Predisposing Factors:

Precipitating Factors:

Prior injuries  Abnormal Spinal Curvature

Neuromotor deficits Having the following disorders:
Ankylosing Spondylitis
Drug or alcohol abuse Acute tissue damage to the
Degenerative disk
History of cancer spinal motion segment and disease
Use of corticosteroids associated soft tissues Osteoporosis 
Pregnancy 
Desk jobs or jobs that require heavy lifting or
pushing
Obesity
Lack of exercise
Age (<40)

Peripheral neural pathways

are activated

Inflammation response

Lower back dull/achy pain that worsens when

Chronic pain
moving or standing up straight
Deformity
Neurologic impact
Acute Lower Back Pain Muscle spasms and tightness in the low back,
pelvis, and hips
Motor or sensory deficits
Stinging, burning pain in lower extremities

Pain management using

nonopiods like acetaminophen XRays
and NSAIDS as ordered

Magnetic Resonance Imaging (MRI)

Muscle relaxants
Computed Tomography scan (CT scan)
Back Brace
Epidural steroid injections Epidural Venogram 
Spinal Decompression Surgery EMG
Meylogram

Acute Pain RT Muscuskeletal Impaired Physical Mobility RT Activity Intolerance RT Impaired

problems Pain Mobility

Independent

Independent
Ask the patient to rate the pain from 0 to
Independent
Encourage patient’s family members to
10, and describe the pain they are
stay with the patient in order to reduce
experiencing to create a baseline data.
Instruct patient to move slowly and the time that the patient is without
Reposition the patient in [ ]
assisted if necessary, circular assistance.
Encourage pursed lip breathing and
motions and swaying should be Assist patient in ROM exercises
deep breathing exercises.
avoided, sleeping  Schedule patient’s activities with rest
Provide cognitive-behavioral
Keep the bed railings up and periods and instruct patient on energy-
interventions such as distraction, guided
important items close by saving techniques
imagery, and relaxation techniques
Assist patient in passive and active Encourage frequent ambulation if
Apply cold compresses
ROM exercises possible
Instruct patient to sleep on the side, on
Schedule patient’s activities with rest
the stomach, or in a semi-fowler’s
periods
Dependent

position.

Dependent
Prepare patient for restorative hearing
Refer to a physiotherapist if needed
treatment

Dependent

Provide analgesics as prescribed

 Legend
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

Tests

Disease Condition

Disease Complication

Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Precipitating Factors:
Predisposing Factors:

- Being an athlete
-High risk activities like sports, raking, painting,
- Having a job that requires the same etc…

movements over and over for long -Sitting or standing the wrong way for a long
periods of time like carpentry. 
time 

-Adults especially those over the age of -Poor posture

40 although it can happen at any age -Not stretching enough or at all before
exercising

-Sudden injury

-Infection

 Bursal Inflammation 

Tendon inflammation

Increase collagen formation and

fluid production Mucoid degeneration

More permeable capillary membrane

allows entrance of high protein fluid
Fibrinoid necrosis in tendons

Bursa becomes filled with fluid, which

is often rich in fibrin, and the fluid can
become hemorrhagic

 Bursal lining may be replaced by

granulation tissue followed by fibrous
Physical examination
tissue Medical Hx
MRI
X-rays

Pharmacologic Intervention:

NSAIDS: Ibuprofen &

Naproxen Bursitis and Tendinitis
Corticosteroid 
Injection
Redness 
Swelling 

Tenderness

Pain in the affected part of the body

Surgical Intervention:

Bursectomy
Tendon repair
surgery
Bursal aspiration

Chronic pain and swelling 

Tear in tendon that may cause the
tendon to separate from the bone

Acute pain r/t inflammation and Impaired physical mobility r/t pain and Self-care deficit r/t musculoskeletal
swelling
swelling in the affected joint
impairment; pain on movement

Independent

Encourage the use of stress management Independent

Independent

techniques such as progressive relaxation, Assess and continuously monitor degree of joint Urge the patient to perform activities of
biofeedback, visualization, guided imagery, inflammation and pain
daily living (ADLs), such as practicing
self-hypnosis, and controlled breathing. Assist with active and passive ROM and resistive
Provide Therapeutic Touch.
exercises and isometrics when able.
good hygiene, dressing and feeding
Employ the use of RICE (Rest, Ice, Encourage patient to maintain upright and erect himself.

