Nursing management of patients with musculoskeletal problems.
Nursing Management of Patients with Musculoskeletal Problems
Musculoskeletal problems affect bones, muscles, joints, and connective tissues, leading to pain, functional limitations, or deformities. Nursing care focuses on pain relief, promoting mobility, preventing complications, and providing education to enhance the patient’s quality of life.
Assess the onset, location, duration, and intensity of pain.
History of trauma, previous surgeries, or chronic illnesses.
Evaluate functional limitations and activities of daily living (ADLs).
Physical Examination:
Inspect for swelling, deformities, or redness.
Palpate for tenderness, warmth, and crepitus.
Assess joint mobility and muscle strength.
Neurological assessment: Sensory and motor function (for spinal or nerve involvement).
Diagnostic Monitoring:
Review laboratory results:
Calcium, phosphorus, uric acid levels.
Rheumatoid factor (RF), anti-CCP for RA.
Monitor imaging results:
X-rays, CT, MRI for fractures or joint abnormalities.
Bone density (DEXA scan) for osteoporosis.
Nursing Diagnoses
Acute or chronic pain related to joint inflammation, fractures, or muscle spasms.
Impaired physical mobility related to pain, stiffness, or structural deformities.
Risk for injury related to bone fragility or weakness.
Self-care deficit related to limited mobility.
Impaired tissue perfusion related to compartment syndrome (fractures).
Nursing Interventions
1. Pain Management
Administer prescribed analgesics:
NSAIDs (e.g., ibuprofen, naproxen) for inflammation.
Acetaminophen for mild pain.
Opioids for severe pain (short-term use).
Apply non-pharmacological methods:
Heat therapy for muscle relaxation.
Cold therapy to reduce inflammation and swelling.
Transcutaneous electrical nerve stimulation (TENS) for chronic pain.
Educate on proper posture, ergonomics, and joint protection techniques.
2. Promoting Mobility
Encourage range-of-motion (ROM) exercises to prevent stiffness.
Provide assistive devices (crutches, canes, walkers) and teach safe use.
Collaborate with physical and occupational therapists for rehabilitation plans.
Educate on weight-bearing restrictions for fractures and joint replacements.
3. Preventing Complications
Fractures:
Monitor for signs of compartment syndrome (pain, pallor, paresthesia, paralysis, pulselessness).
Assess for infection in open fractures.
Ensure proper alignment of immobilization devices (casts, splints, traction).
Osteoporosis:
Educate on fall prevention strategies.
Administer prescribed calcium and vitamin D supplements.
Encourage weight-bearing exercises to strengthen bones.
Joint Replacements:
Monitor for signs of deep vein thrombosis (DVT) or pulmonary embolism (PE).
Promote early ambulation to prevent complications.
Educate on hip precautions to avoid dislocation (e.g., avoid crossing legs).
4. Managing Inflammatory Conditions
Administer disease-modifying antirheumatic drugs (DMARDs) for RA:
Methotrexate, hydroxychloroquine.
Provide corticosteroids or biologics (e.g., infliximab) as prescribed.
Encourage low-purine diets for gout patients to reduce uric acid levels.
Educate on joint protection techniques and energy conservation.
5. Enhancing Self-Care
Provide adaptive tools (e.g., reachers, shoehorns) to aid with daily tasks.
Encourage independence while providing necessary support.
Assist with bathing, dressing, and grooming as needed.
6. Emotional and Psychological Support
Address feelings of frustration or depression due to limited mobility.
Encourage participation in support groups for chronic conditions like arthritis.
Provide reassurance and realistic expectations about recovery.
Patient Education
Medication Adherence:
Teach proper use, dosage, and side effects of medications (e.g., NSAIDs, DMARDs, supplements).
Warn against overuse of painkillers or non-prescribed remedies.
Diet and Nutrition:
High-calcium, vitamin D-rich foods for osteoporosis prevention.
Low-purine diet for gout (avoid alcohol, organ meats, seafood).
Encourage hydration to prevent kidney stones in gout.
Activity and Exercise:
Engage in low-impact activities like swimming or walking.
Avoid high-stress activities that may worsen joint pain.
Fall Prevention:
Remove hazards like loose rugs and ensure proper lighting at home.
Use non-slip footwear and handrails in bathrooms and staircases.
Post-Surgical Care:
Teach wound care and signs of infection (redness, swelling, drainage).
Reinforce importance of physical therapy for joint function recovery.
Complications to Monitor
Fractures:
Compartment syndrome, delayed union, or malunion.
Infection in open fractures.
Arthritis:
Joint deformities or ankylosis (fusion of joints).
Osteoporosis:
Pathological fractures, particularly of the hip or spine.
Post-Surgical:
DVT, PE, or prosthetic joint infection.
Outcomes
Pain reduction and improved mobility.
Prevention of complications like falls or infections.
Enhanced ability to perform ADLs independently.
Increased understanding of disease management and prevention.
Review of anatomy and physiology and pathophysiology Arthritis,
Review of Anatomy and Physiology Related to Arthritis
Anatomy of Joints
Types of Joints:
Synovial Joints:
Freely movable (e.g., knee, hip).
Components:
Articular Cartilage: Covers the ends of bones to reduce friction.
Synovial Membrane: Produces synovial fluid for lubrication.
Synovial Fluid: Provides nutrients and reduces friction.
Joint Capsule: Encloses the joint and provides stability.
Ligaments: Connect bones and stabilize the joint.
Tendons: Attach muscles to bones.
Cartilaginous Joints:
Limited movement (e.g., intervertebral discs).
Fibrous Joints:
Immovable (e.g., skull sutures).
Support Structures:
Muscles: Generate movement by pulling on bones.
Ligaments and Tendons: Provide structural support.
Bursa: Fluid-filled sacs that reduce friction between structures.
Physiology of Joints
Function:
Joints facilitate movement, bear weight, and provide structural support.
Synovial fluid lubricates the joint, nourishes cartilage, and absorbs shock.
Cartilage:
Avascular and relies on diffusion for nutrients.
Provides a smooth surface to reduce friction during joint movement.
Pathophysiology of Arthritis
Arthritis is inflammation of one or more joints, leading to pain, stiffness, and swelling. Common types include osteoarthritis (OA), rheumatoid arthritis (RA), and gout.
1. Osteoarthritis (OA)
Definition:
A degenerative joint disease characterized by the breakdown of articular cartilage and bone remodeling.
