MSK Flashcards
ruptured cerebral aneurysm signs
astomaptic unless they rupture
“known as silent killers”
- no warning signs sometimes
“ worst headache”
what pt say if they have cerebral aneurysm rupture
WORST HEADACHE OF MY LIFE
clients with casted extremtities afer acture injury are at risk for
decreased peripheral perfusion due to increased edema and a cast that restricts the skins ability to expand CAUSING COMPAREMENT SYNDROME
expected symtoms of casted extremity
- milf to moderate edema
- warmth or thorrbing
- pain on movement
- pain that improves with anagesics
- itching
- dry skin under the cast
severe pain unresposnie to angesics
comparement syndome
compartment syndrome signs
severe pain unresp to anaglesics
- immoblilty of digits
- changes in sensation (numbess or tingling)
- lack of pulse in distal extremity’
- cool and pale dsital extremity
rheumatoid arithis
chronic
systemic
inflamm
autoimmune where the body attacks the joints leading to bone erosion and joint deformity
charasteritic of RA
symmetrical pain and swelling that affects the small joints of the hands and feet
- mornings tiffness that last 60 min-sevreal hours
- -elevated ESR and rhuematoid factor levels
- cervical spine and doesnt invole any other spine
osteoarthyritis characterisic
assymetric pain
creiptus esp over knee joints
ankylosing spondylitis.
low back pain and stifness
worse in the morning and improves as day goes on
gout
pain
swelling
redness in one or more extremitiy joints
RA intital affects the
small joints of the wrists, hands and feet
halo external fixation
stablizes cervical and throacic fracture when there is damage to the liaments or spinal cord
halo traction nursing intervention
cleaning pin sites with sterile solution such as chorhexideine or water to prevent infection
- keeping the vest liner clean and dry (changing weekly or when soiled, using cool dryer to dry)
- placing foam inserts under pressure joints
- placing small pullow under clients head when suprine to reduce pressure on the device
- keeping correct sized wrench avialble at all times
who adjust the pins
provider
the nurse should avoid doing what with halo
grabbing the device frame when moving or position the client because it can cause the screws to loosena and alter the alignment
what is a contrindication to doing total joint replacement surgery
recent/current infection as wound infection is more liekly to occur in a client with preexting infection (so report burning urination to HCP)
what is expected in clients undergoing total knee replacement
severe knee pain
education before doing total knee placement
stop taking nsaids such as cox2 and celebrex 7 days before to decrease bleeding
prevnting hip flexion contractures
the limb should not be elevated esp after 24 hours of amputations (INSTEAD MANAGE THE EDEMA BY FIGURE EIGHT COMPRESSION)
- bandage should be worn at all times
- place pt prone with hup in extension for 30 mins 3-4 times a day
- AVOID sitting in chair for more than one hour
hip dislocation following total hip replacement is prevented using
abductor pillow to maintain hip in straight and neutral poistion
- also do not bend at the hip more than 990 degree
- dont cross ankles or legs
buck traction
immbolizes hip and fremur fractures
- a boot or traction tape is applied to the ext and a weight pulls the limb in traction
- client is supine witht he foot of the bed raised to maintain countertraction
after new cast is placed
elevate the limb above the heart for the first 48 hours to decrease edema and increase venous return however dont elevate if compartment syndrome dev
dont do what to the leg if compartment sydrome happens
DONT elevate it
residual limb care after above knee ampution (AKA) or (BKA)
- clean the limb by washing it daily with soap and warm water and dry throughly
- inspect signs of infection
- keep limb socks, weaps, and appliances /prostheses clean and dry
- dont apply irrtants such as etoh or lotion or power
- perform daily ROM to improve muscle stength
complication of residual limb
hip flexion contratures
sprain
stretch or tear of a liagment
treatment for sprain
REST- acivity should be stopped and mov limited for 24-8 jours to promote healing
- ice (cold, cyrotherpy) apply ice pack or cold thepy for 10-15 mins every hour for the first 24-48 hours. DONT apply ice directly to the skin
- compression (ace wrap or splint) to prevent edema and promote fluid return
- elevation- ext should be elvated above heart on pullows for 24-48 hours to help reduce swelling
- Analgesia – Mild analgesia with a nonsteroidal anti-inflammatory drug (eg, ibuprofen) can be taken every 6 hours as needed to relieve pain and reduce swelling
- Exercise rehabilitation program – This should be initiated as soon as possible after the injury (ie, when pain subsides) to restore range of motion, flexibility, and strength and prevent reinjury
tingling and hand hand weakness when using crutches
using incorrecntly and not ftted correctly
pain and swelling after injury
normal
RA stiffness intervnetion
take warm shower or bath when awking up
- then do ROM
- apply heat packs to stiff joints and ice packs to painful joints
