Musculoskeletal

System
FRAY JOHN LOUIS S. RICAMORA, OSA
Risk Factors associated with Musculoskeletal
Disorders
1. Autoimmune disorders 7. Medications
2. Calcium deficiency 8. Metabolic disorders
3. Degenerative conditions 9. Neoplastic disorders
4. Falls 10. Obesity
5. Hyperuricemia 11. Postmenopausal states
6. Infection 12. Trauma and injury
DIAGNOSTIC
TESTS
Radiographs
1. Description: Radiography is a commonly used procedure to
diagnose disorders of the musculoskeletal system.
2. Interventions:
a. Handle injured area carefully.
b. Administer analgesics as prescribed before the procedure,
particularly if the client is in pain.
c. Remove any radiopaque objects, such as jewelry.
d. Shield client’s testes, ovaries, or pregnant abdomen.
e. The client must lie still during a radiograph.
Radiographs
2. Interventions:
f. Inform the client that exposure to radiation is minimal and not
dangerous.
g. Health care provider is to wear a lead apron if staying in the
room with the client.
Radiographs
Arthrocentesis
1. Description:
a. Involves aspirating synovial fluid, blood, or pus via a needle inserted
into a joint cavity.
b. Medication may be instilled into the joint if necessary to alleviate
inflammation.
2. Interventions:
a. Obtain an informed consent.
b. Apply a compress bandage postprocedure as prescribed.
c. Instruct the client to rest the joint for 8 to 24 hours postprocedure.
d. Instruct the client to notify the physician if a fever or swelling of the joint
occurs.
Arthrocentesis
Arthrogram
1. Description:
a. Arthrogram is a radiograph examination of the soft tissues of
the joint structures and is used to diagnose trauma to the joint
capsule or ligaments.
b. A local anesthetic is used for the procedure.
c. A contrast medium or air is injected into the joint cavity, and
the joint is moved through range of motion as a series of x-ray
films are taken.
Arthrogram
Arthrogram
2. Interventions:
a. Instruct the client to fast from food and fluids for 8 hours
before the procedure as prescribed.
b. Assess the client for allergies to iodine or seafood before the
procedure.
c. Obtain an informed consent.
d. Inform the client of the need to remain as still as possible,
except when asked to reposition.
e. Minimize the use of the joint for 12 hours after the procedure.
Arthrogram
2. Interventions:
f. Instruct the client that the joint may be edematous and tender for
1-2 days after the procedure and may be treated with ice packs
and analgesics as prescribed.
g. Instruct the client that if edema and tenderness last longer than 2
days to notify the physician.
h. If knee arthrography was performed, an elastic wrap over the knee
may be prescribed for 3 to 4 days.
i. If air was used for injection, crepitus may be felt in the joint for
up to 2 days.
Arthroscopy
1. Description:
a. Arthroscopy provides an endoscopic examination of various
joints.
b. Articular cartilage abnormalities can be assessed, loose bodies
can be removed, and the cartilage can be trimmed.
c. A biopsy may be performed during the procedure.
Arthroscopy
Arthroscopy
2. Interventions:
a. Instruct the client to fast for 8 to 12 hours before the procedure.
b. Obtain an informed consent.
c. Administer pain medication as prescribed postprocedure.
d. An elastic wrap should be worn for 2 to 4 days as prescribed
postprocedure.
e. Instruct the client that walking without weight bearing usually
is permitted after sensation returns but to limit activity for 1 to
4 days as prescribed following the procedure.
Arthroscopy
2. Interventions:
f. Instruct the client to elevate the extremity as often as possible
for 2 days following the procedure and to place ice on the site
to minimize swelling.
g. Reinforce instructions regarding the use of crutches, which
may be used for 5 to 7 days postprocedure for walking.
h. Advise the client to notify the physician if fever or increased
knee pain occurs or if edema continues for more than 3 days
postprocedure.
Bone Mineral Density Measurements
1. Dual energy x-ray absorptiometry
a. Measures bone mass of the spine, other bones, and the total body.
b. Radiation exposure is minimal.
c. Used to diagnose metabolic bone disease and to monitor changes
in bone density with treatment.
2. Quantitative ultrasound
a. Quantitative ultrasound evaluates strength, density, and elasticity
of various bones using ultrasound rather than radiation.
b. Inform client that the procedure is painless.
