MUSCULOSKELETAL SYSTEM - Maxilla (2)

- Zygomatic (2)
Functions:
- Mandible (1)
 Support - Nasal (2)
 Protect - Platine (2)
 Body Movement - Inferior nasal concha (2)
 Hemopoiesis - Lacrimal (2)
 Fat storage - Vomer (1)
 Mineral Storage  Auditory Ossicles
- Malleus (2)
- Incus (2)
Anatomy and Physiology - Stapes (2)
 Vertebral Column
Axial - Cervical vertebrae (7)
- Thoracic vertebrae (12)
 80 bones
- Lumbar vertebrae (5)
 Lie along longitudinal axis
- Sacrum (1)
 Skull (contains 22 bones, from
- Coccyx (1)
which 8 are cranial and 14 are
 Thoracic cage
facial)
- Sternum (1)
 Hyoid
- Ribs (24)
 Vertebrae (26 bones)
 Ribs (24, 12 pairs)
 Sternum
Appendicular:
 6 middle Ear ossicles (3 in each
ear)  Pectoralis girdles
- Clavicle (2)
Appendicular
- Scapula (2)
 126 bones  Upper Extremity
 Limbs - Humerus (2)
 Shoulder - Radius (2)
 Hips - Ulna (2)
- Carpals (16)
- Metacarpals (10)
Axial - Phalanges (28)
 Pelvic Girdle
Skull: - Coxal, innominate or
 Cranial Bones hipbone
- Parietal (2)  Lower Extremity
- Temporal (2) - Femur (2)
- Frontal (1) - Tibia (2)
- Occipital (1) - Fibula (2)
- Ethmoid (1) - Patella (2)
- Sphenoid (1) - Tarsals (14)
 Facial Bones
 - Metatarsals (10) - Protect vital organs and
- Phalanges (28) often contain blood
forming cells
4. Irregular bones
A. Types of Bone Cells: - Has unique shape
5. Sesamoid
a) Osteoblasts - Develop in tendons or
- Bone generating cells “B” ligaments
means building
b) Osteocytes D. LONG BONES HAVE SEVERAL COMPONENTS:
- Mature bone cells, spider
shaped and maintain bone
tissue  diaphysis - makes up most of the bone's
c) Osteoclasts length
- Bone destroying cells “C”
means chewing
- Breakdown bone matrix for  periosteum - covers & protects the
remodeling and release of diaphysis
calcium.

 epiphyses- ends of the long bone

B. Types of Osseous Tissue:

a) Spongy
- Forms from the interior  epiphyseal line- remnant of the
- Can withstand forces in epiphysial plate that closes when the
many directions growing bone has reached its full length
b) Compact
- Outer shell of a bone
- Can withstand forces  endosteum-covers the marrow cavity of
predominantly in one the long bones & the spaces in spongy
direction bones
- OSTEON – fxnal unit of a
compact bone
E. BONE MARROW

C. Bone Classification According to Shape:

1. Red bone marrow
1. Long bones - produces RBC, WBC &
- Often bears weight platelets
2. Short bones 2. Yellow bone marrow
- Small and bear little or - storage area for
no weight adipose tissue
3. Flat bones
Articulations
c.3. pivot
- junctions or spaces between 2 or
more bones
- allow for rotation,
- hold bones together securely but
supination & pronation
give the rigid skeleton mobility
c.4. gliding
 LIGAMENTS
- hold the bone & joint in the
- allows limited
correct position
movement in all
direction
 JOINTS
- Commonly called an
 the only muscle type subject to
articulation, joints are formed
conscious control
when two or more bones meet.
 muscles are attached by tendons to
There are three types of joints
bones
based on the amount of
movement allowed between
bones
Skeletal muscles
1. Synovial Joints
2. Cartilaginous Joints FUNCTIONS:
3. Fibrous Joints
a) Provide force to move bones
 JOINTS CAPSULES b) Assist in maintaining posture
- Tough, fibrous sheath
surrounding the c) Assist in heat production
articulating bone
- Lined with synovial
membrane which TYPES OF MUSCLE CONTRACTION
secretes synovial fluid
 isometric-"same length" length of the
into the joint capsule
muscle remains constant but the force
Types of Joints:
generated by the muscle is increased
a. Synarthrosis- fixed joints
b. amphiarthrosis- slightly movable
 isotonic-"same tension" characterized
c. diarthrosis-freely movable
by shortening of the muscle with no
increase in tension within the muscle
c.1. ball & socket