Pathophysiology:
Repeated mechanical stress or aging causes wear and tear on cartilage.
Loss of cartilage exposes underlying bone.
Bone-on-bone contact leads to pain, stiffness, and osteophyte (bone spur) formation.
Synovial inflammation and reduced joint mobility occur as secondary effects.
Symptoms:
Joint pain and stiffness, especially after activity.
Crepitus (grating sound during movement).
Joint deformities in advanced stages.
2. Rheumatoid Arthritis (RA)
Definition:
An autoimmune disorder causing chronic inflammation of the synovial membrane, leading to joint destruction.
Pathophysiology:
Autoimmune response triggers T-cell activation and cytokine release.
Gout: Metabolic, caused by uric acid crystals. Understanding the anatomy, physiology, and pathophysiology of arthritis is crucial for developing effective treatment and management strategies.
osteomyelitis,
Osteomyelitis: Overview
Definition: Osteomyelitis is an infection of the bone caused by bacteria, fungi, or other microorganisms. It can occur due to direct contamination, spread from adjacent tissues, or hematogenous (bloodborne) spread.
Review of Anatomy and Physiology Related to Osteomyelitis
Fungi: Rare, seen in immunocompromised individuals.
Risk Factors:
Open fractures or orthopedic surgery.
Diabetes, peripheral vascular disease.
Immunosuppression, intravenous drug use.
Prosthetic implants.
Types of Osteomyelitis
Acute Osteomyelitis:
Sudden onset of symptoms, usually within 2 weeks of infection.
Subacute Osteomyelitis:
Symptoms develop more gradually over weeks to months.
Chronic Osteomyelitis:
Long-standing infection with necrotic bone (sequestrum) and sinus tracts.
Symptoms
General Symptoms:
Fever, chills, malaise.
Localized pain, tenderness, and swelling.
Acute Osteomyelitis:
Sudden onset of severe pain and redness over the affected area.
Restricted movement of the nearby joint.
Chronic Osteomyelitis:
Persistent pain, swelling, and drainage from sinus tracts.
Non-healing wounds or ulcers near the affected area.
Diagnosis
Clinical Assessment:
History of trauma, surgery, or infection.
Symptoms of localized pain, swelling, and fever.
Laboratory Tests:
Elevated WBC count, ESR, and CRP levels (markers of infection).
Blood cultures to identify causative organisms.
Imaging Studies:
X-rays:
May show bone destruction or sequestra after 2-3 weeks.
MRI:
Gold standard for early detection; shows bone marrow edema.
CT Scan:
Detects bone destruction and abscesses.
Bone Scan:
Uses radionuclides to identify areas of increased metabolic activity.
Biopsy and Culture:
Bone biopsy is definitive for diagnosing and identifying pathogens.
Complications
Chronic Osteomyelitis:
Persistent infection with draining sinus tracts.
Pathological Fractures:
Weakened bone due to infection.
Sepsis:
Systemic infection spreading from the bone.
Amputation:
Necessary in severe, uncontrolled cases.
Management
1. Medical Management
Antibiotics:
Intravenous antibiotics initially, followed by oral therapy.
Empiric therapy based on likely organisms, later adjusted to culture results:
Staphylococcus aureus: Nafcillin, oxacillin, or vancomycin.
Gram-negative bacteria: Ciprofloxacin or ceftazidime.
Duration: 4-6 weeks for acute cases; longer for chronic cases.
Analgesics:
NSAIDs for pain management.
Hyperbaric Oxygen Therapy (HBOT):
Used in chronic cases to promote healing by increasing oxygen supply to infected tissue.
2. Surgical Management
Debridement:
Removal of necrotic bone and tissue.
Drainage:
Abscess or sinus tract drainage.
Bone Grafting:
To fill defects after debridement.
Amputation:
In severe cases with life-threatening infection or unresponsive chronic osteomyelitis.
Nursing Management
Assessment:
Monitor for signs of infection (fever, pain, swelling).
Assess wound or surgical site for drainage, erythema, or necrosis.
Evaluate neurovascular status (capillary refill, pulses, sensation).
Interventions:
Antibiotic Administration:
Ensure timely administration of prescribed antibiotics.
Monitor for side effects like allergic reactions or renal toxicity.
Pain Management:
Administer prescribed analgesics.
Use non-pharmacologic methods (e.g., positioning, ice packs).
Wound Care:
Perform regular dressing changes using aseptic techniques.
Monitor for changes in wound size, color, or drainage.
Mobility Support:
Encourage immobilization of the affected limb to reduce pain and prevent further damage.
Collaborate with physiotherapists for rehabilitation after infection control.
Patient Education:
Medication Compliance:
Emphasize completing the full course of antibiotics.
Wound Care:
Teach proper dressing techniques to prevent reinfection.
Lifestyle Modifications:
Encourage a high-protein diet to promote healing.
Educate on controlling risk factors like diabetes or smoking.
Signs of Complications:
Teach patients to recognize symptoms of recurrence or systemic infection (e.g., fever, increased pain).
Prognosis
Acute Osteomyelitis: Good with prompt treatment.
Chronic Osteomyelitis: Requires prolonged management; recurrence is common.
Prevention: Proper wound care and infection control reduce risks.
bursitis,
Bursitis: Overview
Definition: Bursitis is the inflammation of a bursa, a small fluid-filled sac that cushions bones, tendons, and muscles near joints. It commonly affects joints that perform repetitive motions.
Review of Anatomy and Physiology
Bursa:
Thin, lubricated sac that reduces friction between tissues (e.g., between bones, tendons, or muscles).
Located near joints such as the shoulder, elbow, hip, knee, and ankle.
Contains synovial fluid to facilitate smooth movement.
Function of the Bursa:
Acts as a cushion to reduce friction and pressure during movement.
Prevents wear and tear on tendons and muscles during joint motion.
Commonly Affected Bursae:
Shoulder (Subacromial Bursa): Beneath the acromion and deltoid muscle.
Elbow (Olecranon Bursa): Behind the elbow joint.
Hip (Trochanteric Bursa): Near the greater trochanter of the femur.
Knee (Prepatellar Bursa): In front of the kneecap.
Ankle (Retrocalcaneal Bursa): Behind the heel.
Pathophysiology of Bursitis
Cause of Inflammation:
Repetitive motion, overuse, or direct trauma irritates the bursa.
Leads to synovial fluid overproduction, swelling, and inflammation.
