Muscleskeletal Flashcards
What is Osteoarthritis?
Degenerative joint disease
**most common among joint disorders
What are the two different classifications of OA?
Primary or Idiopathic - no prior event or disease related to it
Secondary - results from previous injury or inflammatory disease
What are causes of OA?
What are S/S of OA?
Pain
Stiffness
Functional impairment
Usually worse in AM
What is Rheumatoid Arthritis
Autoimmune inflammatory disease
Differences between OA and RA PT history
OA:
-C/O palpable bony joint
-morning stiffness
-pain
RA:
-pain duration > 6 weeks
-morning stiffness
-Systemic symptoms (fatigue, anorexia, etc)
Differences between OA and RA: physical exam
OA:
-Reduced ROM
-Joint malalignment
-Crepitus
RA:
-Synovitis
-joint involvement, symmetrical
-joint destruction
-extra-articular manifestation
Differences between OA and RA Tests:
OA:
-Osteophytes
-joint space narrowing
-lab: clear synovial fluid
RA:
-Erosion on X-ray / MRI
-synovitis noted by ultrasound
-ESR or C-reactive protein
-Anti-CCP
-Reheumatoid factors
Differences between OA and RA Tests:
Ways to prevent OA
Weight reduction
prevention of injuries
perinatal screening for congenital hip disease
What are some medical managements options for OA
-Heat
-Weight reduction
-joint rest
-Orthotic devices
-Pharm
*NSAID
*APAP (Tylenol)
*Cox-2 inhibitors (Celebrex)
*Corticosteroids
What are surgical options for OA
-Osteotomy
-Arthroplasty (replacement)
Nursing interventions for OA:
-weight loss
-assistive devices
-Exercise
-Analgesic
-Physical therapy
What is lower backpain
leading cause of occupational disability in the world!
-most common cause of missing work days
-50-80% cause of ppl who miss work is bc of this
What are some caused of lower back pain
80-90% = mechanical
5-15% = neurogenic
1-2% = non-mechanical spinal condition
1-2% referred visceral pain
1-4% = other
What are mechanical causes
-unknown
-degenerative disc or joint disease
-vertebral fracture
-Congenital deformity
-Spondylolysis
-Instability
What are neurogenic causes?
-Herniated disc
-Spinal Stenosis
-Osteophytic nerve root composition
-Ammular fissure with chemical irritation to nerve root
-Failed back surgery
-Infection (Herpes Zoster)
What are non-mechanical spinal conditions?
-Neoplastic (primary or secondary) *cancer / tumor
-infection (osteomyelitis, deicitis, or abscess)
-Inflammatory arthritis
-Paget’s disease (type of cancer)
Red Flag Syndroms
These must be ruled out before diagnosis:
-onset at age <20 or >50
-non-mechanical pain (aka unrelated to a specific activity)
-Thoracic pain
-Prev history of carcinoma, steroids or HIV infections
-Fever, night sweats, unexplained weight loss (fear of cancer
-widespread neurological symptoms especially sphincter disturbance (loss of bowel or bladder control)
-Structural spinal deformity
Red Flags for spinal fractures
-Very sudden onset of severe central pain in the spine which is releived by lying down
-major trauma
-minor trauma
-structural deformity of spine
-pint tenderness over vertebral body
Red Flag for malignancy or infection
-pain that remains when lying down, aching at night, disturbed sleep
-onset age 50+
-history of cancer
-S/S of infection
-Recent bacterial infection
–Immune suppression
What are pharmacological treatment options for back pain
-simple analgesia
-NSAID
-Opiates *try not to go here due to dependence
-Steroids
-Muscle relaxant
What are other therapy options for lower back pain?
-Physical therapy
-regular activities
-group exercise
-Massage / manipulation
-Acupuncture, electrotherapies & spinal injections
-Epidural Injections
-Radiofrequency Denervation
What are surgery options for lower back pain?
-Vertebroplasty and kyphoplasty
-spinal laminectomy / spinal decompression
-discectomy
-foraminotomy
-nucleoplasty, also called plama disk decompression
-spinal fusion
-artificial disc replacement
What is Arthroplasty?
