Musculoskeletal disorder

The exact cause of chronic pain of a nonmalignant nature may or may not be known. This type of pain includes the pain associated with various neuropathic and musculoskeletal disorders such as headaches, fibromyalgia, rheumatoid arthritis, and osteoarthritis. 

Before giving a nonnarcotic analgesic to a patient, the nurse assesses the type, onset, and location of the pain. It is important to determine if this problem is different in any way from previous episodes of pain or discomfort. If the patient is receiving a nonnarcotic analgesic for an arthritic or musculoskeletal disorder or soft tissue inflammation, the nurse should examine the joints or areas involved. The appearance of the skin over the joint or affected area or any limitation of motion is documented. The nurse evaluates the patient s ability to carry out activities of daily living. This important information is used to develop a care plan, as well as to evaluate the response to drug therapy. 

Relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other musculoskeletal disorders (see Chap. 19 for more information on these disorders)... 

Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking drugs used to treat musculoskeletal disorders. 

List some nursing diagnoses particular to a patient taking a drug for the treatment of musculoskeletal disorders. 

List the types of drugs used to treat musculoskeletal disorders. 

I ARY DRUG TABLE DRUGS USED TO TREAT MUSCULOSKELETAL DISORDERS (Cbntinued)... 

Drowsiness is the most common reaction seen with the use of skeletal muscle relaxants. Additional adverse reactions are given in die Summary Drug Table Drugp Used to Treat Musculoskeletal Disorders. Some of the adverse reactions tiiat may be seen with the administration of diazepam include drowsiness, sedation, sleepiness, letiiargy, constipation or diarrhea, bradycardia or tachycardia, and rash. 

The bisphosphonates are drags used to treat musculoskeletal disorders such as osteoporosis and Fhget s disease. This chapter will discuss the use of these drugs in the treatment of osteoporosis. 

Corticosteroids are hormones secreted from the adrenal cortex. These hormones arise from the cortex of the adrenal gland and are made from the crystalline steroid alcohol cholesterol. Synthetic forms of the natural adrenal cortical hormones are available The potent antiinflammatory action of the corticosteroids makes these drugs useful in the treatment of many types of musculoskeletal disorders. The corticosteroids are discussed in Chapter 50. 

The miscellaneous drugp are used to treat a variety of musculoskeletal disorders. Ffenicillamine, methotrexate (MTX), and hydroxychloroquine are used to treat rheumatoid arthritis in patients who have had an insufficient therapeutic response to or are intolerant of other antirheumatic drugp such as the sailcylates and NSAIDs. The Summary Drug Table Drug s Used to Tream Musculoskeletal Disorders provides additional information about these and other drug s. One compound, hylan G-F 20, listed in the Summary Drug Table is not used for rheumatoid arthritis, but rather, for osteoarthritis knee pain. It is a viscous, elastic... 

Promoting an Optimal Response to Therapy The patient with a musculoskeletal disorder may be in acute pain or have longstanding mild to moderate pain, which can be just as difficult to tolerate as severe pain. Along with pain, there may be skeletal deformities, such as the joint deformities seen with advanced rheumatoid arthritis. For many musculoskeletal conditions, drug therapy is a major treatment modality. Therapy with these drugs may keep the disorder under control (eg, therapy for gout), improve the patient s ability to carry out the activities of daily living, or make the pain and discomfort tolerable. 

Fhtients with a musculoskeletal disorder often have anxiety related to the symptoms and the chronicity of their disorder. In addition to physical care, these patients often require emotional support, especially when a disorder is disabling and chronic. The nurse explains to the patient that therapy may take weeks or longer before any benefit is noted. When this is explained before therapy is started, the patient is less likely to become discouraged over the slow results of drug therapy. 

Robaxin) PO for a musculoskeletal disorder. Available for administration are 500-mg tablets. The nurse administers. ... 

Table 1. Associated Musculoskeletal Disorders in Patients Susceptible to Malignant Hyperthermia...

Topical analgesics sometimes are used for mild pain or as an adjunct to systemic therapy. There are limited data to support the use of salicylate-containing rubefacients (e.g., methyl salicylate and trolamine salicylate) or other counterirritants (e.g., menthol, camphor, and methyl nicotinate) in OA.32 See Chap. 57 for more information on these products when used for musculoskeletal disorders. 

Develop a monitoring plan to assess treatment of a patient with musculoskeletal disorders. 

O The two primary goals of treatment of musculoskeletal disorders are to (1) relieve pain and (2) maintain functionality. 

NSAIDs are a preferred choice over acetaminophen in musculoskeletal disorders where inflammation is evident. 

Musculoskeletal disorders are commonly self-treated, so true estimates of the incidence of both acute and chronic injury are difficult to obtain. Musculoskeletal disorders, including arthritis, are among the most frequently reported health problems in the United States.5 These disorders account for a large portion of the utilization of health care resources and are the leading cause of work-related disability in all ages, including Americans aged 65 and over. 

In addition to chronic conditions such as arthritis and low-back pain, some musculoskeletal disorders are induced by... 

Inflammation is a common pathway in soft-tissue injury of musculoskeletal disorders. Inflammatory processes lead to two outcomes swelling and pain. Inflammatory processes... 

Musculoskeletal disorders owing to acute injury may be associated with other signs of the injury such as abrasion. 

Treatment of musculoskeletal disorders involves three phases (1) therapy of an acute injury using the RICE principle, (2) pain relief using oral or topical agents, and (3) lifestyle and behavioral modifications for rehabilitation and to prevent recurrent injury or chronic pain (Fig. 57-3). 

NSAIDs are used commonly for musculoskeletal pain because of their availability without a prescription and anti-inflammatory effects.30,31 NSAIDs are a preferred choice over acetaminophen in musculoskeletal disorders where inflammation is evident.27 However, there is some controversy because the inflammatory response may be necessary for healing.13 Nevertheless, most experts recommend the use of NSAIDs early after acute injury to control inflammation and the range -of-motion limitations that may accompany swelling.27... 

Where pain is worsened by muscle spasm, oral muscle relaxants may serve as a useful adjunct to therapy.25 These agents include baclofen, metaxalone, methocarbamol, carisoprodol, and cyclobenzaprine. Muscle relaxants may decrease spasm and stiffness associated with either acute or chronic musculoskeletal disorders. These agents should be used with caution because they all may cause sedation, especially in combination with alcohol or narcotic analgesics. 

Assess the patient s symptoms to determine if empirical care is appropriate or whether diagnostic evaluation is warranted. Determine the timing of injury (if applicable), duration of pain, type and degree of pain, and exacerbating factors. Determine if the musculoskeletal disorder interferes with usual activities or range of motion. 

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