Disorders of the Muscle Flashcards
What is the purpose of the musculoskeletal system?
Protect organs, provide support and stability, and enable coordinated movement.
What are the components of a neurovascular assessment?
Pain and swelling, paresthesia, paralysis, pulses and capillary refill, pallor and temperature.
What is paresthesia?
Numbness and tingling.
What is a normal pulse rating?
2+.
What is the normal capillary refill time?
Less than 3 seconds.
What is a strain?
Stretching of a muscle or tendon.
What is a sprain?
Injury to a ligament surrounding a joint, usually occurs due to twisting.
What are the signs and symptoms of sprains and strains?
Pain, swelling, decreased function, and bruising.
What does RICE stand for?
Rest, Ice, Compression, Elevation.
What are safety concerns with compression?
Monitor for numbness and tingling, loosen bandage if needed, wrap distally.
What are the signs and symptoms of dislocation?
Deformity, pain and tenderness, local swelling, and loss of function.
What can increase the risk of dislocation?
Paralysis after a stroke (arm hangs and gravity pulls it out of socket). Prevent this by putting the paralyzed arm in a sling.
What is the difference between dislocation and subluxation?
Dislocation is a complete separation, while subluxation is a partial separation.
What is the treatment for dislocation?
Reduction: closed (manually) or open (surgically).
Why is a dislocation considered an orthopedic emergency?
Avascular necrosis or death of the surrounding tissue occurs if blood supply is cut off.
What is nursing care for dislocation?
Pain management, frequent neurovascular assessment, and joint support.
How long is a patient likely to wear a splint with a dislocation?
6-8 weeks; needs to be immobilized to heal.
What is carpal tunnel syndrome?
A repetitive use injury causing swelling of the carpal tunnel, leading to compression of the nerve.
What are the signs and symptoms of carpal tunnel syndrome?
Weakness, numbness and tingling, and pain.
What are the diagnostic tests for carpal tunnel syndrome?
Nerve conduction study, Phalen’s sign, Tinel’s sign.
What is Phalen’s sign?
Hands down pressed against each other, causing compression of the nerve, leading to numbness and tingling if the disorder is present.
What is Tinel’s sign?
Tapping over the nerve on the wrist, causing numbness and tingling if the disorder is present.
How can carpal tunnel disease be prevented?
Ergonomics: proper body mechanics and anatomical position.
What are the treatments for carpal tunnel disease?
Brace/splint, exercise, corticosteroid injections, and carpal tunnel release.
What are the types of rotator cuff injury?
Gradual (over time/repeated use) and sudden.
What are the signs and symptoms of a rotator cuff injury?
Weakness, pain, and inability to maintain abduction (arm out away from body).
What is the drop arm test?
The nurse holds the patient’s arm out and then lets go; the patient should try to hold the arm out after they let go. A person with this injury will not be able to.
What is a rotator cuff injury?
Injury to a group of muscles and tendons around the shoulder.
What is the diagnosis for a rotator cuff injury?
MRI, which shows soft tissues.
What is the treatment for a rotator cuff injury?
NSAIDs (for gradual tear), corticosteroid injections, ice/heat, support (sling), and surgery.
What is arthroscopic surgery?
Use of a scope that is placed into the joint; it is outpatient.
What are the post-operative care steps for arthroscopy?
Frequent neurovascular checks, compression bandage, limit activity, elevate, ice, and monitor for infection.
What is a greenstick fracture?
An incomplete fracture where the bone is bent but only partially broken; most common in children due to not having set bones.
What are the signs and symptoms of a fracture?
Deformity, pain, swelling, decreased function, erythema, bruising, and crepitation.
What is crepitation?
The grating sound heard when the ends of a broken bone move together.
What are the goals of care for a fracture?
Reduction of fracture, immobilization, and restoring fracture.
What is the purpose of traction?
Immobilization, reduction, pain reduction, and reducing swelling.
What are the types of traction?
Bucks (skin) and skeletal.
What is Bucks traction?
Short term (48-72 hours) while the patient waits for surgery or uncontrolled pain; uses 5-10 pounds.
What is skeletal traction?
Long term; uses pins inserted into the bone and skin above and below the site of the fracture; uses 25-40 pounds and weights should hang free.
What is cast care?
Frequent neurovascular checks (usually moving toes/fingers and cap refill), pain management, and monitoring for infection.
What are hot spots in cast care?
Areas where warmth or heat can be felt through the cast.
What is internal fixation?
Placement of hardware into the bone to stabilize and keep it together.
What are the risks for internal fixation?
Rejection, infection, and loss of range of motion (ROM).