- permit full freedom of

MINERALS & HORMONES AFFECTING
movement
MUSCULOSKELETAL SYSTEM
c.2. hinge
1. Calcium
- permit movement in
one plane only - 99% is in the bones
 - normal serum calcium 8.6-10 - how?
mg/dl  increases absorption of
Ca from the intestine
- small changes in Ca level is fatal  promotes the action of
since most function of nerve cells PTH on bones
depends on Ca ions

- sources: milk & milk products 6. Growth hormone (GH)

- secreted by anterior part of the
2. Phosphorus pituitary gland; increases bone
length
- 85% is in the bone

- normal serum phosphorus = 2.5-  GHRH (GH-releasing

4.5 mg/dl hormone) stimulates
the release of GH.
- sources: milk & meats

3. PTH  GHIN (GH-inhibiting

- secreted by parathyroid glands hormone) inhibits the
serum Ca level and serum release of GH.
Phosphate level
- How?
 bones = release Ca
 Adipocytes break down
 kidneys = reabsorption of Ca
triglycerides
& urinary excretion of
phosphate
 Intestine = reabsorption of
 The liver breaks down
Ca via activation of Vit. D
glycogen

4. Calcitonin
 Insulin-like growth
- secreted by parafollicular cells in
factors (IGFs) stimulate
the thyroid
amino acid uptake by
- serum Ca level
target cells, promoting
- how?
protein synthesis
 bones inhibit release of Ca
 kidneys = increases renal
excretion of Ca
7. Sex hormones
- initially cause "growth spurt" that
occurs during teenage years;
5. Vitamin D estrogen and testosterone have
- functions as a hormone in important effect on bone
regulating serum Ca remodeling
BONE GROWTH Objective data

 Estrogen and Testosterone (Male and 1. Kyphosis- an increased forward

Female Sex hormones from ovaries curvature of the thoracic spine
/testes + adrenal glands) 2. Lordosis, or swayback, an exaggerated
- at puberty released in larger curvature of the lumbar spine
quantities 3. Scoliosis, a lateral curving deviation of
- increasing osteoblast activity and the spine
synthesis matrix  Milwaukee brace- orthotic device
- responsible for "growth spurts" that helps immobilize the torso and
teen yrs. neck of a patient in the treatment of
- Levels of Estrogens scoliosis and lordosis and kyphosis.
(9)/Androgens(o) at the end of
puberty cause epiphyseal plate to
close (epiphyseal line) Bone integrity

- Deformities and alignment

- Symmetry
MUSCULOSKELETAL ASSESSMENT

Subjective Data
 Genu valgum- knees angle in and touch
1. PAIN
one another when the legs are
 Bone pain- described as a dull, deep
straightened
ache that is "boring" in nature

 Genu varum-deformity marked by

 Muscular pain- described as soreness
medial angulation of the leg in relation
or aching and is referred to as
to the thigh
"muscle cramps”

 Sharp pain-bone infection with

muscle spasm or pressure on a
sensory nerve & Fracture

 Pain that increases with activity:

indicate joint sprain or muscle strain

 Radiating pain: conditions in which

pressure is exerted on a nerve root Joint Function

- Range of motion
Altered Sensations/Sensory Changes - Deformity
- Stability
 Paresthesias: caused by pressure on
- Nodular formation
nerves or by circulatory impairment
 Goniomotor
 A protractor designed for
evaluating joint motion
DIAGNOSTIC EXAMINATIONS inserted into a joint cavity for
examination or to relieve pain
1. RADIOGRAPHY
- normal synovial fluid clear, pale,
- detects musculoskeletal structure,
scanty in volume
integrity, texture or density
- after the procedure, apply
problems
compress bandage & rest the
- allows evaluation of disease
joint for 24 hours
progression & treatment efficacy