Compression, and Elevation)

posture when sitting, standing, walking.
Assess barriers to participation in self-
Consider reports of pain, noting location and Discuss and provide safety needs such as raised care. Identify and plan for environmental
chairs and toilet seat, use of handrails in the tub,
intensity (scale of 0–10). Note precipitating modifications.

shower and toilet, proper use of mobility aids and

factors and nonverbal pain cues.
wheelchair safety.
Ascertain usual level of functioning before
Provide gentle massage
onset or exacerbation of illness and
Dependent
potential changes now anticipated.

Dependent
Refer to physical therapist
Dependent

Administer NSAIDS as prescribed

Administer NSAIDS as prescribed
Maintain mobility, pain control, and
Administer corticosteroid injections as Administer corticosteroid injections as prescribed

 Bursectomy
exercise program as prescribed

prescribed

Bursectomy
Bursal aspiration 
Consult with rehabilitation specialists
Bursal aspiration 
Tendon repair surgery
(occupational therapists)

Tendon repair surgery

Legend
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

Tests

Disease Condition

Disease Complication

Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Precipitating Factors:

Bleeding within the joints

Predisposing Factors
death of tissues lining the joints
associated with tuberculosis
Being an athlete osteoarthritis
rheumatoid arthritis
fractures
Trauma and bone cartilage
inflammation
Dislocation of the patella Benign tumors of the synovial
membrane

Intra-articular bleeding or by death of Clinical manifestations:

synovial tissue

Intermittent locking of the joints

making it hard to bend or extend
the knee.
Disease complications:
Fragments of the cartilage detach from limitation of motion or trouble
the bone and float within the synovial walking
Deterioration of the articular cartilage fluid knee pain or the feeling of
something moving in the knee
swelling or inflammation

Pharmacologic Interventions:

NSAID Loose bodies Diagnostic tests:

Analgesics

Surgical
X-ray
MRI
Arthrotomy
CT Scan

Acute pain related to inflammation as Self-care deficit related to limitation of

Impaired physical mobility related to
evidenced by facial grimacing, guarding of movements imposed by the disease
limitation of motion
the affected side, and reports of pain condition

Independent nursing interventions: Independent nursing interventions:

Independent nursing interventions:

Schedule patient’s activities with rest periods.

Note the location and intensity of pain. Ascertain usual level of functioning before
Assist the patient with active and passive ROM
Encourage the patient to elevate the affected onset or exacerbation of illness so potential
and resistive exercises and isometrics if
side with bed cradle  changes can be planned.
tolerated.
Provide a firm mattress or bedboard, small
Encourage the patient to maintain an upright and Maintain mobility, pain control, and exercise
pillow.
erect posture when sitting, standing, and program.
Encourage the patient to assume a position of
walking. Urge the patient to perform activities of daily
comfort.
Urge the patient to perform ADLs such as living such as practicing good hygiene, dressing
Encourage the use of stress management
practicing good hygiene, dressing, and feeding and feeding himself.
techniques such as progressive relaxation,
himself.
biofeedback, visualization, guided imagery, self- Assess barriers to participation in self-care and
Discuss and provide safety needs such as raised
hypnosis, and controlled breathing. identify and plan for environmental
chairs and toilet seat, use of handrails in the tub,
shower and toilet, and proper use of mobility aids modifications.
Dependent nursing intervention: Allow the patient sufficient time to complete
and wheelchair safety.
Administer analgesic as ordered. Advise the patient to reposition frequently using tasks to the fullest extent of ability.
adequate personnel.
Dependent nursing intervention:

Dependent nursing intervention:

Refer the patient to an occupational therapist.

Refer the patient to a physical therapist.

Legend
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

 Tests

Disease Condition

Disease Complication

Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Predisposing Factors:

Precipitating Factors:
Injury tot he shoulder joint
Activities that involve repetitive Bones that are shaped in such a way that
movements of the arm and shoulder have less space within the joint
Age (>50) swelling of tendons in shoulder or bursa.
Bone spurs that may develop from wear
and tear on bones. Chronic repetitive compression of
conjoint tendon of rotator cuff.

Subacromial space width changes

Cuff becomes increasingly

compressed

Inflammation, edema, and

hemorrhage of the rotator cuff
conjoint tendon

Increased friction between the

Signs and Symptoms tendon

Pain and tenderness

inability to move the shoulder joint fully and normally
Inflammation Fibrosis and tendonitis of the
Swelling
rotator cuff
Catching or grating of the muscles when you rotat or
raise arm.