What is external fixation?
A device placed into the fracture site with the main hardware on the outside; used for patients with open fractures waiting for surgery.
What are the risks for external fixation?
Infection and fall risk.
What factors affect bone healing?
Age, circulation, smoking, and co-morbidities.
What are the causes of impaired healing?
Delayed union, nonunion, and malunion.
What is delayed union?
Prolonged healing.
What is nonunion?
A nonhealed fracture after 4-6 months; very common in smokers.
What is malunion?
Malalignment of a healed fracture; fixed by rebreaking the bone and realigning the fracture.
What is osteomyelitis?
Infection in the bone, often starting within the patient and making its way out.
What are the risk factors for osteomyelitis?
Open wound (not just fractures), soft tissue injury, internal fixation (foreign substance in body), and urinary tract infection (bacteria travels).
What are the signs and symptoms of local osteomyelitis?
Bone pain, swelling, tenderness, and warmth.
What are the signs and symptoms of systemic osteomyelitis?
Fever and chills, drainage from the site, restlessness, nausea, malaise, and increased WBC.
What are the diagnostics for osteomyelitis?
Cultures (wound and blood), labs (CRP and WBC), and X-ray (will show infection).
Which vital sign is the most important related to infection?
Temperature.
What are antibiotic beads?
Placed where infection is occurring; the beads slowly release the antibiotic into the wound.
What is compartment syndrome?
Increased pressure within a compartment.
What is ischemia?
Lack of blood supply.
What are the assessment findings with compartment syndrome?
Pain, paresthesia, pulselessness, paralysis, pallor, and pressure.
How can compartment syndrome be prevented?
Frequent neurovascular checks, pain assessment, and elevation.
What should be done with suspected compartment syndrome?
Notify provider, monitor urinalysis output, do not elevate above heart, and do not use cold compresses.
Why do you check urinary output with suspected compartment syndrome?
Myoglobin in the urine shows muscle breakdown.
What is the treatment for compartment syndrome?
Fasciotomy.
What is a fasciotomy?
Surgical decompression; left open with a risk for infection.
What are the risks for venous thromboembolism?
Hip fracture, pelvic fracture, hip or knee replacement, and decreased mobility.
What is fat embolism syndrome?
Fat globules make their way to the lungs, similar to a pulmonary embolism.
What bones are affected by fat embolism syndrome?
Long bones (hip, femur, ribs, tibia, pelvis).
What are the signs and symptoms of fat embolism syndrome?
Confusion, restlessness, petechiae on the chest, respiratory distress, and feeling of doom.
How can fat embolism syndrome be prevented?
IV fluids and fracture immobilization (less likely the fat will get into the systemic system).
Why is fat embolism syndrome dangerous?
There are no drugs like anticoagulants to break the fat globule apart.
Why are hip fractures more common in women?
Higher risk for osteoporosis.
What are the signs and symptoms of a hip fracture?
Pain, deformity (leg is shorter than the other), and externally rotated.
What are the nursing priorities for a hip fracture?
Hydration, respiratory support, neurovascular checks, pain control, and vital signs.
What labs would be needed before hip fracture repair?
CBC, WBC, and type and cross.
What changes will there be to vital signs if a patient is bleeding after hip fracture repair?
Low BP, increased HR, and decreased O2.
What is arthroplasty?
Replacement of a diseased or injured joint with mechanical devices.
What are the reasons for arthroplasty?
Osteoarthritis, rheumatoid arthritis, and fractures.
What joints are the most commonly replaced?
Knees and hips.
What is a partial replacement?
Only replaces the ball.
What is a total replacement?
Both the ball and socket are replaced.
What is an anterior hip replacement?
Incision in the front; recover faster but is less common.
What is a posterior hip replacement?
Most common type; incision in the back.
Why is a urinalysis important before joint replacement?
To check for a UTI; if present, the risk of infection increases significantly.
How can you know a patient has a UTI?
Foley catheter puts them at risk, delirium, bloody urine, increased frequency and urgency, odor, and sediment in urine.
What is post-operative care for joint replacement?
Monitor for bleeding, monitor for infection, activity (out of bed on day 1), pain management (narcotic analgesics), anticoagulation (until they are completely weight-bearing), and incision care (teach signs of infection).
What are the hip replacement precautions?
Need a pillow between legs at all times, no bending at the waist, and no crossing legs.
What is a CPM machine?
A machine used after knee replacement that flexes and extends the leg for range of motion.
What medication is used to treat VTE?
Anticoagulation enoxaparin (heparin substitute) given subcutaneously twice a day.
