Osteoporosis Fractures Degenerative Joint Disease/Osteoarthritis
Total Hip and Knee Prostheses Bone Infections / Osteomyelitis Gout
Musculoskeletal Disorders Part I Slide 2 Emergency & Ortho
Nursing ..is Not for the Faint of Heart ! Slide 3 Fractured femur
2* Gun Shot Wound Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Slide 9
Slide 10 Transverse fracture Slide 11 Oblique fracture / spiral
fracture / torsion fracture Slide 12 Green stick fracture Slide 13
Concept Map: Selected Topics in Musculo-Skeletal Nursing
PATHOPHYSIOLOGY Fracture Osteoporosis Degenerative Joint Disease
Osteoarthritis Osteomyelitis Gout Amputation Total Joint
Replacement PHARMACOLOGY Opioids NSAIDs Antibiotics Disease
Specific ASSESSMENT Physical Assessment Inspection Palpation
Percussion Auscultation Neuro / Circ Checks --The 6 Ps Lab
Monitoring Care Planning Plan for client adls, Monitoring, med
admin., Patient education, morebased On Nursing Process:
A_D_O_P_I_E NURSING DIAGNOSES THAT APPLY. Nursing Interventions
& Evaluation Execute the care plan, evaluate for Efficacy,
revise as necessary Slide 14 Nursing Diagnoses That (Might) Apply
Pain, acute Comfort, impaired Mobility, altered Self-care deficit
feeding, grooming; bathing, hygeine; toileting Falls, risk for Skin
breakdown, risk for Constipation, risk for Diversional activity,
risk for Mobility, Physical, impaired Mobility, bed, risk for
Walking, impaired, Tissue perfusion, impaired peripheral Peripheral
neurovascular dysfunction, risk for Knowledge, deficient Body
image, disturbed Grieving More Slide 15 Musculoskeletal Disorders
Objectives See the Study Guide for Complete List of Objectives
Compare and contrast different types of fractures Discuss the usual
healing processes for bone Identify complications of fractures
Describe the nursing care of the client with casts or traction,
including client education Prioritize nursing care for patients who
are at risk for osteopenia Describe the role of drug therapy, diet,
and exercise in management of osteoporosis. Slide 16
Musculoskeletal Disorders Objectives See the Study Guide for
Complete List of Objectives Describe the pain management of client
with bone disorders Prioritize nursing care for a patient who has
had a hip ORIF or knee replacement Identify common types of
amputations Identify appropriate nursing care for patients with
degenerative joint disease (DJD) Prioritize nursing care for
patients who are at risk for osteomylitis (bone infection) Describe
the role of drug therapy in prevention and management of
degenerative joint disease Describe the causes of gout and
appropriate treatments. Slide 17 Musculoskeletal Disorders Review
of Bone physiology this is a picture of normal bone, with
osteoblasts rebuilding injured or old bone, faster than osteoclasts
can break it down o o Healthy bone o Slide 18 Musculoskeletal
Disorders This is one osteoclast dissolving bone As part of the
normal healing process Slide 19 MusculoSkeletal Disorders Healthy
bone provides structure and support for the human body. The marrow
makes stem cells which produce our red and white cells when they
mature. Slide 20 Slide 21 Musculoskeletal Disorders
----Osteoporosis Osteoporosis number one cause of fractures in the
elderly, >1.5 million per year Primary Osteoporosis is caused by
osteopenia or thinning of the bone. This occurs when osteoclastic
bone loss is faster than osteoblastic (bone building) activity.