2. CT SCANS
6. ARTHROSCOPY
- show soft tissue, bone & spinal
- allows direct visualization of a
cord in 3 dimensional, cross-
joint; treatment of tears, defects
sectional images
and disease may also be
performed
3. MRI
- NPO for 8-12 hours
- allows study of soft tissue in
- after the procedure, wear elastic
multiple planes of the body.
wrap for 2-4 days; limit activities
- patients with metal implants &
for 1-4 days; put ice & elevate
pacemakers are not candidate
extremity
- remove metals
- sedate patients with
7. BONE SCAN
claustrophobia
- Imaging study with the use of a
- inform that he will hear rhythmic
contrast radioactive material
knocking sound during the
- Pre-test: Painless procedure, IV
procedure
radioisotope is used, pregnancy is
contraindicated
- Intra-test: IV injection, waiting
4. ARTHROGRAPHY
period of 2-3 hours before X-ray,
- injection of radiopaque substance
Fluids allowed, Supine position
or air into the joint cavity to
for scanning
identify acute or chronic tears of
- Post-test: Increase fluid intake to
the joint capsule or supporting
flush out radioactive material
ligaments
- after injecting dye, the joint is put
8. ELECTROMYOGRAPHY
through ROM while a series of x
- measures muscle electrical
rays are obtained
impulses for diagnosing muscle or
- if a tear is present, contrast agent
nerve disease
leaks out of the joint & will be
- instruct that needle insertion is
evident on the x-rays
uncomfortable slight bruising
may occur at the needle insertion
sites
5. ARTHROCENTESIS - warm compress
- involves aspirating of synovial
fluid, blood or pus via a needle
 9. BONE MARROW ASPIRATION  3 types: 1st degree; 2nd degree; 3rd
 Usually involves aspiration of the degree
marrow to diagnose diseases like  s/sx: mild-severe pain, swelling,
leukemia, aplastic anemia tenderness, decrease in function
 Pre-test: consent
 Intratest: local anesthesia; needle
puncture may be painful; usual site 2. SPRAIN
is the sternum and iliac crest  injury to the ligaments surrounding a
 Post-test: maintain pressure joint, caused by wrenching or
dressing and watch out for twisting motion
bleeding  3 types of sprain: 1st degree, 2nd
degree; 3rd degree
 s/sx: edema, pain, discoloration,
10. ANA (Anti-Nuclear Antibody) decrease in function
 positive results are associated with
SLE, RA, RF
MANAGEMENT FOR STRAIN & SPRAIN:
11. ESR (Erythrocyte Sedimentation Rate)
 elevation common in arthritic Rest
conditions, infection, inflammation, Ice
cancer or cell destruction
Compression

Elevation
12. RF (Rheumatoid Factor)
 measures the presence of a Heat
macroglobulin type of antibody Immobilization
found in
Surgery

13. RA & other connective tissue disease

13. SUA (Serum Uric Acid) 3. JOINT DISLOCATION
 used to detect gouty arthritis  dislocation = complete contact is lost
between articulating bones
 subluxation partial loss of contact
between articulating joints
 s/sx: pain, change in contour of the
DIFFERENT DISORDERS joint, change in length of extremity:
MUSCULOSKELETAL DISORDERS loss of normal mobility: "popping" at
affected site
INJURIES

1. STRAIN
 "muscle pull" from overuse,
overstretching, or excessive stress
MANAGEMENT: C. ACCORDING TO LINES OF FRACTURE

 immobilization  greenstick - splintering on one side of

 reduction the bone
 meds - analgesics; muscle relaxants;  spiral - fracture twisting around the
anesthesia shaft of the bone
 passive ROM - done several days to  comminuted - fracture in which the
weeks after reduction, 3-4 times a day bone is splintered into several
fragments
 transverse -break is straight across a
TRAUMATIC DISLOCATIONS bone
 oblique - fracture occurring at an angle
 ASSOCIATED JOINT STRUCTURES, across the bone; less stable than
BLOOD SUPPLY. NERVES ARE transverse
DISTORTED
 Avascular Necrosis