Coracoid impingement test

Rotator cuff degeneration

cuff tear arthropathy
adhesive capsulitis
Impingement   Jobes's test

reflex sympathetic Syndrome

dystrophy

Interventions (Pharmacologic/Surgical) X-ray

Pharmacological

Anti-inflammatories: aspirin, ibuprofen

Cortisone and steroid injections

Surgical

Subacromial decompression
Neer test
Removal of some of the affected tissue and part of the
bursa

Chronic pain R/T disease process of disease Impaired physical mobility related to limited Risk for injury related to inability to move
condition
range of motion
arm freely.

Independent nursing interventions:

Independent nursing interventions: Independent nursing interventions:

Assess and note for signs and symptoms Evaluate the patient’s ability to perform Assess the client’s ability to ambulate
related to chronic pain  ADLs efficiently and safely on a daily Guide the patient to their surroundings.
Aid the patient in making decisions about basis. Put the call light within reach and teach
choosing a particular pain management Assess impediments to mobility how to call for assistance/
strategy. Assist the patient for muscle exercises Utilize alternative to restraints that can
Educate patient of pain management as able or when allowed out of bed.
approach that has been ordered, including
be used to prevent falls and injuries.
Present a safe environment related to
therapies, medication administration, side the patient’s condition.
effects, and complications.
Execute passive or active assistive
Provide the patient and family with adequate
information about chronic pain and options ROM exercises to all extremities

available for pain management

Dependent nursing interventions:

Dependent nursing interventions: Give medication prescribed by the physician

Apply analgesic medication as prescribed by

the physician.

Legend
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

Tests

Disease Condition

Disease Complication

Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Predisposing Factors

Having a small carpal tunnel Precipitating Factors:

Gender (female)
Age (40-70)
Wrist trauma or injury
Pregnancy
High-force (hammering).
Joint or bone disease 
Frequent exposure of the
Thyroid gland hormone
hands to vibration or cold
imbalance (hypothyroidism).
temperatures

Diabetes
Repetitive motion of the hands or Increased carpal tunnel pressure 

wrists

Median nerve compression and

entrapment

Changes of microvascular structure of

the nerve

Reduction in the endoneurial blood flow 

Edema 

irreversible median nerve

Weakness when gripping  damage

Pain or numbness  Chronic wrist and hand pain

"Pins and needles" feeling atrophy and weakness of the
Swollen feeling in the fingers muscles at the base of the thumb
Burning or tingling in the fingers Hypoxia 
in the palm of the hand.

Pain or numbness

Axonal degeneration of median nerve

and neuritis

Nonsurgical therapy

Wrist splinting
Nonsteroidal anti-inflammatory drugs
(NSAIDs).
Corticosteroids Carpal Tunnel Physical examination.
X-ray
Syndrome
Ultrasound
Surgery Electromyography
Nerve conduction study
Endoscopic surgery.
Open Surgery

Acute pain. r/t inflammation and swelling

  Self care deficit regarding Activities
secondary to pressure on the median
of Daily Living
nerve.

Independent NSG Intervention

Independent NSG Intervention
Encourage verbalization of feelings about the Assess age developmental issues affecting
pain. 
ability of individual to participate in own care 
Instruct/encourage use of relaxation technique,
 Assist the client to improve self care .
such as deep breathing exercise to distract
 Establish remotivation or resocialization
attention and reduce tension .
programs when indicated.  provide for
Encourage diversional activities such as:
communication among those who are
watching TV. Listening music and socialization
involved in caring for assisting the client.
with others 
 Provided privacy and equipment within easy
Extend and stretch both wrists and fingers
reach during personal care activities. 
acutely as if they are in a hand-stand position. Assist in necessary adaptation to
Hold for a count of 5.
accomplish ADL.
Straighten both wrists and relax fingers.  Make
a tight first with both hands.  Then bend both Dependent NSG Intervention
wrists down while keeping the fist. Hold for a
count of 5.  comfort measures.  assist medication regimen as necessary,
Straighten both wrists and relax fingers, for a encouraging timely use of medications.

count of 5.  exercise should be repeated 10

times. arms hang loosely at the side and
shake them for a few seconds. 

