Disorders of the Musculoskeletal System Flashcards
Musculoskeletal Assessment
Inspection
Palpation
Motion: Passive and Active ROM
Strength: during contraction; 0-5 scale
Use of assistive devices: walker, cain, wheelchair
Osteomalacia
Demineralized Bone - lack of Vitamin D
easily confused w/ osteoporosis b/c of fracture risk
looser’s zone
Osteomalacia Dx
serum calcium
phosphate
alkaline phosphatase
X-rays
Osteomalacia interventions
increase dietary Vit. D - 600 to 800 per day
calcium/phosphorus
increase exposure to sun
increase exercise
Paget’s Disease
Osteitis deformans - excessive bone resorption followed by replacement of normal marrow by vascular fibrous connective tissue
skull, femur, tibia, pelvic bones – enlarged thickened skulls
ID’d on X-ray
Cannot be fixed, only slowed down
Paget’s Disease manifestations
Waddling gait, spine bent
chin rests on chest
slow changes to bone appearances
Paget’s Disease Tx
calcitonin
biphosphonate drugs: boniva, phosinex – prevent further bone breakdown
NSAIDS
weight control
reduce stress on weak bones - reduces fracture risks
Soft Tissue Injuries: Sprain
injury to tendenoligament surrounding a joint
ankle or wrist
Soft Tissue Injuries: Strain
excessive stretching of muscle and fascial sheath
usually back
Acute Intervention for Soft Tissue Injuries
RICE - decreases inflammation and pain
cold causes vasoconstriction and decreased nerve pain impulses
compression decreases swelling
48 hours: warm moist heat, NSAIDS, tylenol for swelling
RICE
rest, ice, compression, elevation
Carpal Tunnel Syndrome
compression of the median nerve in the wrist
caused by increased pressure in the carpel tunnel from trauma or edema
may be hormone related: increased incidence during menstrual cycle, pregnancy, menopause
Increased incidence in DM and hypothyroidism
associated with hobbies, occupations requiring repetitive wrist movements
Carpal Tunnel Syndrome manifestations
Weakness (particularly of thumb)
Burning pain
numbness, impaired sensation
difficulty performing fine hand movements
Phalen’s Test
Tinel’s Test
Atrophy of thenar muscles (late stages); recurrent pain and dysfunction of hand
Phalen’s Test
put back of hands together
Tinel’s Test
tap the nerve to elicit numbness, tingling of hands
Carpal Tunnel Syndrome collaborative care
prevention - exercises, good body mechanics, braces
cease aggravating movement
wrist splints
avoid temp extremes - cannot feel hot -> risk for burns
Lifestyle/occupational changes
surgical tx: neurovascular checks post-op; rehab up to 7 wks
Amputation
Hazardous occupation, circulation impairment, thermal injury, trauma
indicated when there is an extremity with:
- loss of sensation
- inadequate circulation
- pallor/necrosis
- local infection
- vascular studies indicate the client is not a candidate for revascularization
Levels of Amputation
Above or below the knee, above or below the elbow
Closed or “flap” amputation
stump is covered with a flap of skin sutured over the end of it
performed when there is no infection present
Open or “guillotine”
infection present and requires second surgery when infection is gone
Amputation nursing management
assess for signs of bleeding/oozing
surgical tourniquet
elevate stump for first 24hrs then flat on bed (depending on Dr preference) - can get contractures
Assess incision for signs of healing
encourage ROM
prepare client for phantom limb sensation (can occur up to 2-3months after amputation) - nerve based pain b/c the nerves are still there even though limb is gone
Tourniquet
for excessive bleeding; hemorrhage – always note the time applied
amputation nursing management
compression bandage to reduce edema, increase healing, decrease pain, promote shrinkage
measure for prosthesis in OR
limit hip flexion: position on abdomen 3-4X/day for extension; limit time sitting in chair
rehab
Low back pain
2nd most common client complaint
risk factors: more muscle tone, obesity, poor posture, smoking, stress, heavy lifting, prolonged sitting (occupational risks)
Etiology: lumbosacral strain, instability of lumbosacral bony mechanism, osteoarthritis of lumboscral vertebrae, degenerative disk disease, herniation of intervertebral disk
Acute low back pain
pain lasting 4 wks or less
Acute low back pain dx studies
hx and PE
MRI and CT if trauma or systemic disease suspected
Acute low back pain collaborative care
anaglesics (NSAIDS, opioids if severe) muscle relaxants massage alternating warm and cold compresses rest avoid lifting, bending, twisting, prolonged sitting
Chronic Low Back Pain
pain lasting more than 3 months or repeating episodes (pain is usually every day)
Spinal Stenosis: pain in back radiated to buttock and leg
Intervertebral lumbar disk damage: radicular pain, straight leg raising test
chronic low back pain: 3 s/s to report to dr immediately
depressed or absent reflexes
parasthesia and weakness to lower extremities
bowel/bladder incontinence, impotence (cauda equina)
Cauda Equina
bowel/bladder incontinence, impotence
Classic sign of low back pain
Pain in the back that radiates to buttock and legs
chronic low back pain dx studies
X-rays
mylegram
MRI/CT
EMG
Chronic low back pain conservative therapy
physical therapy
epidural corticosteroids injections
opioids muscle relaxants alternating warm and cold compress rest avoid lifting, bending, twisting, prolonged sitting
Chronic low back pain surgical therapy
laminectomy with or without spinal fusion
diskectomy - remove disc
artificial disc replacement
spinal fusion - using pt’s bone to make a graft to fuse spine together
chronic low back pain post op nursing care
bed rest/logrolling (depends on procedure and surgeon's preference) analgesia report leakage of CSF or severe headache Assess extremity movement and sensation assess peripheral pulses adequate bladder emptying
Report bladder/bowel incontinence or difficulty evacuating to surgeon -> cauda equina
no twisting/bending: reverse trandelenburg when eating
spinal fusion post op nursing care
may require immobilization for extended period
rigid orthosis
must assess bone graft donor site (where they took bone from) - often more painful than infused site
chronic low back pain teaching
teach proper body mechanics
all twisting motions contraindicated
firm mattress