Bone Mineral Density Measurements
Bone Scan
1. Description
a. Radioisotope is injected IV and will collect in areas that
indicate abnormal bone metabolism and some fractures, if they
exist.
b. The isotope is excreted in the urine and feces within 48 hours
and is not harmful to others.
Bone Scan
Bone Scan
Bone Scan
2. Interventions:
a. Hold fluids for 4 hours before the procedure.
b. Obtain an informed consent.
c. Remove all jewelry and metal objects.
d. Following the injection of the radioisotope, the client must
drink 32 oz of water (if not contraindicated) to promote renal
filtering of the excess isotope.
e. From 1 to 3 hours after the injection, have the client void, and
then the scanning procedure is performed.
Bone Scan
2. Interventions:
f. Inform the client of the need to lie supine during the procedure
and that the procedure is not painful.
g. No special precautions are required after the procedure
because a minimal amount of radioactivity exists in the
radioisotope.
h. Monitor the injection site for redness and swelling.
i. Encourage oral fluid intake following the procedure.
Bone or Muscle Biopsy
1. Description: Biopsy may be done during surgery or through aspiration or
punch or needle biopsy.
2. Interventions:
a. Obtain an informed consent.
b. Monitor for bleeding, swelling, hematoma, or severe pain.
c. Elevate the site for 24 hours following the procedure to reduce edema.
d. Apply ice packs as prescribed following the procedure to prevent the
development of a hematoma.
e. Monitor for signs of infection following the procedure.
f. Inform the client that mild to moderate discomfort is normal following
the procedure.
Bone or Muscle Biopsy
Electromyography
1. Description:
a. Electromyography measures electrical potential associated with
skeletal muscle contractions.
b. Needles are inserted into the muscle, and recordings of
muscular electrical activity are traced on recording paper
through an oscilloscope.
Electromyography
2. Interventions:
a. Obtain an informed consent.
b. Instruct the client that the needle insertion is uncomfortable.
c. Instruct the client not to take any stimulants or sedatives for 24
hours before the procedure.
d. Inform the client that slight bruising may occur at the needle
insertion sites.
Myelogram
1. Description: A myelogram requires injection of dye or air into the
subarachnoid space followed by radiography to detect
abnormalities of the spinal cord and vertebras.
2. Preprocedure interventions:
a. Obtain an informed consent.
b. Provide hydration for at least 12 hours before the test.
c. Assess client for allergies to iodine or seafood (shellfish).
d. Premedicate for sedation as prescribed.
Myelogram
Myelogram
3. Postprocedure interventions:
a. Obtain vital signs and perform neurological assessment
frequently as prescribed.
b. If a water-base dye is used, elevate the head 15 to 30 degrees
for 8 hours as prescribed.
c. If an oil-base dye is used, keep the client flat 6 to 8 hours as
prescribed.
d. If air is used, keep the head lower than the trunk.
e. Encourage fluids and monitor intake and output.
INJURIES
Tendons vs. Ligaments
Strains
1. Strains are an excessive
stretching of a muscle or tendon.
2. Management involves cold and
heat applications, exercise with
activity limitations, anti-
inflammatory medications, and
muscle relaxants.
3. Surgical repair may be required
for a severe strain (ruptured
muscle or tendon).
Strains
Sprains
1. Sprains are an excessive stretching of a ligament, usually caused
by a twisting motion.
2. Sprains are characterized by pain and swelling.
3. Management involves rest, ice, and a compression bandage to
reduce swelling and provide joint support.
4. Casting may be required for moderate sprains to allow the tear to
heal.
5. Surgery may be necessary for severe ligament damage.
Sprains
Sprains
Rotator Cuff Injuries
1. Musculotendinous or rotator cuff of the shoulder sustains a tear,
usually as a result of trauma.
2. Injury is characterized by shoulder pain and the inability to
maintain abduction of the arm at the shoulder (drop arm test).
3. Management involves nonsteroidal anti-inflammatory drugs
(NSAIDS), physical therapy, sling support, and ice/heat
applications.
4. Surgery may be required if medical management is unsuccessful
or for those who have complete tear.
 FRACTURES
A fracture is a break in the continuity of the bone caused by trauma,
twisting as a result of muscle spasm or indirect loss of leverage, or
bone decalcification and disease that result in osteopenia.
Types of Fractures
Closed or Simple: Skin over the Comminuted: The bone is splintered or
fractured area remains intact. crushed, with three or more
fragments.
Types of Fractures
Complete: The bone is separated Compression: A fractured bone is
completely by a break into two parts. compressed by other bone.