4. FRACTURES
 break in the continuity of the bone

A. ACCORDING TO TYPE

 complete - complete separation of

bone: produces 2 fragments
 incomplete - break only occurs in a part
of the bone

D. OTHER SPECIFIC TYPES:

B. ACCORDING TO EXTENT
 avulsion - pulling away of a fragment of
 simple/closed - skin over the fracture is bone by a ligament or tendon
intact  compression - bone is depressed
 compound/open - skin surface over a  epiphyseal fracture through the
broken bone is disrupted epiphyses
 pathologic - spontaneous fracture
 impacted - bone fragments are driven
into each other

II. SIGNS & SYMPTOMS:

 Pain or tenderness over the involved

area
  Loss of function  involves the application
 Obvious deformity of screws, plates, pins,
 Crepitation or nails to hold the
 Erythema, edema, ecchymosis fragments in alignment
 Muscle spasm and impaired sensation  provides immediate
 Shortening bone strength.

III. INITIAL CARE OF A FRACTURE OF AN b. External fixation

EXTREMITY  an external frame is
used with multiple pins
 Immobilize affected extremity. applied through the
 If a compound /open fracture exists, bone
splint the extremity and cover the  Minimal blood loss than
wound with a sterile dressing. internal fixators
 Provides more freedom
IV. MEDICAL MANAGEMENT of movement than with
traction
1. REDUCTION  Prone to pin tract
- restores the bone to proper infection
alignment
a. Closed reduction
 is performed by manual 3. TRACTION
manipulation - is the exertion of a pulling force applied
 may be performed in two directions to reduce and
under anesthesia immobilize a fracture
 a cast may be applied - provides proper bone alignment and
following reduction reduces muscle spasms
b. Open reduction
 correction and
alignment of the a. Skeletal traction
fracture after surgical o is applied mechanically to the
dissection and exposure bone with pins, wires, or tongs
of fracture o allows use of longer traction
 treatment of choice for
time & heavier weight (15-30
compound fractures
lbs)
 May be treated w/
o Provide pin care
internal fixators
b. Skin traction
o Traction is applied by the use of
2. FIXATION
elastics bandages or adhesive
a. Internal fixation
o Decreases painful muscle spasm
 follows open reduction
that accompany fractures
o Weight is limited to (5-10lbs)
1. Buck's traction 4. Bryant's traction
- Alleviates muscle spasms & immobilizes - "used in young children with fractures
a lower limb by maintaining a straight of the femur and congenital
pull on the limb abnormalities of the hip
- The affected leg is in extension

INTERVENTIONS:

 Maintain proper body alignment

 Ensure that the weights hang

freely and do not touch the floor

2. Russell's traction  Do not remove or lift the weights

- Similar to Buck's traction, but a sling without a physician's order
under the knee suspends the leg

 Ensure that pulleys are not

obstructed and that ropes in the
pulleys move freely

 Check the ropes for fraying

 Avoid moving or jarring the bed

3. Balanced Suspension Traction
- is used with skin & skeletal traction
- Used to treat fractures of the femur,  Inspect traction sites for signs of
tibia or fibula irritation or infection; do
circulatory checks

5. CASTS
- Casts are made of plaster or fiberglass
to provide immobilization of bone and
joints after a fracture or injury
TYPES OF CASTS

(Short Arm Casrt, Long arm cast, Arm Cylinder

Cast)

(Unilateral hip spica cast, One and one-half hip

spica cast, Bilateral long leg hip spica cast)

(Shoulder spica cast, Minerva cast, short leg

cast, Leg cylinder cast)
  Instruct the patient not to place sticks
or any objects inside the cast Use
additional padding around bony
prominences

 Monitor for the presence of a foul odor

or hot spots (infection): wet spots (need
for drying / drainage)

 Teach the client to keep the cast clean

and dry Instruct the client in isometric
exercises to prevent muscle atrophy

 Neurovascular checks; 6 P's

 Prepare for window or bivalving if

circulatory impairment occurs

INTERVENTIONS: BIVALVING

When cutting a cast in half (bivalving), the

physician or nurse practitioner proceeds as
 Instruct to expect sensation of heat
follows:
while the cast is drying.

