The Musculoskeletal and Neuro Disorders Management insight

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Musculoskeletal & Mobility

Osteoarthritis (OA)- Morning stiffness → warm shower/bath; low-impact daily walking;

consider cane to ofÒoad joint.

Acetaminophen safety: ≤4,000 mg/day total; typical dosing q6h, not q4h at 1,000 mg.

Acute sprain (ankle)- First 24–48 h: RICE (Rest, Ice 20 min on/off, Compression,

Elevation). No early heat. Gradually add gentle ROM; delay full weight-bearing until

advised.

Carpal tunnel- Median nerve compression → numbness/tingling of thumb–index–middle

fingers; positive Phalen/Tinel; night splinting; ergonomics.

Osteomyelitis risk- Highest with poorly controlled diabetes + foot ulcer; inspect feet

daily; timely antibiotics/wound care.

Hip fracture care (prolonged stay)- Early pulmonary hygiene (IS), hydration, ankle pumps,

avoid unnecessary bedrest orders; DVT prevention.

Muscular dystrophy (peds)- Priority: respiratory monitoring/infection prevention; bowel

regimen (fiber, fluids) for immobility.

Back-safety coaching- Bring load close to body, bend knees/hips (not waist), tighten

core; avoid twisting; change positions often.

Paget disease- Expect bisphosphonates (e.g., alendronate); teach upright posture after

dose, empty stomach, water only.

Osteomalacia (vitamin D deficiency)- Emphasize vitamin D + calcium (fortified milk/OJ,

eggs, mushrooms, oily fish); pair with dietary fat.

Gout- Acute flare: colchicine/NSAID per order (avoid thiazide diuretics that raise uric

acid). Prevention: gradual weight loss, hydrate ≥2–3 L/day, limit alcohol/purines (organ

meats).

Osteoporosis teaching- Daily weight-bearing activity; calcium + vitamin D (e.g., salmon,

fortified milk/OJ); reduce caffeine/colas; recognize postmenopausal women/older men

at higher risk; long-term steroids worsen bone loss.

oComplications to spot

Fat Embolism Syndrome (FES) after long-bone/hip fracture: acute hypoxemia, tachypnea,

neuro change, petechiae; high-flow O₂, stabilize fracture.

Acute Compartment Syndrome: early paresthesia, then pain out of proportion, pallor,

pulselessness late → emergent notification.

Post-amputation spasms: gentle residual-limb support, avoid prolonged elevation,

prevent contractures (prone lying, hip/knee extension), figure-8 wrapping.

Psoriatic arthritis

Enthesitis (e.g., plantar fasciitis), dactylitis, nail pitÝng; not isolated podagra (big-toe

gout).

Neuro: Stroke, Seizures, Parkinson’s, Cranial Nerves, Headache

Ischemic stroke (AIS) thrombolysis- Confirm LSN (last seen normal), screen

inclusion/exclusions, manage BP, glucose; give alteplase per protocol (bolus + 60-min

infusion). Door-to-needle ≤60 min is the target.

Hemorrhagic stroke- Red flags for ICP: sudden agitation, altered pupils, worsening neuro

checks → escalate immediately; quiet, non-stimulating environment; HOB ~30°, neutral

neck.

TIA- Brief focal deficits (e.g., ataxia, aphasia) that fully resolve; warning for future stroke

→ urgent workup/risk-reduction.

/R hemisphere patterns- Left-hemispheric stroke: aphasia/apraxia; may understand but

struggle to express (Broca).

Right-hemispheric: left neglect, poor insight, impulsivity, depth-perception loss.

Seizure care- During: ease to floor, turn head to side, protect from injury, do not restrain

or place objects in mouth, time the event.

Postictal priority: assess breathing pattern/airway before re-orientation.

Status epilepticus: first-line IV benzodiazepine (e.g., diazepam/lorazepam), then long-

acting antiseizure (fosphenytoin).

