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Chapter 46

Chapter 46. Nursing Care of Patients with Musculoskeletal and Connective Tissue Disorders. Bone and Soft Tissue Disorders. Strain Sprain Dislocation Bursitis Rotator Cuff Injury. Carpal Tunnel Syndrome. Median Nerve Compression in Wrist’s Carpal Tunnel

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Chapter 46

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  1. Chapter 46 Nursing Care of Patients with Musculoskeletal and Connective Tissue Disorders

  2. Bone and Soft Tissue Disorders • Strain • Sprain • Dislocation • Bursitis • Rotator Cuff Injury

  3. Carpal Tunnel Syndrome • Median Nerve Compression in Wrist’s Carpal Tunnel • Occurs with Swelling in Tunnel • Finger, Hand, Arm Pain/Numbness

  4. Carpal Tunnel Syndrome (cont’d) • Relieve Inflammation and Rest Wrist • Splint • Anti-inflammatory • Surgery • Teach Prevention

  5. Fractures • Break in a Bone • Cause • Trauma • Pathological (From Disease ) • Open – Breaks Skin • Closed – Does Not Break Skin

  6.   Types of Fractures

  7. Signs and Symptoms • Pain • Decreased ROM • Limb Rotation • Deformity, Shortening of Limb • Swelling • Bruising

  8. Diagnostic Tests • X-Ray • CT scan

  9. Emergency Treatment • Splint It As It Lies! • Seek Medical Treatment

  10. Fracture Management • Goals • Realignment of Bone Ends • Immobilization

  11. Fracture Healing Phases  

  12. Closed Reduction • Manual Realignment • Bandages/Splints • Casts • Traction • Skin • Skeletal

  13. Types of Skin Traction

  14. Balanced Suspension and Skeletal Traction

  15. Fracture Management (cont’d) • Open Reduction with Internal Fixation • External Fixation

  16.   External Fixation

  17. Complications of Fractures • Nonunion • Neurovascular compromise • Hemorrhage • Infection • Thromboembolitic Complications • Acute Compartment Syndrome • Fat Embolism Syndrome

  18. Compartment Syndrome

  19. Bivalving Cast

  20. Nursing Diagnoses • Acute Pain • Impaired Physical Mobility • Impaired Walking • Ineffective Health Maintenance • Risk for Peripheral Neurovascular Dysfunction

  21. Nursing Diagnoses (cont’d) • Risk for Ineffective Tissue Perfusion • Risk for Ineffective Skin Integrity

  22.   Palming the Cast

  23. Nursing Care • Cast Care • Traction Care • Pain Control • Neurovascular Checks • Skin Care • Nutrition

  24. Nursing Care (cont’d) • Self Care Deficits • Psychosocial

  25. Patient Education • Cast Care • Pin Care • Nutrition

  26. Osteomyelitis • Infection of Bone • Prevention is Key! • Fever, Redness, Heat, Pain, Swelling, Pain • Long-term Antibiotic Therapy • Incision and Drainage • Amputation

  27. Osteomyelitis (cont’d)

  28. Osteomyelitis (cont’d) • Nursing Care • Medication Teaching • Hand Hygiene • Sterile Dressing Changes

  29. Osteoporosis • Low Bone Mass as Bone Loses Density • Prone to Fractures Occur • Spine, Wrist, Hip Most Common • All Bones Affected

  30. Osteoporosis Prevalence • 10 Million People • 8 Million Females • 2 Million Males • Over Age 50 Fractures • 1 in 2 Women • 1 in 4 Men  

  31. Osteoporosis Fracture Effects • Hip/Vertebral Fractures • Reduced Quality of Life • Increased Disability • Risk of Death (During Year After Fracture)

  32. Osteoporosis Prevention • Build Bone Through Age 30 • Obtain Adequate Calcium and Vitamin D • Exercise (Especially Childhood ) • Avoid Alcohol and Smoking

  33. Osteoporosis (cont’d) • Imbalanced Remodeling Process

  34. Osteoporosis Risk Factors • Aging • Female • Caucasian/Asian • Fracture History • Family History • Petite Body Build • Postmenopausal Women

  35. Osteoporosis Risk Factors (cont’d) • Low Testosterone and Estrogen • Low Calcium Intake • Low Vitamin D • Excessive Caffeine, Protein, Sodium • Sedentary Lifestyle • Excessive Alcohol Use • Cigarette Smoking

  36. Osteoporosis (cont’d) • Signs and Symptoms • Dowager’s Hump • Kyphosis • Height Decreases • Back Pain • Fracture

  37. Osteoporosis (cont’d) • Body System Effects • Functional Effects • Emotional effects • Socialization

  38. Osteoporosis Diagnostic Tests • Dual-energy X-Ray Absorptiometry • Serum Calcium, Vitamin D Decreased • Serum Phosphorus Increased • Serum Alkaline Phosphatase Increased

  39. Osteoporosis Therapeutic Interventions • Reduce Risk Factors • Calcium Supplements • Vitamin D Supplements • Medications

  40. Antiresorptive Medications • Bisphosphonates • Alendronate (Fosamax) • Ibandronate (Boniva) • Risedronate (Actonel) • Zoledronic acid (Reclast) • Calcitonin (Fortical, Miacalcin)

  41. Antiresorptive Medications (cont’d) • Selective Estrogen Receptor Modulator • Raloxifene (Evista) • Estrogen Therapy

  42. Anabolic(Bone Forming) • Teriparatide (Forteo)

  43. Osteoporosis Nursing Care • Pain Relief • Symptom Management • Education • Diet: Increase Calcium, Vitamin D • Exercise • Medication • Fall Prevention

  44. Paget's Disease • Increased Bone Loss • Disorganized Bone Deposits • No Obvious Symptoms Usually • X-Ray, Bone Scan • Calcitonin (Calcimar) • Relieve Pain, Teach, Promote Life Quality

  45. Bone Cancer • Primary Malignant Tumors • Osteosarcoma • Most Common • 50% Occur in Distal Femur in Young Men • Metastasizes to Lung Within 2 Years

  46. Bone Cancer (cont’d) • Primary Malignant Tumors • Ewing’s Sarcoma • Most Malignant • Chrondrosarcoma • Cancer of Cartilaginous Cells • Better Prognosis

  47. Primary Bone Cancer • Therapeutic Interventions • Surgery, Chemotherapy, Radiation • Nursing Care • Postoperative Care • Supportive

  48. Metastatic Bone Disease • Bone-seeking Cancers • Prostate, Breast, Lung, Thyroid • Pathological Fractures • Severe Pain • Therapeutic Interventions • Radiation

  49. Metastatic Bone Disease (cont’d) • Nursing Care • Supportive Care as with Other Cancers

  50. Gout • Pathophysiology • Systemic Connective Tissue Disorder • Uric Acid Build Up • Urate Crystals Deposited in Joints/Connective Tissues • Severe Inflammation

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