MSK disorders - part 2 Flashcards
Guidelines for neurovascular checks:
- Observe capillary refill by _______ the ______ bed of the finger or toe, release and count the seconds until the nail turns pink
- Observe the ______ of the casted tissues and compare with like tissues on the opposite side of the body
- Feel the ________ of both extremities or like tissues of both sides of the body. The casted tissue will be slightly _____
- Observe for presence and amount of _____. The affected tissues may be slightly to moderately _______, but the skin should not be tight
compressing, nail
colour
temperature, cooler
edema, edematous
How is edema ranked?
Scored as 1+ if edema is 1mm
3+ for 3mm
anything above 4 is considered gross edema
Guidelines for neurovascular checks (continued):
- Ask patient to describe _______
- Ask the patient to _____ the fingers or toes neighbouring the casted tissues
- ask the patient about the amount of ______ and changes in ______ if experienced
- ______ the casted side with the opposite side, report and record any differences
sensation
move
pain, function
compare
Describe the nursing interventions for prevention of the following MSK complications:
- Muscle atrophy
- Contractures
- Foot drop
- Pain
- Muscle spasms
Muscle atrophy - isometric exercises
Contractures - good alignment, regular position changes and ROM exercises
Foot drop - foot support (support foot in dorsiflexion
Pain - corrective action, loosen device, etc.
Muscle spasms - apply heat (can also use anti-spasm medications but less often used), do not massage
What is foot drop?
a contracture in which the person’s foot is locked in plantar flexion essentially
What is the number one fracture that occurs in the elderly?
What is the most common cause?
Hip fracture
Falls
Hip fracture:
- 70% of hip fractures are related to _________
- gender impact?
- Requires one of the ______ hospital stays
- 25% of hip fracture clients die from complications within __ year(s)
- 40% will require ____
- Approximately 75% of the elderly do not return to their prior level of _______
osteoporosis women > men longest 1 year LTC functioning
What are the risk factors for individuals over 65 for hip fractures?
Poor muscle tone polypharmacy decreased vision and hearing Slower reflexes Orthostatic hypotension
What is orthostatic hypotension?
Drop in BP when changing position - 10-20 torr drop in systolic
What are the three main reasons that a senior will go to a nursing home?
Mobility issues, confusion and memory impairment, incontinence
Describe functioning after a hip fracture (stat)/
Approximately 75% of seniors do not return to their prior level of functioning following a hip fracture
What are the clinical manifestations of a hip fracture?
External rotation of the affected leg
Muscle spasm
Shortening of the affected leg
Severe pain and tenderness in the region of the fracture site
What are the nursing interventions to keep a client’s hip in alignment?
Place large billow between client’s legs when turning
keep leg abductor splints (if ordered) on, except when bathing
turn only on the side approved by the surgeon
Avoid positions/activities that predispose the client to dislocation
What activities/positions predispose a client to hip dislocation?
Hip flexion > 90°
Adduction
internal rotation
After a hip fracture, we have to remind patients to not do this for the first 6 weeks.
Cross their legs
What is a trochanter roll?
Take a towel, stick one end under the affected area and then roll it towards the client - immobilizes limb
What are some nursing diagnoses for a client with a hip fracture?
At risk for ineffective respiratory function related to decreased mobility
Acute pain related to hip surgery
Risk of impaired skin integrity..
Impaired physical mobility, etc.
Legal responsibility:
- All _______ injuries such as fractures resulting from abuse or neglect are a reportable event.
intentional
Scoliosis:
- a lateral curvature of the spine measuring ___° or more on an x-ray
- 80-85% of the cases are due to?
- More common in _______
- 3-5 out of 1000 kids develop spinal curvature that are considered large enough to require _______
- should not be confused with poor ______
10 idiopathic scoliosis females treatment posture
Screening for scoliosis:
- Difference in _____ height
- _____ is not centered with the rest of the body
- Difference in ____ height or position
- Difference in ________ ______ height or position
- When standing straight, difference in the way the ____ hang beside the body
- When bending forward, the sides of the back appear different in ______
shoulder head hip shoulder blade arms height
Reduction of bone density and a change in bone structure which leads to increased risk of fragility fractures.
Osteoporosis
Responsible for 80% of the fractures over age 60.
Osteoporosis
Why are women over 50 more at risk for osteoporosis?
Menopause and subsequent drop in estrogen
Osteoporosis risk factors:
- Over ____ years old
- ________ compression fracture
- ________ deficiency or early _______ (before age 45); ______ deficiency in men
- Family ______
- primary __________
- ________ visible on x-ray
- tendency to ______
- Medical conditions that affect ______ absorption
- > __ months continuous _______ use
65 vertebral estrogen, menopause, testosterone history Hyperparathyroidism osteopenia fall nutrient >6 months on continuous corticosteroids
Decreased bone density but not to the extent of osteoporosis. This decreased bone density leads to bone fragility and an increased change of breaking a bone
osteopenia
Occurs when one or more of the four parathyroid glands grows into a tumour and behaves inappropriately by constantly making excess parathyroid hromone.
