StudyDaddy Health & Medical I uploaded 3 videos together with 3 workbooks need to be finished. Your task is listening to 3 videos and write the answers in detail from the videos on the uploaded workbooks. every answers are in t

I uploaded 3 videos together with 3 workbooks need to be finished. Your task is listening to 3 videos and write the answers in detail from the videos on the uploaded workbooks. every answers are in t

CNA253 Professional Practice 2

Week 7 Online Workbook:

Musculoskeletal System Health and Care

Learning objectives:

At the end of the workshop and practical you should be able to:

  • Use vocabulary relating to musculoskeletal system health and care in verbal and written form.

  • Demonstrate and apply knowledge of the structure and function of the musculoskeletal system, pharmacology and medications related to the musculoskeletal system 

  • Demonstrate knowledge of a range of health issues related to the musculoskeletal system and how they present

  • Apply knowledge, skills and clinical reasoning to simulated and clinical situations related to musculoskeletal system health

  • Describe risk factors for falls in hospitals

  • Describe simple bedside mobility assessment methods, identify how you would assist a patient to mobilise safely and how you might utilise a mechanical aid to do so


Resources:

  • Amerman, E. 2019. Human Anatomy & Physiology 2nd ed. Pearson.

Chapters 6, 7, 8, 9 & 10 - please con sider these chapters judiciously and source what you need

  • Porth, C. 2015. Essentials of Pathophysiology. 4th Ed. Wolters Kluwer.

Chapters 43 pp1078 – 1090, Ch 44 pp1111 – 1115, 1128 - 1130

  • Tollefson, J. & Hillman, E. 2016. Clinical psychomotor skills; assessment tools for nurses. Cengage Learning Australia

Skill 13 pp 73

Skill 25 pp 140

Skill 20 pp 110

Skill 21 pp 116

  • Farrell, M. (Ed). 2017. Smeltzer & Bare’s Textbook of Medical-Surgical Nursing. 4th ed A&NZ Ed. Wolters Kluwer: Sydney

Chs 61 (pp 1942 – 1949), 62 (pp1964 – 1965, 1980 - 1983), 63 (pp1994 – 1998, 1999 - 2000), 64 (pp2028 - 2035)

  • Levett-Jones, T. 2013. Clinical reasoning; learning to think like a nurse. Pearson Australia

Chapter 1 – Clinical reasoning: What is it and why it matters

Additional Resources:

  • Australian Medicines Handbook Online. https://amhonline.amh.net.au/

  • Berman, A. et al. 2017. Skills in Clinical Nursing – Safe Patient Moving. Pearson Australia: Melbourne – reading available on MyLO.

  • Meehan, A. et al. 2019. The International Collaboration of Orthopaedic Nursing (ICON): best practice nursing care standards for older adults with fragility hip fracture. Int. J. of Orthopaedic and Trauma Nursing. 32: pp 3 – 26 - available on MyLO

  • Moxham, L & Reaburn, P. 2018. Activity and Exercise in Kozier & Erb’s Fundamentals of Nursing. Eds Berman et al. 4th Ed. Pearson: Australia. pp 1162 – 1182 – available on MyLO pp 1178 - 1182

  • Osteoporosis Australia. 2013. Building health bones throughout life. Ebeling P et al, Editors. MJA. 2:(Supp 1) – document available on MyLO

  • International Osteoporosis Foundation. https://www.iofbonehealth.org/news/understanding-results-your-dxa-test

  • ACSQHC. 2009. Preventing Falls and Harm from Falls in Older people: Best Practice Guidelines for Australian Community Care. – document available on MyLO

  • ACSQHC. 2009. Falls Facts for Nurses. Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Australian Hospitals. – document available on MyLO.

  • ACSQHC. 2012. Standard 10: preventing Falls and Harm from Falls. – document available on MyLO

  • ACSQHC. 2016. Hip Fracture care Clinical Care Standard. – document available on MyLO

  • ACSQHC. 2017. NSQHS Standards – Standard 5 Comprehensive Care. Actions 5.24, 5.25 & 5.26. – document available on MyLO




























Musculoskeletal System Health and Care

The musculoskeletal system is controlled and coordinated by the nervous system. Nervous system dysfunction or decline results in dysfunction of the musculoskeletal system. Musculoskeletal dysfunction results in reduced mobility. Reduced and impaired mobility is implicated in many disease processes as well as falls.

Consider the Patient Situation

Indrani Singh is an 82yo lady who has lived in Australia for 56 years. She lives alone now because her husband died 12 months ago. When he was alive, they used to go walking every day and Indrani enjoyed cooking meals. She used to enjoy growing vegetables. But, sadly, she has lost interest in these things and does not get out and about much anymore. Her family have all moved to other cities, and she does not see them much either. She has lost quite a bit of weight over the past 12 months and has lost some strength in her trunk and lower limb muscles so has developed quite a stooped posture and finds it harder to get out of a chair. She has also become more unsteady on her feet and complains that she sometimes feels dizzy when she gets out of bed or stands up. She gets frustrated with her children when they point out that she keeps repeating herself and has trouble remembering, when they are talking on the phone.

 

For some years, Indrani has been taking prednisolone daily. This keeps her asthma well under control along with some inhaled medications. She has been taking frusemide 20 mg daily to manage the oedema from some mild R) sided heart failure. She also takes calcium and vitamin D supplements to "help with her bones". 3 weeks ago, she went to her GP for a check-up and she was complaining about increasing pain in her hips.