Removal of the bursa in severe or recurrent cases.
Nursing Management
Assessment:
Monitor for signs of inflammation (redness, warmth, swelling).
Evaluate pain severity and functional limitations.
Observe for systemic signs of infection (fever, chills).
Interventions:
Pain and Inflammation Management:
Administer prescribed NSAIDs or corticosteroids.
Apply cold packs during acute inflammation.
Immobilization:
Assist in using braces or splints to protect the joint.
Infection Control:
Educate on wound care to prevent septic bursitis.
Administer prescribed antibiotics for confirmed infections.
Patient Education:
Activity Modification:
Avoid repetitive motions and apply ergonomic principles.
Gradually resume activities to prevent flare-ups.
Weight Management:
Encourage a healthy diet and exercise to reduce stress on joints.
Follow-Up Care:
Emphasize completing the full course of antibiotics for septic bursitis.
Advise routine monitoring for recurrence.
Complications
Chronic bursitis with recurrent inflammation.
Septic bursitis leading to abscess formation or sepsis.
Limited joint mobility due to persistent pain or fibrosis.
Prognosis
Acute Bursitis: Responds well to conservative treatment.
Chronic or Septic Bursitis: May require advanced therapies but has a favorable prognosis with early intervention.
Fractures,
Fractures: Overview
Definition: A fracture is a break in the continuity of a bone, typically caused by trauma, stress, or pathological conditions. It can vary in severity, from a simple crack to a complete break with bone displacement.
Review of Anatomy and Physiology Related to Fractures
Bone Structure:
Compact Bone: Dense outer layer providing strength and support.
Spongy Bone: Inner porous layer found in the ends of long bones, houses bone marrow.
Periosteum: Outer membrane containing blood vessels and nerves.
Bone Marrow:
Red Marrow: Produces blood cells.
Yellow Marrow: Stores fat and is a source of energy.
Bone Remodeling and Healing:
Bone tissue is dynamic, constantly undergoing formation and resorption.
Osteoblasts build new bone, while osteoclasts break down old bone.
Bone Vascularity:
Bones have a rich blood supply, crucial for healing.
Types of Fractures
Based on Cause:
Traumatic Fracture: Due to direct or indirect injury.
Pathological Fracture: Occurs in weakened bones (e.g., osteoporosis, cancer).
Stress Fracture: Repeated mechanical stress (common in athletes).
Based on Appearance:
Closed (Simple) Fracture: Bone breaks but does not pierce the skin.
Open (Compound) Fracture: Bone breaks and protrudes through the skin, increasing the risk of infection.
Based on Pattern:
Transverse: Break is horizontal across the bone.
Oblique: Diagonal break.
Spiral: Twisting force causes a spiral-shaped break.
Comminuted: Bone shatters into multiple fragments.
Greenstick: Incomplete fracture, common in children.
Impacted: Bone fragments are driven into each other.
Special Types:
Avulsion: Fragment of bone is pulled away by a tendon or ligament.
Compression: Bone collapses (common in the spine).
Hairline: Thin crack without displacement.
Pathophysiology of Fracture Healing
Stages of Healing:
Hematoma Formation (0–72 hours):
Blood vessels in the bone and periosteum rupture.
Clot forms to stop bleeding and provide a scaffold for healing.
Inflammatory Stage (2–14 days):
Inflammatory cells migrate to the site, releasing growth factors.
Granulation tissue forms.
Reparative Stage (2–6 weeks):
Fibroblasts and osteoblasts create a soft callus.
Cartilage is replaced by woven bone (hard callus).
Remodeling Stage (Months to years):
Woven bone is replaced with lamellar (stronger) bone.
Bone regains its original strength and shape.
Factors Affecting Healing:
Positive:
Adequate blood supply, proper alignment, early immobilization.
Negative:
Infection, poor nutrition, smoking, advanced age, and comorbidities (e.g., diabetes).
Causes of Fractures
Trauma:
Falls, motor vehicle accidents, sports injuries.
Pathological Conditions:
Osteoporosis, bone tumors, osteogenesis imperfecta.
Repetitive Stress:
Common in runners and military recruits.
Symptoms of Fractures
General Symptoms:
Pain, swelling, and bruising.
Deformity or abnormal limb alignment.
Inability to bear weight or use the affected limb.
Crepitus (grating sound or sensation).
Specific Signs of Open Fractures:
Bone visible through the skin.
Risk of bleeding and infection.
Diagnosis
Clinical Assessment:
History of trauma or underlying conditions.
Physical examination: Swelling, deformity, tenderness, and loss of function.
Imaging Studies:
X-rays: Standard for fracture diagnosis.
CT Scan: Provides detailed imaging, useful for complex fractures.
MRI: Identifies soft tissue injuries and stress fractures.
Bone Scan: Detects fractures not visible on X-rays.
Nerve or Vascular Injury: Leading to loss of function or ischemia.
Late Complications:
Malunion: Improper alignment during healing.
Nonunion: Failure of the bone to heal.
Avascular Necrosis: Loss of blood supply leading to bone death.
Nursing Management
Assessment:
Monitor for signs of neurovascular compromise:
Check for the 6 Ps: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.
Assess pain and provide appropriate relief.
Monitor for signs of infection, swelling, or compartment syndrome.
Interventions:
Immobilization:
Maintain proper alignment with splints or casts.
Ensure the cast is not too tight.
Wound Care:
Use sterile techniques for dressing changes.
Promote Circulation:
Elevate the limb and encourage isometric exercises.
Patient Education:
Instruct on cast care (e.g., keeping it dry).
Advise on signs of complications (e.g., increased pain, swelling).
Prognosis
Good prognosis with early and appropriate treatment.
Recovery time depends on fracture type, patient age, and overall health.
dislocation and trauma
Dislocation and Trauma: Overview
Dislocation
Definition: A dislocation is the displacement of a bone from its normal position in a joint, leading to loss of alignment and joint function. It typically results from trauma but may also be caused by underlying conditions like ligament laxity or joint disease.
Trauma
Definition: Trauma refers to physical injury or wound caused by external forces such as falls, blunt force, or penetrating objects. It can affect bones, joints, soft tissues, or organs.
Review of Anatomy and Physiology
Joints:
Synovial joints are most commonly affected by dislocations.
Components include:
Articular Cartilage: Reduces friction between bones.
Joint Capsule: Provides structural support.
Ligaments: Stabilize the joint by connecting bones.
