VNSG 1510 – Nursing in Health & Illness III
Unit II – Care of the Patient with Disorders of the Musculoskeletal System
1.
Objectives
Discuss assessment of patients with musculoskeletal
disorders.
I.
Content
Assessment
A. History
B. Physical assessment
1. Pain
2. Altered sensation
3. Structural changes
a. Kyphosis
b. Lordosis
c. Scoliosis
d. Contracture
e. Atrophy
f. Joint deformities
4. Muscular weakness
a. Grip strength
5. Mobility (gait)
6. Neurovascular impairment
a. Pain
b. Pallor
c. Paresthesia
d. Pulselessness
e. Paralysis
f. Capillary refill
C. Risk factors
D. Developmental variations
2.
Identify clinical significance and nursing
implications of various tests and procedures used for
diagnosis of musculoskeletal disorders.
II. Diagnostic Tests
A. Lab tests
1. Blood and urine calcium levels
a. Phosphatase
B. Diagnostic imaging
1. X-ray
2. Scans/MRI
C. Arthroscopy
3.
Using the nursing process describe the nursing
management of the patient needing assistive devices.
III. Assistive devices
A. Casts
B. Traction
C. Splints
Learning Opportunities
Review
Anatomy & Physiology
Hopper - Chapter 45, 46
Video
#54 & 55 “Care of the Patient in a Cast”
Objectives
Content
D.
E.
F.
G.
H.
Learning Opportunities
Turning frames
Prosthesis
Braces
Crutches
Walker
4.
Describe etiology, pathophysiology, and clinical
manifestations of the selected musculoskeletal
disorders.
IV. Selected Problems Associated with the
Musculoskeletal System
A. Arthritis
1. Rheumatoid
2. Osteoarthritis
B. Gout
C. Osteoporosis
D. Traumatic injuries
1. Contusions
2. Sprains/ Strains
3. Fractures
E. Tumors
5.
Use the nursing process to describe care for patients
with selected musculoskeletal disorders including
treatments, medications, teaching plans and
complications.
V. Implementation
A. Dependent
1. Medications
a. Salicylates
b. Nonsteroidal anti-inflammatories
(NSAIDs)
c. Corticosteroids
d. Analgesics
e. Immunosuppressants
B. Independent
1. Cast care
2. Skin care
3. Positioning
4. Prevention of injury
5. Monitor for signs and symptoms of
complications
a. Fat embolus
b. Gas gangrene
c. Tetanus
d. Compartment syndrome
e. Volkman’s contracture
6. Patient Teaching
7. Refer to community resources
Review
Osteomyelitis
Osteosarcoma
Fractured Hip
Muscular Dystrophy
Video
#1109 “Assisting with casts & traction”
VIDEO TVCC Website
Body Mechanics: The Science of Moving Safely
Range of Motion Exercises: Theory and Practices
Objectives
Content
American Chronic Pain Association
Arthritis Foundation
National Easter Seals Society
National Osteoporosis Foundation
National Institute of Arthritis and
Musculoskeletal and Skin Disorders
f. National Osteoporosis Association
g. National Association of Orthopedic
Nurses
h. National Rheumatoid Association
C. Interdependent
1. Pain assessment
2. Activity levels
3. Muscle setting exercises
4. Gait training
5. Physical therapy
Learning Opportunities
a.
b.
c.
d.
e.
6.
Discuss the interdisciplinary approach to
rehabilitation for the care of patients with self-care
deficit, impaired physical mobility, impaired skin
integrity, and altered patterns of elimination.
VI. Rehabilitation
A. Interdisciplinary approach to rehab
1. Activities of Daily Living
2. Positioning
3. Range of Motion Exercises
4. Independent mobility
5. Ambulatory aides
6. Skin integrity
7. Urinary and bowel training
B. Role of rehab team members
C. Significance of continuity of care
7.
Discuss nursing care of patients having surgeries
involving the musculoskeletal system.
VII. Orthopedic surgeries
A. Open reduction internal fixation (ORIF)
B. Reconstructive joint surgery
1. Hip replacement
2. Knee replacement
C. Amputations
1. Phantom limb pain
2. Prosthesis
V\Vocation\Level III\VN 1510 Musculoskeletal
Review 07/12