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Interventions for Clients with
Musculoskeletal Problems
Osteoporosis


Metabolic disease, in which bone
demineralization results in decreased density and
subsequent fractures
Osteopenia (low bone mass), which occurs when
there is a disruption in the bone remodeling
process
Classification of Osteoporosis



Primary 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


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Ensure adequate calcium intake.
Avoid sedentary life style.
Continue program of weight-bearing exercises.
Drug Therapy
Hormone replacement therapy
 Parathyroid hormone
 Calcium and vitamin D
 Bisphosphonates
 Selective estrogen receptor
modulators
 Calcitonin
 Other agents used with varying
results

Diet Therapy

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Protein
Magnesium
Vitamin K
Trace minerals
Calcium and vitamin D
Avoid alcohol and caffeine
Others
Exercise
 Pain management
 Orthotic devices

Osteomalacia




Softening of the bone tissue characterized by inadequate
mineralization of osteoid
Vitamin D deficiency, lack of sunlight exposure
Similar, but not the same as osteoporosis
Major treatment: vitamin D from exposure to sun and
certain foods
Paget’s Disease of the Bone

Metabolic disorder of bone remodeling, or
turnover; increased resorption of loss
results in bone deposits that are weak,
enlarged, and disorganized
Paget’s Disease of the Bone


Nonsurgical management: calcitonin, selected
bisphosphonates, mithramycin
Surgical management: tibial osteotomy or partial or total
joint replacement
Osteomyelitis
A condition caused by the invasion by
one or more pathogenic
microorganisms that stimulates the
inflammatory response in bone tissue
 Exogenous, endogenous,
hematogenous, contiguous

Nonsurgical Management
Drug therapy
 Infection control
 Hyperbaric oxygen therapy

Surgical Management
Sequestrectomy
 Bone grafts
 Bone segment transfers
 Muscle flaps
 Amputation

Bone Tumors

Benign bone tumors (noncancerous):
– Chrondrogenic tumors: osteochondroma, chondroma
– Osteogenic tumors: osteoid osteoma, osteoblastoma,
giant cell tumor
– Fibrogenic tumors
Interventions
Nondrug pain relief measures
 Drug therapy: analgesics, NSAIDs
 Surgical therapy: curettage (simple
excision of the tumor tissue), joint
replacement, or arthrodesis

Malignant Bone Tumors

Primary tumors, those tumors that
originate in the bone
– Osteosarcoma
– Ewing’s sarcoma
– Chondrosarcoma
– Fibrosarcoma
– Metastatic bone disease
Acute Pain; Chronic Pain

Interventions include:
– Treatment aimed at reducing the size or
removing the tumor
– Drug therapy; chemotherapy
– Radiation therapy
– Surgical management
– Promotion of physical mobility with
ROM exercises
Potential for Fractures

Interventions
– Nonsurgical management: radiation
therapy and strengthening exercises.
– Surgical management: replace as much
of the defective bone as possible, avoid
a second procedure, and return client to
a functioning state with a minimum of
hospitalization and immobilization.
Carpal Tunnel Syndrome
Common condition; the median nerve
in the wrist becomes compressed,
causing pain and numbness
 Common repetitive strain injury via
occupational or sports motions
 Nonsurgical management: drug
therapy and immobilization
 Possible surgical management

Phalen’s maneuver for detection of carpal
tunnel syndrome
Hand Disorders
Dupuytren's contracture—slowly
progressive contracture of the
palmar fascia resulting in flexion of
the fourth or fifth digit of the hand
 Ganglion—a round, cystlike lesion,
often overlying a wrist joint or
tendon

Disorders of the Foot
Hallux valgus
 Hammertoe
 Morton’s neuroma
 Tarsal tunnel syndrome
 Plantar fasciitis
 Other problems of the foot

Scoliosis
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Changes in muscles and ligaments on the concave side of
the spinal column
Congenital, neuromuscular, or idiopathic in type
Assessment: complete history, pain assessment,
observation of posture
Interventions: exercise, weight reduction, bracing, casting,
surgery
Osteogenesis Imperfecta
Rare genetic disorder in which the
bones are fragile and fracture easily,
resulting in bone deformity
 Clinical manifestations: poor skeletal
development
 Treatment: palliative; client’s life
span is often shortened
 Steroids, calcium, vitamin C, and
possibly sodium fluoride

Progressive Muscular
Dystrophies
At least nine types of muscular
dystrophies identified; categorized as
slowly or rapidly progressive
 Diagnosis often difficult
 Management

– Supportive, making client as
comfortable as possible
– Prednisone, immunosuppressive agents,
anabolic steroids
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