Muscles and Tendons: Assist in movement and stability.
Bone and Soft Tissue:
Bones provide structural support and protect vital organs.
Ligaments, tendons, and muscles ensure joint stability and movement.
Soft tissues (e.g., skin, blood vessels, nerves) are often injured in trauma.
Pathophysiology
Dislocation
Trauma or force exceeds the joint’s stability, causing displacement of bone.
Surrounding structures (e.g., ligaments, joint capsule, muscles) are stretched or torn.
Complications include:
Damage to blood vessels, leading to ischemia.
Nerve compression or injury, causing sensory or motor deficits.
Recurrent dislocations due to weakened joint structures.
Trauma
Direct or indirect force causes tissue damage, which may include:
Contusions (bruising).
Abrasions (skin damage).
Lacerations (cuts).
Fractures or dislocations.
The inflammatory response leads to swelling, pain, and potential loss of function.
Types of Dislocation
Traumatic Dislocation:
Due to high-impact forces (e.g., falls, sports injuries).
Common sites: Shoulder, hip, elbow, knee, and fingers.
Congenital Dislocation:
Present at birth (e.g., developmental dysplasia of the hip).
Pathological Dislocation:
Secondary to underlying conditions like arthritis, infection, or ligament laxity.
Recurrent Dislocation:
Repeated dislocations due to weakened ligaments or joint capsule.
Types of Trauma
Blunt Trauma:
Caused by impact or compression (e.g., motor vehicle accidents, falls).
Penetrating Trauma:
Caused by sharp objects like knives or bullets.
Crush Injuries:
Compression of body parts, leading to severe soft tissue and bone damage.
Blast Injuries:
Caused by explosions, leading to a combination of blunt, penetrating, and thermal injuries.
Symptoms
Dislocation:
Visible deformity of the joint.
Intense pain, swelling, and loss of joint function.
Bruising and tenderness around the joint.
Numbness or tingling if nerves are compressed.
Trauma:
Localized pain, swelling, and bruising.
Deformity in cases of fractures or dislocations.
Open wounds or lacerations in penetrating trauma.
Reduced range of motion or weakness.
Diagnosis
History and Physical Examination:
Assess mechanism of injury.
Observe for deformity, swelling, and tenderness.
Evaluate neurovascular status (e.g., capillary refill, pulse).
Immobilize the affected joint to prevent further damage.
Apply cold packs to reduce swelling.
Administer analgesics or sedatives for pain relief.
Reduction:
Closed Reduction:
Manual realignment without surgery.
Requires sedation or local anesthesia.
Open Reduction:
Surgical intervention if closed reduction fails or there is associated fracture.
Immobilization:
Splints, slings, or braces to allow healing.
Duration depends on the joint and severity.
Rehabilitation:
Physical therapy to restore strength and prevent recurrence.
Trauma
Initial Care (ABCDE Approach):
Airway: Ensure airway patency.
Breathing: Assess and manage respiratory distress.
Circulation: Control bleeding, restore perfusion.
Disability: Evaluate neurological status.
Exposure: Examine for injuries and maintain body temperature.
Wound Care:
Clean and dress wounds to prevent infection.
Administer tetanus prophylaxis for open injuries.
Pain Management:
Administer NSAIDs or opioids as needed.
Surgical Intervention:
For severe injuries requiring internal fixation, wound debridement, or vascular repair.
Rehabilitation:
Restore function and mobility through physical therapy.
Complications
Dislocation:
Joint instability or recurrent dislocations.
Nerve or blood vessel damage.
Avascular necrosis (e.g., in hip dislocation).
Arthritis in the affected joint.
Trauma:
Hemorrhage leading to shock.
Infection in open wounds or fractures.
Compartment syndrome due to increased pressure in muscles.
Chronic pain or disability.
Nursing Management
Assessment:
Monitor for signs of neurovascular compromise:
Pulses, capillary refill, and sensation distal to the injury.
Assess pain and administer prescribed analgesics.
Interventions:
Immobilization:
Use splints, slings, or braces to stabilize the injury.
Cold Therapy:
Apply ice packs to reduce swelling.
Wound Care:
Perform dressing changes using aseptic technique.
Rehabilitation:
Encourage gentle exercises as advised to prevent stiffness.
Patient Education:
Activity Modification:
Avoid activities that strain the joint or increase risk of recurrence.
Rehabilitation Importance:
Stress the need for physical therapy to regain strength and flexibility.
Signs of Complications:
Educate on recognizing infection, worsening pain, or decreased mobility.
Prognosis
Dislocation: Good with timely treatment; risk of recurrence in chronic or ligament-lax joints.
Trauma: Recovery depends on severity, associated injuries, and prompt intervention.
Prolapsed disc
Prolapsed Disc (Herniated Disc): Overview
Definition: A prolapsed disc, also known as a herniated disc, occurs when the soft, jelly-like center (nucleus pulposus) of an intervertebral disc protrudes through a tear or rupture in its tough outer layer (annulus fibrosus). This condition can compress nearby nerves, causing pain, numbness, or weakness.
Review of Anatomy and Physiology
Intervertebral Discs:
Located between vertebrae in the spinal column.
Function:
Act as shock absorbers.
Allow flexibility and movement of the spine.
Structure:
Nucleus Pulposus: Gel-like center that provides cushioning.
Annulus Fibrosus: Tough, fibrous outer layer.
Spinal Nerves:
The spinal cord is surrounded by vertebrae and intervertebral discs.
Spinal nerves exit through foramina (openings) between the vertebrae.
A prolapsed disc can compress these nerves, leading to neurological symptoms.
Pathophysiology
Initial Injury:
Overloading or degeneration of the intervertebral disc weakens the annulus fibrosus.
A tear or rupture allows the nucleus pulposus to herniate out.
Nerve Compression:
The protruding material exerts pressure on nearby spinal nerves.
Inflammation and chemical irritation further exacerbate symptoms.
Common Sites:
Most common in the lumbar spine (L4-L5, L5-S1 levels).
Less common in the cervical spine (C5-C6, C6-C7 levels).
Causes and Risk Factors
Trauma:
Lifting heavy objects improperly.
Sudden twisting or bending movements.
Degeneration:
Age-related wear and tear of the discs.
Other Factors:
Obesity: Increases stress on the spine.
Sedentary lifestyle: Weakens supporting muscles.
Genetic predisposition to weak connective tissue.
Smoking: Reduces disc hydration and elasticity.
