CHAPTER 16
Disorders of the Musculoskeletal System
LEARNING OUTCOMES
Upon completion of this chapter, the nurse will:
1. Summarize the different disorders of the musculoskeletal system
2. Examine approaches to assess different disorders of the musculoskeletal system
3. Determine approaches that can be used for more than one musculoskeletal disorder
MUSCULOSKELETAL DISORDERS
Disorders of the musculoskeletal system can range from minor ailments to more severe chronic conditions. The disorders identified are the most common ones appropriate for telephonic care and include:
Sprain
Repetitive use injury
Fracture
Amputation
Osteoporosis
Gout
Osteoarthritis
Post-polio syndrome
Rheumatoid arthritis
Ankylosing spondylitis
Spinal stenosis
Osteomyelitis
Back pain
Fibromyalgia
Spinal deformity
Foot disorders
ASSESSING DISORDERS OF THE MUSCULOSKELETAL SYSTEM
Remember that the client is already diagnosed with a musculoskeletal problem. When providing telephonic care, you are assessing the client’s current condition, symptoms, and if anything has changed or needs to be referred to the doctor/health care professional.
Health Problem | Question |
Sprain | When were you told that you had a sprain? |
| Where is the sprain located? |
| When did the sprain occur? |
| What were you told to do to treat the sprain? (RICE)
|
| Are you able to walk with the sprain? |
| What are you doing to treat the pain? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the sprain? |
Repetitive use injury | When were you told that you have a repetitive use injury? |
| Where is it located? |
| What are your symptoms?
|
| How long have you had this injury? |
| What are you doing for the injury?
|
| Have you been told that you might need surgery?
|
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the injury? |
Dislocation | What joint was dislocated? |
| When did it happen? |
| How did it happen? |
| Was the joint “put back into the socket”? (closed reduction) |
| What were you told to do to treat it?
|
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the injury? |
Fracture | What bone was broken (fractured)? |
| When did it happen? |
| How did it happen? |
| What has been done to treat it?
|
| If casted, what have you been directed to do to care for the cast such as:
|
| How long do you need to wear the cast? |
| Have you been told that you will need physical therapy after the cast is removed? |
| (If a lower extremity is casted) What are you using to help you walk?
|
| When do you go back to have the broken bone checked? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the broken bone? |
Amputation | When did you have your (leg/arm) amputated? |
| Can you tell me why it needed to be amputated? |
| How long ago was that done? |
| Has your stump healed? |
| Have you been fitted for a prosthesis?
|
| (If below knee amputation) Are you doing any exercises to make sure your knee can be bent and straightened? |
| (If above knee amputation) Were you directed to lie on your stomach on the bed for short periods of time every day to make sure your hip joints do not get tight? |
| Are you having any pain in your leg/arm with the amputation? (Might experience phantom limb pain.) If so,
|
| When are you supposed to go back and see the surgeon for the amputation? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the amputation? |
Osteoporosis | Who told you that you have osteoporosis? |
| How was it diagnosed? |
| How long ago were you told? |
| What medicine are you taking for the osteoporosis? Are you taking the medicine as prescribed such as:
|
| Are you supposed to take calcium and vitamin D supplements also? |
| Have you been directed to do anything to help with the osteoporosis such as:
|
| Have you had any broken bones because of the osteoporosis? If so,
|
| When are you supposed to see your doctor again for the osteoporosis? |
| For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the osteoporosis? |
Gout | When were you told that you have gout? |
| Where is the gout located?
|
| What are/were your symptoms:
|
| What medicine are you taking for the gout?
|
| What else are you doing to treat the gout?
|
| When are you supposed to see your doctor again for the gout? |
| For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the gout? |
Back pain | When did you start to have back pain? |
| How long has it been going on? |
| Were you doing anything in particular when it started? Such as:
|
| What have you been doing to treat the back pain, such as:
|
| Were you told the reason for the back pain, such as:
|
| Are you having any problems, such as:
|
| Were you told that you need/did you have surgery for the back pain? If so,
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