Types of Fractures
Depressed: Bone fragments are driven Greenstick: One side of the bone is
inward. broken and the other is bent; these
fractures occur most commonly in
children.
Types of Fractures
Impacted: A part of the fractured bone Incomplete: The bone is partially
is driven into another bone. broken.
Types of Fractures
Oblique: The break extends in an Open or compound: The bone is
oblique direction. exposed to air through a break in the
skin, and soft tissue injury and
infection are common.
Types of Fractures
Pathological: The fracture results from Spiral: The break partially encircles
weakening of the bone structure by bone.
pathological processes such as
neoplasia or osteomalacia. Also
called spontaneous fracture.
Types of Fractures
Transverse: The bone is fractured
straight across.
Assessment of a Fracture of an
Extremity
1. Pain or tenderness over the involved area
2. Loss of function
3. Obvious deformity
4. Crepitation
5. Erythema, edema, ecchymosis
6. Muscle spasm and impaired sensation
Initial Care of a Fracture of an
Extremity
1. Immobilize affected extremity.
2. If a compound (open) fracture exists, splint the
extremity and cover the wound with a sterile dressing.
Interventions for a Fracture
1. Reduction
2. Fixation
3. Traction
4. Casts
Reduction restores the bone to proper alignment.
1. Closed Reduction
a. Performed by manual manipulation
b. May be performed under local or general anesthesia
c. A cast may be applied following reduction.

2. Open Reduction
a. Involves a surgical intervention
b. Fracture may be treated with internal fixation devices.
c. The client may be placed in traction or a cast following the
procedure.
Fixation
1. Internal Fixation
a. Follows open reduction
b. Involves the application of screws, plates, pins, or nails to hold
the fragments in alignment
c. May involve the removal
d. Provides immediate bone strength
e. Risk of infection is associated with the procedure
Fixation
2. External Fixation
a. Used with multiple pins applied through the bone
b. Provides more freedom of movement than with traction
Traction
1. Description
a. Traction is the exertion of a pulling force applied in two directions to reduce
and immobilize a fracture.
b. Traction provides proper bone alignment and reduces muscle spasms.
2. Interventions
a. Maintain proper body alignment.
b. Ensure that the weights hang freely and do not touch the floor.
c. Do not remove or lift the weights without a physician’s order.
d. Ensure that pulleys are not obstructed and that ropes in the pulleys move freely.
e. Place knots in the ropes to prevent slipping.
f. Check the ropes for fraying.
Traction
T – Check temperature
R – Ropes hang freely
A – Check alignment appropriately
C – Check circulation
T – Type and location of fracture (re health education, care, etc.)
I – Increase fluid intake (hydrated to facilitate healing)
O – Overhead trapeze
N – No weights on the bed or floor
Skeletal Traction
1. Description: Traction is applied mechanically to the bone with
pins, wires, or tongs.
2. Interventions
a. Monitor color, motion, and sensation of the affected extremity.
b. Monitor the insertion sites for redness, swelling, or drainage.
c. Provide insertion site care as prescribed.
3. Cervical tongs and a halo fixation device
Cervical Skin Traction
1. Description: Traction is applied by the use of elastic bandages or
adhesive.
2. Cervical Skin Traction
a. Cervical skin traction relieves muscle spasms and compression in the
upper extremities and neck.
b. Cervical skin traction uses a head halter and a chin pad to attach the
traction.
c. Use powder to protect the ears from friction rub.
d. Position the client with the head of the bed elevated 30 to 40 degrees,
and attach the weights to a pulley system over the head of the bed.
Cervical Skin Traction
 Buck’s (extension) Skin Traction
1. Buck’s skin traction is used to alleviate muscle spasms and
immobilizes a lower limb by maintaining a straight pull on the limb
with the use of weights.
2. A boot appliance is applied to attach to the traction.
3. Weight is attached to a pulley; allow the weights to hang freely over
the edge of bed.
4. Not more than 8 to 10 lb of weight should be applied.
5. Elevate the foot of the bed to provide the traction.
Russel’s Skin Traction
 Pelvic Skin Traction
1. Pelvic skin traction is used to relieve low back, hip, or leg pain and
to reduce muscle spasm.
2. Apply the traction snugly over the pelvis and iliac crest and attach to
the weights.
3. Use measures as prescribed to prevent the client from slipping down
in bed.
