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PatW5Sub2.docx

Professor’s Comment:

The referencing and citing of scholarly work is mandatory to support the idea that is being presented in the participation discussion. ALL peer responses require an in text citation, a reference, and 6 or more sentences. References should be between 2018 to 2022.

Post 3:

Musculoskeletal disorders comprise diverse conditions affecting bones, joints, muscles, and connective tissues (Falkner and Green, 2018). These disorders may result in pain and loss of function and are among the most disabling and costly conditions. Disorders of the musculoskeletal system are conditions that might result from hereditary, congenital, or acquired pathologic processes. Impairments may result from infectious, inflammatory, or degenerative processes, traumatic or developmental events, or neoplastic, vascular, or toxic/metabolic diseases. Musculoskeletal health refers to the performance of the locomotor system, comprising intact muscles, bones, joints and adjacent connective tissues. There are more than 150 different diseases/conditions that affect the system and are characterized by impairments in the muscles, bones, joints and adjacent connective tissues leading to temporary or lifelong limitations in functioning and participation.

Musculoskeletal conditions are typically characterized by pain and limitations in mobility and dexterity, reducing people’s ability to work and participate in society. Pain experienced in musculoskeletal structures is the most common form of non-cancer pain. Pain, stiffness, and other limitations imposed by musculoskeletal disorders can make even simple household tasks and everyday activities a formidable challenge (El-Tallawy, Nalamasu, Salem, LeQuang, Pergolizzi and Christo, 2021). Besides the direct cost of the burden of musculoskeletal disorders, such as hospital inpatient care, outpatient care, doctor consultations, cost of drugs and surgical interventions, a large portion of indirect costs due to dependency of these patients on others for their daily activities, need to be considered, along with the consequent loss of productivity. It is psychologically stressing to be unable to do activities that one used to be doing, therefore patients with musculoskeletal disorders need a lot of counseling and psychological support.

El-Tallawy, S. N., Nalamasu, R., Salem, G. I., LeQuang, J. A. K., Pergolizzi, J. V., & Christo, P. J. (2021) Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain and therapy, 10(1), 181–209. https://doi.org/10.1007/s40122-021-00235-2

Falkner, A. & Green, S. (2018). Musculoskeletal, Metabolism, and Multisystem Complexities. In Grand Canyon University (Ed). Pathophysiology Clinical Applications for Client Health. Retrieved from https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/#/chapter/5

Post 4:

There are many musculoskeletal conditions that can impede a patient from successfully completing ADLs. Musculoskeletal conditions can affect quality of life as well due to restrictions that can result from different conditions. musculoskeletal dysfunctions include osteoarthritis, osteoporosis, and Rheumatoid Arthritis. Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune disease. Healthy tissues especially in the synovial joints are attacked by the body’s immune system which results in connective tissue destruction (Falkner & Green, 2018). Inflammation in the joints is usually symmetric and as time progresses, joints and cartilage are destroyed and bones erode. People with RA have antibodies called anti-citrullinated protein antibodies (ACPA) which develop and can present as IgG, IgM, or IgA. Immune cells enter the synovium, which leads to fibroblasts causing osteoclastic behavior leading to bone erosion (Chauhan et al., 2022). Pre- RA and RA are established into five phases based on its level of progression. Phase I includes the interaction between genetics and environmental risk factors, phase II is when RA autoantibodies are created like RF and anti-CCP, phase III is when arthralgia occurs, phase IV is when arthritis develops in 1-2 joints, and stage V is confirmed RA (“Rheumatoid arthritis,” 2021). There is not one main trigger that promotes the development of RA however there are some factors that can increase the risk of being diagnosed with RA. Cigarette smoking is the primary environmental risk factor that is related to the development of RA. Besides cigarette smoking, obesity and dietary changes are additional modifiable risk factors that can be addressed to decrease RA risk (Chauhan et al., 2022). Non-modifiable risk factors include female sex, age, and family history of RA. Manifestations from RA include warm, swollen joints, joint stiffness that is worse in the morning after inactivity, fatigue, loss of appetitive, and fever. Joint pain in early RA affects the smaller joints like in the hands and fingers and slowly progresses to the knees, elbows, and hips. In addition, other parts of the body can be affected by RA like the skin, nerve tissue, heart, lungs, and blood vessels (“Rheumatoid arthritis,” 2021). Deformity from flare ups can result as swelling and pain occurs then dissipates. The abnormal presentation of joint deformity due to RA can be extensive and is painful. For example, the swan-neck finger deformity includes hyperextension and flexion within the finger (Smith & Diamond, 2022). The patient’s functions are altered and impeded due to joint deformity and pain. The boutonniere, hitchhiker’s thumb, and claw toe deformities are also possible with RA. These can impede one’s ability to open medication vials, twist open a bottle of water, hold a cane, hold a fork, and complete other essential tasks of daily living. It is important to note that special medicine caps are available at the pharmacy for those who have RA and are unable to press down and open medication bottles. Depending on current symptomology, a patient’s medication regimen may differ. Some medications for RA include NSAIDs, steroids, DMARDS [conventional and targeted synthetic], and biologics (“Rheumatoid arthritis,” 2021). Surgery is also an option to address and repair joints to decrease pain and increase function and movement. Exercise can also serve as beneficial because it improves strength, flexibility, and joint function. When muscles become stronger, the joints have more support. Weight bearing exercises like walking can aid against the development of osteoporosis which can lead to RA as well. If RA is severe and is in the knees and larger joints, low-impact exercising (not weight bearing) may be beneficial and include biking and swimming.