- plan freq rest periods
nsaids should not be taken
empty stomach
overtime with RA
reduced ability to perform actv of faily living (toileting, abthing, drssing) and engage in routine tasks (walking, opening doors)
fat emobli happens with
bone or pelvic fractures
pancreatitis
liposcution
symtoms of fat emobli
resp prob (dyspnea, tacypnea, hypoxemia)
- neuro changes
- petichae rash (neck, chest, axilla)
- fever (>101.4 F)
paresthia includes
numbess, tingling and burning and these are sogns of compartment sydnrome
osteroarthrities (OA)
synovial joints (kneem fingers, hip)
maesnifications of OA
- pain excerbated by weight bearing actv
- crepitus
- morning stiffness that subsides within 30 mins of arising
- decreased joint mobility and ROM
- atrophy of muscles due to dicuse-
- typically noninflammtory
biomarker or lab tests for OA
none
biopartker for rhymatoic arthertis
rhumetoid factor
average length of stay after total knee arthoplasty
3-5 days
total knee arthroplasty after surgery
PT
isometric
should be fullyy weight bearing by discharge
-use asstive decies to help them sit, rise safely
-knee immbolizer to maintain extension during abulation and at rest for 4 week
complications total knee arthroplasty i
DVT
PE
bleeding (look for low hgb)
infection-look at WBC
what should be prescribed after total knee arthroplasty i
anticogution for 2 wk after surgery
- ankle excercises
- anti emoblic stoccks
compartment syndrome results from
compression from restrictive dressings and casts
-increased pressure within compartment (bleeding, indalmmation, and edema)
6 P’s for compartment syndrome
pain (unleved by respoistion or analgesics) P-pallor P-pulseness P-parestesia -poikilothermia (coolness) -paralysis
if compartment syndrome is suspected
elevate the ext at heart level to promote venous return and limit swelling
- loosen tight bandaging and casting material
- fasciotomy
volkmann contracture occurs as a result of
compartment syndrome
volkmann contrature causes
swelling which causes pressure restricting the arterial blood flow
-the ischemia that results from this leads to tissue damage
-wrist contractures
-inbailty to extend the fingers
“i have been having trouble extending my fingers “
-MED EM
to prevent hip prosthesis dislcation following total knee arthroplasty
do not force the hup >90 degree of flexion
so when using chair with arm rests, place the arm on the arm rest while lowering themselves onto the seat
-dont bend forward when getting into a chair bc that creates >90 degree
-should not twist from the waist, reach acorss the affected ext, bend forward when dressing, putting slippers shoes.
-use asstive equipment when getting dressed such as reacher/grabber, sock puller
excercises for total knee arthroplasty to prevnt dislocation
leg excercises 2-3 X/day
- isometric quadriceps and gluteal setting
- leg raises
- abduction excercises from supine and postion poistions
most common mechanisms of pevlic fractures
MVC
MOTORCYLE CRASHES
when caring for a client with fractured pelvis assess for
internal hemmorhage (abdominal distention, vitals igns, hgb /hct)
- parlytic ileus
- neurovascular deficits (ext circulation, sensation, mov)
- abdominal and GU organ injries (hematuria, UOP)
what is expect with fractures
- eccymosis UNLESS IT IS OVER THE SUPRAPUBIC REGION
- tenderness
- burisshing
prioity manibular fracture
maintaining patent airway so suction if this didnt work then cut the wires but DO NOT CUT THE WIRE unless ARDS OR CARDIAC ARREST requiring intubation
what must be taoed to the bed for mandibular fracture
wire cutter
cutting the wires on mandibular fracture
can worsen the airway prob
preventing disease process in RA
joint protection- fibrosis from ra can shorten tendons and ligaments so body aligners and immbolizers should be used to keep ext straight
- remain active but take rests during painful episodes
- meds such as metthotrexate should be used regarless of the symtoms
obesity is a risk factor for
osteroarthirits not RA
colles fracture
wrist fracture (fork) -occurs when the client tries to break the fall with outstretched arm or hand and lands on the heels of the hand
colles is related to
osteopenia
osteroporosis
colles intervention
neuro assessment (pulses, cap , sensation, mov)
- pain meds
- ice pack
- elevate the ext on pillow above the heart to reduce edmea
- instruct the client to move fingers
osteopneia
more than normal bone loss for clients age and sex
calcium foods
MILK AND MILK PRODUCTS cheese ice cream green veg almonds tofu salon sardines yogurt cereal
vit d
milk yogurt salmon sardines cereeak tuna oily fish egg yoak liver oil
relieve itching under cast
cool setting of hair dryer
- never place any object, lotions, pwders in or around the cast area
- persistent itching should be reported to hcp
total knee arthroplasty to prevent adduction
place abduction pullow bwtween legs
casts (fiberglass, plaster) care
report foul ordors and hot areas- infection
- avoid getting cast wet
- elevate the affected ext above heart level for first 8 hours to reduce edema
- perform ismoteric and ROM to prevent atrophy.
