Disorders of the Musculoskeletal System Flashcards
Osteoarthritis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications, Therapeutic Measures, Client Education
-progressive degenerative deterioration and loss of cartilage in one or more joints
Contributing Factors:
1.Aging
2.Female
3.Metabolic disease
4.Obesity
5.Repetitive use or abuse of joints
6.Smoking
Manifestations:
1.Chronic joint pain and stiffness
2.Pain diminished after rest and worsens after activity
3.Crepitus
4.Limited movement
5.Heberden’s nodes (closest to the end of the fingers and toes)
6.Bouchard’s nodes (middle joints of fingers or toes)
7.Excess joint fluid (especially with knee involvement)
8.Skeletal muscle atrophy from disuse
Diagnostic Procedures:
1.X-rays
2.MRI
3.Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) show slight elevation.
Nursing Interventions:
1.Assess and manage pain.
2.Instruct client to use ice or heat for comfort.
3.Encourage client to perform range of motion and isometric exercises.
4.Encourage adequate rest and sleep as needed to relieve pain.
5.Involve physical therapy as appropriate.
6.Use assistive devices to help increase independence and complete activities of daily living.
Medications:
1.NSAIDs
2.Corticosteroids
3.Topical analgesics
4.Supplements
a.)Glucosamine
b.)Chondroitin sulfate
Therapeutic Measures:
1.Total joint arthroplasty
2.Total joint replacement
Client Education:
1.Use of mobility devices and safety
2.Prevention of complications
3.Perform exercises per treatment plan.
Referral and Follow-up:
1.Physical therapy
2.Rehabilitation therapy
Rheumatoid Arthritis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications, Therapeutic Measures, Client Education
-chronic, progressive autoimmune connective tissue disorder primarily affecting synovial joints
Contributing Factors:
1.Physical and emotional stress
2.Female gender
3.Young to middle age
4.Family history
5.Manifestations
6.Morning stiffness; pain at rest or after immobility
7.Bilateral joint inflammation with decreased range of motion
Joint deformity in late stages
Warmth, redness, and edema of affected areas
8.Dry eyes and mouth (Sjögren’s syndrome)
9.Numbness, tingling, or burning in the hands and feet
Diagnostic Procedures:
1.X-ray
2.MRI
3.Positive rheumatoid factor
4.Synovial fluid analysis
5.Antinuclear antibody test
6.Erythrocyte sedimentation rate
7.C-reactive protein
Nursing Interventions:
1.Instruct client to use ice or heat for comfort.
2.Encourage physical activity to maintain joint mobility (within client’s capacity).
3.Monitor client for indications of fatigue.
4.Monitor for complications related to therapy (e.g., secondary osteoporosis, vasculitis).
5.Complementary Therapies
a.)Hypnosis
b.)Imagery
c.)Acupuncture
d.)Music therapy
e.)Omega-3
f.)Tai chi
Medications:
1.NSAIDs
2.Corticosteroids
3.Disease-Modifying Antirheumatic Drugs (DMARDs)
4.Biologic-Response Modifiers (administered parenterally)
a.)Etanercept
b.)Adalimumab
Therapeutic Measures:
1.Plasmapheresis for severe, life-threatening exacerbation
2.Synovectomy
3.Total joint arthroplasty if unresponsive to medication
Client Education:
1.Use of mobility devices and safety
2.Prevention of complications
3.Perform exercises per treatment plan.
Referral and Follow-up:
1.Occupational/physical therapy
2.Rehabilitation therapy
3.Arthritis support group
Gouty Arthritis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications, Therapeutic Measures, Client Education
-systemic inflammatory disease caused by problems with purine metabolism (primary gout) or hyperuricemia (secondary gout)
Contributing Factors:
1.Family history
2.Excessive alcohol intake
3.High intake of foods with purines (e.g., organ meats, yeast, sardines, spinach)
4.Obesity
5.Comorbid conditions of DM and/or kidney disease
Manifestations:
1.Excruciating pain and inflammation in one or more small joints (great toe is most common joint; appears warm and red)
2.Appearance of tophi (i.e., deposits of sodium urate crystals; generally appear after years of gouty arthritis)
3.Progressive joint damage and deformity
4.Increased incidence of uric acid renal stone
Diagnostic Procedures:
1.Serum uric acid greater than 7 mg/dL
2.ESR
3.Synovial fluid analysis (will show uric acid crystals)
Nursing Interventions:
1.Maintain bed rest during acute attacks.