Dependent NSG Intervention

Take meds as ordered by the physician . Non-
steroidal anti-inflammatory drugs (NSAIDs)  
Take medicines such as ibuprofen or naproxen Legend
for the first 2 or 3 days after an injury.
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

Tests

Disease Condition

Disease Complication

Nursing Diagnosis

Interventions

Pathogenesis Line
 Predisposing Factors
Precipitating Factors:
Age (15-40 years old)
Arthritis
Gender (females)

Muscle
Surgical Interventions:
Weakness Flaw in the joint
trauma applied to the
capsule or tendon Tingling Sensation
Immobilization joint
sheath
Pain

Surgical Interventions:

Fluid in the joint bulges out

Visible Lump
Aspiration

Physical assessment

Surgical Interventions:

Ganglion

are non cancerous lumps that

most commonly develop along
Surgery X-Ray
the tendons or joints of your
wrist or hands

MRI

Impaired Tissue Integrity related Disturbed Body Image related to

Acute pain related to Infection
to disease condition
disease condition

Legend
Predisposing Factor

Independent Nursing Interventions Precipitating Factor

Independent Nursing Interventions

- Assess meaning of loss or change to

- Perform pain assessment each time pain
patient 
Disease Pathology
occurs and evaluate its characteristics Independent Nursing Interventions

- Assess the perceived impact of change

and intensity using a pain scale
- Determine etiology
in ADLs, social participation, personal Clinical Manifestation
- Provide cognitive-behavioral therapy for - Assess the site of impaired tissue
relationships, and occupational activities.

pain management. Like distraction integrity and its condition

- Acknowledge and accept expression of Laboratory and Diagnostic
technique, guided imagery, and - Monitor status of the skin around the
feelings of frustration, dependency, anger, Tests
meditation.
wound
grief, and hostility

- Acknowledge pain experience and - Provide tissue care as needed Disease Condition
- Support verbalization of positive or
convey acceptance of client’s response to - Tell the patient to avoid rubbing and
negative feelings

pain
scratching Disease Complication
Dependent Nursing Interventions

Collaborative Nursing Interventions

- Administer analgesics, as ordered
- Refer to physical and occupational Nursing Diagnosis
therapist as needed

Interventions

Pathogenesis Line

Did not happen

 Old age (>50 yrs. old)
Genetic: family history of disease
Have Scandinavian or Northern
European background Gout
Male Smoker
Arthritis Alcoholic
Diabetes

Thickening of skin in palm of hand

Skin will pucker or dimple

Thickened fiber cords are formed 

Cords of tissue extend to distal palm

Dull aching discomfort

Morning numbness Limited ability:

Cramping - to fully open hand
Cord tightens; fingers are pulled toward palm
Stiffness - grasp large objects
Nodules, cords, and - get hand into narrow places
contracture

Depatterns Disease
Inspection
Palpation
or Dupuytren's contracture

Impaired physical mobility related to Self-Care Deficit related to musculoskeletal

Postoperative Diagnosis: Acute
stiffness of muscles secondary to impairment and physical limitations
pain related to surgical procedure
contractures secondary to contractures 

Independent Nursing Interventions: Independent Nursing Interventions: Independent Nursing Interventions:

Assess the patient’s level of functional Assess the patient’s limitations to self- Instruct the patient to elevate the hand to
mobility and ability to perform ADLs. care by asking open-ended questions. heart level with pillows.
Assist the patient during exercises and Encourage the patient to use assistive Instruct the patient to have intermittent
when performing ADLs. devices and grooming aids as needed. use of ice packs to the surgical area
Ensure the safety of the patient’s during the first 24-48 hours.
environment. Dependent Nursing Interventions Unless contraindicated, encourage the
Encourage the patient to perform ROM in all patient to perform active extension and
Refer the patient to an occupational flexion of the fingers to promote
extremities.
therapist. circulation.
Dependent Nursing Interventions Encourage sleep and rest.

Refer to the physiotherapy and occupational Dependent Nursing Interventions

therapy team.
Administer pain medication as prescribed
by the physician.