1. With a cast cutter, a longitudinal cut is made

 Keep the cast and extremity elevated.
to divide the cast in half.

 Handle with palms of the hands and not

2. The underpadding is cut with scissors.
with the fingertip.

3. The cast is spread apart with cast spreaders

 Turn the extremity unless
to relieve pressure and to inspect and treat the
contraindicated.
skin without interrupting the reduction and
alignment of the bone.

 Expose the cast to air and avoid use of

tans, heat lamps, hair drier to
4. After the pressure is relieved, the anterior
unnaturally dry the cast.
and posterior parts of the cast are secured
together with an elastic compression bandage
to maintain immobilization.
 Petal edges when cast is totally dried.
 6. To control swelling and promote SHOCK
circulation, the extremity is elevated
 Common, fractures of the extremities,
(but no higher than heart level, to
thorax, pelvis or spine
minimize the effect of gravity on
perfusion of the tissues).  Because the bone is very vascular, large
quantities of blood may be lost as a
result of trauma, especially in fractures
PHYSIOLOGY OF BONE HEALING of the femur and pelvis
1.HEMATOMA FORMATION TREATMENT OF SHOCK

 Occurs 1-3 days after fracture  IVF and blood transfusions

 Blood forms a clot  Pain relievers

 Migration of phagocytic cells  Adequate splinting

2.CELLULAR PROLIFERATION FAT EMBOLISM

 3 days to 2 weeks  Is the release of fat globules from the

bone marrow into the venous
 Migration of fibroblasts and osteoblast
circulation after fracture
3.CALLUS FORMATION
 Can occur within the first 72 hours
 2-6 weeks following the injury

 Fibrocartilaginous callus SIGNS AND SYMPTOMS

4. OSSIFICATION  Restlessness

 3 weeks to 6 months  Respiratory distress

 Callus of rigid bone crosses the fracture  Hypotension, tachycardia, tachypnea

gap to join the fragments
 Petechial rash over the upper chest and
5.REMODELLING neck

 6 months to 1 year MANAGEMENT

 Unnecessary callus is reabsorbed  Prevention: Careful handling,

appropriate splinting, and avoidance of
BONE CELLS unnecessary manipulation of injured
 Osteoblasts-build up bone tissue areas, fluid and electrolyte balance

 Osteoclasts-Break down bone tissue  Bedrest

 Chondroblasts-build up cartilage tissue  Oxygen

 Fibroblasts-produce collagen tissue  Intubation

COMPLICATIONS OF FRACTURES  Fluid volume replacement

  Corticosteroids 2.Bone grafts

COMPARTMENTS SYNDROME 3. Prosthetic Replacements

 Is increased pressure within one or Delayed Union, Malunion, and Nonunion

more compartments, causing massive
 Persistent discomfort abnormal
compromise of circulation to an area
movement of the fractured site
 Causes, tight cast, bleeding, edema radiologically the fracture is still visible

SIGNS AND SYMPTOMS S/Sx:

 PAIN-increasing and unrelieved by  Fracture site remains tender

analgesics, elicited with passive motion
 Bone may still move when stressed
 PARESTHESIA
 On x-ray visible
 POIKILOTHERMIA
Delayed union-occurs when healing does not
 PALLOR occur within the expected time frame for the
location and the type of fracture
 PULSELESSNESS
Malunion-failure of the ends of a fracture bone
 PARALYSIS to unite in normal alignment
FASCIOTOMY Nonunion-failure of the ends of a fracture bone
NURSING MANAGEMENT to unite

