Musculoskeletal Flashcards
what are contusions
occur when external force such as a fall or blow breaks capillaries without breaking the skin
bruising and swelling
contusions manifestation
bruising
pain
swelling
contusions care
first 24-48 hours, apply ice for 15 min, 3x a day
wrap the area to compress
color change to greenish-yellow after 3-5 days
should completely heal within 7-10 days
observe for a bruise that keeps spreading
observe any changes in mental status if bruise is realted to the head
what are strains
cause by overstretching, overexertion or miscuse of muscles
first degree strains manifestations
mild and gradual onset
feels stiff and sore locally
muscle will be tender to the touch
may experience muscle spams
no loss of range of motion
little to no edema or ecchymosis will be seen
second degree strain manifestation
sudden onset, with acute pain that eventually leaves the area tender
extreme muscle spams and passive motion will increase pain
edema will develop early and later, ecchymosis will appear
third degree strain anifestation
occurs when there is severe stretching of muscle with tear
feels sudden, snapping or burning sensation
muscle spams
joint tenderness
edema - extreme
cannot move the strained muscle voluntarily
1st degree strain care
ice
rest
possibly immobilize for short term
elevate it
oral, non-opioid analgesics or NSAIDs
2nd degree strain care
elevate limb
ice for first 24-48 hours
apply moist heat
limit mobility, using compression bandage
use muscle relaxants, analgesics and NSAIDs
implement physical therapy
3rd degree strain care
elevate
ice for first 24-48 hours
immboilize or limit mobility
limit weight bearing on lower limbs
use muscle relaxants, analgesics and NSAIDs
physical therapy
what are sprains
involves injury to ligament structure by stretching, overexertion or traums
1st degree sprain manifestations
localized edema or hematoma
some mild discomfort
increased pain when limb is palpated or bears weight
no loss of functioning or weakening the joint structure
2nd degree sprain manifestations
edema
possible hematoma
decreased active ROM
mild weakening of the joint and pain
3rd degree sprain manifestation
severe edema with hematoma
severe pain
dramatice decrease in their active ROM
loss of joint integrity and function
1st degree sprain care
wrap
keep limb raise
ice for 24-48 hours
analgesics
isometric exercise
- to increase circulation and resolve hematoma
2nd degree sprain care
dress splint and immboilize it
elevate limb
24-48 hours, alternate:
- ice for vasoconstriction
- moist heat to decrease swelling and provide comfort
analgesics
physical therapy
3rd degree sprain care
casting/immobilizations
surgery may be needed to restore the integrity of joint
same as 2nd degree:
ice then heat
compression banadage:
if tingling below area heppans, bandage was wrapped too tihgtly, remove then reapply
types of fractures
complete: when bone is broken into two or more pieces
incomplete: bone is broken but still in one piece
close: simple fracture that does not break the skin
open: breaks the skin
fractures manifestations
swelling
pallor and ecchymosis
loss of sensation to body parts
deformity
pain and/or tenerness
muscle spams
loss of function, abnormal mobility
crepitus
shortening of the affected limb
decreased or absent pulses
affected extrremity colder than the other
fractures care
closed reductions: procedure to set broken bone without surgery
- allows bone to grow back together
0 wroks best hen done as soon as the bone breaks
- x-rays are done to see if it was successful
immobilization: keeps the bone fragments from moving and relieves pain
- casting
- traction
- splints
- braces or external fixation
stages bone healing
- hematoma formation
- fibrocartilage/ granulation tissue formation
- callus formation
- ossification
- consolidationg/remodeling
bone healing complications
immediate: shock fat embolism - can occur 24 hours after the injury and more common in pelvic/femur fractures DVT PE
delayed:
joint stiffness and post-traumatic arthritis
reflex sympathy dystrophy
myostitis ossificans
malunion
- fractured bone heals in an abnormal position
delayed union
- bone is slow to heal
nonunion
- when gracture does not heal
bone healing management
check neurovascular status
palpate for pulses, sensation, skin temp, ability to move appendages
elevate limb above level of heart, unless compartment syndrome is suspected
apply cold