This is measured by BMD (bone mineral density) Osteopenia = T-score
of less than- 1.0 Treatment starts here, new guidelines 2008
Osteoporosis = T-score of > -2.5 Slide 22 Musculoskeletal
Disorders- -----Osteoporosis Secondary Osteoporosis Caused by other
disease mechanisms, or treatments, i.e. long term corticosteroids,
methamphetamine or alcohol abuse, or prolonged immobility can occur
within 12 weeks Treatments are the same for both types and
osteoclastic activity is the same Slide 23 Low-power scanning
electron microscope image of normal bone architecture in the 3 rd
lumbar vertebra of a 30 year old woman marrow and other cells have
been removed to reveal thick, interconnected plates of bone Slides
courtesy of the Bone Research Society BRS, UK Slide 24 Low-power
scanning electron microscope image of osteoporotic bone
architecture in the 3 rd lumbar vertebra of a 71 year old woman
marrow and other cells have been removed to reveal eroded, fragile
rods of bone Slide 25 Detail of a trabicular bone element
perforated by osteoclast action-- note pitting of the bone
stalagmite Slide 26 Musculoskeletal diseases Osteoporosis Risk
Factors Age Post-menopause (lack of estrogen stimulation) Thin lean
body build Asian or thin Caucasian race Calcium and Vitamin D
deficiency Lack of weight bearing exercise Alcohol abuse Tobacco
use Excessive caffeine use (> 3 cups per day) Eating disorders
Malabsorption disorders Slide 27 Musculoskeletal diseases
Osteoporosis Diagnostics: DEXA Scan Screening annually of
post-menopausal women DEXA Screening for hypothyroid and
hyperthyroid patients Qualitative US not used much Bone Scan is
used for differential diagnostics, i.e. to rule out bone cancer
Labs for Calcium, Magnesium, Phosphorus levels Urine for pyridinium
levels Slide 28 DXA Scan This is a typical bone densitometry study.
A low dose x-ray is performed of the lumbar spine, hip (shown here)
or wrist. From the resulting image /measurement, calculations can
be made to determine the density of the patient's bone (T-score)
and compare it to the reference standard of a healthy
thirty-year-old of the same sex and ethnicity to determine future
risk of fracture. http://www.radiologyinfo.org/en/info.cfm?pg=dexa
Slide 29 Musculoskeletal diseases Osteoporosis Treatments and
Nursing Interventions Educate Side effects of meds Calcium
supplementation new evidence is 1700 mg of calcium per day, or more
for post-menopausal women not on hormone therapy. May use TUMS if
stomach is upset with supplements Exercises Fall prevention and
safety Biphosphonates i.e. Fosamax, Actonel, Boniva have to be
taken 1 hour before any other foods or vitamins, with only water to
be absorbed. Vitamin D therapy not usually needed in the sunny
desert, found in dairy and green leefy vegetables Slide 30 Slide 31
Musculoskeletal Disorders Fracture treatment Nursing primary
concern is to assess and prevent neuro-vascular dysfunction. Neuro
/ circulation checks should be done of the affected limb every 15
minutes x 4, then every 30 minutes x2, then every hour. ( The book
says every hour, but that is really too long, and your patient
could go into shock) Immobilize the limb Control the pain Assess
for shock Slide 32 Risk for Peripheral Neurovascular deficit Other
fracture interventions (with casting or immobilization/traction).
Monitor for numbness, tingling, hyperesthesia, hypoesthesia Monitor
for DVTs check pulses and color Instruct the client to examine the
skin daily for any breakdown or alterations, call MD if oozing or
redness occur Instruct client to avoid crossing their legs Instruct
patient to completely abstain from tobacco Remove home safety
hazards in the home Instruct patient not to scratch underneath the
cast or around the pins/traction Give patient anticoagulants and
analgesics if ordered Instruct patient to take vitamins, adequate
amoaunts of magnesium, vitamin C, etcfor healing. Slide 33
Neurovascular Components: The 6 Ps Early or Late Signs Assessment
ParametersClient Teaching / Symptoms to Report Pain Early Assess
area involved using 0 to 10 rating scale: 0 = no pain 10 = worst
pain imaginable Increasing pain not relieved with elevation or pain
medication Paresthesia Early Assess for numbness/tingling, pins or
needles sensation: Should be absent. Numbness or tingling, pins or
needles sensation Pallor Early Assess capillary refill. Brisk is
< 3 seconds Increased capillary refill time > 3 seconds, blue
fingers or toes Polar Late Assess skin temperature by touch: Warm
Cool Cool/cold fingers or toes Paralysis Late Assess mobility:
Moves fingers or toes Able to plantar dorsiflex the ankle area not
involved or restricted by cast Unable to move fingers or toes
Pulses Late Assess pulse(s) distal to injury: Pulse is palpable and
strong Weak palpable pulses, unable to palpate pulses, pulse
detected only with Doppler Slide 34 Musculoskeletal Disorders
Fractures- Pathological fractures occur when abnormal force is
applied, or the bone is already weakened (osteoporosis, cancers,
sarcomas, benign bone cysts, etc.). The type of fracture depends on
the type of loading force and stress applied to the bone. See
below. Closed - Greenstick -Spiral - Open (compound) Slide 35 This
is a photograph of 70 year old woman who first presented like this
with a massive chondrosarcoma of her right upper humerus of 8
months duration. She refused all treatment, and she died of a
massive haemorrhage when the tumour burst the following week.