Phenytoin monitoring- Therapeutic 10–20 mcg/mL; 8 mcg/mL is low → assess

adherence, interactions (tube feeds, antacids), dosing schedule.

Parkinson’s disease (PD)- Autonomic features: orthostatic hypotension, drooling,

constipation; fall risk. Teach to schedule activities during “on” time after meds; don’t

stare at feet—use upright posture, wide base, assistive devices; Tai Chi can improve

balance.

Aspiration risk: if cough/wet voice or awaiting swallow eval → dysphagia diet +

aspiration precautions (upright, small bites/sips, double swallow).

Trigeminal neuralgia- Triggers: light touch, breeze, brushing teeth, chewing; small, soft,

lukewarm meals; adherence to carbamazepine monitoring.

Bell’s palsy- Protect the eye (artificial tears, night shield/taping); gentle facial

massage/exercises to maintain tone.

Migraine trigger- Alcohol → vasodilation; teach trigger diary, hydration, sleep hygiene.

Sumatriptan is contraindicated with CAD/vasospastic disease or concurrent nitrates.

Vision & Eye Post-ops

Cataracts

Progressive blurry/double vision, glare, ↓ color perception (not flashes/floaters).

Primary open-angle glaucoma (POAG)

Goal is preventing progression/blindness; vision typically does not improve; adherence

to drops (e.g., pilocarpine may cause brief blurred vision—expected, clears in minutes)

Age-related macular degeneration (AMD)

Amsler grid distortion (wavy/missing lines) → prompt evaluation.

Post-vitrectomy with gas bubble

Face-down positioning as prescribed; avoid air travel/high altitude until cleared.

Viral conjunctivitis

Highly contagious; handwashing ≥20 s, avoid touching/eye rubbing; no antibiotics for

simple viral cases.

Post-cataract: when to call

New floaters/flashes, curtain over vision, severe pain, purulent discharge → urgent

report; mild scratchy feeling is common.

Hearing & Ear Disorders

Hearing-impaired client to MRI

Pre-arrange non-metal picture board/dry-erase for communication; review call-bell use.

Stapedectomy (conductive loss)

Expect early improvement in hearing; teach to report facial droop (possible CN VII

injury), vertigo, drainage.

Recurrent acute otitis media

Anticipate tympanotomy (tubes) when conservative care fails.

Radical mastoidectomy

Report facial asymmetry/droop or extra-ocular movement changes (nerve involvement).

Head/ear trauma red flags

Clear watery otorrhea (possible CSF leak) and Battle sign (mastoid ecchymosis) →

immediate escalation.

Ménière’s disease

Low-sodium plan; avoid high-salt items (e.g., pickles); vestibular safety teaching.

Ototoxicity prevention

Counsel about meds with risk (aminoglycosides, loop diuretics, high-dose salicylates,

chemo); report tinnitus, fullness, new hearing changes promptly.

Cerumen removal

Soften first with warmed mineral oil (or carbamide peroxide) 15–30 min; no cotton

swabs/essential oils.

Safety Algorithms Students Should Memorize

RICE for sprains → restore ROM → graded return to weight-bearing.

Stroke FAST + LSN → activate protocol; hemorrhagic = BP/ICP vigilance; ischemic =

thrombolysis window.

Seizure: protect airway postictal first; emergency meds sequence

Glaucoma drops: lifelong, punctual occlusion 1–2 min, 5-min spacing between different

drops.

PD falls/aspiration: med-timed mobility, upright eating, chin-tuck, small bites/sips.

Rapid Self-Check Prompts (for your review sessions)

What OA non-pharm measures reduce morning stiffness?

First 48-hour priorities after ankle sprain?

Earliest sign of compartment syndrome?

Top three FES clues after long-bone fracture?

One thing you must verify before alteplase?

Why is Tai Chi good—not bad—for PD?

Post-cataract “call now” symptoms vs normal?

Which foods to limit in Ménière’s—and why?

How would you counsel a patient on ototoxic meds?

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