The GP referred Indrani for a bone mineral density assessment. Her T-score was -2.5. Her GP added alendronate 70mg weekly to Indrani's other medications which also include; paracetamol 665mg (controlled release) TDS, mirtazapine 15mg nocte to help her sleep and prednisolone 5mg daily.


Assessing the Patient – Cue Collection

Review current information, gather new information, and recall knowledge

  1. Identify Indrani’s risk factors for osteoporosis.

Recall (Develop) Knowledge

  1. Refer to the Australian Medicines Handbook online (UTas Library Databases) and identify why Indrani would have been prescribed the medications she was taking. Describe the mechanism of action of each medication.

    1. calcium & vit D supplements

    1. alendronate

  1. Evaluate the efficacy of these medications by reviewing the following;

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000227.pub4/full?highlightAbstract=d%7Cwithdrawn%7Cvitamin


https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001347.pub2/full?highlightAbstract=d%7Cvitamin%7Ccalcium


Osteoporosis Australia. 2013. Building health bones throughout life. Ebeling P et al, Editors. MJA. 2:(Supp 1) – document available on MyLO

  1. Use the following to explain the significance / meaning of Indrani’s DEXA T- score.

https://www.iofbonehealth.org/news/understanding-results-your-dxa-test






One week later, Indrani was putting the bins out, and tripped on the gutter. She landed heavily, was in a great deal of pain, and could not get up. Fortunately, a neighbour saw her fall, called an ambulance and made her comfortable while they waited.

  1. What is sarcopaenia and could it have increased Indrani’s risk of falling? Refer p5, Meehan et al 2019 – document available on MyLO




  1. Use the following to identify some of the reasons Indrani was at risk of falling.

https://www.osteoporosis.org.au/moving-safely

https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-RiskFactors-508.pdf











  1. Which of Indrani’s medications increased her risk of falling? Explain.


At the hospital, an x-ray showed that she had fractured her left neck of femur. She was scheduled for surgery and admitted to the ward.

 

The medical officer (MO) requested the application of 2.5kg of skin traction which you applied.
Take Action

  1. What is skin traction and why would it have been requested for Indrani? Refer Farrell pp1964 – 1965

  1. What assessments should you undertake during the time Indrani has the skin traction applied? Refer Farrell pp1964 – 1965




You discuss the insertion of an indwelling urinary catheter (IDC) with Indrani and the MO. Both agree.

  1. Provide rationale for your decision that an IDC is a justified nursing intervention for Indrani.

  1. Identify the risks that an IDC poses for Indrani. Refer Tollefson p140

As Indrani is going for her surgery, she is fasted. Intravenous therapy has been commenced.

  1. Why would Indrani be receiving intravenous fluids? What assessments should you include in your care because of this? Refer Tollefson p 116




Indrani had her surgery yesterday and placement of an internal fixation device. She needs to mobilise today, and the surgeon has instructed that she be only partially weight bearing on the affected leg. Unfortunately, there are no physiotherapists available, so, you will need to assist her. Before that happens, she will have a blood test (FBC & U&Es) and a hip x-ray.

 

The x-ray is reviewed by the MO and Indrani is cleared for mobilisation. Her Hb is 98 g/L.

 

You undertake an assessment of Indrani before you assist her to mobilise. 

  1. Why are an x-ray and Hb level done before mobilising Indrani?

  1. Review the Hip Fracture Clinical Care Standard 2016 (available on MyLO). List the implications of Quality Statement 5 for clinicians.

  1. You check the anaesthetic record to see how much blood Indrani lost during surgery. It was a moderate amount, which explains her Hb level. Do you think this might have any impact on her safety when mobilising? If yes, why?

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  1. You assess Indrani’s vital signs prior to mobilisation. Would you mobilise her? If yes, what might you be particularly observant for?


  1. You undertake a mobility assessment using the Banner Mobility Assessment Tool for Nurses. You can find the tool on MyLO in the Workbook and Resources folder.

Assessment findings:

Indrani was able to, sit upright, and rotate onto the edge of the bed. She used the bedrail to do this. She was able to “shake your hand” appropriately. She was able to bend her ankle with leg out-stretched and point her toes. She was able to stand for a “count of five”, using the bed rail, although she said that “hurt quite a bit”.

  1. Given this information, and Indrani’s post-operative instructions, at what mobility level would you score her?

  1. What assistive device do you think might be most appropriate for Indrani? Why?

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The next day you are caring for Indrani. She says she just doesn’t want to get out of bed. You assess her pain, she reports it as 2/10.

  1. Read Meehan, A. et al 2019, p6 “Factors affecting mobilisation” and identify some possible barriers to Indrani’s mobilisation.

  1. Read Meehan, A. et al 2019, p6 “Mobility: Summary of Best Practice”. How much muscle strength does Indrani risk losing for each day she spends in bed?

  1. Mobilisation and physical activity can reduce the risk of the following complications. Explain what mechanisms are involved and identify one nursing action you could implement to reduce the risk to Indrani. Refer Moxham & Reaburn 2018 – available on MyLO

    1. Deep vein thrombosis

    1. Hypostatic pneumonia


    1. Pressure injuries

    1. Contractures


    1. Anorexia

    1. Urinary tract infection


    1. Constipation

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