Symptoms
General Symptoms:
Localized pain at the site of the prolapsed disc.
Reduced range of motion in the spine.
Radiculopathy (Nerve Root Compression):
Pain radiating along the path of the affected nerve.
Lumbar Herniation:
Sciatica: Pain radiates from the lower back to the buttocks, down the leg, and possibly into the foot.
Weakness or numbness in the lower limb.
Cervical Herniation:
Pain radiates from the neck to the shoulder, arm, or hand.
Tingling or weakness in the upper limb.
Severe Cases:
Cauda Equina Syndrome (Medical Emergency):
Compression of nerve roots in the lower spine.
Symptoms: Saddle anesthesia, bowel or bladder dysfunction, leg weakness.
Corticosteroids: Oral or epidural injections for severe inflammation.
Physical Therapy:
Strengthening exercises for core and back muscles.
Stretching and posture training.
Heat or cold therapy for pain relief.
Lifestyle Modifications:
Weight management to reduce stress on the spine.
Ergonomic adjustments for workstations.
2. Interventional and Surgical Management
Epidural Steroid Injections:
Reduces inflammation and nerve root irritation.
Minimally Invasive Procedures:
Discectomy:
Surgical removal of the herniated portion of the disc.
Microdiscectomy:
Similar to discectomy but uses smaller incisions and tools.
Spinal Fusion:
For recurrent or severe cases with instability.
Fuses two or more vertebrae to stabilize the spine.
Artificial Disc Replacement:
Replaces the damaged disc with an artificial one to preserve motion.
Complications
Chronic Pain:
Persistent pain even after treatment.
Neurological Deficits:
Weakness, numbness, or paralysis in severe cases.
Cauda Equina Syndrome:
Requires immediate surgical intervention to prevent permanent damage.
Recurrent Disc Herniation:
Can occur even after surgical treatment.
Nursing Management
Assessment:
Monitor pain levels and characteristics.
Evaluate for signs of nerve compression (e.g., numbness, weakness).
Assess mobility and activities of daily living (ADLs).
Interventions:
Pain Management:
Administer prescribed analgesics and muscle relaxants.
Apply heat or cold packs for symptomatic relief.
Mobility Support:
Teach proper body mechanics to reduce strain on the spine.
Encourage gradual activity resumption based on tolerance.
Education:
Teach about medication adherence and potential side effects.
Advise on lifestyle changes, including weight management and exercise.
Emphasize the importance of physical therapy.
Preventing Complications:
Monitor for signs of cauda equina syndrome (e.g., bowel or bladder dysfunction).
Ensure early intervention for worsening symptoms.
Prognosis
Most cases resolve with conservative management within 6 weeks.
Surgical outcomes are generally good if performed for well-indicated cases.
Recurrence is possible, emphasizing the importance of rehabilitation and lifestyle changes.
Osteomalacia and osteoporosis
Osteomalacia and Osteoporosis: Overview
Both osteomalacia and osteoporosis are conditions that weaken bones, but they differ in their underlying mechanisms, clinical presentations, and treatments.
Osteomalacia
Definition:
Osteomalacia is the softening of bones caused by defective bone mineralization due to a deficiency or impaired metabolism of vitamin D, calcium, or phosphate.
Anatomy and Physiology
Bone Composition:
Collagen Matrix: Provides flexibility.
Mineral Component (Calcium and Phosphate): Provides strength and hardness.
Role of Vitamin D:
Enhances calcium and phosphate absorption from the intestine.
Promotes mineralization of the bone matrix.
Pathophysiology of Osteomalacia
Vitamin D Deficiency:
Decreases calcium and phosphate absorption in the gut.
Leads to hypocalcemia and secondary hyperparathyroidism.
Impaired Mineralization:
Unmineralized bone matrix (osteoid) accumulates.
Results in soft, weak bones prone to deformities.
Causes:
Nutritional deficiencies (lack of sunlight or poor diet).
Osteoporosis is a condition characterized by reduced bone mass and microarchitectural deterioration of bone tissue, leading to increased fragility and fracture risk.
Anatomy and Physiology
Bone Remodeling:
A dynamic process where old bone is resorbed by osteoclasts and new bone is formed by osteoblasts.
In osteoporosis, bone resorption exceeds formation.
Peak Bone Mass:
Achieved by the mid-20s.
Declines with age, particularly in postmenopausal women due to estrogen deficiency.
Pathophysiology of Osteoporosis
Imbalance in Bone Remodeling:
Increased bone resorption or decreased bone formation.
Risk Factors:
Non-Modifiable:
Age, female gender, family history, ethnicity (Caucasian, Asian).
Spread of cancer to distant organs (e.g., liver, lungs, brain).
Nursing Management
Assessment:
Monitor for changes in size, shape, or symptoms of the tumor.
Assess for side effects of treatment (e.g., nausea, fatigue, hair loss).
Observe for complications like infection, bleeding, or organ dysfunction.
Interventions:
Symptom Management:
Administer prescribed analgesics for pain relief.
Provide antiemetics for chemotherapy-induced nausea.
Nutritional Support:
High-protein, high-calorie diet to counteract weight loss.
Manage appetite loss with small, frequent meals.
Emotional Support:
Offer psychological counseling or refer to support groups.
Provide education on treatment options and prognosis.
Monitoring During Treatment:
Observe for adverse effects of chemotherapy (e.g., myelosuppression, alopecia).
Ensure hydration and manage fatigue.
Patient Education:
Teach about early detection signs and importance of follow-ups.
Educate on lifestyle modifications to reduce recurrence risk.
Prognosis
Benign Tumors:
Excellent prognosis with complete surgical removal.
Malignant Tumors:
Prognosis depends on the type, stage, and overall health of the patient.
Early detection improves survival rates significantly.
Amputation
Amputation: Overview
Definition: Amputation is the surgical removal of a limb or part of a limb. It is performed to treat severe conditions such as trauma, infection, cancer, or vascular diseases that cannot be managed conservatively.
Types of Amputations
Based on Location:
Upper Limb:
Finger/Partial hand amputation.
Below elbow (transradial).
Above elbow (transhumeral).
Shoulder disarticulation.
Lower Limb:
Toe/Partial foot amputation.
Below knee (transtibial).
Above knee (transfemoral).
Hip disarticulation.
Based on Cause:
Planned/Surgical Amputation:
Performed due to medical necessity.
Traumatic Amputation:
Sudden, unplanned limb loss due to injury.