Pelvic Skin Traction
 Balanced Suspension Traction
1. Description:
a. Balanced suspension traction is used with skin or skeletal traction.
b. Balanced suspension traction is used with to approximate
fractures of the femur, tibia, or fibula.
c. Balanced suspension traction is produced by a counterforce other
than client.
Balanced Suspension Traction
 Balanced Suspension Traction
2. Interventions:
a. Position the client in low Fowler’s on either the side or the back.
b. Maintain a 20-degree angle from the thigh to the bed.
c. Protect the skin from breakdown.
d. Provide pin care if pins are used with the skeletal traction.
e. Clean the pin sites with sterile normal saline and hydrogen
peroxide or povidone-iodine (Betadine) as prescribed or per
agency procedure.
 Dunlop’s Traction
1. Description: Horizontal traction is used to align fractures of the
humerus; vertical traction maintains the forearm in proper alignment.
2. Interventions:
a. Weight is attached to a pulley; allow the weights to hang freely
over the edge of bed.
b. Not more than 8 to 10 lb of weight should be applied.
Dunlop’s Traction
 Casts
1. Description: Casts are made of plaster or fiberglass to provide
immobilization of bone and joints after a fracture or injury.
2. Interventions:
a. Keep the cast and extremity elevated.
b. Allow a wet cast 24 to 48 hours to dry (synthetic casts dry in 20
minutes).
c. Handle a wet cast with the palms of the hands until dry.
d. Turn the extremity unless contraindicated so that all sides of the
wet cast will dry.
 Casts
e. Cool setting on a hair dryer can be used to dry a plaster cast (heat cannot
be used on a plaster cast because the cast heats up and burns the skin).
f. The cast will change from a dull to a shiny substance when dry.
g. Examine the skin and cast for pressure areas.
h. Monitor the extremity for circulatory impairment such as pain, swelling,
discoloration, tingling, numbness, coolness, or diminished pulse.
i. Notify the physician immediately if circulatory compromise occurs.
j. Prepare for bivalving or cutting the cast if circulatory impairment occurs.
k. Petal the cast; maintain smooth edges around the cast to prevent
crumbling of the cast material.
 Casts
l. Monitor the client’s temperature.
m. Monitor for the presence of a foul odor, which may indicate infection.
n. Monitor drainage and circle the area of drainage on the cast.
o. Monitor for warmth on the cast.
p. Monitor for wet spots, which may indicate a need for drying or the presence
of drainage under the cast.
q. If an open drainage area exists on the affected extremity, the physician will
make a cut-out portion of the cast or a window.
r. Instruct the client not to stick objects inside the cast.
s. Teach the client to keep the cast clean and dry.
t. Instruct the client in isometric exercises to prevent muscle atrophy.
 Complications of Fractures
1. Fat Embolism
2. Compartment Syndrome
3. Infection and Osteomyelitis
4. Avascular Necrosis
5. Pulmonary Embolism
 Fat Embolism
1. Description
a. A fat embolism originates in the bone marrow and occurs after a fracture.
b. Clients with long bone fractures are at the greatest risk for the development
of fat embolism.
c. Fat embolism can occur within the first 72 hours following the injury.
2. Assessment
a. Restlessness
b. Mental status changes e.g. confusion
c. Tachycardia, tachypnea, and hypotension
d. Dyspnea
e. Petechial rash over the upper chest and neck
 Fat Embolism
3. Interventions
a. Notify the physician immediately.
b. Treat symptoms as prescribed to prevent respiratory failure and
death.
 Compartment Syndrome
1. Description
a. Compartment syndrome is increased pressure within one or more
compartments, causing massive compromise of circulation to an area.
b. Compartment syndrome leads to decreased perfusion and tissue anoxia.
c. Within 4 to 6 hours after the onset of compartment syndrome,
neuromuscular damage is irreversible if not treated.
2. Assessment: unrelieved or increased pain, swelling, pain with passive
motion, inability to move joints, loss of sensation (paresthesia),
pulselessness
3. Interventions: Notify the physician immediately.
 Infection and Osteomyelitis
1. Description: Infection and osteomyelitis can be caused by the
interruption of the integrity of the skin; the infection invades bone
tissue.
2. Assessment: fever, pain, erythema in the area surrounding the
fracture, tachycardia, elevated WBC
3. Interventions:
a. Notify the physician.
b. Prepare to initiate aggressive intravenous antibiotic therapy.