immboilize the client as soon as possible
turn every 2 hours
- use pressure air mattress
- position with proper alignment
incentive spirometry frequently
proper coughing and deep breathing
monitor for signs of infection
proper wound care and antibiotics
VTE prophylaxis is key for clients who are immobilized after a frature
- hydration
- comopression stockings
- pneumatic devices
fat embolism cannot be prevented with these interventions
skeletal traction care
perform daily pin care
inspect traction apparatus every 8 hours
ensure weights are free hanging
teach how to bear weight and how much weight is permitted
teach how to use assistive device
teach cast care:
- keep dry
- dont put anything inside cast
- itch with hair dryer on cool setting
- report swelling and anything abnormal
use incentive spirometyr
5 P’s
pain paresthesia pallor paralysis pulse
factors that enhance healing
fracture near a good blood supply
minimal damage to soft tissue
anatomic rduction
fragments are in a good position to heal
immobilization
weight can be borne on lone bones
factors that delay healing
poor blood supply
severe damage to soft tissue
separation of fragments
improper fixation allows bones to move or rotate
pre-exisiting factors:
- obesity
- diabetes
- steroid use
- smoking
severely comminuted fractures
bone loss
infection
what is rhabdomyolysis
acute condition involving the breakdown of skeletal muscle tissue
occurs when trauma to the muscle compresses tissue, it causes ischemia and necrosis
rhabdomylosis manifestation
myalgia - muscle pain
weakness
myoglobinuria - tea colored urine
triad of symptoms
rhabdomylosis diagnostic studies
elevated CK level = most sensitive
serum creatinine - elevated
- can indicate kidney injury
serum electrolytes - hyperkalemia
rhabdomylosis care
early recognition and management of ABCs
intervention will focus on:
- preserving renal function
- preventing acute kidney injury
by administering large volumes of IV fluid
what is osteoarthritis
degenerationg of the aritcular cartilage and formation of bones
types of osteoarthritis
primary OA:
- idiopathic and is most often related to aging process
- symptoms appear in middle age and progresses with age
secondary OA:
resulting from predisposing condition or trauma
- obesity, family hx of degenerative joint disease
- joint abnormality
- excessive wear
- repetitive stress common in certain occupations
- mostly in caucasian women
osteoarthritis manifestations
joint stiffness after period of rest
pain in a movable joint, typically worse with action and relieved by rest
paresthesia
joint enlargement
- Heberden’s nodes: joint closest to fingernail gets enlarged
- Bouchard’s nodes: middle joint of the finger and closest to body gets enlarged
joint deformities
tenderness on palpation
joint surfaces no longer fit together
muscle spasm and contract
joints are blocked by osteophytes and loose bodies
creptitation and crunching ocurrs when joints are moved
eventual ankylosis or stiffening of joint
changes to gait occur
shortneed stance
abnormal antalgic gait
- limp that help avoid pain
widened base of support
shortened step length
osteoarthritis diagnostic studies
x-rays bone scans MRI and/or CT scan history physical exam
osteoarthritis management
functional and mobility assessment
pain management
correct use of assistive devices
implementation of prescribed heat and/or cold therapies
proper posture and body mechnics
weight reduction if obese
collaboration with physical and occupational therapy
referral to support agencies
home safety
osteoarthritis pharmacological interventions
aspirin
- can cause tinnitus, gastritis, peptic ulcer disease
NSAIDs
- ibuprofen, naproxen
- celexicob, indomethacin
- meloxican
- may cause GI bleeding
corticosteroid injections
hyaluronic acid injections
opioids analgesics
osteoarthritis nonpharmacologic itnerventions
assistive devices
TENS has been shown effective for pain relief
physical exercise
relaxationtechniques
appropriate nutrition and weight loss
active stretching and non-weight bearing activities like swimming
acupuncture and massage therapy may help lessen the pain
what is carpal tunnel syndrome
compression of the median nerve that neters the hand through a tunnel of ligaments and bone at wrist
repetitive strain injury
dibaetes, peripheral vascular disease and rheumatoid arthritis have higher incidence of CTS
carpal tunnel syndrome manifestation
