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Chapter 27 Musculoskeletal Conditions Assessment of Musculoskeletal Problems • Abnormal gait • Abnormality of structure • Dysfunction of a limb • Favoring of one side • Tremor • Paralysis Assessment of Musculoskeletal Problems (cont.) • Weakness • Atrophy of a limb • Redness; swelling of a joint • Use of cane, walker, or wheelchair Physical Examinations of the Musculoskeletal System • Shoulder • Neck • Elbow • Wrist • Finger • Hip • Knee • Ankle • Toe Desired Outcomes • The patient: – Verbalizes acceptance of realistic body changes. – Uses effective coping mechanisms. – Identifies and engages in meaningful activities. – Is free from depression, withdrawal, and other complications associated with body image and selfesteem disturbances. Facilitating Musculoskeletal Function • A well-balanced diet rich in proteins and minerals • A minimum of 1500 mg calcium included in the diet daily for elderly men and women not taking estrogen – (1000 mg if taking estrogen) • Weight control • Activity and exercise Contributing Factors to Fractures in the Elderly • Trauma • Cancer • Metastasis to the bone • Osteoporosis • Brittle bones of older persons fracture more easily. • Slower rate of healing Measures to Prevent Falls • Avoid risky activities. • Rise from a kneeling or sitting position slowly. • Wear safe, properly fitting shoes with a low, broad heel. • Use hand rails for climbing stairs or rising from the bathtub. • Place both feet near the edge of a curb or bus before stepping up or down. • Use a night-light in the bathroom and bedroom. Symptoms of Fractures • Pain • Change in the shape or length of a limb • Abnormal or restricted motion of a limb • Edema • Spasm of surrounding tissue • Discoloration of tissue • Bone protruding through the tissue Most Common Fracture Sites • Neck of the femur • Colles’ fracture • Compression fracture of the vertebrae Factors Contributing to Osteoarthritis • Disequilibrium between destructive and synthetic elements • Stress to the joints • Obesity • Genetic factors • Low vitamin D and C levels Therapeutic Measures for Osteoarthritis • Analgesics to control pain • Rest, heat or ice, ultrasound, and gentle massage • Splints, braces, and canes • Cold water fish; other foods high in the essential fatty acids • Vitamins A, B, B6, C, and E and zinc, selenium, niacinamide, calcium, and magnesium • Weight reduction Symptoms of Rheumatoid Arthritis • Fatigue • Malaise • Weakness • Weight loss • Wasting • Fever • Anemia Patient Education for Rheumatoid Arthritis • Knowledge of the disease • Treatments • Administration of medications • Identification of side effects • Exercise regimens • Use of assistive devices • Methods to avoid and reduce pain Potential Causes of Osteoporosis • Inactivity or immobility • Diseases • Reduction in anabolic sex hormones • Diet • Drugs Problems Associated with Osteoporosis • Kyphosis and a reduction in height • Spinal pain • Bones may fracture more easily Treatment of Osteoporosis • Calcium supplements • Vitamin D supplements • Progesterone and estrogen • Anabolic agents • Fluoride or phosphate • Synthetic form of calcitonin • Bisphosphonates Treatment of Gout • Reduction of sodium urate through a low-purine diet • Administration of drugs • Avoidance of alcohol • Use of colchicine or phenylbutazone to manage acute attacks • Use of vitamin E, folic acid, and eicosapentaenoic acid (EPA) • Use of herbs such as yucca and devil’s claw Podiatric Conditions • Calluses • Corns • Bunions • Hammer toe • Plantar fasciitis • Foot infections • Ingrown toenails Patient Teaching for Proper Foot Care • Keep feet clean and dry. • Wear safe and proper-fitting shoes. • Exercise feet. • Cut nails straight across and even with the top of the toe. • Seek professional podiatric care for problems. Nursing Considerations for Pain Management • Heat application • Passive stretching of an extremity • Avoidance of excessive exercise and musculoskeletal stress • Back rubs • Proper positioning and protection from trauma • Diversional activities • Alternative therapies Measures to Prevent Injury • Pay attention to the area where one is walking. • Climb stairs and curbs slowly. • Use both feet for support as much as possible. • Use railings and canes for added balance. • Wear properly fitting, safe shoes for good support. • Avoid long trousers, nightgowns, or robes. • Use heat safely. Promoting Independence • Use of canes, walkers, and other assistive devices • Referral to physical and occupational therapists Source • Eliopoulos, C. (2005). Gerontological Nursing, (6th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).