Legend
Predisposing Factor

Precipitating Factor

Disease Pathology

Clinical Manifestation

Laboratory and Diagnostic

Tests

Disease Condition

Disease Complication
Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Predisposing Factors Precipitating Factors:

Middle-aged individual (>40 years old) Exercise that places

Foot anatomy (flat, high arches, or with stress on the heels
alignment issues) Wearing poorly fitting
Overweight or obese shoes
Occupation with long
standing/walking hours

Stress is placed on the

connective tissue

Fascia is strained with

continuing overuse

Intense pain in the morning

Pain when weight is placed on the foot

Therapeutic Interventions:

Fibers of fascia would be worn

and tears appear
Stretching
Night splint
Custom Orthotics
Extracorporeal shock wave therapy
Ultrasound
X-ray
MRI
Pharmacologic Interventions:

Naprosyn
Ibuprofen
Corticosteroid shot  Plantar Fasciitis Local infection
Localized argyria
Contact dermatitis
Lymphoplasia
Surgical Interventions:

Edema
Hematoma formation
Tenex
Keloids
Plantar fasciitis release
Epidermal Cyst formation

Impaired physical mobility R/T Self-care deficit R/T ambulating

Acute pain R/T tear in fascia
intense pain difficulty

Legend

Independent Nursing Interventions Independent Nursing Interventions Independent Nursing Interventions Predisposing Factor
- Perform pain assessment each time pain - Assess client’s perception of activity and - Perform or assist meeting the client’s need
occurs and evaluate its characteristics and exercise needs - Assist client in traveling to bathroom when Precipitating Factor
intensity using a pain scale - Determine degree of immobility and presence needed
- Provide cognitive-behavioral therapy for pain of complications - Provide privacy during personal care Disease Pathology
management. Like distraction technique, - Support affected leg with pillows, foot activities like bathing
guided imagery, and meditation. supports, or gel pads - Instruct client to request assistance when Clinical Manifestation
- Acknowledge pain experience and convey - Schedule activities with adequate rest needed and place call device within reach
acceptance of client’s response to pain periods to reduce fatigue Laboratory and Diagnostic
Dependent Nursing Interventions Tests
Dependent Nursing Interventions Dependent Nursing Interventions - Collaborate with rehabilitation professionals
to promote client independence Disease Condition
- Administer appropriate pain medications - Administer medications prior to activity as
(acetaminophen or NSAIDS) as ordered by needed for pain relief
Disease Complication
physician

Nursing Diagnosis

Interventions

Pathogenesis Line

Did not happen

 Predisposing Factors
Precipitating Factors:
Age
Obesity Ill-fitting footwear
Diabetes Foot deformities
Rheumatoid arthritis Certain physicla activities

Repeated friction and pressure

of the skin on bony
prominences

Hyperkeratotic thickness

Thick skin
Pharmacologic Interventions:
Erythema and heat
Excess production of horny
Central keratin plug
Salicylic acid (12.6-40%) epithelial layer Firm, dry and tender lesion with a shiny
Urea (20-50%)
polished surface
Silver nitrate
Hydrocolloid dressings

Physical examination
Pedographic studies. Detect altered
Corn distribution of foot pressure
Surgical Interventions:

MRI. Delineate diabetic foot problems

Ablative laser therapy Biopsy. Reveal hyperkeratosis and mucin
deposition
Dermoscopy. Show areas of
hyperkeratosis without vascular or
hemorrhagic structures
Radiographs. Show bony prominences
Fasting glucose levels and rheumatoid
Bascterial or fungal infection factor. Find etiology of foot deformity
Bleeding
Septic arthritis
Osteomyelitis
Maceration
Tinea pedis
Ulceration

Imparied skin integrity RT

Risk for infection RT Skin injury
Disruption of skin surface
Legend
Predisposing Factor

Independent Nursing Interventions Precipitating Factor

Independent Nursing Interventions
- Wash reddened area gently with mild - Wash reddened area with mild soap
soap Disease Pathology
- Teach self-care and wound care
-Inspect daily for erythema or trauma - Teach about the signs and symptoms of
-Advise to wear well-fitting and roomy Clinical Manifestation
infection
shoes
Laboratory and Diagnostic
-Teach to use protective padding while the Dependent Nursing Interventions Tests
foot heals - Administer anti-infectives, as ordered
-Soak corn in warm water and then use Disease Condition
pumice stone to lightly wear away dead
skin
Disease Complication
-Instruct to never cut corn on their own 
Nursing Diagnosis
Collaborative Nursing Interventions
- Refer to podiatrist
Interventions

Pathogenesis Line

Did not happen