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