weakness pain, tingling numbness or decreased sensation in the affected hand difficulties with fine motor movement atrophy of thumb muscles
carpal tunnel syndrome diagnostic studies
history
physical exam
identification of risk/precipitating factors
corresponding clinical symptomaology
postitive Tinels sign
- compress with 2 fingers at wrist and see if there is tingling
positive phalen’s sign
- put both wrists at a 90 degree downward and see if there is tingling
carpal tunnel syndrome nursing management
relieving underlying cause of nerve compression
wrist splint
ergonometry with workstation modification
physical therapy
hand/wrist exercise
NSAIDs
rest, ice
if conservative treatment does not work, then more invasive treatment may includes:
- corticosteroid injection
- surgery
what is plantar fascitis
inflammation of the plantar fascia, located on the arch of the foot
often seen in middle age and older adults, esp runners
obesity is a contributing factor
plantar fascitis manifestations
severe pain in arch of foot, esp when getting out of bed
pain worsens with weight bearing
most have unilateral plantar fascitis, it can affect both feet
plantar fascities diagnostic studies
history and physical exam
identification of risk factors
corresponding clinical symptomalogy
plantar fascitis nursing management
rest, ice
physical therapy
stretching exercises
shoes with good support
orthotic shoe inserts
NSAIDs
steroid for pain and inflammation
if these are unsuccessful then endoscopic surgery is needed to remove the inflamed tissue
if taking corticosteroid, important to NOT abruptly stop taking them
- take with food to prevent GI upset
if diabetic, monitor for higher than usual blood sugar levels
what is rheumatoid arthritis
chronic, systemic inflammatory disease of the connective tissue
does have genetic tendency
- more common in women than men
irreversible and will lead to ankyloses of the joint
- abnormal stiffening and immobility of a joint
rheumatoid arthritis manifestations
general signs: fatigue loss of appetite weight loss enlarged lymph nodes
early RA:
painful, stiff joints
warm, red, swollen and incapable of full ROM
late RA: bony ankyloses destruction of joint adhesions inflammation and effusions Raynauds syndrome
may present with ulnar deviation
- deformed hands and fingers, including swan neck of fingers and joints
rheumatoid arthritis diagnostic studies
history and physical exam
radiographic studies
aspiration of synovial fluid
labs: decreased ESR increased RBC positive c-reactive protein positive antinuclear antibody positive rheumatic fever
rheumatoid arthritis care
surgical intervention
splinting
adequate rest
ice for joint inflammation
heat for joint stiffness
nutrition therapy:
weight reduction if obese
calcium supplements
rheumatoid arthritis complementary health
gamma-linolenic acid fish oil ginger, boswelia green tea turmeric - the three have ongoing research
rheumatoid arthritis management
psychosocial support
education related to corticosteroids
promotion of self care and independence
pain control is priority assessment
administration of meds
balancing exercise and rest, energy conservation
assistive devices
speak HCP before using herbal or OTC medications
what is systemic lupus erythematosus
chronic, systemic inflammatory disease of the collagen tissues
african americans, hispanics, asians and antive americans are 2-3 time more likely to have lupus
- most cases are found in women
may experience kidney damage that is progressive and can lead to end-stage renal dsease
- requiring dialysis or kidney transplantation
systemic lupus erythematosus manifestation
SLE more likely to present if client has 4 or more findings:
- arthritis
- butterfly rash: malar rassh
- discoid lupus skin lesions
- photosensitivity
- oral ulcers
- serositis
- renal disorder: persistent proteinuria
- seizures or psychosis in absence of drugs
- hemolytic anemia
- positive lupus erythematosus cell preparation
- abrnomal titer of antinuclear antibody
systemic lupus erythematosus care
control system involvement
monitor findigns
promote remission
pharmacological interventions: salicylates NSAIDs corticosteroids anti-infectives anti-cancer drugs antimalarial drugs
systemic lupus erythematosus management
maintaining skin integrity
weight management
energy conservation techniques
sun protection
well balanced diet - no specific diet needed or avoided
what is gout
metabolic disease marked by painful inflammation of joints