http://worldortho.com/dev/index.php?option=com_content&
task=view&id=1814&Itemid=328 Slide 36 Slide 37
Musculoskeletal Disorders Fractures- Complications of fractures
include: Fat emboli syndrome/CVA/Stroke Hematoma (leakage from the
bone marrow usually), which can also be a hemmorhage Callus
formation DVT- thromboembolism Infection to Osteomyelitis Ischemic
necrosis Fracture blisters Delayed union, nonunion, and malunion
Osteoblastic proliferation.. Slide 38 i.e. Osgoods Schlatters
Osteoblastic proliferation: Osgood Schlatters is a common disorder
among athletes and runners stemming from small fractures of the
tibial plateau from impact which heals builds up bone callous.
Slide 39 Immobilizing Interventions: Casts, Splints, & Traction
Perform/assist with relevant laboratory, diagnostic, and
therapeutic procedures within the nursing role, including:
Preparation of the client for the procedure. Client teaching
(before and following the procedure). Accurate collection of
specimens. Accurate interpretation of procedure results (compare to
norms) and appropriate notification of the primary care provider.
Assessment and evaluation of the clients response (expected,
unexpected adverse response, comparison to baseline) to the
procedure. Planning and implementing body system specific
interventions as appropriate. Monitoring and taking actions,
including client education, to prevent or minimize the risk of
complications. Recognizing signs of potential complications and
reporting to the primary care provider. Recommending changes in the
test/procedure as needed based on client findings. Protect the
client from injury. Monitor therapeutic devices
(drainage/irrigating devices, chest tubes), if inserted, for proper
functioning. Identify the clients prognosis based on knowledge of
pathophysiology and understanding of the clients pathology report.
Slide 40 Casts Casts are more effective than splints or
immobilizers because they cannot be removed by the client. Types of
casts include: Short and long arm casts. Short and long leg casts.
Spica cast, which refers to a portion of the trunk and one or two
extremities. Body cast, which encircles the trunk of the body.
Splints and Immobilizers Splints are removable and allow for
monitoring of skin swelling or integrity. Splints can be used to
support fractured/injured areas or used for postparalysis injuries
to avoid joint contracture. Immobilizers are prefabricated and are
fastened with Velcro straps. Slide 41 Traction Traction uses a
pulling force to promote and maintain alignment to the injured
area. In straight or running traction, the countertraction is
provided by the clients body. In balance suspension traction, the
countertraction is produced by devices such as slings or splints.
Goals of traction include: Realignment of bone fragments.
