Hyperuricemia
• Infection
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RISK FACTORS (Continued)
• Medications
• Metabolic disorders
• Neoplastic disorders
• Obesity
• Postmenopausal states
• Trauma and injury
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Diagnostic Evaluation
• Imaging Procedures– X-ray– Computed Tomography
(CT)– Magnetic Resonance
Imaging (MRI)– Arthrography– Bone Densitometry
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Diagnostic Evaluation
• Nuclear Studies– Bone Scan
• Endoscopic Studies– Arthroscopy
• Other Studies– Arthrocentesis– Electromyography– Biopsy
• Laboratory Studies– (CBC)– Urinalysis (Calcium)– Blood Chemistry– Serum Calcium– Serum Phosphate– Uric Acid– Serum Creatinine– LDH, SGOT, CPK
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X-RAYS
• DESCRIPTION• IMPLEMENTATION
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ARTHROCENTESIS
• DESCRIPTION• IMPLEMENTATION
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ARTHROGRAM
• DESCRIPTION• IMPLEMENTATION
Arthrogram of the Knee
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ARTHROSCOPY
• DESCRIPTION• IMPLEMENTATION
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BONE SCAN
• DESCRIPTION• IMPLEMENTATION
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BONE OR MUSCLE BIOPSY
• DESCRIPTION• IMPLEMENTATION
Muscle Biopsy Showing Polymyositis
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ELECTROMYOGRAPHY (EMG)
From Mourad LA (1991) Orthopedic disorders. St. Louis: Mosby.
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MYELOGRAM
From Herlihy B, Maebius NK: The human body in health and illness, Philadelphia, 2000, W.B. Saunders.
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MUSCULOSKELETAL INJURIES
• Skeletal Trauma• Injuries to Support
Structures
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Fractures
• Described according to location and type
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Types of Fractures
• Complete or Incomplete
• Open (formerly referred to as compound)
• Closed (formerly referred to as simple)
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Complete Fractures
• Linear
• Oblique
• Transverse
• Spiral
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Complete Fractures
• Comminuted
• Impacted
• Pathologic
• Avulsion
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Complete Fractures
• Compression
• Displaced
• Extracapsular
• Intracapsular
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Incomplete Fractures
• Greenstick
• Torus
• Bowing fracture
• Transchondral fracture
• Stress Fractures
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TYPES OF FRACTURES
From Ignativicius, D. & Workman, M. (2002). Medical-surgical nursing, ed 4, Philadelphia: W.B. Saunders.
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Types of Fractures
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Pathophysiology of a Fracture
• Tissue Disrupted• Bleeding Occurs • Hematoma Forms• Bone Tissue
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Healing of a Fracture
• Inflammatory response
• Vascular tissue • Bone-forming cells• Callus formation• Osteoblasts • Remodeling
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Speed of Healing
• Hematoma formation – within hours• Procallus – within days• Callus formation – within weeks• Replacement and remodeling – up
to 4 years
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Fractures – Clinical Manifestations
• Impaired function• Deformity (unnatural
alignment)• Swelling• Muscle spasm• Tenderness• Pain• Impaired sensation
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FRACTURE OF AN EXTREMITY
• ASSESSMENT• INITIAL CARE
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INTERVENTIONS FOR A FRACTURE
• Reduction• Fixation• Traction• Casts
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Fractures - Treatment
• Reduction– Closed manipulation– Traction (skin or skeletal)– Open reduction and internal fixation (ORIF),
(insertion of prosthesis, screw, plate, nail or wire).
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CLOSED REDUCTION
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
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INTERNAL FIXATION
From Browner BB et al (1992) Skeletal trauma. Philadelphia: W.B. Saunders.
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Types of Internal Fixation for a Hip Fracture
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EXTERNAL FIXATION
From Ignatavicius, D., Workman, M. (2002). Medical-surgical nursing, ed 3, Philadelphia: W.B. Saunders. Courtesy of Smith and Nephew, Inc., Orthopedics Division, Memphis, TN.
