Musculoskeletal System:
Bone and connective Tissue Disease
Rheumatic Diseases: Affects joints, muscles, and soft tissue.




S/S: Most common s/s are arthritis & pain.
Clinical Manifestations: Pain, joint swelling, limited ROM, stiffness, weakness, fatigue.
Medical Management: MEDS TO TARGET
o Inflammation (aspirin, NSAIDS)
o Management of s/s: DMARDs (disease, modifying, antirheumatic drugs/ suppress
immune system.
o Pain: non opioid
o Nonpharm: hat, assistive devices/ braces, exercise, TENS.
Nursing Management: Functional modifications, pain, psychological status. LABS: ERS
& CRP (ELEVATED DUE TO INFLAMMATION).
Rheumatic Arthritis:






Autoimmune disease originated in the soft tissue of the distal joints. (WRISTS, HANDS,
ELBOW, KNEE, ANKLES)
Cycles of exacerbation and remission. HAVE FLAIR UPS DUE TO TRIGGERS.
Risk factors: pollution, smoking, family hx.
Scoring system: has to be greater than 6!! Joint involvement, blood studies, elevated
ESR & CRP, and duration of s/s, and RF Factor.
Clinical manifestation: symmetrical joint pain, morning stiffness, redness, warmth,
decreased ROM. HALLMARK SIGN: SWAN-NECK DEFORMITIY & ULNAR
DEVIATION. Underwight.
Medical Management: Reduce pain, swelling, achieve remission, prevent/ decrease joint
deformity, minimize disability. PT/ OT.
o Meds: DMARD (methotrexate) get , corticosteroids, NSAIDS, opioids.
o Labs: Baseline of liver function and reassess periodically ( r/t methotrexate use).
 CBC to monitor WBC for infection.
Systemic Lupus Erythematosus: (LUPUS)





Inflammation autoimmune disease, AFFECTING NEARLY ALL ORGANS!!
Clinical Manifestation: Fever, fatigue, weight loss, anorexia, butterfly shaped rash
across bridge of nose.
Cardiac System manifestations: Pericarditis, myocarditis, HTN, arrhythmias.
Medical management: Goal is to prevent progressive loss of organ function, minimize
disfunction, and preventing complications.
Medical management:
o Hydroxychloroquine: tx cutaneous, musculoskeletal, and system
features.
o Monoclonal antibodies ( Belimumab): Reduces disease activity &
flare ups.
 Nursing Management: Pt teaching for smoking cessation & light exposure, routine
follow- ups, monitor for infection & osteoporosis.
Gout:




Acute inflammatory arthritis caused by INCREASED URIC ACID LEVELS ( ↑ 6.8).
Clinical manifestation: Tophi (crystal deposits), urinary stones, nighttime onset (red/
swollen/ warm joints. MAINLY COMMON IN THE BIG TOE!!
Risk factors: Increased BMI, regular consumption of alcohol, red meat/shellfish, high
fructose drinks, diuretic use, aspirin.
Medication management: DURING ATTACK ADMIN. Colchicine, CAUSES N/V &
DIARRHEA!! Indocin, corticosteroids
o Following acute attack: Administer allopurinol, febuxostat.
o Lifestyle changes: weight loss, diet modification (reduces intake of alcohol, red
meat, shellfish, and sugary drinks.
FIBROMYALGIA: Chronic pain syndrome (muscle aching, stiffness, sleep disturbance,
functional impairment.
OSTERO-ARTHRITIS: (Degenerative Joint disease)





Non-inflammatory degenerative disease.
ONLY AFFECTS THE JOINTS, NO SYSTEMIC SYMPTOMS.
Risk Factors: Increased age, obesity, female, occupational selection, genetics.
S/S: Pain stiffness, functional impairment, crepitus, HERBERDEN’S &
BOUCHARD’S NODES. NON-SYMMETRICAL!
Medical Management: Symptom management & pain control. Tylenol, opiods, topical
agents (diclofenac gel). Diet & exercise, PT/OT, improve & maintain functionality.
Arthroplasty:
 Total hip replacement & total knee replacement:
 Rest & exercise balance, heat therapy, ice therapy.
 Total hip: no bending at the hip, no crossing the legs, do not turn on affected side.
Septic Arthritis:


Joint becomes infected. S. aureus common cause.
S/S: Warm, painful, swollen joints, decreased ROM.
o Systemic: fever, chills, leukocytosis
o
Musculoskeletal trauma & Orthopedic Surgery
Fractures:






Complete or incomplete disrupted in the continuity of bone structure.
S/S: Pain, loss of function, deformity, shortening, crepitus, localized edema or
ecchymosis.
Management: Immobilize, check pulses and sensation distal to the site, OPEN
FRACTURE: SPLINT & APPLY STERILE DRESSING.
Open Reduction: IV antibiotics & tetanus shot, wound irrigation and wound vacs
Cast: Tx of choice for fractures, used to correct/ prevent deformity & immobilize
fracture. Will feel a warm sensation while cast is drying
Splints & Braces: performed in acute care setting with plans to cast eventually.
Assessment:

5 Ps- Pain, Pallor, pulselessness, paresthesia, paralysis.
Nursing Management:





Apply ice over fracture site.
Elevate the extremity for 24-48 H.
Move joints above and below cast regularly.
Assess for hot spot, pulselessness, drainage, pressure injury.
DO NOT: Get plaster cast wet, insert any objects inside the cast, bear weight, cover cast
with plastic for prolonged periods.
Complications:



Compartment syndrome: increased pressure withing confined space, compromises,
blood flow and tissue perfusion. Can be reversible if caught soon enough.
o Remove cast, hold cast at heart level to promote blood flow, fasciotomy
Disuse disorder: muscle atrophy, loss of strength because of prolonged immobilization
Cast syndrome: GI distress due to having a body or spica cast.
External fixator:


Manage fractures with soft tissue damage, corrects defects, nonunion, and lengthens
limbs.
Advantages: Immediate immobilization, minimal blood loss, pt comfort, early
mobilization.


Disadvantages: pin site loosening and infection, risk for osteomyelitis.
Nursing Management: assess for pressure injuries, sensation/ cap refill in ext, adhere to
weight baring restrictions, encourage exercising withing approved limits
Traction:



Pulling force to promote and maintain alignment to injured body part.
CONTINOUS, WITH WEIGHT HANGING FREELY.
Goals: decrease muscle spasms and pain, realign bone fracture, correct/ prevent
deformities.
Complications: Shock, compartment syndrome, VTE, PE, delayed complications (union,
avascular necrosis.
Fat emboli


S/S OF FAT EMBOLI: SOB, LOW O2 SAT, INITIAL INCREASES HR,
PETECHIAE ON THE CHEST, CHEST PAIN, MORE COMMON CAUSED
FROM FEMUR FRACTURE.
Management: IVF, vasopressors, oxygen, steroids to reduce inflammation.
Compartment syndrome: Impaired perfusion leading to necrosis and permanent dysfunction

s/s: unrelenting pain worsening with ROM. Assess 5 Ps.