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Nutrition for Nurses

19.3 Implement Nutritional Strategies to Impact Musculoskeletal and Integumentary Wellness

Nutrition for Nurses19.3 Implement Nutritional Strategies to Impact Musculoskeletal and Integumentary Wellness

Learning Outcomes

By the end of this section, you should be able to:

  • 19.3.1 Assess the client for readiness to learn.
  • 19.3.2 Teach nutritional strategies to optimize musculoskeletal and integumentary wellness.

Holistic Nursing Assessment of the Client

Maintaining overall health within the musculoskeletal and integumentary systems is critical to holistic health. One way to attain this goal is to review specific nutritional plans with the client. Some plans, such as gluten free or Mediterranean, are found to be helpful in decreasing the symptoms associated with musculoskeletal and integumentary disorders. Some research suggests there is an inflammatory immune response related to gluten—a protein found in wheat, barley, and rye grains. Some people may find that eating gluten makes their rheumatoid arthritis symptoms flare up and that reducing or eliminating gluten helps relieve their symptoms. Another anti-inflammatory nutritional plan, the Mediterranean diet, which emphasizes fresh fruits and vegetables, fish, whole grains, nuts, and mono- and polyunsaturated fats, is helpful for reducing inflammation and works well to reduce arthritis symptoms. This diet plan includes omega-3 fatty acids, vitamin C, fiber-rich foods, polyphenols, and other known inflammation fighters. Polyphenols, found in various foods, are organic compounds that contribute to the food’s color and smell. The nurse should ensure the client understands the premise behind the nutritional plan and that they can read and interpret food labels and ingredients properly.

The client must also be assessed for readiness to learn. This can be accomplished through a holistic assessment—an in-depth client assessment that delves into:

  • Physiological health—Physical condition, physical limitations, medical conditions, past medical and surgical history, and current medications
  • Psychological health—Mental health condition, cognitive level, anxiety, stress
  • Social and environmental—Support systems, living conditions, financial barriers, access to resources
  • Cultural factors—Traditions, languages, set of beliefs
  • Spiritual factors—Alcohol consumption, dietary choices, procedures allowed, advanced directives

By working with the client to establish holistic goals for good health, client/nurse communication is enhanced, and trust is established. Holistic nursing provides a deeper respect for the client and helps them gain control over their lifestyle changes.

As a part of the physiological health assessment, the nurse should determine the client’s list of medications. As a part of client teaching, the nurse should educate the client about the medications that have been prescribed for treatment. Some of the most ordered medications for musculoskeletal disorders include NSAIDS like ibuprofen, diclofenac, naproxen, indomethacin, meloxicam, and others.

Client Teaching

When a client is hospitalized, teaching starts at admission and is an ongoing process throughout the stay until discharge. Education should be provided in small segments for better client retention. Nurses should speak in a language that the client can understand, refraining from using complex medical terminology. In some instances, return demonstration is needed right before discharge. The nurse should educate according to the learning style of the client and should include the caretakers who will be assisting the client once home (Morris, 2022).

Client teaching should always include nutritionally related teaching strategies. Too often at discharge, the nurse focuses on the physical problem exclusively. Nutritional client education that focuses on the musculoskeletal and integumentary system is a more holistic approach to treatment. See Table 19.8 for important nutritional teaching concerning both the integumentary and musculoskeletal systems.

Function Nutritional Importance Nutrients to Support System
Integumentary System
  • First line of defense for the body against environmental trauma and pathogens
  • Skin has thermoregulation properties as well as sensory, endocrine and immune functions
  • Unhealthy eating impacts the skin and leads to malnutrition. This impacts the body’s homeostasis in relation to protection, thermoregulation, sensory, endocrine and immune functions.
  • A healthy diet helps to maintain and repair body tissue.
  • Foods high in water content such as fruits and vegetables help to prevent dehydration and dry skin, promoting skin integrity
  • Foods with anti-inflammatory properties
    • Nuts
    • Fruits (blackberries, blueberries, avocados, grapes, cherries)
    • Turmeric
    • Omega-3 fatty acids (salmon)
    • Green tea
    • Olive oil
  • Foods that promote wound healing
    • Proteins (cottage cheese, beef, salmon, tuna, chicken breast, beans, nuts)
    • Whole grains
    • Vitamin C (citrus fruits, broccoli)
    • Vitamin A (carrots, apricots)
    • Zinc (shellfish, eggs, poultry)
    • Iron (red meat, dark green leafy vegetables)
Musculoskeletal System
  • Supports the body’s weight and provides stability and movement
  • Malnutrition can severely impair the musculoskeletal system.
  • Proper nutrition is important to minimize normal bone loss that occurs over time.
  • A healthy diet promotes healthy weight which decreases the strain on bones, joints, muscles and ligaments.
  • Proper nutrition assists to decrease inflammation, promote bone marrow production, and maintain overall mobility.
  • Foods with anti-inflammatory properties:
    • Nuts
    • Fruits (blackberries, blueberries, avocados, grapes, cherries)
    • Turmeric
    • Omega-3 fatty acids (salmon)
    • Green tea
    • Olive oil
  • Maintenance of bone and muscle mass and strengthens bones:
    • Vitamin D (milk, cheese)
    • Fruits
    • Vegetables
    • Zinc (pumpkin seeds, lentils)
    • Magnesium (bananas, dark chocolate, whole grains, leafy green vegetables)
    • Phosphorus (whole wheat, cheese)
  • Promotes bone formation:
    • Proteins (cottage cheese, beef, salmon, tuna, chicken breast, beans)
    • Greek yogurt
Table 19.8 Nutritional Teaching for Musculoskeletal and Integumentary Systems (sources: Campbell, 2023; Cleveland Clinic, 2023; 2013)

As seen in the table above, both the musculoskeletal and the integumentary systems are affected by inflammation. Therefore, anti-inflammatory foods are important to consider for both systems. The muscles of the musculoskeletal system can become inflamed due to injury, infection, or overuse. Likewise, the soft tissue and skin of the integumentary system can become inflamed due to injury or infection. The injured muscle often involves the surrounding tissue and skin. Bones that are injured (fractures) often manifest signs in the integumentary system, such as bruising and discoloration. The injured tendons and ligaments of the musculoskeletal system manifest signs in the integumentary system, such as ecchymosis and edema. These are just a few examples of how the musculoskeletal system and the integumentary system are connected to one another.

Unfolding Case Study

Part B

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

The nurse prepares to instruct the client on nutritional strategies to manage her arthritis. Client teaching for Anne includes the reinforcement teaching of a nutritional plan that has anti-inflammatory properties for her osteoarthritis with edema in the knees. Along with nutritional education, the nurse instructs the client to stay as active as possible, doing stretching exercises daily as prescribed by the physical therapist to maintain or gain ROM in lower extremities. The nurse instructs Anne to pay close attention to the skin surrounding her knees, observing for warmth or redness. Anne is encouraged to report these integumentary symptoms if they occur because they could indicate septic arthritis of the knees.

From what is known about nutrition and the impact that it has on the musculoskeletal system, which of the following foods would you expect the nurse to include in dietary teaching for the client?
  1. Leafy green vegetables
  2. Dairy products
  3. Red meat
  4. Protein shakes
After the nurse finishes the instructions, which of the following statements by the client indicates additional education is needed?
  1. “I will try to incorporate more berries into my diet.”
  2. “I will stop eating nuts.”
  3. “I will try to eat more salmon and tuna.”
  4. “I will eat fewer carbohydrates.”

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