 Cover with moist sterile saline dressing Factors

 Splint in functional position  Impaired blood supply

 Elevate to heart level MANAGEMENT

 Passive ROM exercise every 4-6 hours 1.Internal fixation

Orthotic (inserts) 2.Bone grafting

AVASCULAR NECROSIS 3.Electrical bone stimulation

 Is an interruption in the blood supply to NURSING MANAGEMENT

the bony tissue, which results in the  Pain management
death of the bone
 Monitor for possible complications
SIGNS AND SYMPTOMS
 Provide emotional support and
 Pain encouragement
 Decreased sensation  Periodic x-rays
MANAGEMENT  Reinforce educational information
1.Removal of necrotic tissue
  Encourage compliance to the Tx 3. Phantom limb sensation -feeling that
regimen the amputated part is still present
diminishes overtime
AMPUTATION
4. Phantom limb pain- pain felt by the
 Is the surgical removal of a part of the
patient in the part of the body that has
body
been amputated
PRE-OPERATIVE INTERVENTIONS
-seen more frequently in above the knee
 Health teachings especially on amputation
acceptance of situation CARPAL TUNNEL SYNDROME
 Strengthening extremities not affected,  is an instrument median neuropathy:
trunk and abdominal muscles occurs when the median nerve at the
 Monitor for infection and hemorrhage wrist is compressed in the carpal tunnel

 Keep a tourniquet at the bedside  more common in women

 If prescribed during the first 24 hours FACTORS

elevate the foot of the bed  repetitive hand and wrist movement
 Do not elevate the stump itself  repetitive exposure to cold
 After 24 and 48 hours postoperatively temperature; vibrations or extreme
position the client prone if prescribed direct pressure

 In the prone position, place the pillow  obesity

under the abdomen and stump and  arthritis
keep the legs close together
 diabetes
 Wash the stump with mild soap and
water and apply lanolin to the skin if  trauma
prescribed
MANAGEMENT
 Massage the skin toward the suture line
 rest
 Teach how to ambulate using crutches
 cold compress
 Encourage the client to look at the
 splint
stump
 drugs: NSAID’s: corticosteroids
 Assist the client to identify coping
mechanisms to deal with loss  Surgery: open release endoscopic laser
surgery
COMPLICATIONS
OSTEOPOROSIS
1. Hemorrhage
 is an age-related metabolic disease
2. Infection
 bone demineralization
  greater bone resorption and bone A. Exogenous calcium
formation occurs  calcium carbonate calcium
citrate
RISK FACTORS
B. Vitamin D supplements
 aging C. Biphosphonates- Alendronate
(Fosamax)
 gender D. Selective estrogen receptor
 family history modulators-- Raloxifene (evista)
E. Calcitonin
 immobility; sedentary lifestyle F. Hormone replacement therapy-
methylprogesterone
 Medications (corticosteroids, heparin)
OSTEOMALACIA
 Diet
 Bone becomes abnormally soft
 prolonged use of caffeine, cigarettes,
because of a disturbed calcium
alcohol
and phosphorus balance
 other diseases (osteomalacia, secondary to vitamin D
hyperthyroidism) deficiency

SIGNS AND SYMPTOMS  similar condition in children is

called rickets; more severe in
 possibly asymptomatic
adult
 back pain ETIOLOGY
 "Dowager's Hump (Kyphosis of the  Deficiency in activated vitamin
dorsal spine) D(calcitriol) related:
 pathologic fracture A. Lack of sunlight exposure
 constipation, abdominal distension and B. Dietary intake
respiratory impairment C. Crohn's disease
D. Complication of surgeries of small
MANAGEMENT intestines
 institute safety measures E. Chronic use of anticonvulsant

SIGNS & SYMPTOMS

 provide range of motion exercises
 Bone pain
 provide a diet high in protein, calcium,
vitamin C and D and iron  muscle weakness
 encourage adequate fluid intake and  pathologic fractures
high fiber diet
 Spinal kyphosis
 instruct the patient to avoid alcohol
and coffee  Bowed legs