Decreasing muscle spasms and pain. Correcting or preventing further
deformities Types of Traction Manual Skin Skeletal Halo Traction
Slide 42 Pin Site Care * Pin care is done frequently throughout
immobilization (skeletal traction and external fixation methods) to
prevent and to monitor for signs of infection including: --Drainage
(color, amount, odor). --Loosening of pins. --Tenting of skin at
pin site (skin rising up pin). Pin care protocols (use of hydrogen
peroxide, povidone iodine) are based on provider preference and
institution policy. A primary concept of pin care is that one
cotton-tip swab is used per pin to avoid cross-contamination. Every
8 hr is a common parameter for pin care schedule. Slide 43
Immobilization: (Casts, Splints, & Traction) Casts plaster
& fiberglass Slide 44 Bi-Valved (bivalve) Plaster Cast Slide 45
Posterior Splints Slide 46 Crutchfield Tongs Slide 47 Halo Traction
Stryker Frame Slide 48 Slide 49 Slide 50 Slide 51 External Fixation
External fixation involves fracture immobilization using
percutaneous pins and wires that are attached to a rigid external
frame. Used to treat: Comminuted fracture with extensive soft
tissue. Leg length discrepancies from congenital defects. Bone loss
related to tumors or osteomyelitis. Advantages include: Immediate
fracture stabilization. Allows three plane correction of the
injury. Minimal blood loss occurs in comparison with internal
fixation. Allows for early mobilization and ambulation.
Disadvantages include: Risk of pin tract infection. Potential
overwhelming appearance to client. Slide 52 Slide 53 Slide 54 Slide
55 Slide 56 Slide 57 Slide 58 Musculoskeletal Disorders Fractures-
complications Acute Compartment Syndrome (ACS) A serious condition
which can lead to a loss of life and limb, usually an arm or a leg.
The swelling of an injury or trauma causes lack of innervation and
compromised circulation to the affected part of the body, causing
tissue death and necrosis. Edema causes this. Treatment is mandated
by alleviating the pressure. The most common type of acute
compartment syndrome in the hospital is infiltration of IV fluids,
and in trauma victims. Slide 59 Musculoskeletal Disorders --Acute
Compartment Syndrome (ACS) Slide 60 Musculoskeletal Disorders Signs
and Symptoms of ACS: Greater pain with passive movement than with
active movement Swelling Pain not relieved with analgesics These
are early signs and the physician needs to notified at once. ACS
can lead to renal failure, shock, and loss of the limb or life.
Slide 61 Musculoskeletal Disorders Acute Compartment Syndrome (ACS)
Slide 62 Musculoskeletal Disorders Acute Compartment Syndrome (ACS)
Treatment Determine the cause of swelling, If the cast is too tight
then it needs to be cut off. If the dressing is too tight,
loosening the bandage will release the pressure Surgical release of
tissue pressure is often required. (Fasciotomy) Slide 63
Musculoskeletal Disorders Assessing fractures and trauma: Color or
pallor of patient Color of the limb distal to the injury Movement
Sensation Distal pulses Pain Skin temperature Capillary refil Slide
64 Musculoskeletal Nursing Slide 65 Slide 66 Slide 67 Pharmacology
Associated with Musculoskeletal Patients--General Information
Assess/monitor the clients need for pain medication, and plan and
provide care to meet the clients needs for pain intervention.
Assess/monitor the effectiveness of pain intervention, and advocate
for the clients needs as indicated. Provide appropriate client
education, and reinforce client teaching regarding the purposes and
possible effects of pain medications. Assess/monitor the client for
expected effects of medications. Assess/monitor the client for
side/adverse effects of medications. Assess/monitor the client for
actual/potential specific food and medication interactions.
Identify contraindications, actual/potential incompatibilities, and
interactions between medications, and intervene appropriately.
Identify symptoms/evidence of an allergic reaction, and respond
appropriately. Evaluate/monitor and document the therapeutic and
adverse/side effects of medications. Assess/collect data regarding
the clients medication use over time. Slide 68 Musculoskeletal
Pharmacology : Medications for Pain & Inflammation NSAIDsNon
Steroidal Anti-Inflammatory Drugs Prototypes: 1 st Generation:
Aspirin 2 nd Generation: celecoxib (Celebrex) Pharmacological
Action Inhibition of cyclooxygenase: Inhibition of COX-2 results in
inflammation, pain, and fever. Inhibition of COX-1 results in the
of platelet aggregation Therapeutic Uses Inflammation suppression
Analgesia for mild to moderate pain Fever reduction Dysmenorrhea
Low level suppression of platelet aggregation Aspirin
contraindications include: Peptic ulcer disease. Bleeding disorders
(e.g., hemophilia, vitamin K deficiency) Hypersensitivity to
aspirin and other NSAIDs. Pregnancy (Pregnancy Risk Category D).
