Date post: | 07-May-2015 |
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Health & Medicine |
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Dinah Hernandez MSN, PHN, RN
Common Medical Treatments for MSApplication of hot and coldHot, cold compress or paraffinPhysical Therapy Tx (PROM, AROM)External Immobilization
Braces, corsets, splints, casts, tractionSurgical Treatment
Joint- replacement surgery/ arthroplasty Amputation
Data CollectionSkeletal deformity
posture, coordination, body build assymetry, deformity
Muscle mass, swelling, deformity, tendernessAssess musculoskeletal function
muscle strength, balance, gaitAssessment of immobilization device
pressure, infection, hemorrhage Complications: neurovascular compromise
Complications of pressureWound infectionInfection to the boneHemorrhage
Diminished color Tachycardia Hypotension Rapid respiration Anxiety/panic/confusion Diaphoresis Oliguria
Planning and implementationPreventing disorders of immobility
Skin breakdown Contractures Constipation Thromboembolism
Providing comfortable positioningProviding skin careAdequate nutritionExercise
Evaluation
Musculoskeletal Disorders◦ Amputation – the absence or removal of all part or limb/
body organ w/c can be congenital or as a result from an injury/ surgery
◦ Reasons for surgical treatment: Malignancy Trauma Gangrene
Amputation of any extremety is performed at the most distal part to preserve joint and maximize limb length; prosthesis fitting is easier.
Amputation is classified1.According to the affected limb2.According to the level of amputation
Levels of Amputation◦ Below elbow amputation◦ Above elbow amputation◦ Below knee amputation◦ Above knee amputation
◦ Phantom limb pain is an after effect of amputation. It refers to the sensation of pressure, itching that occurs to the areas of amputation, and the feeling as if the absent body part is still present. The sensation is common and results from damage to the nerves in the stump
Prosthesis – artificial device that replaces part or all necessary extremity.Clients are fitted w/ prosthesis asap after
surgeryNursing consideration:
Wound dressing twice daily Preventing complication Client teaching Provide emotional support Assisting in exercises
Replantation – is the re-attachment of a completely severed body part back to the body.
Chronic back painContributing factors
Combination of prolonged muscular and ligament strain, pressure on the lumbosacral vertebrae, aging process
Causes: Abnormal spinal column curvatures Poor posture Congenital disease Malignancy Compression fracture Osteoarthritis Rickets Rheumatoid arthritis aging
Intervertebral Disk (IVD) results when a small pad or disk or cartilage ( nuclues pulposus) between two vertebrae presses against the spinal nerve that radiate out from the spinal cord.Also known as herniated nucleus pulposus
(HNP)Also know as sciatica
Diagnostic Tests:MRICT Scan combine with myelography/Diskography
Medical Treatment of IVDPhysical therapyAntispasmodic/analgesicUltrasound/intermittent traction. TENS therapySurgical Treatment
Surgical TreatmentLumbosacral decompressionLaminectomyDiskectomyMicrodiskectomySpinal fusionInterbody fusion
Nursing considerationProvide postoperative care Assist with pain managementWound careWatch for s/s of bleeding, drainageEvaluate pt for neurologic functionFollow physician’s orders
Lumbar DecompressionObserve for clients sensation/mobilityObserve for complications of spinal nerve damage/cord Immediately report complaints of tingling, numbness or
difficulty moving legsCheck for edema due to traumaEncourage pt to move to prevent respiratory
complication
Postlumbar decompression concernsNerve damageEdemaChanges in level of consciousnessMuscle spasmThrombophlebitisAdditional injuryInfection
Cervical decompressionDifficulty/changes in sensation in armsDifficulty in moving armsDifficulty in breathing
Nursing consideration◦ Log roll◦ Pain medicine (PCA)◦ Use of thoracic-lumbar-sacral orthosis (TLSO)◦ Use of fracture bed; advice pt not to reach/stretch for
articles◦ Application of antiembolism stocking & pneumatic
compression devices◦ Use of cervical collar ( cervical diskectomy)◦ Teach pt to keep his neck in neutral pos’n & aligned pos’n◦ Teach pt for cervical collar care◦ Assist pt with sitting by supporting pt’s neck & shoulder
Temporomandibular Joint (TMJ) – painful, aching disorder involving facial bones/ muscles around the joint between mandible & temporal bones.
Causes: ◦ Stress◦ Malocclusion of the upper and lower jaw◦ Poorly fitting dentures◦ Rheumatoid arthritis◦ Neoplasm
s/s: clicking sound during chewing Tinnitus DeafnessTreatment:Identify the causative etiologyPhysical therapyAnti-inflammatoryBraces/surgery
Muscular Dystropathies -chronic degenerative dse of the skeletal muscle often inherited; progressive weakening and wasting of muscles.