deposits of urates in and around the joints
usually an excessive amount of uric acid in the blood
peak incidence between 40-60 years old
does have familial tendency
abdnormal purine metabolism or excessive purine intake results
deposits most often found in the metatarsophalangeal joint of the greater toe or in ankle
gout manifestations
tight, reddened skin over inflamed joint
elevated temperature
edema of involved area
severe pain in affected joint
hyperuricemia because uric acid levels are in bloodstream
acute attacks begin at night and last 3-5 days
may follow trauma, diuretics increased alcohol consumption a high purine diet stress suddently stopping maintenance meds
g
gout diagnostic studies
synovial fluid analysis will revel uric acid crystals
blood work will show hyperuricemia
gout care
pharamcological interventions
NSAIDs
- indomethacin
colchine
- used when NSAIDs are contraindicated
- enhances the excretion of uric acid
antihyperuricemic agents
- allopurinol
heat or cold therapy
dietary changes to low purine diet
gout management
pain management
elevate affected limb
bedrest and immobilize joint
avoid putting pressure or bedding on affected joint
reinforce need for dietary management low purine diet: - protein is okay - avoid organ meats - shellfish (shrimp) - sardines
incrase fluid intake to prevent renal calculi
use aspirin and diuretics cautiously and avoid if possible
HALLMARK of gout are: flareups or acute episodes of sevre pain, lasting days to weeks
- during an acute attack –> goal is to treat with colchine and manage pain
what is osteomalacia
occurs when mineralization is delayed, resulting in a soft weak bonew
rickets caused by vitamin D deficiency
- not having enouhg calcium and phosphorus
osteomalacia manifestation
generalized muscle pain and skeletal pain in hips and lower back
waddling gait
wide stance and may not want to walk at all
deformities in weight bearing bones
scoliotic or kyphotic deformities of the spine
bones tend to break easily
osteomalacia diagnostic studies
radiiographic findings
lab tests:
- decreased calcium and phosphorus
- alkaline pshophatase will be moderately elevated
osteomalacia care
pharmacological interventions;
- calcium gluconate
- vit D daily, until signs of healing take place
- high protein diet
- UV radiation therapy
osteomalacia management
teach about intake of dietary vit D
importance of safe sun exposure to gain vit D
what is osteporosis
reduction in bone mass, loss of bone strength and an increased risk of fracture
contributing factors to osteoporosis
aging heredity nutrition lifestyle medications
risk factors in osteoporosis
low bone density history of scoliosis female - northern european and asian neruological impairement - stroke parkinsons decreasd vision complications of diabetes
osteoporosis manifestations
acute fractures
hisotyr of falls
pain greater when active and typically occurs in mid-low thoracic spine
kyphosis: dowagers humps
- may lose 2 or more inches in height
osteoporosis manifestations
CBC of calcium, phosphate, alkaline phosphatase
x-rays
DEXA scan
- assess cortical and trabecular bones in the spine and hip
T-score of -2.5 ore lower indicates osteoporosis
osteoporosis care
weight bearing exercises
nutritional changes
pharmacological interventions:
antiresportive agents
- do not increase bone mass but prevetnt further bone loss
estrogen therapy calcitonin peptide hormone biphosphonates - inhibit bone resoprtion
androgen
-taken long term
surical intervention
- Vertebroplasty
- kyphoplasty
clients taking oral biphosphonates should be instructed to:
- take them with a full glass of water
- take them at least 30 minutes before food and other meds
- stay upright for at lesat 30 min after taking them
what is pagets disease
slow progressing resporption and irregular remodeling of bone
cause is unknown
- viral implication and family tendencies
bone is resolved and new bone develops poorly
bone is weak and fractures easily - affects the skull - femur 0 tibia - pelvis - vertebrae
pagets disease manifestation
initially asymptomatic
as disease progresses:
- pain and point tenderness of affected limbs develops
pathologic fractures - femur or tibia
deformity of long bones
pagets disease diagnostic studies
radiographic studies
- show a bowing of long bones
- thickened areas of bones
labs
- increase in alkaline phosphataste
- increase in urinary hydroxyproline
- calcium will be normal
pagets disease care
