Download 2AlterationsinMobili..

ALTERATIONS IN
MOBILITY
Assessment of the
Musculoskeletal System
And How Mobility can be
Altered
Skeletal System
Brief Overview of Anatomy
•
•
•
•
Bone types
Bone structure
Bone function
Bone growth and metabolism affected by
calcium and phosphorus, calcitonin, vitamin
D, parathyroid hormone, growth hormone,
glucocorticoids, estrogens and androgens,
thyroxine, and insulin
Bone Structure
Joints
• Types include synarthrodial,
amphiarthrodial, diarthrodial.
• Structure synovial joint.
• Subtyped by anatomic structure:
–
–
–
–
–
Ball-and-socket
Hinge
Condylar
Biaxial
Pivot
Structure Diarthrodial Joint
Muscular system assessment
and how it can affect mobility.
•
•
•
•
Patient history
Nutritional history
Family history and genetic risk
General inspection:
– Posture and gait
Muscular System Assessment
(Cont.)
Specific Assessments
•
•
•
•
•
•
•
Face and neck
Spine
Hand
Hip
Ankles, feet
Neurovascular assessment
Psychosocial assessment
Diagnostic Assessment
• Laboratory tests—serum calcium and
phosphorus, alkaline phosphatase, serum
muscle enzymes
• Radiographic examinations—standard
radiography, bone density, tomography and
xeroradiography, myelography,
arthrography, and CT
• Other diagnostic tests—bone and muscle
biopsy
Question?
What is the patient at risk for developing during a
CT scan with contrast material?
A.
B.
C.
D.
Claustrophobia
Renal failure
Allergic reaction to the contrast material
Panic attack
Neuromuscular affects on
mobility
The electromyography
• EMG aids in the diagnosis of
neuromuscular, lower motor neuron, and
peripheral nerve disorders; usually with
nerve conduction studies.
• Low electrical currents are passed through
flat electrodes placed along the nerve.
• If needles are used, inspect needle sites for
hematoma formation.
Arthroscopy
• Fiberoptic tube is inserted into a joint for
direct visualization.
• Patient must be able to flex the knee;
exercises are prescribed for ROM.
• Evaluate the neurovascular status of the
affected limb frequently.
• Analgesics are prescribed.
• Monitor for complications.
Arthroscopy (Cont’d)
Other Tests
•
•
•
•
Bone scan
Gallium or thallium scan
Magnetic resonance imaging
Ultrasonography
Mobility can be affected by
diseases
Exemplar: Osteoporosis
• Chronic metabolic disease, in which bone
loss causes decreased density and possible
fracture
• Osteopenia (low bone mass), which occurs
when osteoclastic activity is greater than
osteoblastic activity
Exemplar: Osteoporosis
(Cont’d)
Exemplar: Osteoporosis
(Cont’d)
•
•
•
•
Etiology and genetic risk
Genetic considerations
Incidence/prevalence
Cultural considerations
Classification of Osteoporosis
• Generalized osteoporosis occurs most
commonly in postmenopausal women and
men in their 60s and 70s.
• 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.
Health Promotion/Illness
Prevention
• Teaching should begin with young women
who begin to lose bone after 30 years of
age.
• The focus of osteoporosis prevention is to
decrease modifiable risk factors.
• Ensure adequate calcium intake.
• Avoid sedentary lifestyle.
• Continue program of weight-bearing
exercises.
Assessment
•
•
•
•
Physical assessment
Psychosocial assessment
Laboratory assessment
Imaging assessment:
– DXA
– QCT
– QUS
Nursing Interventions
• Nutrition therapy
• Exercise
• Other lifestyle changes
Drug Therapy
•
•
•
•
•
•
Calcium and vitamin D supplements
Estrogen or hormone therapy
Bisphosphonates
Selective estrogen receptor modulators
Calcitonin
Other agents used with varying results
Surgical Interventions
• Vertebroplasty
• Kyphoplasty
Cultural Consideration
Question?
Which ethnic group typically has the least amount of
bone density of any group?
A.
B.
C.
D.
African-American women
Asian women
Caucasian women
American-Indian women
Diseases that affect mobility
continued
Exemplar: Osteomalacia
• Loss of bone related to vitamin D
deficiency
• Bone softens because of inadequate deposits
of calcium and phosphorus in the bone
matrix
• Rickets
Collaborative Care
• Assessment
• The major treatment for osteomalacia is
vitamin D
Alterations in Mobility
Exemplar: Paget’s Disease
• Chronic metabolic disorder in which bone is
excessively broken down and reformed
• Genetic considerations
• Collaborative care:
– Physical assessment
– Diagnostic assessment
Nonsurgical Management
•
•
•
•
•
•
•
Analgesics
Decrease bone resorption
Selected bisphosphonates
Calcitonin
Plicamycin
Diet therapy
Nonpharmacologic pain-relief measures
Surgical Management
• Tibial osteotomy
• Partial or total joint replacement
• Surgical decompression and stabilization of
the spine
• Exemplar: Osteomylitis
– Infection of the bone
Osteomyelitis of the tibia of a young child.