Children with chickenpox or influenza. Use NSAIDs cautiously in
older adults, clients who smoke cigarettes, and in clients with H.
pylori infection, hypovolemia, hay fever, chronic urticaria, and/or
a history of alcoholism. Slide 69 Musculoskeletal Pharmacology :
Medications for Pain & Inflammation NSAIDsNon Steroidal
Anti-Inflammatory Drugs Prototypes: 1 st Generation: Aspirin 2 nd
Generation: celecoxib (Celebrex) CONTINUED Therapeutic Nursing
Interventions and Client Education Advise the client to stop
aspirin 1 week before an elective surgery or expected date of
childbirth. Advise the client to take aspirin with food, milk, or a
full glass of water to reduce gastric discomfort. Instruct the
client not to chew or crush enteric-coated or sustained-release
aspirin tablets. Advise the client to notify the primary care
provider if signs and symptoms of gastric discomfort or ulceration
occur. Clients unable to tolerate aspirin due to GI ulceration,
risk of bleeding, or renal impairment should be prescribed a 2nd
generation NSAID, such as celecoxib (Celebrex). One 1st generation
NSAID, ketorolac (Toradol), is used for short-term treatment of
moderate to severe pain such as that associated with postoperative
recovery. Ketorolac provides analgesia without anti- inflammatory
effect. When ketorolac is used concurrently with opioids, the
analgesic effect of opioids is enhanced without the occurrence of
adverse effects associated with opioids (e.g., respiratory
depression, constipation). When ketorolac is used with other NSAIDs
serious adverse effects can occur; therefore, ketorolac should be
used no more than 5 days. Usually started as parenteral
administration and then progresses to oral doses. Depending on
therapeutic intent, effectiveness of NSAID USE may be evidenced by:
Reduction in inflammation. Reduction of fever. Relief from mild to
moderate pain or dysmenorrhea. Platelet aggregation suppression.
Slide 70 Musculoskeletal Pharmacology : Medications for Pain &
Inflammation Acetaminophen Prototypes: acetaminophen (Tylenol )
Pharmacological Action Acetaminophen slows the production of
prostaglandins in the central nervous system. Therapeutic Uses
Analgesic (relief of pain) effect Antipyretic (reduction of fever)
effects Side/Adverse Effects: Nursing Interventions and Client
Education Acute toxicity that results in liver damage with early
symptoms of nausea, vomiting, diarrhea, sweating, and abdominal
discomfort progressing to hepatic failure, coma, and death Advise
the client to take acetaminophen as prescribed and not to exceed 4
g per day. Administer the antidote, Acetylcysteine (Mucomyst ). Use
cautiously in clients who consume three or more alcoholic
drinks/day and those taking warfarin (interferes with metabolism).
Nursing Interventions and Client Education Acetaminophen is a
component of multiple prescribed and over-the-counter medications.
Keep a running total of daily acetaminophen intake and follow
recommended dosages as prescribed by the primary care provider to
prevent toxicity, not to exceed 4 g per day. In the event of an
acetaminophen overdose, liver damage can be reduced by
administering a weight- based dosage of the antidote acetylcysteine
(Mucomyst) in a diluted form via an oroduodenal tube (has an
unpleasant odor that risk of emesis). Nursing Evaluation of
Medication Effectiveness Depending on therapeutic intent,
effectiveness may be evidenced by: Relief of pain. Reduction of
fever. Slide 71 Musculoskeletal Pharmacology : Medications for Pain
& Inflammation Opioid Agonists Prototypes: Morphine sulfate
Pharmacological Action Opioid agonists, such as morphine, codeine,
meperidine, and other morphine-like medications (fentanyl), act on
the mu receptors, and to a lesser degree on kappa receptors.
