mmusculoskeletal Flashcards
osteoarthritis
breakdown of articular cartilage leading to damage of bone; osteophytes form in joint space causing narrowing and decreased movement causing progressive degen.
risk factors of osteoarthritis
old age, female, obesity, labor-intensive occupations, sports activities
manifestations of osteoarthritis
pain when moving under stress (relieved by rest), hard & boney, stiff joints, morning stiffness (~30 min), usually impacts weight bearing joints (hips, knees, cervical spine, lumbar spine)
osteoarthritis bony growths
heberden- distal and bouchard- proximal
osteoarthritis assessment
crepitus over joint, mild effusion from inflammation, non-systemic, xray shows decreased joint space and osteophyte formation, subchondral bones may appear thick
osteoarthritis does not appear
bilaterally, it can but it does not have to
osteoarthritis management
decrease pain/stiffness, improve/maintain mobility, exercise t preserve joint, weight loss, OT/PT, orthotics and walking devices, NSAIDs/steroids, severe cases may require arthroplasty
osteoporosis
bone resorption (osteoclast) > bone formation (osteoblast) causing thinning of the bone
osteoporosis can lead to…
compression FX in T and L spine, FX in hips and wrists
osteoporosis risk factors
small frame, female gender, ethnicity, aromatase inhibitor use, nutritional factors, autoimmune diseases, steroid use, immobility, diabetes
onset of osteoporosis age
men around 60-70 and women around 50-60
manifestations of osteoporosis
low bone mineral density on DEXA scan, rounding of upper back (dowagers hump), osteoporotic FX, otherwise asymptomatic
osteoporosis assessment
Xray show radiolucency if significant demineralization (undetectable otherwise), dual energy xray (DEXA) provides bone mineral density of spine and hips
prevention of osteoporosis
balanced diet high in calcium and vit. D, regular weight bearing exercises (20-30 min/day)
weight training stimulates…
bone mineral density
management of osteoporosis
pharmacologic therapy to improve bone density (bisphosphenates or alendronate), hip FX managed with joint replacement, compression FX managed conservatively
osteoporosis nursing interventions
teach pt how to prevent worsening, manage pain, improve bowel elim. to avoid FX, injury prevention
osteomalacia
inadequate mineralization of bone caused by Vit. D deficiency causing soft/weakened bones
causes of osteomalacia
failure to absorb calcium, excessive calcium loss, GI disorders, liver disease, kidney disease, renal insufficiency, hyperparathyroidism, malnutrition
osteomalacia assessment
xray shows general demineralization and can show compression FX; labs show low Ca, low Phos, elevated alkaline phosphatase; bone biopsy show increased osteoid
osteoid
demineralized cartilaginous bone matrix aka pre-bone
why low calcium and low phosphorus in osteomalacia?
d/t bone unable to mineralize
why elevated alkaline phosphatase in osteomalacia?
indicative of increased bone turnover
management of osteomalacia
treat underlying cause if possible, Vit. D and Ca supps, sun exposure, if kidney disease is problem then activated form of vit D prescribed, if dietary is cause then recommend diet change, deformities may require braces
pagets disease
idiopathic; hyperactive osteoclast cause increased compensation of osteoblast creating larger but weaker bones; causing of pathologic fractures, bowing of legs, commonly affects skull, femur, tibia, pelvis, vertebrae
paget manifestation
usually asymptomatic, bowing of femur and tibia, spine is bent forward, bone may be warm and tender, pain is moderate aching and increases with weight bearing
paget disease assessment
elevated alkaline phosphatase, normal Ca level, demineralized and overgrowth mosaic pattern on Xray, diagnose with xray or bone biopsy
management of paget
NSAIDs, Ca with Vit. D, bisphosphonates to slow excessive bone remodeling
osteomyelitis
infection of bone resulting in inflammation, necrosis, and new bone formation; >50% d/t S. aureus, can extend to soft tissues and joints adjacent; if not properly treated then bone abscess can form
3 types of osteomyelitis
hematogenous: blood borne, contiguous-focus: surgery directly induced infection to bone, vascular insufficiency: diabetes oof PVD
manifestations of osteomyelitis- hematogenous
sudden onset, septic, systemic, fever and tachycardi
manifestations of osteomyelitis- contiguous-focus
no septic like, surface overlying bone is swollen, warm, painful
manifestations of chronic otesomyelitis
nonhealing ulcer overlying infected bone
manifestations of diabetic osteomyelitis
nonhealing FX, impaired immune response, foot ulcer >2cm is suspicious
osteomyelitis iassessment
acute: Xray, bone scan, MRI, leukocytosis, elevates ESR (inflammation marker), ~50% of cultured wounds are positive
chronic: xray, bone scan, ESR and WBC are normal, anemia is possible
management of osteomyelitis
delay elective orthopedic surgery if infection present, sterile technique for surgery, prophylactic Antibx, prompt drain removal, aseptic post-op care, debridement, antibiotic (long term)
osteomyelitis nursing interventions
pain management, improve mobility, control infection, promote home based/transitional care
septic arthritis
infection of joint; mortality for single infected joint is 11%
septic arthritis risk factors (who is more at risk of developing this)
older age, diabetes, RA, skin infection, alcoholism, Hx of joint surgery, IV drug use
manifestations of septic arthritis
warm/painful/swollen joint, decreased ROM, chills/fever/leukocytosis, half of all cases are the knee
septic arthritis assessment
