1. Interventions for Clients with Musculoskeletal Problems

2. 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
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3. Osteoporosis

4. 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.

5. Health Promotion/Illness Prevention
Ensure adequate calcium intake.
Avoid sedentary life style.
Continue program of weight-bearing exercises.
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7. Assessment Physical assessment Psychosocial assessment
Laboratory assessment
Radiographic assessment

9. Drug Therapy Hormone replacement therapy Parathyroid hormone
Calcium and vitamin D
Bisphosphonates
Selective estrogen
receptor modulators
Calcitonin
Other agents used with
varying results

10. Diet Therapy Protein Magnesium Vitamin K Trace minerals
Calcium and vitamin D
Avoid alcohol and caffeine

11. Fall Prevention Hazard-free environment
High-risk assessment through programs such as Falling Star protocol
Hip protectors that prevent hip fracture in case of a fall
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12. Others
Exercise
Pain management
Orthotic devices

13. 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
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14. Osteomalacia

16. 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
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17. Paget’s Disease of the Bone
Nonsurgical management: calcitonin, selected bisphosphonates, mithramycin
Surgical management: tibial osteotomy or partial or total joint replacement

18. 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

20. Nonsurgical Management
Drug therapy
Infection control
Hyperbaric oxygen therapy

21. Surgical Management Sequestrectomy Bone grafts Bone segment transfers
Muscle flaps
Amputation

22. Bone Tumors Benign bone tumors (noncancerous):
Chrondrogenic tumors: osteochondroma, chondroma
Osteogenic tumors: osteoid osteoma, osteoblastoma, giant cell tumor
Fibrogenic tumors

23. Bone Tumors

24. Interventions Nondrug pain relief measures
Drug therapy: analgesics, NSAIDs
Surgical therapy: curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis
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25. Malignant Bone Tumors
Primary tumors, those tumors that originate in the bone
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma
Fibrosarcoma
Metastatic bone disease

26. 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

27. Anticipatory Grieving
Interventions include:
Active listening
Encouraging client and family to verbalize feelings
Making appropriate referrals
Helping client and others to cope with the loss and grieving
Promoting the
physician-client relationship

28. Disturbed Body Image Interventions include:
Recognize and accept the client’s view of body image alteration.
Establish and maintain a trusting nurse-client relationship.
Emphasize the client’s strengths and remaining capabilities.
Establish realistic mutual goals.

29. 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.
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30. Phalen’s maneuver for detection of carpal tunnel syndrome

31. 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
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32. Carpal Tunnel Syndrome

33. 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
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34. Disorders of the Foot Hallux valgus Hammertoe Morton’s neuroma
Tarsal tunnel syndrome
Plantar fasciitis
Other problems of the foot

37. Scoliosis
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
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38. 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
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39. 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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40. Progressive Muscular Dystrophies