Activation of mu receptors produces analgesia, respiratory
depression, euphoria, and sedation, whereas kappa receptor
activation produces analgesia, sedation, and GI motility.
Therapeutic Uses Relief of moderate to severe pain (e.g.,
postoperative pain, myocardial infarction pain, cancer pain)
Sedation Reduction of bowel motility Codeine: cough suppression
Contraindications/Precautions Contraindicated: after biliary tract
surgery. for premature infants (during and after deliverydue to
respiratory depressant effects). Used Cautiously: because of
respiratory depression asthma, emphysema, and/or head injuries
Infants and older adult clients Pregnant clients Clients in labor
Clients with inflammatory bowel disease Clients with an enlarged
prostate Slide 72 Demerol -- meperidine Repeated use of meperidine
(Demerol) can result in the accumulation of normeperidine, which
can result in seizures and neurotoxicity. Do not administer
meperidine more than 600 mg/24 hr, and limit its use to less than
48 hr. Slide 73 Morphine Sulfate Side Effects / Adverse Effects
Nursing Interventions / Client Education Respiratory depression
--Monitor the clients vital signs. --Stop opioids if the clients
respiratory rate is less than 12/min, and then notify the primary
care provider. --Avoid the use of opioids with CNS depressant
medications (e.g., barbiturates, benzodiazepines, and consumption
of alcohol). Constipation -- fluid intake and physical activity.
--Administer a stimulant laxative, such as bisacodyl (Dulcolax), to
counteract bowel motility, or a stool softener, such as docusate
sodium (Colace), to prevent constipation. Orthostatic hypotension
--Advise the client to sit or lie down if symptoms of
lightheadedness or dizziness occur. --Avoid sudden changes in
position by slowly moving the client from a lying to a sitting or
standing position. --Provide assistance with ambulation as needed.
Urinary retention --Advise the client to void every 4 hr. --Monitor
I&O. --Assess the clients bladder for distention by palpating
the lower abdomen area every4 to 6 hr. Cough suppression --Advise
the client to cough at regular intervals to prevent accumulation of
secretions in the airway. --Auscultate the clients lungs for
crackles, and instruct the client to intake of fluid to liquefy
secretions. Sedation --Advise the client to avoid hazardous
activities such as driving or operating heavy machinery. Biliary
colic --Avoid giving morphine to clients who have a history of
biliary colic. Use meperidine as an alternative. Emesis
--Administer an antiemetic such as promethazine (Phenergan). Opioid
overdose triad of coma, respiratory depression, and pinpoint pupils
--Monitor the clients vital signs. --Place the client on a
ventilator. --Administer opioid antagonists, such as naloxone
(Narcan) or nalmefene (Revex). Slide 74 Musculoskeletal
Pharmacology Medications for Pain & Inflammation Agonist
Antagonist Opioids Prototypes: pentazocine (Talwin )
Pharmacological Action Compared to pure opioid agonists, agonist-
antagonists have: --A low potential for abuse causing little
euphoria. In fact, high doses can cause adverse effects (e.g.,
anxiety, restlessness, mental confusion). --Less respiratory
depression. Kappa receptors will cause a certain degree of
respiratory depression and then no more (have a ceiling).
Therapeutic Uses Agonists-antagonists opioids relieve mild to
moderate pain; not used for treatment of severe pain.
Contraindications/Precautions Use cautiously in clients with a
history of myocardial infarction ( cardiac workload) and clients
who are physically dependent on opioids. Nursing Interventions and
Client Education Take the clients baseline vital signs. If the
clients respiratory rate is less than 12/min, withhold the
medication and notify the primary care provider. Warn the client
not to dosage without consulting the primary care provider. Nursing
Evaluation of Medication Effectiveness --Monitor for improvement of
symptoms, such as relief of pain. Slide 75 Musculoskeletal
Pharmacology Medications for Pain & Inflammation Opioid
Antagonists Prototypes: naloxone (Narcan ) Pharmacological Action
Opioid antagonists interfere with the action of opioids by
competing for opioid receptors. Opioid antagonists have no effect
in the absence of opioids. Therapeutic Uses Treatment of opioid
overdose Reversal of effects of opioids, such as respiratory
depression Reversal of respiratory depression in an infant
Contraindications/Precautions Hypersensitivity Opioid dependency
Pregnancy Risk Category B Therapeutic Nursing Interventions and
Client Education Naloxone has rapid first-pass inactivation and
should be administered IV, IM, or SC. Do not administer orally.
