Tabloski ch18 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Musculoskeletal System

18

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Outcomes

1. Explain normal changes in the musculoskeletal system associated with aging.

2. Identify risk factors for the older person related to common musculoskeletal problems.

3. Apply nursing diagnoses of older persons related to common musculoskeletal problems.


Learning Outcomes

4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Paget’s disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.


Learning Outcomes

5. Discuss the nonpharmacological management of the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Paget’s disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

6. Implement the nursing management principles related to the nursing care of older patients with arthritis.


The Normal Musculoskeletal System and Joints

• The musculoskeletal system consists of the body’s skeleton, muscles, ligaments, bursae, and joints.

• The skeleton provides form and support for the body.



• Bones provide protection for delicate body parts and are an important source of minerals as well as blood cells.

• The skeletal muscles provide movement of various body parts.



• Normal changes of aging often bring about complaints of musculoskeletal pain and various joint limitations, and aging appears to predispose an individual to the development of diseases such as osteoporosis and arthritis.



• The older person may then be forced to give up an independent lifestyle and become increasingly dependent on others for assistance.


Skeletal System: Structure and Function

• The adult body has 206 bones.• There are two major categories: the

axial skeleton and the appendicular skeleton.

• Bones are also classified by shape:–Long bones–Short bones–Flat bones– Irregular bones


Joints: Structure and Function

• Joints, the area where two bones are attached, provide stability and mobility to the skeleton.

• A joint may be:– freely movable,– immobile,–only slightly movable.


Muscles: Structure and Function

• Skeletal muscles are the largest organs of the body and account for 50% of lean body mass in a healthy young person.

• The more than 600 muscles in the body vary in size and shape.


Function of Skeletal Muscles

• The motor unit is the functional unit of the neuromuscular system. A motor unit consists of muscle fibers innervated by a single motor nerve, its axon, and an anterior horn cell.


Normal Changes of Aging

• Significant alterations in human structure, function, biochemistry, and genetic patterns are responsible for the changes in the muscles, tendons, bones, and joints of the older person.


Skeleton

• The bone loss of normal aging has been described in two distinct phases: –Type I, or menopausal bone loss–Type II, senescent bone loss


Common Musculoskeletal Illnesses

• Osteoporosis, osteomalacia, and Paget’s disease are metabolic bone diseases.

• The three most common inflammatory joint diseases affecting the older person are rheumatoid arthritis, gout, and pseudogout.


Falls and the Older Person

• Falls are a major health problem for the older person, with serious implications for medical as well as financial outcomes.

• In the United States, falls are the leading cause of accidental death in persons over 65 years of age.



• An important part of nursing care of the older person is to maintain safety and prevent falls and fall-related deaths.



• The goals are to recognize older persons at risk for falling; to identify and correct fall risk factors; to improve balance, gait, mobility, and functional independence using a structured interdisciplinary approach; to reduce or eliminate environmental factors that contribute to fall risk; and to evaluate outcomes with revision of the plan as needed.


Hip Fracture

• Hip fractures are a serious problem for the older person.


Common Diagnostic Findings for Musculoskeletal Illnesses

• A variety of tests (urine, blood, synovial fluid) and procedures may be done to diagnose and monitor the treatment of any musculoskeletal problem.


Pharmacology and Nursing Implications

• The physiological changes of aging and resulting altered drug metabolism frequently cause serious side effects as well as drug toxicities. The older person often has more than one clinical problem and may be taking over-the-counter drugs as well. A complete history and physical as well as baseline tests should be done to determine baseline function.


Nonpharmacological Treatment of Musculoskeletal Problems

• Lifestyle changes such as increase in exercise, weight loss, and eating a healthy diet are important for all elderly adults.


Falls and Fall-related Injuries

• Assessment of functional mobility, such as gait, balance, and position changes, provides valuable clues regarding a person’s risk for future falls.


Falls and Fall-related Injuries

• Balance exercises are one way for the older person to increase confidence in their balance and take an active part in preventing falls and fractures.

• Many functional and performance assessment tools are available that will provide quantitative data (a score) on an older person’s limitation in mobility and risk for falls.


Treatment of Hip Fractures

• The goals of joint replacement surgery are to decrease pain and increase joint function.


Treatment of Hip Fractures

• Excellent nursing care, including knowledge of the procedures and specific assessment and critical thinking skills for the joint replacement patient, will help the older person have the best possible outcome, and return to function and activities with increased mobility and reduced pain.

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