2.Use bed cradle to keep linen elevated above affected joint.
3.Promote fluid intake 3 L daily.
4.Limit foods high in purine.
Medications:
1.Acute phase: colchicine
2.Chronic treatment: allopurinol
3.NSAIDs
4.Corticosteroids
5.Injection of corticosteroid into affected joint by provider
Client Education:
1. Foods to avoid (i.e., those high in purine)
2. Instruct client to keep diary of triggering factors.
3. Avoid alcohol.
4. Lose weight slowly (rapid weight loss may precipitate a flare-up or increase the incidence of uric acid renal stones).
Fractures: Interventions, Therapeutic Measures,
Interventions:
1.]Assess client’s neurovascular status (6 P’s), noting bilateral comparisons.
a.)Pain
b.)Pressure
c.)Paralysis
d.)Pallor
e.)Pulselessness
f.)Paresthesia
2.]Monitor for changes in skin temperature.
3.]Monitor for complications of fat embolism (most common with long bone fractures):
a.)Confusion, anxiety
b.)Tachycardia
c.)Chest pain
d.)Tachypnea
e.)Hemoptysis
f.)Petechiae over neck, upper arms, chest, abdomen (late sign)
4.]Monitor for complications of compartment syndrome (irreversible if compromise persists beyond 4 to 6 hr).
a.)Pain unrelieved by positioning or medication
b.)Cyanosis
c.)Tingling
d.)Paralysis
5.]Maintain correct body alignment.
6.]Provide nursing care specific to therapeutic measures of fracture reduction.
Therapeutic Measures:
1.]Cast: application of plaster or fiberglass to immobilize and maintain alignment of the bone
a.)Assess neurovascular status.
b.)Allow plaster cast to air-dry. Handle cast with palms while drying.
c.)Elevate affected extremity.
d.)Monitor for complications.
e.)Client may “petal” plaster cast if irritation around edges develops.
f.)To help reduce risk of infection, remind client to not place objects down cast.
Skin Traction
-provides a mechanical pulling force to overcome muscle spasms, to immobilize or relieve pain
Buck’s
Bryant’s
Cervical halter
Pelvic
Skeletal Traction
-applied directly to a bone to reduce a fracture or maintain surgically manipulated bone alignment
1.]Pins or wires inserted through skin and soft tissue into the bone
2.]Balanced suspension using splints, slings, weights
External Fixation Device
-rigid metal frames with attached percutaneous pins or wires used to align and immobilize
Interventions:
a.)Assess pulses and vascular status.
b.)Maintain proper body alignment.
c.)Verify weights are free-hanging.
d.)Monitor skin for pressure points or breakdown.
e.)Promote strengthening exercises for uninjured areas.
f.)Consult with physical therapy team.
g.)Pin site care per agency protocol.
h.)Administer medications (e.g., opioids, NSAIDs, muscle relaxants).
Osteoporosis: Contributing Factors, Manifestations, Interventions, Medications, Client Education
Contributing Factors:
1.]Primary Osteoporosis
a.)Women age 65 and older
b.)Men age 75 and older
c.)Asian and Caucasian ethnicity
d.)Family history
e.)Estrogen or androgen deficiency
f.)Protein deficiency
g.)Sedentary lifestyle
h.)Smoking and alcohol intake
2.]Secondary Osteoporosis
a.)Bone cancer
b.)Cushing’s syndrome
c.)Diabetes mellitus
d.)Medications: corticosteroids, phenytoin, cytotoxic agents, immunosuppressants, loop diuretics
e.)Paget’s disease
f.)Prolonged immobilization
g.)Rheumatoid arthritis
Manifestations:
1.Shortened height
2.History of fractures
3.Thoracic kyphosis
4.Decreased bone mass
Nursing Interventions:
1.Encourage safe weight-bearing exercises.
2.Teach strengthening exercises; encourage walking.
3.Instruct client to increase foods rich in calcium and vitamin D.
4.Refer to smoking cessation program.
5.Implement fall precautions.
Medications:
1.Biophosphonates
2.Calcium supplements
3.Vitamin D supplements
4.Estrogen agonists/antagonists
5.Calcitonin
6.Parathyroid hormone (prepared as teriparatide [Forteo]): Teach to administer subcutaneously each day.
Client Education:
1.Instruct client to continue health screenings and diagnostic evaluations.
2.Instruct client to avoid activities with increased risk of falls (e.g., ice, slippery surfaces).