Specialized Amputations:
Disarticulation: Removal at a joint (e.g., hip disarticulation).
Hemicorporectomy: Amputation of the lower half of the body (rare and extreme).
Indications for Amputation
Vascular Disorders:
Peripheral artery disease (PAD) causing gangrene.
Diabetes mellitus leading to non-healing ulcers or infections.
Trauma:
Severe crush injuries or degloving injuries.
Uncontrollable bleeding or extensive tissue damage.
Infection:
Osteomyelitis (severe bone infection).
Necrotizing fasciitis (flesh-eating bacteria).
Malignancy:
Bone or soft tissue tumors (e.g., osteosarcoma).
Congenital Conditions:
Birth defects causing non-functional or painful limbs.
Other Causes:
Frostbite, burns, or electric shock injuries.
Pathophysiology of Amputation
Trauma/Injury:
Significant tissue damage or blood supply loss leads to ischemia and necrosis.
Vascular Compromise:
Chronic conditions like diabetes or PAD reduce oxygenation, causing tissue death and gangrene.
Infection:
Persistent infections result in systemic complications or sepsis, necessitating amputation.
Surgical Removal:
Involves removal of necrotic/infected tissue with proper stump formation for rehabilitation and prosthesis fitting.
Symptoms Leading to Amputation
Pain (ischemic, traumatic, or tumor-related).
Non-healing ulcers or wounds.
Gangrene (tissue death with discoloration and foul smell).
Monitor for signs of infection (redness, swelling, drainage).
Perform regular dressing changes using aseptic techniques.
3. Stump Care
Early Post-Op:
Elevate the stump to reduce swelling.
Use compression bandages to shape the stump.
Long-Term Care:
Maintain stump hygiene.
Monitor for skin breakdown or ulcers.
4. Mobility and Rehabilitation
Physical therapy to strengthen remaining muscles.
Training in the use of assistive devices (e.g., crutches, prostheses).
Occupational therapy to regain daily living skills.
5. Psychological Support
Address emotional and psychological concerns.
Provide access to counseling or support groups.
Prosthetic Fitting
Timing:
Temporary prosthesis during initial rehabilitation.
Permanent prosthesis once the stump has healed completely.
Types:
Cosmetic prosthesis.
Functional prosthesis (mechanical or robotic).
Training:
Teach proper use and maintenance of the prosthesis.
Nursing Management
Assessment:
Monitor vital signs for signs of infection or hemorrhage.
Assess the stump for healing, drainage, and swelling.
Interventions:
Administer prescribed medications (pain relief, antibiotics).
Encourage gradual mobilization and participation in physical therapy.
Provide emotional support and education on self-care techniques.
Patient Education:
Importance of stump hygiene and skin care.
Recognizing early signs of complications (e.g., infection, phantom pain).
Adapting to lifestyle changes with assistive devices or prostheses.
Prognosis
Good Prognosis:
Achievable with effective rehabilitation, prosthetic use, and support.
Challenges:
Emotional adjustment and restoring independence.
Diagnositc procedures
Diagnostic Procedures: General Overview
Diagnostic procedures help identify and confirm diseases or conditions. They range from non-invasive tests like imaging to invasive techniques such as biopsies. These procedures are essential for planning effective treatment and monitoring disease progression.
Types of Diagnostic Procedures
1. Laboratory Tests
Analyze blood, urine, stool, or other body fluids to detect abnormalities.
Common Tests:
Complete Blood Count (CBC):
Measures red blood cells, white blood cells, hemoglobin, and platelets.
Used for anemia, infections, and leukemia.
Blood Chemistry:
Tests electrolytes, kidney and liver function (e.g., sodium, potassium, BUN, creatinine, ALT/AST).
Urinalysis:
Checks for infections, kidney function, and metabolic disorders.
Provide visual information about the internal structures of the body.
Common Imaging Techniques:
X-Rays:
Visualize bones, lungs, and some soft tissues.
Common for fractures, pneumonia, and arthritis.
Ultrasound:
Uses sound waves to image soft tissues and organs (e.g., pregnancy, gallstones).
CT Scan (Computed Tomography):
Provides cross-sectional images using X-rays.
Used for detecting tumors, internal bleeding, and complex fractures.
MRI (Magnetic Resonance Imaging):
Uses magnetic fields and radio waves to image soft tissues.
Ideal for brain, spinal cord, joints, and ligaments.
PET Scan (Positron Emission Tomography):
Evaluates metabolic activity, commonly used in oncology.
Mammography:
X-ray of the breast for early cancer detection.
3. Endoscopic Procedures
Use a flexible camera to visualize internal organs and collect tissue samples.
Common Procedures:
Colonoscopy:
Visualizes the colon and rectum.
Used for detecting polyps, colorectal cancer, or inflammatory bowel diseases.
Upper GI Endoscopy:
Examines the esophagus, stomach, and duodenum.
Detects ulcers, tumors, or GERD.
Bronchoscopy:
Examines the lungs and airways.
Useful for detecting tumors, infections, or foreign bodies.
Cystoscopy:
Examines the bladder and urethra.
4. Biopsy
Removal of tissue for microscopic examination to confirm the diagnosis.
Types:
Fine Needle Aspiration (FNA):
Thin needle to extract cells, commonly used for thyroid and breast lumps.
Core Biopsy:
Uses a larger needle for a tissue sample.
Excisional Biopsy:
Removes the entire lump or suspicious area.
Bone Marrow Biopsy:
Evaluates bone marrow disorders like leukemia or lymphoma.
5. Genetic Testing
Analyzes DNA to detect genetic disorders or predispositions.
Applications:
Prenatal testing for genetic disorders (e.g., Down syndrome).
BRCA gene testing for breast cancer risk.
Carrier screening for inherited diseases.
6. Cardiovascular Diagnostics
Assess heart and blood vessel function.
Common Tests:
Electrocardiogram (ECG/EKG):
Measures electrical activity of the heart.
Detects arrhythmias, ischemia, or heart attack.
Echocardiogram:
Uses ultrasound to visualize heart structure and function.
Stress Test:
Monitors heart function under physical stress.
Angiography:
X-ray of blood vessels after injecting contrast dye.
Used to detect blockages in coronary or peripheral arteries.
7. Respiratory Diagnostics
Pulmonary Function Tests (PFTs):
Measure lung capacity and airflow.
Used for asthma, COPD, and restrictive lung diseases.