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TYPES OF HIP FRACTURES
• Intracapsular
• Extracapsular
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HIP REPLACEMENTS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby. Courtesy of Zimmer, Inc., Warsaw, IN.
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TOTAL HIP REPLACEMENT
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
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HIP FRACTURE
• POSTOPERATIVE CARE
• CLIENT EDUCATION
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TOTAL KNEE REPLACEMENT
• DESCRIPTION• POSTOPERATIVE
CARE
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KNEE PROSTHESIS
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
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CONTINUOUS PASSIVE MOTION
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CASTS
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Cast Care
• Educate• Apply Ice• Instruct• Prevent• Attend
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TRACTION
• DESCRIPTION• IMPLEMENTATION
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SKELETAL TRACTION
• DESCRIPTION• IMPLEMENTATION
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SKIN TRACTION
• DESCRIPTION– Traction applied by the
use of elastic bandages or adhesive
Side Arm
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CERVICAL SKIN TRACTION
From James, S. Ashwill, R., & Droske, S. (2002). Nursing care of children, ed 2, Philadelphia: W.B. Saunders.
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HEAD HALTER TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
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BUCK’S SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
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PELVIC SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
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BALANCED SUSPENSION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.
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DUNLOP’S SKIN TRACTION
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
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COMPLICATIONS OF FRACTURES
• Fat embolism
• Compartment syndrome
• Infection and osteomyelitis
• Avascular necrosis
• Pulmonary emboli
• Venous thrombosis
• Delayed union & nonunion
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FAT EMBOLISM• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
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COMPARTMENT SYNDROME
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INFECTION AND OSTEOMYELITIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
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AVASCULAR NECROSIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION
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PULMONARY EMBOLISM• DESCRIPTION
– Caused by immobility precipitated by a fracture
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Venous Thrombosis
• Description
• Assessment
• Implementation
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Delayed Union & Nonunion
• Description
• Assessment
• Implementation
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Other Skeletal Trauma
• Dislocation• Subluxation• Injuries to Support Structures
– Tendon tear– Ligament tear– Strain– Sprain– Avulsion– Tendonitis– Bursitis
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Soft Tissue Injury of Hip
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CARPAL TUNNEL SYNDROME
Associated with occupations that require continuous wrist movement.
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Sports-Related Injuries
• Rotator Cuff Tears
• Epicondylitis (Tennis Elbow)
• Lateral & Medial Collateral Ligament Injury
• Anterior & Posterior Cruciate Ligament Injury
• Meniscal Injuries
• Rupture of Achilles Tendon
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CRUTCH WALKING
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CRUTCH GAITS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
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SINGLE- AND QUAD-FOOT CANES
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
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WALKERS
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HERNIATION: INTERVERTEBRAL DISC
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CERVICAL DISC
CERVICAL COLLAR
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LUMBAR DISC
• DESCRIPTION• IMPLEMENTATION
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LOW BACK CARE
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
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TYPES OF DISC SURGERY
• CHEMOLYSIS• DISCECTOMY• DISCECTOMY WITH
FUSION• LAMINOTOMY• LAMINECTOMY
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DISC SURGERY
• PREOPERATIVE
• POSTOPERATIVE: CERVICAL DISC
• POSTOPERATIVE: LUMBAR DISC
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AMPUTATION OF A LOWER EXTREMITY
• DESCRIPTION– The surgical removal
of a lower limb or part of the limb
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AMPUTATION FLAPS
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
