2023 MSS.ppt
- 1. Assessment & Management For The Patient With chronic Musculoskeletal System Disorders 1
- 2. Session objectives Upon completion of this System, the students should be able to: – Identify joint and connective tissue disorders with their respective causes, c/m, pp and management – Describe metabolic bone disorders – Implement nursing process for all disorders 2
- 3. Joint & Connective Tissues Disorders 3
- 4. Rheumatoid Arthritis A chronic systemic disease characterized by recurrent inflammation of diarthrodial joints and related structures Onset can be acute or insidious Characterized by periods of remissions and exacerbation. 4
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- 6. Rheumatoid Arthritis Etiology Infection Autoimmunity Genetic C/M Nodules Arteritis Neuropathy Scleritis Pericarditis Lymphadenopathy Splenomegaly 6
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- 8. Rheumatoid Arthritis (Lab Dx) Elevated Erythrocyte Sedimentation Rate (ESR) – reflects inflammatory activity Elevated Rheumatoid Factor (RF) – Measures the presence of unusual IgG and IgM. Anemia (Decreased RBC) C-Reactive protein (CRP) and antinuclear antibody (ANA) may also be positive Arthrocentesis – Needle aspiration of synovial fluid: fluid is cloudy, milky, or dark yellow, containing WBCs 8
- 9. Rheumatoid Arthritis (Management) Pharmacologic Therapy (Disease modifying drugs) – Methotrexate, 7.5mg P.O., once per week. Increase dose gradually to a maximum of 25mg per week. Plus – Folic acid 5mg P.O., per week with methotrexate at least 24 hours after the methotrexate dose. OR/Plus – ChloroQuine phosphate, 150mg P.O., (as base) daily for 5 days of each week for 2–3 months. OR – SulfasalaZine, 500mg P.O., 12 hourly. Oral corticosteroids: – Prednisolone, 40mg P.O., daily for 2 weeks during acute flares 9
- 10. Rheumatoid Arthritis (Management) NSAIDs: – Ibuprofen, 800mg, P.O.,TID with meals. Or – Diclofenac, Immediate or delayed release tablet: 150- 200mg/day P.O., in 2-4 divided doses. – Indomethacin, 25-50mg P.O., BID TO TID; maximum dose: 200mg/day. Nutritional: weight control, Reconstructive Surgery 10
- 11. Rheumatoid Arthritis (Management) Rest and Activity – Naps, avoid over-exertion – Avoid positions of flexion – Energy conservation – Exercise therapy – for flexibility, strength, endurance, to maintain joint mobility/function Joint protection – Splints for acutely inflamed joints Cold therapy – for inflammation during flare-ups Heat therapy – for chronic stiffness 11
- 12. Gouty Arthritis Most common inflammatory arthritis in elderly – Increasing prevalence with age (75-85 years high) – Men > women, (for < 65years) Deposition of urate crystals in tissue Gout in women – Usually > 65 years. – Loss of estrogens induced uricosuric effect 12
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- 14. Gouty Arthritis (Risk factors) Purine rich foods & nutritional supplements (animal product consumers) Some drugs (low dose aspirin, thiazides, niacin, pyrazinamide, ethanbutol….) Obesity & excessive weight gain Moderate to heavy alcohol intake, high BP Abnormal kidney function 14
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- 16. Gouty Arthritis (Management) NSAIDs: Aspirin up to 500mg Ibuprofen up to 800mg Indomethacin 25-50mg Corticosteroids: prednisone 30-40 mg/d for 5 days Prednisolone 5mg Bethamethasone 6mg/ml Methylprednisolone 16-32 mg 16
- 17. Osteomyelitis Is an infection of the bone that becomes infected by one of the three modes. – Extension of soft tissue infection (e.g. Vascular ulcer, incisional infection) – Direct bone contamination from bone surgery, or traumatic injury (e.g gun shot) – Hematogenous spread from other sites of infection (e.g. upper respiratory infections). 17
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- 19. Osteomyelitis (C/M) painful, swollen and extremely tender Osteomyelitis (lab Diagnosis) Elevated leukocyte levels and elevated sedimentation rate. Wound and blood culture studies Standard x-ray studies 19
- 20. Osteomyelitis (Management) Antibiotic therapy for 3-6 weeks. – Amoxicillin-clavulanate 875 mg/125 mg PO Q12h or. – Ciprofloxacin 750 mg PO Q12h plus clindamycin 300-450 mg PO Q6h or. – Levofloxacin 750 mg PO daily plus clindamycin 300-450 mg PO q6h. Supportive measures such as hydration, high protein & vitamins. Immobilize the affected area to prevent pathogenic fracture. Internal fixation or external supportive device may be need. 20
- 22. 22 Loss of bone exceeds rate of bone formation which usually increases in older women, white race and null parity.
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- 24. Osteoporosis 10/3/2023 24 C/M: Mostly ‘silent disease’ b/c of lack of s/sx Bone pain, Decrease movement Easily breakable bones Ominous/worrying signs: pain in lower back, deformity, kyphosis, loss of height, markedly aged appearance
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- 26. Osteoporosis (Classification) 10/3/2023 26 Generalized osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s……primary osteoporosis (because of inadequate intake or absorption of calcium, estrogen deficiency, and sedentary life) Secondary osteoporosis results from an associated medical condition such as hyperparathyroidism, long-term drug therapy, long-term immobility. Regional osteoporosis occurs when a limb is immobilized.
- 27. Osteoporosis diagnosis methods X-rays CT – scans Serum calcium, phosphorous and alkaline phosphatase levels, 27
- 28. Osteoporosis (Management) 10/3/2023 28 There is no cure! But as a supportive management: Calcium.. … to enhance bone strength Vitamin D … to support bone metabolism Estrogen replacement… to decrease bone resorption Estrogen with progestin … SERM (Selective Estrogen Receptor Modulator) with anti- estrogens
- 29. Osteoporosis (Management) Exercise Avoid caffeine intake Improve protein, K,..intake Providing hazard free environment to avoid fall Safety for pathologic fracture (Health education) 29
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- 31. Osteomalacia 10/3/2023 31 Softening of the bone tissue characterized by inadequate mineralization of osteoid. Causes: Lack of activated Vitamin D (this results in poor utilization of calcium and phosphorous) Hyperparathyroidism leads to skeletal decalcification and thus to osteomalacia by increasing phosphate excretion in the urine. Prolonged use of antiseizure medication (phenytoin, phenobarbital) poses a risk for osteomalacia, as does insufficient vitamin D (dietary, sunlight).
- 32. Osteomalacia Osteomalacia may result from failed calcium absorption (malabsorption syndrome) or from excessive loss of calcium from the body. Gastrointestinal disorders (eg, celiac disease, chronic biliary tract obstruction, chronic pancreatitis, small bowel resection) in which fats are inadequately absorbed In addition, liver and kidney diseases can produce a lack of vitamin D because these are the organs that convert vitamin D to its active form. 32
- 33. Diagnosis method of osteomalacia X-rays CT – scans Serum calcium, phosphorous and alkaline phosphatase levels, 33
- 34. Osteomalacia C/M: easily breakable bones, Management: vitamin D from exposure to sunlight Nutritional / proteins, minerals/ Physical, psychological, and pharmaceutical measures are used to reduce the patient’s discomfort and pain. 34