L10 Musculoskeletal System disorders.pptx

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1. Musculoskeletal System disorders BURSITIS: Bursitis is a painful inflammation of the bursae . Bursae are fluid-filled sacs that prevent friction between joint structures during joint activity. The inflammation restricts joint movement. Clinical Manifestations Pain around a joint commonly the knee, elbow, shoulder, and hip. Varying degrees of redness, warmth, and swelling may be visible. There is point tenderness and limited ROM on examination. Management and Nursing Interventions Rest and immobilization of affected joint ROM exercises Surgery indicated when calcified deposits or adhesions have diminished function Nonsteroidal anti-inflammatory drugs (NSAIDs) to control the inflammation and pain

2. OSTEOARTHRITIS Osteoarthritis, or degenerative joint disease, is a chronic, non inflammatory, slowly progressing disorder that causes deterioration of articular cartilage. It affects weight-bearing joints (hips and knees) Cause: Cause is unknown, but aging and obesity are contributing factors. Previous trauma may cause secondary OA. Diagnostic Evaluation: X-rays of affected joints show joint space narrowing, osteophytes, and sclerosis. Analysis of synovial fluid differentiates OA from RA. Management Pain management using non-narcotic analgesics, such as acetaminophen; and NSAIDs. Weight loss, if necessary, to relieve stress on joints. Proper nutrition, sleeps, and stress reduction to improve well-being. Surgical Intervention: Surgical intervention is considered when the pain becomes intolerable to patient and mobility is severely compromised. osteotomy, and debridement

3. OSTEOMYELITIS Osteomyelitis is a severe pyogenic infection of the bone and surrounding tissues that requires immediate treatment. Generally three routes: Bloodstream ( hematogenous spread) Adjacent soft tissue infection (contiguous focus) Direct introduction of microorganisms into the bone Cause Bacteria lodge and multiply in bone. Staphylococcus aureus is the most common infecting microorganism. Clinical Manifestations Infection of long bones with acute pain and signs of sepsis. Localized pain and drainage.

4. Diagnostic Evaluation Aerobic and anaerobic cultures of bone and tissue to identify the organism. ESR elevated, WBC and hemoglobin decreased. Bone necrosis seen 10 to 14 days on X-rays. Management Acute: full recovery possible with minimal loss of function Chronic: develops with inadequate or ineffective course of antibiotics or delayed treatment Pharmacologic Intervention Employ quickly after presentation of symptoms to avoid chronicity Medications depend on organism, but include: Penicillins (Pen G). Extended-spectrum penicillins (ampicillin, carbenicillin , amoxicillin). Tetracyclines . Cephalosporins . Surgical Intervention Surgical intervention may be needed to obtain culture and sensitivity of specimen. Surgical decompression considered when patient does not improve after 36 to 48 hours of antimicrobial therapy. Complications: Non healing wound , Sepsis , Immobility , Amputation

5. Septic (Infectious) Arthritis Joints can become infected through spread of infection from other parts of the body ( hematogenous spread) or directly through trauma or surgical instrumentation. Previous trauma to joints Cause S. aureus causes most adult joint infections, followed by strepatientococci and gram-negative organisms. Risk factors include Advanced age, diabetes mellitus, rheumatoid arthritis, and preexisting joint disease or joint replacement. Clinical Manifestations A warm, painful, swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are present. Diagnostic studies include: Aspiration, examination, and culture of the synovial fluid. Computed tomography may disclose damage to the joint lining.

6. Management Broad-spectrum IV antibiotics are started The IV antibiotics are continued until symptoms disappear. In addition to prescribing antibiotics, the physician may aspirate the joint with a needle to remove excessive joint fluid, exudate, and debris. The inflamed joint is supported and immobilized in a functional position by a splint that increases the patient’s comfort. Analgesics, such as codeine, may be prescribed to control pain. After the infection has responded to antibiotic therapy, NSAIDs may be prescribed to limit joint damage.

7. Musculoskeletal trauma The bony skeleton provides the supporting framework for the human body. Its 206 bones are subject to many stressors, which may result in fractures. Fractures vary in complexity and potential harm to the body. Simple fractures occur with no break from the bone to the outside of the body Compound fractures have an external wound, thus creating contamination of the fracture. Complete fractures occur when bone continuity is completely interrupatiented Partial fractures (incomplete) interrupatient only a portion of bone continuity. Cause Traumatic injuries can be intentional (assaults, gunshot wounds, stab wounds) Unintentional (falls, motor vehicle crashes).

8. CASTS : A cast is an immobilizing device made up of layers of plaster or fiberglass. Purposes: To immobilize and hold bone fragments in reduction. To permit early mobilization To correct and prevent deformities To support and stabilize weak joints Complications of Casts: Pressure of cast on neurovascular and bony structures causes: Necrosis -pressure sores Nerve palsies.

9. AMPUTATION Amputation is the total or partial surgical removal of an extremity. Indications Inadequate tissue perfusion, such as results with diabetes mellitus or other peripheral vascular diseases Severe trauma Malignant tumor

10. CONTUSIONS, STRAINS, AND SPRAINS A contusion: A contusion is an injury to the soft tissue Cause Caused by a blunt force (blow, kick, or fall). Clinical Manifestations Hemorrhage into injured part (ecchymosis) from rupatienture of small blood vessels. Pain, swelling, and ecchymosis. A sprain: A sprain is an injury to ligamentous structures surrounding a joint Cause: Caused by a twist resulting in a decrease in joint stability. Clinical manifestation Pain on passive movement of joint. Increasing pain during first few hours due to continued swelling. A strain: A strain is a microscopic tearing of the muscle. Cause Caused by excessive force, stretching, or overuse. Rapid swelling due to extravasation of blood within tissues.

11. Clinical manifestation Hemorrhage into the muscle. Swelling. Tenderness. May be associated spasm. Management Immobilize in splint, elastic wrap, or compression dressing to support weakened structures and control swelling. Apply ice for first 24 hours. Analgesics usually include non-steroidal anti-inflammatory drugs. Severe sprains may require surgical repair or cast immobilization.

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