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AMPUTATION OF A LOWER EXTREMITY
• POSTOPERATIVE– Monitor vital signs– Monitor for infection and hemorrhage– Mark bleeding and drainage on the dressing if
it occurs– Keep a tourniquet at the bedside– Monitor for pulmonary emboli
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STUMP WRAPPING
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
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BELOW-THE-KNEE AMPUTATION
• POSTOPERATIVE– Prevent edema– Do not allow the stump to hang over the edge
of the bed– Do not allow the client to sit for long periods of
time to prevent contractures
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ABOVE-THE-KNEE AMPUTATION
• POSTOPERATIVE– Prevent internal or external rotation of the
limb– Place a sandbag or rolled towel along the
outside of the thigh to prevent rotation
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DISORDERS OF BONE
• Metabolic Bones Diseases
• Infectious Bone Disease
• Bone Tumors
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Infectious Bone Disease: Osteomyelitis
• Difficult to treat
• Physical disability
• Bacteria– Exogenous– Endogenous
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OSTEOMYELITIS
• DESCRIPTION• ASSESSMENT • IMPLEMENTATION
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Bone Tumors
• Incidence
• Signs & Symptoms
• Diagnosis
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DISORDERS OF JOINTS
• Noninflammatory joint disease
• Inflammatory joint disease
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INFLAMMATORY JOINT DISEASE
• Rheumatoid arthritis• Ankylosing
Spondylitis• Gouty arthritis
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RHEUMATOID ARTHRITIS (RA)
• DESCRIPTION• ASSESSMENT
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RHEUMATOID ARTHRITIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
MUSCLE ATROPHY
BOUTONNIERE DEFORMITY
SWAN NECK DEFORMITY
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RHEUMATOID NODULE
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
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RHEUMATOID ARTHRITIS (RA)
• NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDs)
• CORTICOSTEROIDS• ANTINEOPLASTIC
MEDICATIONS• GOLD SALTS
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RHEUMATOID ARTHRITIS (RA)
• PHYSICAL MOBILITY• SELF-CARE
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RHEUMATOID ARTHRITIS (RA)
• FATIGUE• BODY IMAGE
DISTURBANCE
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RHEUMATOID ARTHRITIS (RA) SURGICAL INTERVENTIONS
• SYNOVECTOMY• ARTHRODESIS• JOINT REPLACEMENT
(ARTHROPLASTY)
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Ankylosing Spondylitis
• Chronic Inflammatory Disease
• Systemic autoimmune disease
• Differs from RA
• Signs & Symptoms
• Treatment
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GOUTY JOINT • Description• Phases• Assessment• Implementation
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GOUT
From Clinical Slide Collection of the Rheumatic Diseases, © 1991,1995,1997. Used with permission of the American College of Rheumatology.
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Noninflammatory Joint Disease
• Degenerative joint disease (osteoarthritis) is the most common
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OSTEOARTHRITIS
• DESCRIPTION– Also known as
degenerative joint disease (DJD)
JOINT CHANGES IN OSTEOARTHRITIS
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OSTEOARTHRITIS
From Kamal A, Brockelhurst J: Color atlas of geriatric medicine, ed. 2, St. Louis, 1991, Mosby.
SEVERE OSTEOARTHRITIS
HEBERDEN’S NODES
BOUCHARD’S NODES
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OSTEOARTHRITIS
• PHYSICAL MOBILITY
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OSTEOARTHRITISSURGICAL INTERVENTIONS
• OSTEOTOMY• TOTAL JOINT
REPLACEMENT (TJR)
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RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS
CLIENT EDUCATION• Assist
• Instruct
• Review
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Metabolic Bone Diseases
• Osteoporosis
• Osteomalacia
• Paget’s Disease
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OSTEOPOROSIS
DOWAGER’S HUMP
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OSTEOPOROTIC CHANGES
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.
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SEVERE OSTEOPOROSIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B. Saunders.
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MILWAUKEE BRACE
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
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OSTEOMALACIA
• Metabolic disease
• Bone volume unchanged
• Osteomalacia – adults
• Rickets - children
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Paget’s Disease
• Osteitis Deformans
• Increased metabolic activity
• Usually no TX
• Affects men and women equally
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Nursing Diagnoses• Knowledge Deficit
• Impaired Physical Mobility
• Self-care Deficit
• Risk for Infection
• Impaired Skin Integrity
• Imbalanced Nutrition
• Acute/Chronic Pain
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THE END OF MUSCULOSKELETAL