Musculoskeletal Assessment of the Older Adult case study PDF

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case study on musculoskeletal system patient...

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Musculoskeletal Assessment of the Older Adult Patient Profile S.T. is a 72-year-old female patient. Her husband died 6 months ago, and she lives alone now. She is seeing the health care provider for her annual physical examination. She has a history of hypertension and osteoarthritis. She currently takes the following medications: • Furosemide 20 mg PO daily every morning • Inderal LA 80 mg PO daily every morning • Celecoxib 200 mg PO daily every morning Subjective Data • Has “some” pain in her right knee • States “It looks like I lost a half an inch this past year” Objective Data • Temperature 98.2°F, pulse 72, respirations 16, blood pressure 130/76 • Height 5 feet 2½ inches, weight 170 lbs., BMI 30.6 kg/m2 • Unsteady gait, walks with a limp Discussion Questions 1. What are some important questions the nurse may ask that would illicit subjective information related to her musculoskeletal system? Answer: She had stated that her right knee hurts. Ask her to describe the pain and if there is any stiffness, joint crepitation, weakness, or limited movement in the right knee or anywhere else. Is the pain present in the morning when she first wakes up, and does it get better or worse as the day progresses and with activity? Does anything exacerbate it or alleviate it? Are there any other prescribed or over-the-counter medications, in addition to those listed in her record (triamterene– hydrochlorothiazide and celecoxib) that she is taking? What, if any, exercise does she do? Has she had any recent surgeries, treatments, or hospitalizations because of a musculoskeletal problem? Is she able to perform her activities of daily living, such as getting up to the bathroom, bathing, and cooking without any problems, or does she require any assistive devices to get around? Rationale: Questions regarding the degree of pain and physical limitations are important information that can allow the nurse to better help S.T. identify and manage her symptoms. 2. Describe what you would include in S.T.’s musculoskeletal assessment. Answer: In S.T.’s case, thoroughly inspect and palpate her right knee that she states she has had pain in and compare it with the left knee. Assess S.T.’s joint mobility or range of motion, both active and passive, in all her joints. Stop manipulation immediately if pain or resistance is felt. Observe S.T.’s gait as she walks. If gait abnormality noted, measure leg length and circumferential muscle mass and compare to sides. Rationale: Inspect the musculoskeletal system from head to toe observing for any swelling, deformity, nodules or masses, and discrepancies in limb length or muscle size. Use the patient’s opposite body part for comparison when an abnormality is suspected.

3. What are some musculoskeletal findings would you expect as part of the normal aging process? Answer: Decreased muscle mass and strength, flabby muscle, and abdominal protrusion can occur as the number and diameter of muscle cells decrease and are replaced by fibrous connective tissue. Joint stiffness, decreased mobility, limited range of motion, and pain with motion or weight bearing can occur because of cartilage erosion, resulting in bone-to-bone contact and overgrowth of bone around joint margins. Loss of height (S.T. did state she lost half an inch in this year) posture change, deformity (e.g., dowager’s hump), and back pain can occur because of loss of water from disks between vertebrae or a decrease in bone density. Rationale: As the body ages, bone mass may decrease, muscles may weaken, and joints may not function as they once had. 4. Based on her past medical history and diagnosis of osteoarthritis as well as the subjective data and physical assessment findings of right knee swelling and tenderness to palpation and decreased range of motion, S.T. is at risk for falls. What are some fall prevention strategies you could teach S.T.? Answer: Instruct S.T. to be sure to take her blood pressure medicine (which is a diuretic) during the day, get up slowly, wear well-fitting shoes, and use an assistive device, such as a walker or cane, if needed. In her home, have her remove any loose rugs in the house, make sure all the walkways are kept clear, use grab bars and nonskid mats in the bathroom, and use appropriate lighting, particularly at nighttime. Rationale: Preventing falls is one of the biggest safety interventions nurses may perform, whether in the hospital or in the home environment. 5. What could you teach S.T. to help improve some of her symptoms? Answer: Losing weight may help decrease symptoms of pain, swelling, and tenderness in the right knee. She may see benefit in employing joint protection measures and using nonpharmacologic therapies, such as heat and cold applications, to assist with her pain management. Rationale: Pain is a huge factor and helping S.T. to find nonpharmacologic ways to reduce pain can help improve the client’s outcomes. Also, nutrition plays an important role in helping the bones, joints, and muscles stay healthy. 6. Based on the subjective and objective data S.T.’s health care provider orders an x-ray examination of the right knee and after reading the radiographs, recommends S.T. have a right knee arthroscopy with possible debridement to visualize the contents of the knee to determine the cause of the pain and identify treatment options. What should you explain to S.T. about this procedure? Answer: A knee arthroscopy is a surgical procedure that is typically performed in an outpatient setting. Rationale: Local, regional, or general anesthesia is used to perform the procedure in which the orthopedic surgeon is able to visualize the structure and contents of the knee and debride any loose bodies or rough edges, if found. After the procedure, the wound is covered with a sterile dressing, and after S.T. has recovered from the anesthetic used, she will be allowed to go home but may have some restrictions on activity and bathing for a few days....