Joint replacement
Whi is arthroplasty indicated for?
-irreversibly damaged joints with loss of function and unremitting pain
-selected fractures
-joint instability
-congenital hip disorders
What is Osteoporosis?
Weak bone density
-new bone does not keep up with removal of old bone
-bones become weak and brittle leaving the pt with an increased risk for Fx (fractures)
What is Osteopenia?
What is Primary osteoperosis?
What is secondary osteoporosis?
What are T-scores and Z-scores?
T-score = compares your results to healthy YOUNG ADULT 20-35
Z-score = compares your results to a person of same gender and age as self
What do Z-scores mean
Z-score between 1 and -2.5 = Osteopenia
Z-score < -2.5 = Osteoperosis
What are causes of osteoporosis
-Genetics
-Age
-Nutrition (low calcium intake, low vitamin D, high phosphate intake)
-lack of physical activity
-lifestyle choices
-medications (corticosteroids, anti seizure medications, heparin, thyroid hormone)
What are manifestations of Osteoporosis?
-Fractures
-Kyphosis
-Decreased calcitonin
-decreased estrogen
-increased parathyroid hormone
How can we help prevent Osteoperosis?
-Identifying it early
-diet
-activities
-lifestyles
What are medical management options for osteoperosis?
-diet
-exercise
-fracture management
What is pharmacologic therapy for osteoperosis?
Calcium supplements with vitamin D
-Bisphosphonates
-calcitonin
-Selective estrogen receptor modulators (SERMS)
What are surgical management options for osteoperosis?
-joint replacement
-closed or open reduction with internal fixation
-open reduction, internal fixation
What are fractures??
complete or incomplete disruption in the continuity of the bone structure
-defined according to type and extent
What adjacent structures are affected during a fracture?
soft tissue edema
hemorrhage
joint dislocation
ruptured tendons
severed nerves
damaged blood vessels
What is a complete fracture?
break across the entire cross-section of the bone and is frequently displaced
What is an incomplete fracture
involved a breakthrough only part of the cross section of the bone
what is a comminuted fracture
one that produces several bone fractures
what is a closed fracture
one that does not cause a break in skin
what is an open fracture
one wehre there is a break in skin
what is a pathological fracture
caused by weaking of the bone as a result of a disease
What are causes of fractures?
direct blows
crushing forces
sudden twisting motions
extreme muscle contractions
What are manifestations of a fracture
-pain
-loss of function
-displacement
-shortening of extremity
-crepitus
-localized edema and ecchymosis
What are complications of fractures
-hypovolemic shock (due to bleeding)
-fat embolism syndrome (higher risk with long bone and pelvic fat)
-compartment syndrome (usually in extremities)
What is compartment syndrome?
All bones are in their own compartments - so everything starts to swell really big and it runs out of room and needs to be cut open to relieve pressure
What are medical management options for fractures
-immediate immobilization
-splinting
-sterile dressing
-fracture reduction (closed or open *open is surgical)
What needs to be completed during a nursing assessment for fractures
-Neurovascular checks (if no pulse, nurse can make minor adjustments)
-open or closed
-S/S of infection
-S/S of hemorrhage or shock
-S/S of compartment syndrome
What are the different materials a cast can be made out of?
Nonplaster (fiberglass)
plaster of paris
What position should a bone be in before casting it?
in its position of function
What are the types of splints?
-Stirrup - foot
-Volar cock-up splint - wrist
-Sugar-tong splint - more complex forearm and wrist fractures (some elbow)
-double sugar tone - elbow fractures
-Ulnar Gutter splint - 4th & 5th metacarpal fractures (boxers fractures)
-Thumb spica - for a thumb break
-HARE Traction splint - if we have a displaced fracture of femur
-Sager Traction splint - both legs
-SAM splint (great for travel bags)
What is a cast
Rigid external immobilizing devise molded to contours of body part
How do we care for a patient with a brace, splint, or cast
What are the 6 Ps for assessing neurovascular changes in a pt with a brace, splint, or cast?