MEDICATIONS  unsteady gait (waddling, limping)

MANAGEMENT D. Mithramycin(mithracin)-potent
antineoplastic
 Daily vitamin D supplement
OSTEOMYELITIS
 adequate intake of calcium, phosphorus
and protein  Infection of the bone

 Braces surgery

PAGET’S DISEASE (OSTEITIS DEFORMANS) Pathogen invasion

 Unknown cause

 Primarily, there is proliferation of Inflammation

osteoclasts

 Then, osteoblasts are stimulated as a

Edema
compensatory mechanism

 A disorganized pattern of bone

develops Decreased blood flow to bone

SIGNS & SYMPTOMS

 10-20 are asymptomatic Bone necrosis

PELVIS: HIP PAIN

SKULL: HEARING LOSS, HEADACHE Bone abscess

SPINE: PAIN, TINGLING AND NUMBNESS IN AN SIGNS AND SYMPTOMS

ARM OR LEG
 localize bone pain
LEG: BOW LEGGED, OSTEOARTHRITIS IN THE
 tenderness, heat and edema
KNEE OR HIP
 restricted movement
MANAGEMENT
 purulent drainage from a skin abscess
 Exercise
 fever and chills
 Heat application, gentle massage
 elevated ESR and WBC
 Diet rich in calcium
MANAGEMENT
 Medications
 prevention is the main goal
A. NSAID ex. Ibuprofen
 give antibiotics when having surgery
B. Calcitonin
- assess wound for signs and symptoms of
C. Biphosphates:
infection
Etidronate disodium(didrone)
urinary catheter, drains, iv sites are removed as
Alendronate sodium (Fosamax) soon as possible
  Antibiotic therapy  Encourage weight loss if necessary

 Infection control  Instruct the client that exercises should

be active rather than passive
 Surgery (ex: debridement)
MEDICATIONS

 Analgesics (Acetaminophen), NSAID’s

OSTEOARTHRITIS
(Celecoxib), Corticosteroids
 Is a slowly progressive, degenerative
TOTAL JOINT ARTHROPLASTY/TJR
join disease characterized by variable
changes in weight-bearing joints  Replacement with a prosthesis

 Affects the articular cartilage, TOTAL HIP REPLACEMENT

subchondral bone and synovium
Nursing Management
Etiology:
 Proper alignment
 Obesity
 Prevent flexion, external/internal
 Aging rotation, hyperextension

 Trauma  Avoid weight bearing

 Genetic predisposition  Monitoring wound drainage:200-500 ml

 Congenital abnormalities  Preventing DVT

SIGNS AND SYMPTOMS  Preventing infection

 Asymmetrical inflammation of joins in TOTAL KNEE REPLACEMENT

the hips, knee, and lumbosacral spines
 CPM (CONTINUOUS PASSIVE MOTION)
 Joint pain that diminishes after rest and using mechanical device that flexes and
intensifies with activity extends the knee at a set range of
flexion and rate
 Stiffness (morning or after awakening)
 Ice
 Functional impairment
 Neurovascular check
 Crepitus
 Monitor for drainage:200-400ml (1st 24
 Presence of Heberden’s nodes or
hours)
bouchard’s nodes
 Neutral position, avoid internal
MANAGEMENT
/external; rotation
 Immobilize the affected joint with a
RHEUMATOID ARTHRITIS
splint or brace
 Is a chronic systemic inflammatory
 Apply heat applications
disease (immune complex disorder)
 Encourage adequate rest
  Leads to destruction of connective 3. HEAT OR COLD APPLICATION: COLD
tissue and synovial membrane within ACUTE, HEAT-AS IT SUBSIDES
the joints
4. POSITIONING
RISK FACTORS
 NO PILLOW UNDER THE
 Gender: Female AFFECTED JOINT

 Age:40 years old 5. EXERCISE

 Genetics 6. DIET: HIGH CHON, IRON, VITAMINS

Phagocytosis MEDICATIONS

 Salicylates (Acetylsalicylic
acid(aspirin)
Enzymes in the joint
 Nonsteroidal anti-inflammatory
drugs (DMARDS)
Breakdown of collagen
-Hydroxychloroquine