Cause: unknownTreatment:
Focus on supportExercise programsSplints to prevent deformitiesBraces to permit ambulation Inform pt need to prevent respiratory infection,Maintain ideal weightStrive for general good health
Osteoporosis- bone mass decrease, common to postmenopausal womenRisk Factors
Advanced age Family history Early menopause Low intake of dietary calcium Excessive alcohol/caffeine intake Sedentary life Smoking
Treatment Calcium supplements Hormones (estrogen, progesterone) Fosamax
Repetitive strain injuries-“overuse disorders”, occurs in workplace because of the necessity of performing certain motions repeatedly in some occupations.
Carpal Tunnel Syndrome – compression neuropathy of the median nerve in the wrist.◦ S/S:
Weak grip Paresthesia Pain of the thumb & 1st 3 fingers (Tinel’s sign)
◦ Causes: Repetitive movements Arthritis Trauma Gout Tumor
Treatment: Wrist splinting NSAIDS Rest Corticosteroid injection Surgery
Lateral Epicondylitis – repeated forceful wrist and finger movements that stress the origins of muscles.
S/S:Pain along the outer aspect of elbow radiating to forearmPain increases on stretching & on resisted wrist and hand
flexion
TreatmentSplintingAnalgesicsRestCorticosteroid injections
Rotator cuff injury Injury to the rotator cuff in the shoulders due to the
repetitive injury or sudden traumaS/S
PainWeaknessLoss of shoulder movement
Treatment:Physical Therapy to increase ROM arm muscle
strengthSurgical intervention
Inflammatory DisordersBursitis – inflm of bursa due to mechanical
irritation, bacterial infection, trauma, goutTreatment : heating and resting affected part Inflammatory agentCorticosteroid injection/aspiration of fluidSurgical drainage – infectious bursitisExcision of bursa
Tenosynovitis – inflammation of tendon sheath that may result from irritation or infection, typically affects the wrist/ankle◦ S/S : pain and tenderness◦ Causes: non-infectious: strains blows prolonged use of tendons
◦ Treatment: Resting Application of ice 1-2 days NSAIDS Surgery Antibiotic Elimination of activities
Arthritis – joint inflammationTypes of arthritis
Rheumatoid arthritisOsteoarthritis, DJD, hypertrophic arthritisAnkylosing spondylitis, rheumatoid spondylitis,
rheumatoid arthritis of the spineGouty arthritisSystemic lupus erythematosus (SLE)Scleroderma, progressive systemic sclerosisMonoarticular arthritis – one jointPolyarticular asrthritis- multiplt joints
Factors causing arthritis:◦ Infection by virus/microorganism◦ Direct injury to a joint ( traumatic arthritis)◦ DJD ( degeneration/deterioration of joint)◦ Metabolic disorder (gout)
◦ Cause: unknown◦ Monocyclic arthritis: 35% cases◦ Polycyclic arthritis: 50% cases◦ Progressive arthritis: 15% cases
Clinical features of arthritis◦ Persistent pain/stiffness◦ Pain & tenderness of joints◦ Swelling in the joints◦ Recurrence of symptoms◦ Obvious redness and warmth in joint◦ Unexplained wt loss, fever, muscle weakness with
joint pain◦ Bouchard’s nodes ( enlargement of proximal
interphalangeal joints)◦ Heberden’s nodes (grows in the terminal phalengeal
joints) with DJD
Rheumatoid arthritis –most painful & crippling., 3x common in womenCause: possibly virus that causes immune
system to become overactive genetic predispositionS/S: fatigue weakness wt loss general body aches painful/tender joints stiff, swollen joints
Tendons/ligaments shorten- joint deformities such as hyperextension, contractures, sublaxation (dislocation)
Medical Treatment of Rheumatoid arthritisGoal: maintain functionReduce inflammation before joints are
permanently damageMultidisciplinary ( nursing, PT, OT)Drug therapyPatient education
OsteoarthritisBelieved to have a genetic cause or
predisposition, caused by wear & tear on a joint.
Treatment:SynovectomyArthroscopic surgeryTotal arthroplasty
Ankylosis spondylitis Rheumatoid arthritis of the spine primarily affects the
facet joints & stabilizing ligaments of the spinal columnS/S:Hip & lower back pain or stiffnessWt lossFatigueFeverConjunctivitisHip contracture & flexion of neck & backBreathing impairedOsteoporotic spine increases spinal fxSpinal stiffeningHumpbackChest curvatureNeck stiffness
Treatment of ankylosis spondylitisPhenylbutazoneTeach pt to refrain from lying on one side to
prevent excess sideways spinal curvatureLight exerciseBrace