 Avascular Necrosis
1. Description: Avascular necrosis is an interruption in the blood
supply to the bony tissue, which results in the death of the bone.
2. Assessment: pain, decreased sensation
3. Interventions:
a. Notify the physician if pain or decreased sensation occurs.
b. Prepare the client for removal of necrotic tissue because it serves as
a focus for infection.
 Pulmonary Embolism
1. Description: Pulmonary embolism is caused by immobility
precipitated by a fracture.
2. Assessment: restlessness and apprehension, dyspnea and chest pain,
diaphoresis, arterial blood gas changes
3. Interventions:
a. Notify the physician if signs of emboli are present.
b. Prepare to administer anticoagulant therapy.
OSTEOARTHRITIS
(Degenerative Joint
Disease)
 Osteoarthritis
1. Description
a. Osteoarthritis is progressive degeneration of the joints as a result of
wear and tear.
b. Osteoarthritis causes the formation of bony buildup and the loss of
articular cartilage in peripheral and axial joints.
c. Osteoarthritis affects the weight-bearing joints and joints that receive
the greatest stress, such as the knees, toes, and lower spine.
d. The cause is unknown but may be trauma, fractures, infections, or
obesity.
 Osteoarthritis
2. Assessment
a. Joint pain that diminishes after rest and intensifies after activity, noted
early in the disease process.
b. As the disease progresses, pain occurs with slight motion or even at rest.
c. Symptoms are aggravated by temperature change and humidity.
d. Crepitus
e. Joint enlargement
f. Presence of Heberden’s nodes (DIP) or Bouchard’s nodes (PIP)
g. Limited range of motion
h. Difficulty getting up after prolonged sitting
 Osteoarthritis
2. Assessment
i. Skeletal muscle atrophy
j. Inability to perform activities of daily living
k. Compression of the spine as manifested by radiating pain, stiffness,
and muscle spasms in one or both extremities
3. Pain
a. Administer NSAIDs, salicylates, and muscle relaxants as prescribed.
b. Prepare the client for corticosteroid injections into joints as prescribed.
c. Place affected joint in a functional position.
d. Immobilize the affected joint with a splint or brace.
 Osteoarthritis
3. Pain
e. Avoid large pillows under the head or knees.
f. Provide a bed or foot cradle.
g. Position the client prone twice a day.
h. Instruct the client in the importance of moist heat, hot packs or
compresses, and paraffin dips as prescribed.
i. Apply cold applications as prescribed when the joint is acutely
inflamed.
j. Encourage adequate rest, recommending 10 hours of sleep at night
and 1- to 2-hour nap in the afternoon.
 Osteoarthritis
4. Nutrition
a. Encourage a well-balanced diet.
b. Encourage weight loss if necessary.
5. Physical mobility
a. Reinforce the exercise program and the importance of participating in the
program.
b. Instruct the client that exercises should be active rather than passive and to
exercise only to the point of pain.
c. Instruct the client to stop exercise if pain is increased with exercising.
d. Instruct the client to decrease the number of repetitions in an exercise when
the inflammation is severe.
 Osteoarthritis
6. Surgical management
a. Osteotomy: The bone is cut to correct joint deformity and promote
realignment.
b. Total joint replacement
i. Total joint replacement is performed when all measures of pain relief
have failed.
ii. Hips and knees are replaced most commonly.
iii. Total join replacement is contraindicated in the presence of
infection, advanced osteoporosis, or severe inflammation
Osteotomy

Total Joint Replacement

 Client Education for Degenerative Joint
Disease
1. Assist the client to identify and correct safety hazards in the home.
2. Instruct the client in the correct use of assistive or adaptive devices.
3. Instruct the client in energy conservation measures.
4. Review the prescribed exercise program.
5. Instruct the client to sit in a chair with a high, straight back.
6. Instruct the client to use only a small pillow when lying down.
7. Instruct the client in measures to protect the joints.
8. Instruct the client regarding the prescribed medications.
9. Stress the importance of follow-up visits with the health care provider.
OSTEOPOROSIS
 Osteoporosis
1. Description
a. Osteoporosis is an age-related metabolic disease.
b. Bone demineralization results in the loss of bone mass, leading to fragile
and porous bones and subsequent fractures.
c. Greater bone resorption than bone formation occurs.
d. Osteoporosis occurs most commonly in the wrist, hip, and vertebral column.
e. Osteoporosis can occur postmenopausally or as a result of a metabolic
disorder or calcium deficiency.
f. Client may be asymptomatic until the bones become so weak that a sudden
injury causes a fracture.
