45. Drugs Used to Treat the Musculoskeletal System



Drugs Used to Treat the Musculoskeletal System


Objectives



Key Terms


cerebral palsy (image) (p. 718)


multiple sclerosis (image) (p. 718)


hypercapnia (image) (p. 719)


spasticity (image) (p. 721)


muscle spasms (image) (p. 721)


stroke syndrome (image) (p. 723)


neuromuscular blocking agents (image image) (p. 724)


image http://evolve.elsevier.com/Clayton


The muscular system involves all of the voluntary muscles that line the skeleton of the body and allow for movement. The most common musculoskeletal disorders are cerebral palsy and multiple sclerosis. Cerebral palsy is a condition in which movement of the extremities is marked with any combination of the following: exaggerated reflexes, abnormal posture, involuntary movements, and walking difficulties. Cerebral palsy can be caused by an injury or a birth defect.


Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progression, severity and specific symptoms of multiple sclerosis are unpredictable and highly variable between persons.


Muscle Relaxants and Neuromuscular Blocking Agents


imageNursing Implications for Skeletal Muscle Relaxants and Neuromuscular Blocking Agents

Assessment

Assessment for Skeletal Muscle Disorders.


Musculoskeletal disorders may produce varying degrees of pain and immobility, impairing the individual’s ability to perform the activities of daily living. The nursing assessments performed are individualized to the muscles affected and the underlying disease.


Current History



History



Medication History



Activity and Exercise



Sleep and Rest



Elimination



Nutrition



Physical Examination



Laboratory and Diagnostic Studies



Assessment for Neuromuscular Blocking Agents



• Assessment of the patient’s vital signs, mental status, and, particularly, respiratory function is mandatory for people having received neuromuscular blocking agents. The adverse effects associated with these drugs may occur 48 hours or more after administration. Close observation of respiratory function, ability to swallow secretions, and the presence of a cough reflex is necessary. Suction, oxygen, mechanical ventilators, and resuscitation equipment should be available in the immediate area.


• Monitor blood pressure, pulse, and respirations. Review the baseline readings of the patient’s vital signs before administration of anesthetic and neuromuscular blocking agents. Generally, changes from the baseline should be reported.


• Monitor the patient closely for clinical signs of hypoxia and hypercapnia (tachycardia, hypotension, and cyanosis). Arterial blood gas levels (see Table 31-1) may be determined to confirm the clinical observations.


Detection of Respiratory Depression



• Early signs of diminished ventilation are difficult to detect, particularly after the patient leaves the immediate postoperative area when continuous monitoring with pulse oximetry is discontinued. Often, the signs of restlessness, anxiety, lethargy, decreased mental alertness, and headache are early subtle clues to distress.


• Use of the abdominal, intercostal, or neck muscles is an indication of respiratory distress. Flaring of the nostrils may be present in severe cases.


• As respiratory distress progresses, respirations become shallow and rapid. Assess for asymmetrical chest movements.


• The development of cyanosis is a late sign of respiratory complications. Respiratory distress should be detected early through close observation before cyanosis develops.


• Assess muscle strength by asking the patient to lift his or her head off the pillow and hold a few seconds.


Pain Assessment.


Assess the degree of pain present because neuromuscular blocking agents paralyze the muscles but do NOT relieve pain.


Implementation

Nursing Interventions With Musculoskeletal Disorders



• Assist with physical examination, drawing of blood samples, obtaining vital signs, and weighing for preparation for diagnostic procedures.


• Adapt procedures to meet the self-care abilities of the individual patient.


• Administer prescribed medications (e.g., anti-inflammatory drugs, analgesics, muscle relaxants).


• Provide specific instructions on the application of hot or cold packs. Generally, ice packs alleviate swelling for the first 48 hours after muscle injury.


• Elevating the extremity immediately after injury decreases swelling and, to some degree, alleviates pain.


• Maintain the activity level prescribed (e.g., bed rest, immobilization of muscle group or limb). During the initial phase of treatment, immobilizing the affected part will decrease muscle spasms and therefore decrease pain. Maintenance of proper alignment of the affected part will also relieve pain and swelling. Various approaches may be used for immobilization, including elastic bandages, splinting, casts, bed rest, or modified activity levels.


• Range-of-motion exercises may be prescribed to maintain joint function and prevent muscle atrophy and contractures. The activity plan prescribed must be individualized to the diagnosis and should be carefully followed for maximum effectiveness.


• Increased anxiety produces stress on the body’s muscles. Implement measures to produce relaxation and provide for the psychological needs of the individual.


Nursing Interventions With Neuromuscular Blockers



• Neuromuscular blockers are used during anesthesia and surgery to relax muscle groups and during the use of mechanical ventilation to improve airflow and oxygenation of the patient. See a critical care nursing text for a detailed discussion of nursing care while the patient is receiving mechanical ventilation. The patient must be intubated and receiving mechanical ventilation before administration of neuromuscular blocking agents.


• Monitor airway patency, respiratory rate, and tidal volume in accordance with hospital policy.


• The histamine release caused by these drugs may produce increased salivation. In patients who are paralyzed or who have incomplete return of control over swallowing, coughing, and deep breathing, these secretions may obstruct the airway. Have suctioning equipment by the bedside.


• Assess for dyspnea and loud or gurgling sounds with respirations. Suction secretions according to hospital policies and procedures. If qualified, palpate for coarse chest wall vibrations and listen for crackles.


• Deep-breathing exercises can allow the opportunity to assess the patient’s cough reflex. Assist the patient by splinting any abdominal or thoracic incisions. Have the patient take three or four deep breaths and then cough. During this process, assess the patient’s ability to breathe deeply.


• Patients can usually cough better in a semi-Fowler’s or high Fowler’s position; therefore, depending on the situation and stability of the patient’s vital signs, elevating the head of the bed may assist coughing and breathing. For unconscious or semiconscious patients, position on the side, using good body alignment. Keep the bed’s side rails up.


• People still paralyzed by the effects of neuromuscular blockers may experience pain and be unable to speak to request medication. Ensure that analgesics are scheduled on a regular basis and administered on time.


• Deal calmly with the patient experiencing respiratory dysfunction. The inability to breathe may cause the patient to panic. Provide reassurance while initiating measures to assist the patient.


• Question antibiotic orders that prescribe aminoglycosides or tetracycline when neuromuscular blockers have been used. These drugs may potentiate the neuromuscular blocking activity.


image Patient Education and Health Promotion

Pain Relief



Activities and Exercise.


The patient must resume activities of daily living within the boundaries set by her or his health care provider. Activities such as regular moderate exercise, meal preparation, resumption of usual sexual activities, and social interaction must be encouraged once specific orders have been obtained.


Psychosocial.


For chronic disorders, encourage the patient to express feelings regarding chronic illness. The adjustment to this situation involves working through great personal fears, frustrations, hostilities, and resentments associated with the loss of personal control in one’s life.


Medications.


Many of the medications used in the treatment of musculoskeletal disorders produce sedation. Teach the patient about safety precautions such as avoiding using power equipment or driving while taking these medications.


Fostering Health Maintenance


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Jul 11, 2016 | Posted by in NURSING | Comments Off on 45. Drugs Used to Treat the Musculoskeletal System

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