References

Chauhan, K., Jandu, J. S., Goyal, A., & Al-Dhahir, M. A. (2022). Rheumatoid Arthritis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441999/

Rheumatoid arthritis. (2021). Mayo Clinic. Rheumatoid arthritis - Symptoms and causes

Post 5:

Osteoporosis occurs when bone mineral density decreases, which causes the bones to become more thin, weak, and brittle. this in turn results in the bones being at a higher risk for fractures and breaks (Falkner & Green, 2018). There are both modifiable and non-modifiable risk factors for osteoporosis. Modifiable risk factors include alcohol consumption, smoking, low BMI, low calcium intake, low vitamin D, eating disorders, low levels of activity, and frequent falls (“Modifiable Risks,” 2022). Smoking decreases bone density which in turn increases fracture risk which already increases with age. Non-modifiable risk factors are those that we are unable to change like age, female sex, menopausal status, ethnicity, family history of osteoporosis, and history of prior fractures. Nurses can provide patient education regarding osteoporosis, the actions that can be taken to decrease its negative effects, and lifestyle changes that can improve quality of life. Advocating for weight-bearing exercises (walking), and low-impact aerobics can assist with decreasing bone and mineral loss. Promoting a healthy diet that focuses on bone strengthening foods like vegetables, fruits, whole grains, proteins, calcium, and vitamin D, with limits on sugar, salt, caffeine, and alcohol can mitigate the symptoms associated with osteoporosis (Weiss, 2022). Nursing care should also involve ensuring that the patient has assistive devices within reach (walker, cane, etc.) to ensure that patients have support when ambulating. Medication adherence is also something that should be addressed by nurses as medication adherence should be concomitant with dietary and exercise changes.

References

Modifiable Risks. (2022). International Osteoporosis Foundation. https://www.osteoporosis.foundation/health-professionals/about-osteoporosis/risk-factors/modifiable-risks

0Weiss, C. (2022). Mayo Clinic Q and A: Osteoporosis and a bone-healthy diet. Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-osteoporosis-and-a-bone-healthy-diet/

Post 6:

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes. This can lead to a decrease in bone strength that can increase the risk of fractures of broken bones (Falkner and Green, 2018). With the aging population, osteoporosis is a growing concern for the medical community. High intakes of alcohol cause secondary osteoporosis due to direct adverse effects on bone-forming cells, on the hormone that regulates calcium metabolism and poor nutritional status, calcium, protein and vitamin D deficiency. People with a history of cigarette smoking and people who smoke are at increased risk of any fracture, compared to non-smokers (Pouresmaeili, Kamalidehghan, Kamarehei and Goh, 2018).

Weight loss is also associated with greater bone loss and increased risk of fracture. However, it is increasingly recognized that obesity is a risk factor for some fractures and for fractures in general. When insufficient calcium is absorbed from dietary sources, the body produces more parathyroid hormone, which boosts bone remodeling, mobilizing osteoclasts in the bone to break down and sacrifice bone calcium to supply the nerves and muscles with the mineral they need. There are indications that protein is also important in that it may act synergistically with vitamin D and calcium. Vitamin D is also essential, since it helps calcium absorption from the intestines into the blood. Vitamin D is made in our skin with exposure to the sun’s ultraviolet rays. In most people casual exposure to the sun for as little as 10-to-15 minutes a day is usually sufficient. However, in elderly people, people who do not go outdoors, and during the winter months in northern latitudes, food or supplemental sources of vitamin D is of importance (Pouresmaeili, Kamalidehghan, Kamarehei and Goh, 2018). Osteoporosis can also be compounded by eating disorders such as anorexia nervosa and bulimia.

Physical inactivity and a sedentary lifestyle as well as impaired neuromuscular function for example reduced muscle strength, impaired gait and balance are risk factors for developing fragility fractures. People with a more sedentary lifestyle are more likely to have a hip fracture than those who are more active. For example, women who sit for more than nine hours a day are more likely to have a hip fracture than those who sit for less than six hours a day (Thulkar, Singh, Sharma and Thulkar, 2016). Visual impairments, loss of balance, neuromuscular dysfunction, dementia, immobilization, and use of sleeping pills, which are quite common conditions in elderly persons, increase the risk of falling and accordingly increase the risk of fracture.

Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A comprehensive overview on osteoporosis and its risk factors. Therapeutics and clinical risk management, 14, 2029–2049. https://doi.org/10.2147/TCRM.S138000

Thulkar, J., Singh, S., Sharma, S., & Thulkar, T. (2016). Preventable risk factors for osteoporosis in postmenopausal women: Systematic review and meta-analysis. Journal of mid-life health, 7(3), 108–113. https://doi.org/10.4103/0976-7800.191013