infectious work up, aspiration/examine/culture (will be purulent pus filled) synovial fluid, CT/MRI, bone scan
septic arthritis management
prompt treatment is primary, broad spect. antibx, aspirate synovial fluid periodically/therapeutic aspiration, splinting, pain relief, progressive ROM, potential for joint fibrosis, watch for recurring
nursing interventions for septic arthritis
pain relief, improve physical mobility, control infection, promote home/community/transitional care
arthroplasty
replacing joint with artificial joint (commonly knee and hip); used for extensive damage, pain, or limited function; result of RA, osteoarthritis, osteonecrosis, or congenital malformation
nursing interventions for arthroplasty
positioning for comfort, care of incision, pain management, early ambul. educate on home care, monitor for PE/DVT/shock/infect./dislocation/Pneum
types of soft tissue injuries
contusion: soft tissue bruise, strain: pulled muscle (overstretched), sprain: ligaments and supporting muscle fiber around joint (d/t twisting), dislocation: articular surfaces of the joint, subluxation: partial or incomplete dislocation
managing soft tissue injury
Rest, ice, compression, elevation to reduce edema, then immobilization
types of FX
closed or simple, open or compound/complex, intra-articular
avulsion FX
Fx where fragment of bone has been pulled away by tendon and its attachement
comminuted FX
Fx in which bone has splintered into several fragments
compression FX
Fx in which bone has been compressed (common in vertebral Fx)
depressed FX
Fx in which fragments are driven inward (commonly seen in skull)
epiphyseal Fx
Fx through epiphysis
greenstick FX
Fx in which one side of bone is broken and other side is bent (common in children)
impacted FX
Fx in which a bone fragment is driven into another bone fragment
oblique Fx
a Fx occurring at an angle across the bone (less stable than transverse Fx)
open Fx
Fx in which damage also involves skin or mucous membrane (aka compound Fx); increased risk of infection
Pathologic Fx
Fx that occurs through an area of diseased bone (osteoporosis, bone cyst, etc.); can occur with or without trauma
simple Fx
Fx that remains contained with no disruption of the skin integrity
spiral Fx
Fx that twists around the shaft of the bone
stress Fx
Fx resulting from repeated loading of bone and muscle
Transverse Fx
Fx that is straight across the bone shaft
manifestation of Fx
loss of function, shortening, edema, deformity, crepitus, ecchymosis
FX assessment
Health HX, comorbidities, Pain, VS, respiratory status, LOC, signs/symptoms of shock, neurovascular assessment of extremity, bowel/bladder elim, BS, I&O (hip Fx), skin condition, anxiety/coping
managment of Fx
immediate immobilizatin, covering open wounds, Fx reduction, fracture reduction then immobilize
3 types of reduction
closed reduction: manual traction; open reduction: surgical; delayed reduction: waiting for pt to stabilize prior to intervention
2 types of immobilizations
external fixation: casts, bandages; internal fixation: plates and screws
FX nursing interventions
elevate, monitor for neurovascular compromise (5 Ps), monitor for normal elimination (hip Fx), isometric muscle exercises, encourage ADLs, pain management, pt education, wound care
Risk factors for FX healing
> 40, corticosteroids, NSAIDs, avascular necrosis (AVN), bone loss, tobacco, comorbidities, local trauma, inadequate immobilization, malalignment, premature weight bearing, infection, local malignancy
acute FX complications
shock, fat embolism, compartment syndrome, DVT, PE, DIC, infection, loss of bladder control (hip FX), hemorrhage
chronic FX complications
delayed union, malunion, nonunion, AVN of bone, complex regional pain syndrome (CRPS), heterotrophic ossification (benign bone growth in atypical location)
Casts/splints/braces assessment
assess injury/treat lacerations/wounds; assess neurovascular status: 5 Ps
5 Ps of neurovascular assessment
Pain, pulse, pallor, parasthesia, paralysis
casts/splints/braces complications
pressure injuries, disuse syndrome (muscle weakness/wasting or joint stiffness), acute compartment syndrome
compartment syndrome
increased pressure within compartment that impairs blood flow ad compromises tissue viability
compartment syndrom assessment
Pain- intense disproportionate to injury, pallor, puselessness, parasthesia- numbness/tingling, paralysis, compartment swelling- taut shiny skin with potential blistering
management of severe compartment syndrome
fasciotomy
external fixator devices assessment and management
used to manage open FX with tissue damage; monitor for infect., elevate, educate pt, never adjust device
traction
immobilizes by applying pulling fors to body; can be done to skeletal or skin (ex: halo vest for cervical spine)
nursing intervention for skin traction
maintain alignment, report pain, assess pressure points, DVT prophylaxis, foot exercise q1Hour, position changes
amputation
can be congenital or traumatic or caused by condition like PVD, infection, malignancy; done to improve pain, disease process, or improve function
amputation assessment
neurovascular assessment and functional status, signs/symptoms of infect, nutritional status, health problems, psychological status/grief/coping
amputation nursing interventions
pain relief, wound care, resolving grief/body image issues, promote independence, assist pt to achieve physical mobility
acute amputation compications
post-op hemorrhage, infection, poor wound healing/skin breakdown, dehiscense
delayed amputation complications
phantom limb pain, joint contracture (prolong immobilization reduces ROM)