-pain
-poikilothermic
-paresthesia
-paralysis
-pulses
-pallor
What are potential problems from having a cast?
What causes pressure ulcers with casts?
Inappropriately applied casts
-creating a hotspot or tightness
What is disuse syndrome?
muscle atrophy and loss of strength
What should a pt report when they have a cast
-persistent pain or swelling
-changes in sensation, movement, color, temp
-s/s of infection
-pressure areas
What is a reduction of fractures?
putting fraction back
Non-surgical: closed reduction
Surgical: ORIF / OREF *uses pins
O:Open
R:Reduction
I:internal / external
F:fixation
What is traction?
(pulling force to a part of the body)
When you have something attached to your body that has weights and pulls limb to give “traction” to bone to get back to normal
Skin
-buck extension traction *boot with weight
-Cervical head halter *create traction
-Pelvic traction *pin in through bone, attach weight to
Skeletal
-pin through bone, and weight pulls on that
Why use traction?
-reduce muscle spasm
-reduce, align and immobilize fracture
-reduce deformity
-increase space between opposing forces
*short term intervention until other modalities are possible
Traction principles
-Must have counterforce
-must be continuous
-never interrupt skeletal traction
-weights are not removed unless intermittent traction has been ordered
-weights must hang freely
-knots or footplate must not touch the food of bed
-skeletal traction - all traction needs to be applied in two directions “vectors of force”
What are nursing management for patients in traction
-assessing anxiety
-assisting with self-care
-monitor and manage complications
*pressure ulcer
*atelectasis (alveoli collapse)
*pneumonia
*constipation
*anorexia
*Urinary stasis
*infection
*DVT
What do pts with a hip replacement need
-preventing dislocation of hip prosthesis
-mobility and ambulation
-drain use postoperatively
-Prevent infection
-prevent DVT
-Pt education and rehab
What do pts with a knee repalcement need?
Postoperatively
-compression on knee
-assess neurovascular **every 2-4 hours
-monitor for complications (infection, bleeding, VTE)
Wound suction drain
-removed in 24-48 hours
-antibiotics prophylactically
-autotransfusion of extensive bleeding
Needs of pts with knee replacement
-CPM (continuous passive motion)
-PT
-Acute rehab (1-2 weeks)
Total recovery time: 6 weeks
Things that need to be assessed during preoperative bone surgery
-routine preop assessment
-hydration
-medication history
-possible infection
-knowledge
-support and coping
Things that need to be assessed during postoperative bone surgery
-pain
-VS, breath sounds
-LOC
-neurovascular tissue
-S/S of bleeding
-wound drainage
-mobility and understanding of mobility restritctions
-bowel sounds and elimination
-flatulence
-urinary output
-s/s DVT
Potential complications - postoperative
-hypovolemic shock
-atelectasis
-pneumonia
-urinary retention
-infection
-thromboembolism: DVT or PE
-constipation or fecal impaction
Nursing interventions post surgery
-Give meds
-alternative method of pain relief (reposition, distraction, guided imagery)
-pain control
-Muscle setting (exercises)
-nutrition
-skin care measures
-follow up PT
-set realistic goals
What is an amputation
total or partial surgical removal of an extremity or digit
What are the types of amputations
BKA - below the knee
AKA - above the knee
Upper extremity
What are reasons for BKA
-peripheral vascular disease
-facilitates successful adaptation to prosthesis bc of retained knee function
what are reasons for AKA
necessitated by trauma or extensive disease
What are reasons for upper extremity amputation
severe trauma
malignant tumors
congenital malformation
What needs to be assessed after amputation
-neurovascular
-history of health problems
-clients understanding of extent of surgery
-coping status
-support system
What re nursing interventions for amputation?
What is Kyphosis
an outward curvature of the spine
“hunch back”
What is lordosis?
an inward curvature of the spine
*lumbar spine
What is scoliosis
lateral curvature of spine