Spirometry:
Measures the amount and speed of air exhaled.
Arterial Blood Gas (ABG):
Analyzes oxygen, carbon dioxide, and pH levels in blood.
8. Neurological Diagnostics
Electroencephalogram (EEG):
Measures brain’s electrical activity.
Used for epilepsy, sleep disorders, and brain injuries.
Nerve Conduction Study (NCS):
Evaluates nerve function and damage.
Lumbar Puncture (Spinal Tap):
Analyzes cerebrospinal fluid for infections, bleeding, or multiple sclerosis.
9. Advanced Molecular and Pathological Tests
Flow Cytometry:
Analyzes cell characteristics, commonly used in hematological malignancies.
PCR (Polymerase Chain Reaction):
Detects specific genetic material, used for infections (e.g., COVID-19) and genetic conditions.
10. Specialized Tests
Bone Density Scan (DEXA):
Measures bone mineral density.
Used to diagnose osteoporosis.
Dermatoscopy:
Examines skin lesions for melanoma.
Capsule Endoscopy:
Swallowed capsule captures images of the digestive tract.
Preparation for Diagnostic Procedures
Patient Consent:
Explain the procedure, risks, and benefits to obtain informed consent.
Pre-Test Instructions:
Example: Fasting for blood tests or contrast imaging.
Adjusting medications (e.g., stopping anticoagulants before invasive tests).
Psychological Support:
Address patient anxiety and answer questions.
Post-Test Care:
Monitor for complications like bleeding or allergic reactions.
Provide aftercare instructions for invasive procedures.
Role of Nurses in Diagnostic Procedures
Preparation:
Educate patients about the procedure.
Ensure pre-test requirements are met (e.g., fasting, bowel prep).
Assistance During Procedure:
Provide equipment and assist the physician.
Monitor patient vitals and comfort.
Post-Procedure Care:
Monitor for complications like bleeding or infection.
Educate patients about follow-up and results.
Nursing management of patients with above problems.
Nursing Management of Patients with Diagnostic Procedures
Nursing care plays a crucial role in ensuring patient safety, comfort, and understanding during diagnostic procedures. The management is divided into pre-procedure, intra-procedure, and post-procedure care, depending on the type of diagnostic test performed.
1. General Nursing Responsibilities
A. Pre-Procedural Care
Patient Preparation:
Obtain informed consent.
Provide a clear explanation of the procedure, its purpose, and expected outcomes.
Address patient anxiety by providing reassurance and answering questions.
Follow specific pre-test instructions (e.g., fasting, medication adjustments).
Prepare the site of the procedure if required (e.g., shaving for catheterization).
Ensure Necessary Supplies:
Verify that required equipment and materials are available and functional.
Baseline Assessment:
Record vital signs and assess the patient’s physical and emotional readiness.
B. Intra-Procedural Care
Ensure Patient Safety:
Maintain a sterile environment during invasive procedures.
Monitor vital signs and patient comfort throughout the procedure.
Assist the healthcare provider by handing over instruments or materials.
Provide Emotional Support:
Stay with the patient to provide reassurance and explain ongoing actions.
C. Post-Procedural Care
Monitor for Complications:
Watch for adverse reactions such as bleeding, infection, or allergic responses.
Assess vital signs regularly to detect changes.
Provide Aftercare Instructions:
Educate the patient about activity restrictions, wound care, or follow-up appointments.
Emphasize the importance of reporting unusual symptoms (e.g., fever, swelling).
Document the Procedure:
Record observations, patient responses, and any interventions performed.
2. Nursing Management for Specific Procedures
A. Laboratory Tests
Blood Tests:
Ensure fasting if required (e.g., lipid profile, glucose tolerance test).
Apply pressure at the puncture site to prevent bleeding.
Urinalysis:
Instruct the patient on proper collection techniques (e.g., midstream clean catch).
Tumor Markers:
Explain the purpose of the test, especially in oncology cases.
B. Imaging Studies
X-Rays:
Remove metallic objects to avoid interference.
Provide lead aprons for radiation protection.
Ultrasound:
Encourage the patient to drink water if a full bladder is required.
CT/MRI:
Check for allergies to contrast agents.
Assess for contraindications (e.g., pacemakers in MRI).
Advise the patient to lie still during the scan.
C. Endoscopic Procedures
Pre-Procedure:
Ensure bowel preparation for colonoscopy.
Advise fasting for upper GI endoscopy.
Intra-Procedure:
Monitor oxygen saturation and vital signs.
Assist in positioning the patient (e.g., left lateral for colonoscopy).
Post-Procedure:
Monitor for complications like perforation or bleeding.
Provide dietary advice (e.g., clear fluids initially).
D. Biopsies
Pre-Procedure:
Explain the purpose of the biopsy and obtain consent.
Intra-Procedure:
Assist with sterile techniques.
Provide emotional support to reduce anxiety.
Post-Procedure:
Monitor for bleeding or infection at the biopsy site.
Advise on limiting activities to prevent site trauma.
E. Genetic Testing
Pre-Test Counseling:
Provide information about the implications of results.
Post-Test Counseling:
Discuss the emotional and medical impact of findings.
Refer to genetic counselors as needed.
F. Cardiovascular Diagnostics
ECG:
Ensure proper electrode placement.
Educate the patient about avoiding movement during the test.
Stress Test:
Monitor for signs of chest pain, breathlessness, or fatigue.
Have emergency equipment readily available.
Angiography:
Post-procedure: Monitor for bleeding at the catheter site and assess peripheral pulses.
G. Respiratory Diagnostics
Pulmonary Function Tests:
Explain the breathing maneuvers required.
Avoid bronchodilators or smoking before the test as advised.
Bronchoscopy:
Post-procedure: Monitor for respiratory distress or bleeding.
H. Neurological Diagnostics
EEG:
Inform the patient to avoid caffeine before the test.
Post-test: Assist in removing electrodes and washing hair.
Lumbar Puncture:
Encourage the patient to lie flat post-procedure to prevent headaches.
Monitor for signs of infection or CSF leakage.
3. Patient Education
Procedure Information:
Simplify complex medical jargon to ensure the patient understands.
Complication Awareness:
Teach patients to recognize and report symptoms like fever, redness, or excessive pain.
Follow-Up:
Stress the importance of attending follow-up appointments for test results and further care.
4. Emotional and Psychological Support
Pre-Test Anxiety:
Offer reassurance and relaxation techniques.