Observe the client for withdrawal symptoms and/or abrupt onset of
pain. Be prepared to address the clients need for analgesia (e.g.,
if given for postoperative opioid-related respiratory depression).
Nursing Evaluation of Medication Effectiveness Reversal of
respiratory depression (e.g., respirations are regular, client is
without shortness of breath, respiratory rate is 16 to 20/min in
adults and 40 to 60/min in newborns) Slide 76 Musculoskeletal
Pharmacology Medications for Pain & Inflammation Adjuvant Pain
Medications Prototypes:Tricyclic anti-depressants; anticonvulsants;
CNS Stimulants; antihistamines; glucocorticoids; &
biphosphonates Tricyclic antidepressants: amitriptyline (Elavil)
Anticonvulsants: carbamazepine (Tegretol), gabapentin (Neurontin),
phenytoin (Dilantin CNS stimulants: methylphenidate (Ritalin),
dextroamphetamine (Dexedrine) Antihistamines: hydroxyzine
(Vistaril) Glucocorticoids: dexamethasone (Decadron), prednisone
(Deltasone) Bisphosphonates: etidronate (Didronel), pamidronate
(Aredia) Pharmacological Actions Adjuvant medications for pain
enhance the effects of opioids. Therapeutic Uses Used in
combination with opioids cannot be used as a substitute for opioids
Treating pain with an adjuvant medication allows for lower dosages
of opioids, and thereby the adverse effects experienced with
opioids (e.g., sedation and constipation). Help alleviate other
symptoms that aggravate pain (e.g., depression, seizures,
dysrhythmias) Used in the treatment of neuropathic pain (e.g.,
cramping, aching, burning, darting and lancinating pain). Used in
cancer-related conditions (e.g., intracranial pressure, spinal cord
compression, bone pain). Slide 77 Musculoskeletal Pharmacology
Medications for Pain & Inflammation Antigout Medication
Prototypes: colchicine Pharmacological Action Colchicine and
indomethacin inflammation in clients with gout by possibly
preventing infiltration of leukocytes. These medications do not
effect uric acid production or excretion. Allopurinol inhibits uric
acid production. Probenecid inhibits uric acid reabsorption by the
renal tubules. Therapeutic Uses Colchicine and indomethacin:
--Treatment of acute gout attacks. --If given in response to
precursor symptoms of an acute gout attack, can abort the attack.
-- in the incidence of acute attacks for clients with chronic gout.
Allopurinol and probenecid: --Hyperuricemia (chronic gout secondary
to cancer chemotherapy). Probenecid: --Prolongs the effects of
penicillins and cephalosporins by delaying their elimination.
Contraindications/Precautions Avoid use of colchicine during
pregnancy (FDA Pregnancy Risk Category C, if used orally; Category
D, if used intravenously). Use colchicine cautiously in older
adults, debilitated clients, and clients with renal, cardiac, and
gastrointestinal dysfunction. Therapeutic Nursing Interventions and
Client Education Instruct the client to concurrently take
preventive measures such as avoiding alcohol and foods high in
purine (e.g., red meat, scallops, cream sauces). The client should
ensure an adequate intake of water, exercise regularly, and
maintain an appropriate body weight. Nursing Evaluation of
Medication Effectiveness Depending on the therapeutic intent,
effectiveness may be evidenced by: --Improvement of pain caused by
a gout attack (e.g., in joint swelling, redness, and uric acid
levels). -- in number of gout attacks. -- in uric acid levels.