osteroporosis treatment
biphosphonate meds (fosamax, risedronate)
external fixator
device used to stablize broken bones
the nurses should promote what in clients with external fixation devices
early mobilization
sometimes right after surgery
clean pin site with
chlorhexidine
sterile normal saline
carpal tunnel
pain and paresthsia of the hand caused by nerve compression
symtoms of carpal tunnel is exacerbated during
sleep because of the prolonged and unintentiaonal wrist flexion
how to manage carpal tunnel symtoms
wrist immbolization splints esoucally the wrist during sleep
-surgery
what can worsen symtoms of carpal tunnel
performing repeitve hand excecises
wearing compression hose
buck traction
skin tracTion used to immbolize hip fractures and reduce pain and spasms
-SIDE TO SIDE INCREASE INJURY so dont repoistion client
nurse should ensure what with clients with buck traction
alignment of the limb and that the limb remains straight in neutral poistion
Ankylosing spondylitis (AS),
inflalmtory disease affecting the spine causing restricted spinal mobility
classic findings of Ankylosing spondylitis (AS),
low back pain
morning stiffness
clients with Ankylosing spondylitis (AS), should
promote extension of the spine with proeper posture, dialy stretaching such as swimming, racquet sports
- practice breathing excercises to increase chest expansion and reduce lung complication
- pain mangement with MOIST heat and nsaids
- take immunosupp and antiinflammtory meds
- REST during flare ups
- SLEEP on their backs on firm matterss NOT SOFT
rhabdomyolysis
msucle fibers are released into the blood after muscle injury from excercise, heat stroke, physical trauma
complications of ehbaymyolsis
renal failure ad in order to prevtn renal damage GIVE FLUID RES to flush it out
signs of rhabdomyolsis are
dark, bloody urine, oliguria
fatigure
priotiy for rbacdoymosis
fluid
pain and paresthesia over first 2 1/3 fingers
carpal
rotator cuff
rotatoion of the arm and gets injured from repritive overheda motion (swimming, tennis, basebal, weight lifting)
cahracteritsitc of rotator cuff
shoulder pain and weakness
- severe pain when arm is abducted between 60-120 degree
- shoulder pain with arm abduction
common clinical manesifitcations of hip fractures
eccymosis and tednerness over the thigh and hip
- groin and hip pain with weight bearing
- muscle spalsms in the injured area
- shorterning of the affected ext
- abduction or adduction
- affected ext externally rotated
bucks skin traction positioning
suprine of semi foweler (max of 20-30)
- eelvating head more than this causes sliding
- assess neuro status and skin tegrity
- when change is made with the application of the boot such as loosen or tightening check the nuero in 30 mins
- frcacture pan to pee pee
- weights should be free hanging at all times and should never touch the floor so have someone support the weight while the client is respoistioned
preventing adduction in total hip replacement
abductor wedge
or place 2-3 pillows between knees
HOB of pt with total hip replacement
≤60 degrees
the affected side of total hip replacement should
not be slept on or turned on or poistoned on the operative side unless HCP said so
fitting crutches the weight should be supported on
hands and arms not the axillae
when abulating there should be how much space
1-2 in (2.5-5 cm) space between armpit and armpit clutch pad
gout causes what to increase in the blood
uric acid
gout complkcation
kidney stones bc or the increases uric acid
imrpovements in uric acid control is often seen when
weight loss and dietary mod
modifications when gout
increase fluid to elominate uric
- low pruine (avoid organ meats such as liver, kidney, brain, sadines and shellfish)
- limit etoh espiclaly beer
- low fat
- dont need to avoid protein
reducing risk of fat emolbi
EARLY STABILZATION OF THE INJURY and surgery asap
- minmize movmeent of the injured ext
- prophalutic anticogulation, scd and early abulation is for DVT NOTTT for fat emboli
brace for scolosis
do not cure existing spinal deformities but do prevent further worsening
brace for scholiss intervention
wear cotton t shirt under the brace to prevent breakdown
- dont use lotion or powder
- build strength and can remove when exercising
how long should the brace be worn for
18-23 hours a day and remove for bathing and excercising
important prob with brace
psochosical
cane length
should be equal the distance from the clients greater trochanter to the floor
teaching points for using cane
52
HOB during autnomic dstflexia
45 or high flower to lower bp