pharmacological interventions:
NSAIDs
biphosphonates - alendronate
- slows bone resportion
calcitonin - slows bone resportion
plicamycin
- used when nerve ares damaged and the client is unresponsive to other treatments
surgicla interventions
pagets disease management
administer meds
pain management
increase mobility
physical therapies cllaborate
collaborate with nutrition therapy
firm mattress for sleep
some may need to wear a corset or back brace
what is oteomyelitis
bacterial infection of the bone
staph aureus is the most common
osteomyelitis manifestation
pain, loclized, tenderness
erythema over the involved bone
decreased ROM at affected bone
irritability
restlessness
fever
osteomyelitis diagnostic studies
lab tests: - increased ESR blood cultures and bone aspirate cultures CBC increased WBC
radiographic tests
- often negative for 10-14 days
bone scan
osteomyelitis care
IV atibiotics will be administered
long term IV access
-4-6 weeks
surgery and/or immobilization
osteomyelitis management
monitor antibiotic levels
- peak and trough
monitor level of comfort
encourage to perform ROM exercises if possible
- but DO NOT allow weight bearing exercises
monitor clients nutritional intake and status
hpysical therapy at home
IV access for antibiotic therapy
what is hip arthroplasty
replacing the entire hip joint, either total hip of the femoral head and acetabulum
or partial hip replacement - femoral head only
indications for surgery
OA RA femoral neck fractures avascular necrosis of femoral head caused by steroids failure of previous prosthesis
hip arthroplasy post op care
immediate post op care:
- benefite from PCA using peripheral or epidural catheter for first 48 hours after
- PCA will aid in early mobilization
intermediate to long term post op care:
- monitor neurovascular status of leg
- pulmonary hygiene
- prevent abduction of hip
- used in the first postoperative week while the clients sits in a chair or bed
- turn client by logrolling
- use fraacture bedpan
- monitor for hip dislocation
- low molecular weight heparin
- collaborate with physical therapist for early ambulation and exercise
hip arthroplasty client and caregiver education
correctly use assistive device
implement strategies to prevent dislocation
- raised toilet seat
perform prescribed exercises at home
avoid sitting for more than one hour at a time
wear antiembolism stocking
adhere to anticoagulant therapy
fall prevention measures
knee arthroplasty post op care
apply ice to knees
physical therapy will be started within 24 hours to promote bone function
continuous passive motion (CPM) in use
when not in use, a knee immobilizer might be used
amputation indications
progressive periphera vascular disease gangrene trauma congenital deformities malignant tumors
amputation management
phantom limb pain can be relieved with:
- stump desensitization through kneading or massaging of the stump
- TENs
- distraction
- beta adrenergic blocking agents for burning, dull pain
- anticonvulsants for sharp and cramping pain
phantom limb pain may occur any time up to 3 months or longer post-amputation
- most common with above the knee amputation
use aseptic dressing change
compression wrapped in a figure eight fashion
casting to control edema
early rehabilitation
prostatic preparation is key to restoring mobility
below the knee amputation;
- client should lie SUPINE with the affected leg fully extended for 20-30 minutes, 3-4 times/day
above the knee amputation:
- client should lie PRONE with the affected leg fully extended for 20-30 min, 3-4 times/day
convey body image acceptance
- not ALL clients are candidates for a prosthesis after amputation, it required a lot of upper body strength.
- for those who struggle in these areas, should use a wheelchair
rheumatoid arthritis pharmacological interventions
pharmacological interventions:
- NSAIDs
- hydroxychloroquine sulfate
immunosuppressant agents like:
- azathioprine
- cyclophosphamide
- methotrexate
- prednisone
- sulfasalazine
- lefluromide
- anakinra
biological response modifiers:
- etanercept
- infliximab
- adalimumba
sulfasalazine side effects
crystalluria
- drink 8 glasses of water to produce 1200- 1500mL/day
photosensitivity
risk of sunburn
folic acid deficiency
- so take folic acid 1mg/day
agranulocytosis (leukopenia)
- report sore throat immediately
stevens johnson syndrome
- stop if getting rash
urine and skin will turn orange but normal
- will go away once discontinued