3.Instruct client to take medications as prescribed.
Osteomyelitis: Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications, Therapeutic Measures
Contributing Factors:
1.Diabetes
2.Hemodialysis
3.Injection drug use
4.Poor blood supply
5.Recent trauma
Manifestations:
1.Bone pain
2.Fever
3.General discomfort, uneasiness, or ill feeling (i.e., malaise)
4.Local swelling, redness, and warmth
5.Other Possible Manifestations
a.)Chills
b.)Excessive sweating
c.)Low back pain
d.)Swelling of the ankles, feet, and legs
Diagnostic Procedures:
1.Bone biopsy (which is then cultured)
2.Bone scan
3.Bone x-ray
4.Complete blood count (CBC)
5.CRP
6.ESR
7.MRI of the bone
8.Needle aspiration of the area around affected bones
Nursing Interventions:
1.Initiate IV antibiotic therapy as soon as possible.
2.In the presence of wound drainage, implement contact precautions.
3.Teach that the full course of antibiotics must be completed, even if manifestations disappear.
4.Implement wound irrigation.
5.Refer to wound care nurse as needed.
Medications:
1.Antibiotics
2.Analgesics
Therapeutic Measures:
1.Surgical excision of dead and infected bone may be needed.
2.Bone grafting may be performed in large impacted areas.
Total Joint Arthroplasty (Replacement): Contributing Factors, Manifestations, Diagnostic Procedures, Interventions, Medications, Client Education, Referral and Follow-Up
-Surgical procedure performed to replace a joint with a prosthetic system. Arthroplasty may be performed for ankle, finger, elbow, shoulder, toe, and wrist. The hip and knee arthroplasties are the most commonly performed procedures .
Contributing Factors:
1.Impaired mobility and uncontrolled pain related to osteoarthritis
2.Congenital anomalies
3.Trauma
4.Osteonecrosis
Nursing Interventions
1.]Position client correctly, maintaining alignment.
a.)Hip arthroplasty: keep abductor pillow in place while in bed, do not flex hip more than 90° (do not position on operative site).
b.)Knee arthroplasty: maintain continuous passive motion (CPM) machine to promote joint mobility.
Assess for pain, rotation, and extremity shortening.
2.Assess neurovascular status.
3.Use aseptic technique for wound care and emptying of drains.
4.Monitor for indications of infection.
5.Ambulate the day of surgery and after stabilization and discharge from PACU.
6.Use toilet seat extender.
7.Teach exercises to reduce risk of DVT: ankle dorsiflexion, circles with the feet, push feet into bed while tightening quads, and straight leg raises.
Medications:
1.Anticoagulants
2.NSAIDs
3.Opioid narcotics; extended-release epidural morphine or PCA
4.Antibiotics
Client Education:
1.Instruct client to participate in exercise regimen.
2.Instruct client in use of ambulatory devices.
Referral and Follow-up:
1.Physical therapy for ambulation, transfer, and joint movement
2.Occupational therapy to meet goals of independence and self-care
Amputation: Types, Contributing Factors, Interventions, Medications, Client Educations, Referral Follow-up
1.Types of Amputations
a.)Above-the-knee
b.)Below-the-knee
c.)Mid-foot
d.)Toe
Contributing Factors:
1.Peripheral vascular disease
2.Severe crushing of tissues or significant vessels
3.Malignant tumors
4.Osteomyelitis
5.Thermal injuries
Nursing Interventions:
1.Assess neurovascular status.
2.Assess psychosocial status.
3.Assess client’s willingness and motivation to withstand prolonged rehabilitation.
4.Manage phantom limb and residual limb pain.
5.Monitor for signs of wound healing.
6.Monitor for complications:
a.)Hemorrhage
b.)Infection
c.)Phantom limb pain
d.)Flexion contractures
7.Promote mobility and range of motion.
8.Promote independence.
9.Maintain aseptic technique with dressing changes.
10.Wrap residual limb with figure-8 elastic bandage after surgical dressing is removed.
Medications:
1.Opioids for residual limb pain
2.Calcitonin to reduce phantom pain
3.Antispasmodics for muscle spasms
4.Beta blockers for constant, dull, burning pain
5.Antiepileptic drugs for knifelike or sharp burning pain
Client Education:
1.Types of pain and management regimen
2.Measures to prevent contractures
3.Use of ambulatory devices or prosthetics
Referral and Follow-up:
1.Rehabilitation therapy
2.Support group