See the numerous abscesses in the bone.
Collaborative Care
•
•
•
•
Assessment
Antibiotic therapy
Hyperbaric oxygen therapy
Surgical management:
– Sequestrectomy
– Microvascular bone transfers
Alterations in mobility
Exemplar: Benign bone tumors
• Often asymptomatic and may be discovered
on routine x-ray or as a cause of pathologic
fracture:
– Chrondrogenic tumors—from cartilage
– Osteogenic tumors—from bone
– Fibrogenic tumors—from fibrous tissue; most
commonly found in children
Interventions
• Non-drug pain-relief measures
• Drug therapy—analgesics, NSAIDs
• Surgical therapy—curettage (simple
excision of the tumor tissue), joint
replacement, or arthrodesis
Alterations in mobility
Exemplar: Bone Cancer
•
•
•
•
•
Primary tumors
Metastatic lesions
Pathophysiology
Assessment
Nonsurgical management:
– Drug therapy
– Radiation therapy
Surgical Management
• Preoperative care
• Operative procedure
• Postoperative care
Community-Based Care
• Home care management
• Health teaching
• Health care resources
Disorders of the hand can
affect a patient’s mobility
Exemplar:
• Dupuytren's contracture—slowly
progressive contracture of the palmar fascia
resulting in flexion of the fourth or fifth
digit of the hand
Alterations in mobility
continued
Exemplar: Ganglion
• Round, benign cyst often found on a wrist
or foot joint or tendon
Disorders of the foot can
affect a patient’s mobility
Exemplars:
•
•
•
•
•
•
Hallux valgus
Hammertoe
Morton’s neuroma
Tarsal tunnel syndrome
Plantar fasciitis
Other problems of the foot
Foot
Disorders of muscles and
ligaments can alter mobility
Exemplar: Scoliosis
• Changes in muscles and ligaments on the
concave side of the spinal column
What problems other then mobility can you see with
this patient?
Exemplar: Scoliosis (Cont’d)
•
•
•
•
Pathophysiology
History
Treatment of children
Treatment of adults
Diseases of the muscles can
impair mobility
Exemplar: Progressive Muscular Dystrophies
•
•
•
•
•
Pathophysiology
Genetic considerations
Diagnosis
Management
Nursing interventions
Pediatric Differences
• Primary ossification
• Secondary ossification
• Long bones
• Muscles, Tendons, and Ligaments
References
Centers for Disease Control and Prevention, National Institutes of
Health. (2009). Arthritis, osteoporosis, and chronic back
conditions. Retrieved April 10, 2010, from
http://www.healthypeople.gov/Document/HTML/
Volume1/02Arthritis#_Toc490538008
Chamley, C.A., Carson, P. Randoall, D, & Sandwell, M. (2005).
Developmental anatomy and physiology of children. St. Louis,
MO: Elsevier.
Harvey, C. (2005). Wound Healing. Orthopedic Nursing 24(2),
143-160.
References
Ignatavicius, D., & Workman, M.L. (Ed.). (2010).
Medical-Surgical Nursing Critical Thinking For
Collaborative Care. (6th Ed.) St. Louis: Elsevier
Saunders.
References
Kallmes DF, Comstock BA, Heagerty PJ, et al. (August, 2009. “A
randomized trial of vertebroplasty for osteoporotic spinal
fractures.” New England Journal of Medicine 361(6): 569-579.
Medline Plus. (2010, July 22). Electromygraphy. Retrieved August
22, 2010, from:
http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm
MayoClinic.com (2010, July 22). Dupuytren’s Contracture.
Retrieved August 23, 2010, from:
http://www.mayoclinic.com/health/dupuytrenscontracture/DS00732
References:
Potter, P. & Perry, A. (2009). Fundamentals of Nursing
(7th ed). St. Louis, Missouri: Mosby.
Vitale, M.G., Gross, J.M., Matsumoto, H., Roye, D.P. (2006).
Epidemiology of pediatric spinal cord injury in the
United States. Journal of Pediatric Orthopedics, 26(6),
745-749.
Wikipedia. (2010, July 10). Ganglion . Retrieved Auguast 23,
2010, from: http://en.wikipedia.org/wiki/Ganglion_cyst
Wikipedia. (2010, August 19). Scoliosis. Retrieved August 23,
2010, from: http://en.wikipedia.org/wiki/Scoliosis