-sulfalazine
Edema
-minocycline

 Corticosteroids
Proliferation of synovial membrane
 Methotrexate- “gold standard”
SIGNS AND SYMPTOMS for RA TX

 Morning stiffness

 Symmetric joint swelling; finger joint or

wrist

 Subcutaneous

 Nodules

 Joint deformity

 Boutonniere deformity

 Elevated ESR

 (+) RF (+) ANA

MANAGEMENT

1. REST

2. SPLINTING
  May be congenital. neuromuscular,
idiopathic
GOUTY ARTHRITIS
SIGNS AND SYMPTOMS
 A genetic defect in purine metabolism
that causes increased serum uric acid  Asymmetry of hip or shoulder

 Primary gout results from a disorder of  Restricted respiration-advanced

purine metabolism scoliosis

 Secondary gout involves excessive uric MANAGEMENT

acid in the blood that is caused by
1. Exercise
another disease
2. Weight reduction
SIGNS AND SYMPTOMS
3. Brace
 Excruciating pain and inflammation
usually small joints (podagra) 4. Spinal fusion
 Tophi KYPHOSIS-increased forward curvature at the
thoracic spine
 Presence of renal stones
LORDOSIS-exaggerated curvature at the lumbar
 Elevation of serum uric acid:7.5mg/dl
spine
MANAGEMENT
ASSISTIVE DEVICES
 Provide a low-purine diet, increase
CANES
alkaline ash foods, avoid alcohol and
starvation diets  Indicated to patient with minimal
weakness of lower extremities, with
 Encourage a high fluid intake of 2000ml
good balance and coordination
 Rest and elevate the affected extremity
 Types, single, tripod, quadripod
 Heat or cold application
 Place 4-6 inches to the side of the foot,
MEDICATIONS hand grips level with the greater
trochanter
 NSAID’s
 Elbow should be flexed at 15-30 angle
 Colchicine
 Cane is held on the hand
 Probenecid
 Opposite the affected leg
 Allopurinol
 Gait, device and affected leg, then
SCOLIOSIS unaffected leg
 Lateral deviation of the spine from the WALKERS
midline
 Provides more support and stability
 Curved may be C or S shaped than canes or crutches
  Put all four points of the walker flat on  Advance unaffected leg
the floor before putting weight on the
 Non weight bearing
hand pieces
D. Swing to
 Instruct to move the walker forward
and walk into it  Advance both crutches
CRUTCHES  Lift both feet
 2 inches below the axillary folds  Swing forward
 6 inches diagonally from small toe  Place feet next to crutches
 Elbow is at approximately 30-degree  Weight bearing on both feet
flexion
 Requires arm strength
 Place the weight on the hand piece not
the axilla E. Swing through

CRUTCH GAITS  Advance both crutches

A. Four point gait  Lift both feet

 Advance left crutch  Swing forward

 Advance right foot  Place feet in front of crutches

 Advance right crutch  Most advanced gait

 Advance left foot  Weight bearing on both feet

 Most stable crutch gaits  Requires coordination and

balance
 Partial weight bearing on both
legs ASSISTING THE CLIENT WITH CRUTCHES TO SIT

B. Two point gait  Place the unaffected leg against the

front of the chair
 Advance left crutch and right
foot  Move the crutches to the affected side
and grasp the arm of the chair with the
 Advance right crutch and left hand on the unaffected side
foot
 Flex the knee of the chair while placing
 More normal walking pattern the affected leg straight out in front
 Partial weight bearing on both ASSISTING THE CLIENT WITH CRUTCHES IN
leg GOING UP AND DOWN STAIRS
C. Three point gait UP THE STAIRS
 Advance both crutches and  The unaffected leg up first
affected leg
  Then affected leg and the crutches up

DOWN THE STAIRS

 Crutches and the affected leg down first

 Then unaffected leg down