Post-Test Concerns:
Discuss implications of findings sensitively.
Provide access to counseling if needed (e.g., genetic testing results).
Goals of Nursing Management
Ensure the diagnostic procedure is performed safely and effectively.
Minimize patient discomfort and anxiety.
Prevent and manage complications.
Educate the patient to promote understanding and adherence to care plans.
Prosthesis and rehabilitation.
Prosthesis and Rehabilitation: Overview
Prosthesis: A prosthesis is an artificial device that replaces a missing body part, such as a limb, tooth, or eye, lost through trauma, disease, or congenital conditions.
Rehabilitation: Rehabilitation involves a comprehensive process aimed at restoring physical, emotional, and social functioning in individuals who have experienced amputations or disabilities. It ensures proper use of prosthetics, enhancing mobility and independence.
Types of Prostheses
1. Based on Body Part Replaced
Upper Limb Prosthesis:
Partial Hand Prosthesis: Replaces fingers or parts of the hand.
Below Elbow Prosthesis: For transradial amputations.
Above Elbow Prosthesis: For transhumeral amputations.
Shoulder Disarticulation Prosthesis: Replaces the entire arm and shoulder.
Lower Limb Prosthesis:
Partial Foot Prosthesis: Replaces toes or part of the foot.
Below Knee Prosthesis: For transtibial amputations.
Above Knee Prosthesis: For transfemoral amputations.
Hip Disarticulation Prosthesis: Replaces the entire leg up to the hip.
Uses electrical signals from muscles for movement.
Advanced Robotic Prosthesis:
Integrates sensors, microprocessors, and AI for natural motion.
Components of Prostheses
Socket: Interfaces with the residual limb, ensuring comfort and stability.
Suspension System: Keeps the prosthesis attached (e.g., straps, suction).
Joints:
Mechanical or microprocessor-controlled for knees or elbows.
Pylon: Connects the socket to the terminal device.
Terminal Device:
Hand, hook, or foot depending on the prosthesis type.
Prosthetic Fitting Process
Assessment:
Evaluate the residual limb’s size, shape, and condition.
Consider functional needs, lifestyle, and goals.
Custom Fabrication:
Prosthesis is designed and molded to fit the individual.
Initial Fitting:
Trial and adjustments for comfort and alignment.
Final Fitting:
Delivery of the fully functional prosthesis.
Goals of Rehabilitation with Prosthesis
Restore Mobility:
Enhance ambulation and functional abilities.
Promote Independence:
Enable self-care and participation in daily activities.
Prevent Complications:
Avoid contractures, skin breakdown, or overuse injuries.
Psychological Adjustment:
Address body image issues and emotional concerns.
Phases of Rehabilitation
1. Pre-Prosthetic Phase
Wound Healing:
Monitor stump healing and manage infections.
Stump Shaping:
Use compression bandages or shrinkers for proper limb contour.
Strengthening Exercises:
Focus on core and remaining limb muscles.
Emotional Preparation:
Provide counseling and peer support.
2. Prosthetic Phase
Prosthetic Training:
Teach proper donning and doffing of the prosthesis.
Educate on weight distribution and balancing techniques.
Mobility Training:
Initiate walking with parallel bars and progress to free ambulation.
Functional Training:
Encourage use of the prosthesis in daily activities.
Prevent Complications:
Inspect for pressure sores or skin irritation.
3. Advanced Rehabilitation Phase
Fine Motor Skills:
Train in precision tasks (e.g., gripping objects with an upper limb prosthesis).
Recreational Activities:
Adapt activities to maintain hobbies and interests.
Vocational Rehabilitation:
Assist in returning to work or school.
Long-Term Care:
Monitor for prosthetic wear-and-tear and provide necessary repairs or upgrades.
Common Challenges in Prosthetic Use
Physical Challenges:
Poor stump shape or skin issues.
Phantom limb pain or residual limb pain.
Psychological Challenges:
Depression, anxiety, or difficulty accepting the prosthesis.
Prosthetic Issues:
Discomfort, improper fitting, or mechanical failure.
Nursing Management
Pre-Prosthetic Phase:
Assess the stump for healing, swelling, or infection.
Encourage isometric exercises to maintain muscle strength.
Educate on proper stump hygiene and care.
Prosthetic Phase:
Monitor the fit and alignment of the prosthesis.
Provide support during initial training sessions.
Encourage adherence to physical therapy and rehabilitation plans.
Emotional Support:
Offer psychological counseling or refer to support groups.
Address concerns related to body image and social interactions.
Patient Education:
Teach proper prosthesis maintenance and cleaning.
Advise on recognizing signs of complications (e.g., skin irritation, pain).
Emphasize the importance of follow-up appointments for adjustments.
Complications to Monitor
Stump Issues:
Pressure sores, infection, or dermatitis.
Phantom Limb Pain:
Sensations of pain in the amputated limb.
Mechanical Failures:
Malfunctioning or poorly aligned prosthetic components.
Prognosis
With proper fitting, training, and rehabilitation, most individuals achieve significant independence and functionality.
Regular maintenance and periodic upgrades of the prosthesis ensure long-term usability.
Transplant and replacement surgeries.
Transplant and Replacement Surgeries: Overview
Definition:
Transplant Surgery: The surgical replacement of a diseased or damaged organ with a healthy one from a donor.
Replacement Surgery: The substitution of a damaged or dysfunctional part of the body (e.g., joints, valves) with an artificial or biological substitute.
Types of Transplant Surgeries
Organ Transplants:
Kidney Transplant: For end-stage renal disease (ESRD).
Liver Transplant: For cirrhosis, hepatocellular carcinoma.
Heart Transplant: For end-stage heart failure.
Lung Transplant: For severe COPD, interstitial lung disease.
Pancreas Transplant: For type 1 diabetes with severe complications.
Intestinal Transplant: For short bowel syndrome.
Tissue Transplants:
Corneal Transplant: For corneal opacity.
Skin Grafts: For burns or extensive wounds.
Bone Marrow Transplant: For leukemia, aplastic anemia.
Combined Transplants:
Kidney-Pancreas Transplant.
Heart-Lung Transplant.
Types of Replacement Surgeries
Joint Replacements:
Knee Replacement (Total or partial): For severe osteoarthritis or rheumatoid arthritis.
Hip Replacement: For hip fractures, osteoarthritis.
Shoulder or Elbow Replacement: For trauma or degenerative diseases.