 Osteoporosis
2. Risk Factors for Osteoporosis
a. Cigarette Smoking
b. Early menopausal
c. Excessive use of alcohol
d. Family history
e. Female gender
f. Increasing age
g. Insufficient intake of calcium
h. Sedentary lifestyle
i. Thin, small frame
j. White (European descent) or Asian race
 Osteoporosis
3. Assessment
a. Possibly asymptomatic
b. Back pain after lifting, bending, or stooping
c. Back pain that increases with palpation
d. Pelvic or hip pain, especially with weight bearing
e. Problems with balance
f. Decline in height from vertebral compression
g. Kyphosis of the dorsal spine
h. Constipation, abdominal distention, and respiratory impairment as a result of
movement restriction and spinal deformity
i. Pathological fractures
j. Appearance of thin, porous bone on x-ray film
 Osteoporosis
4. Interventions
a. Assess risk for injury.
b. Provide a safe and hazard-free environment and assist the client to identify hazards
in the home environment.
c. Use side rails to prevent falls.
d. Move the client gently when turning and repositioning.
e. Encourage ambulation; assist with ambulation if the client is unsteady.
f. Instruct in the use of assistive devices such as a cane or walker.
g. Provide range of motion exercises.
h. Instruct the client in the use of good body mechanics.
i. Instruct the client in exercises to strengthen abdominal and back muscles to improve
posture and provide support for the spine.
 Osteoporosis
j. Instruct the client to avoid activities that can cause vertebral compression.
k. Apply a back brace as prescribed during an acute phase to immobilize the spine and
provide spinal column support.
l. Encourage the use of a firm mattress.
m. Provide a diet high in protein, calcium, vitamins C & D, and iron.
n. Encourage adequate fluid intake to prevent renal calculuses.
o. Instruct the client to avoid alcohol and coffee.
p. Administer estrogen or androgens to decrease the rate of bone resorption as prescribed.
q. Administer calcium, vitamin D, and phosphorus as prescribed for bone metabolism.
r. Administer calcitonin as prescribed to inhibit bone loss.
s. Administer analgesics, muscle relaxants, and anti-inflammatory medications as
prescribed.
GOUT
 Gout
1. Description
a. Gout is a systemic disease in which urate crystals deposit in joints and
other body tissues.
b. Gout leads to abnormal amounts of uric acid in the body.
c. Primary gout results from a disorder of purine metabolism.
d. Secondary gout involves excessive uric acid in the blood that is caused
by another disease.
 Gout
2. Phases
a. Asymptomatic » Client has no symptoms; serum uric acid is elevated.
b. Acute » Client has excruciating pain and inflammation of one or more
small joints, especially the great toe.
c. Intermittent » Client is asymptomatic period between acute attacks.
d. Chronic » Chronic gout results from repeated episodes of acute gout.
Chronic gout results in deposits of urate crystals under the skin and
within the major organs, especially the renal system.
 Gout
3. Assessment
a. Excruciating pain in the involved joints.
b. Swelling and inflammation of the joints.
c. Tophi (hard, fairly large, and irregularly shaped deposits in the
skin) that may break open and discharge a yellow gritty substance.
d. Low-grade fever
e. Malaise and headache
f. Pruritus
g. Presence of renal stones
h. Elevated uric acid levels
 Gout
4. Assessment
a. Provide a low-purine diet as prescribed.
b. Instruct the client to avoid foods such as organ meats, wine, and aged
cheese.
c. Encourage of high fluid intake of 2000 mL to prevent stone formation.
d. Encourage weight-reduction diet if required.
e. Instruct the client to avoid alcohol and starvation diets because they may
precipitate a gout attack.
f. Increase urinary pH (above 6) by eating alkaline ash foods such as citrus
fruits and juices, milk, and other dairy products.
g. Provide bed rest during the acute attacks.
 Gout
h. Monitor joint range of motion ability and appearance of joints.
i. Position the joint in mild flexion during acute attack.
j. Elevate the affected extremity.
k. Protect the affected joint from excessive movement or direct contact with
sheets or blankets.
l. Provide heat or cold for local treatments to affected joint as prescribed.
m. Administer NSAIDs and antigout medications e.g., Allopurinol,
Colchicine, Probenecid, as prescribed.
Musculoskeletal
System
FRAY JOHN LOUIS S. RICAMORA, OSA