Musculoskeletal Focus essay

It also depends on the age where pediatrics and geriatrics are the most susceptible groups. The quality and quantity of the collagen used to make the bone greatly affects the bone density and thus the vulnerability of the bone to breakage. One of the conditions that affect the strength of the bone is osteogenesis imperfecta. Osteogenesis imperfecta also known as the Brittle bone disease is a disorder that leads to weak bones that break easily (Morrison, MD, 2015). In most cases, it is a genetic disorder presented at birth but only develops in children with family history of the same condition. In type 2 babies don’t survive beyond birth. The death is mostly due to lung failures. At birth, they present with misshaped ribs, narrowed chest and underdeveloped lungs and their skull bones are unusually soft.

(Forlino, Marini, 2016). Type 3 is also severe where the bones also have high tendency to break. The initial step of diagnosis is a family history and clinical presentations. Several lab procedures have been used to identify this condition in case its presence is suspected. X-ray can be used to view the bone structure and orientations which can be used as a differential diagnosis. X-ray has been used to check for wormian bones and codfish vertebrae. Collagen test can also be done in the lab to confirm the quality of the collagen. Harriet experienced a simple fall which led to the fracture of the femoral shaft which is lowly expected in this case. Femoral shaft is made up of highly densely packed collagen fibers that are not easily broken.

Femoral shaft fractures often in young people are due to high energy collisions which are not expected in simple fall (Nork, SE, 2014). A lower force incident like falling while standing can cause femoral shaft fracture if the children have bone deformities. This why it is highly postulated that the fracture Harriet experienced was not just due to the fall but rather due to the bone defect. She was also put on 3mg oxycodone and morphine 3mg for the management of acute pain. 30 mg of Pamidronate is given intravenously once per month to aid in bone healing and remodeling. Pamidronate belongs to a group of compounds called bisphosphonates (Qaseem, Forciea, McLean, Denberg, 2017). It is obtained by a combination of a pamidronic acid with sodium hydroxide.

It is available in different strengths of 30mg, 60mg and 90mg vials for intravenous administration. (Aguib, Azmy, Samaka, Salem, 2014) Opioid analgesics are also given or the management of acute pain. Oxycodone and morphine belong to the same class. They both have addiction and dependence hence care must be taken during their administration. They both have good oral activity and can also be given through intramuscular and intravenous. Oxycodone is a full agonist of the Mu- opioid receptor where it inhibits the production of cAMP. The care plan is essentially based on the diagnosis. Harriet presented with pain, swelling, bruising and crying hence she needed a proper care plan. The following were prioritized by the nurse the management. Pain management is the most significant in the emergency department.

Parenteral opioid analgesics are used in the management of acute and severe pains. They are important to show the progress of the patient, they include pulse rate, temperature, respiration rate, blood pressure and also the fluid balance. The hemodynamic monitor is also important because the fracture could lead to internal bleeding which can cause hematoma exposing the young lady to serious complication. such (Bakheet, Pearce, Hart, 2015). The young girl came in crying, therefore, she needed psychological support and assurance that all was well. This support removes anxiety and makes the patient comfortable. Pain monitoring and management were also part of the holistic nursing care provided. From the nurse’s report, the pain was classified as severe. Paracetamol was given intravenously in the management of mild pain.

For severe and acute pain, oxycodone and morphine were used. They are opioid analgesics hence can lead to addiction and dependence. Drugs such as Aspirin would have been given to prevent the occurrence of such (Bakheet, Pearce, Hart, 2015). It is also expected that the patient should have been on a prophylactic management against any bacterial infections especially Staphylococcus spp. Bone fractures are common in elderly and children. Whereas it takes long for elderly to heal, children have a high rate of healing and remodeling. The major causes of bone fractures in young people is due to born deformities one of them being osteogenesis imperfecta a hereditary defect which leads to brittle bones. F. , Pearce, L. A. , & Hart, R. G. The Bone and Joint Journal Vol 91-B.

Malhotra, B. K. , Schoenhard, G. L. gov/25521839/learning-about-osteogenesis- imperfecta/ 28 March 2018. Nork, SE (2014). Femoral shaft fractures. In Rockwood, Green, and Wilkins Fractures in Adults and Children: Eighth Edition. (Vol. , McLean, R. M. , & Denberg, T. D. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Osteogenesis imperfecta. The Lancet, 387(10028), 1657-1671. Joeris, A. , Lutz, N. , Blumenthal, A. , & Rudaz, S. Characterization of oxycodone in vitro metabolism by human cytochromes P450 and UDP- glucuronosyltransferases. Journal of pharmaceutical and biomedical analysis, 144, 129- 137. Brown, D. , Edwards, H. prospective study of functional & radiological outcomes of subtrochanteric femur fractures treated by proximal femur nailing. International Journal of Orthopaedics Sciences, 278-284. Srour, M. , Inaba, K.