Hyperparathyroidism
What is the result of hyperparathyroidism?
Excess PTH –> goes two bones and removes calcium from bones –> can clog arteries and kidneys and cause osteoporosis
Specifically, Celia’s or Chron’s disease can decrease the absorption of these nutrients.
vitamin D, calcium
Osteoporosis risk factors (continued):
- ethnic origin?
- ____ body mass index (
white and asian women low BMI; less than 57 kg in women physical inactivity low vitamin D and calcium intake >1000mL of coffee/day >2 drinks/day
What is the acronym for osteoporosis treatment, what does each letter stand for?
CDEFG S C - calcium D - vitamin D E - exercise F - prevent Falls G - gain weight S - stop smoking
Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next ___ years using information such as the ___ ____ test.
If the risk is not high, treatment might not include ______, but instead focus on modifying lifestyle factors.
For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are _________.
10
bone density
medications
biphosphates
We encourage people to take how much calcium (esp. women) daily?
1500mg +
Most common form of joint disease; slow, progressive non-inflammatory disorder of synovial joints, previously known as wear and tear arthritis
Osteoarthritis
Osteoarthritis:
- ______ common form of joint disease
- slow, progressive ____-________ disorder of synovial joints
- risk increases after _______,
- Results from cartilage damage and erosion of the _______ surface
gender influence?
most non-inflammatory menopause articular affects men and women equally
OA is also known as what?
Wear and tear arthritis or degenerative arthritis
Although OA is not an inflammatory disease, there is inflammation. Why?
As a result of bone grinding
Which joints are more often affected by OA?
What are the classical nodes seen in OA but not RA?
Weight bearing joints
Heberden’s and Bouchard’s nodes
What are some common signs that indicate that it is OA, rather than RA?
Bow-legged (one leg becomes shorter)
Assymetrical nodes at weight bearing joints
Nodes at the distal interphalageal joints.
Heberden’s nodes
Proximal interphalangeal joint nodes
Bouchard’s nodes
Describe the evolution of osteoarthritis/
(articulating) Cartilage breaks down, then the smooth synovial membrane is compromised, leading to bone on bone grinding and pain
Adults should not exceed __g of Tylenol per day.
These medications are effective in treating OA.
4g
Tylenol and Aspirin
Why is Tylenol and Aspirin use limited for treatment of OA?
aspirin can cause gastric bleeding
Tylenol is tough on the liver
OA treatment:
- ______ reduction
- Rest and joint protection
- avoid forceful, _______ movements
- maintain good _____
- ________ devices
- therapeutic exercise (such as?)
- heat and cold
- Topical agents
- Acetominophen, NSAIDs
- Intra-articular _______ ______ injections
- ________ surgery
weight repetitive posture assistive taichi/yoga hyaluronic acid reconstructive
To get around the gastric bleeding issue when taking aspirin, what type should be taken?
enteric coated
RA:
- chronic, _______, _________ disease
- gender impact?
- _________ of CT in the diarthodial (synovial) joints
- Cause ______, ______ predisposition
- _____ stages - they are?
systemic, autoimmune 2-3x more common in women inflammation unknown, genetic four stages - early, moderate, severe, terminal
What causes RA flare ups?
stress - good or bad stress
How are RA nodes different from OA nodes?
RA nodes can happen anywhere and present symmetrically
Describe RA nodes/
calcified accumulations that are pea sized
extra articular manifestation of RA - Dry eyes, mouth, mucus membranes
Sjogren syndrom
Extra-articular manifestation of RA - Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease and blood dysacrias (anemia, thrombocytopenia, granulocytopenia)
Felty syndrome
How is RA diagnosed?
Blood test
look for RF (rheumatoid factor) which occurs in 80% of patients
To confirm, do a sedimentation rate test - ESR - if elevated (off the chart) - diagnose RA
What does ESR test for?
Inflammation in the body
More reliable test than RF.
Erythrocyte sedimentation rate
Describe the following for RA:
- CRP
- Synovial fluid WBCs
C reative protein is not normally found in serum unless there is necrosis or acute inflammatory conditions
in RA, there will be a higher WBC count in the synovial fluid
What scan can be done to help determine an RA diagnosis?
X-ray
The amount of joint movement is measured by a _______, this device measures the angle of the joint in degrees.
Goniometer
What does DMARD stand for?
disease modifying anti-rheumatic drugs
Humira and other monoclonal antibody treatments for RA are very effective, but what limits their use?
very expensive (1500$ per injection)
How is humira administered?
By injection, twice a month
What kind of drug is humira (adalimumab)
TNF blocker (monoclonal antibody)
