musculoskeletal Flashcards
cast care
after swelling subsides, support extremity from underneath the palm
fingertips should NOT be pressed into cast
should not rest on hard or sharp surface before dried
cleanse pt of excess cast material
wait 30 min before weight bearing
dry plaster cast is odorless, resonant, and white, feels close to room temp
compartment syndrome
impaired blood flow within fascia
caused by external pressure (casts, splints, crushing injury, surgery, trauma)
or internal pressure (blood or fluid accumulation)
compromise in circulation, tissue death, nerve injury, ischemic-edema cycle
4-6 hr untreated= irreversible neuromuscular damage
24-48 hr, limb becomes functionless (amputation)
compartment syndrome manifestations
unrelieved ischemic pain (not controlled with analgesics)
pain with elevation (decreased arterial flow)
diminished or absent pulses distal to injury
cyanosis of extremity
tingling/paresthesia
coolness of extremity
weak
irreversible neuromuscular damage, functionless limb
osteoporosis
disrupted remodeling process
osteoclast (bone resorption)
osteoblast (bone building)
low bone mass, loss of Ca, bone deterioration, porous bone
decreased bone mineral density (peaks between ages 10-35), decreased rapidly with postmenopause
increased bone fractures- hip, vertebrae, radius
osteoporosis risk factors
female, post menopause, breastfeeding, caucasian, asian, african american, family hx, sedentary, smoking, alcohol, Ca and/or Vit D deficiency, liver disease, antithyroid med, anticonvulsant med, corticosteroids
osteoporosis patient education
encourage dairy, Ca supplements, Ca foods (greens, sardines, salmon with bone, broccoli)
avoid high intake of protein, sodium, caffeine
weight bearing exercises (walking or running)
Ca supplements with 6-8oz of water and food
disphosphonates to increase BMD (taken 30-60 min before meals)
osteoporosis medical management
prevent loss of BMD
prevent bone resorption= hormone replacement therapy in post menopause
osteoarthritis
slowly progressive chronic-joint disease
degeneration and loss of cartilage covering synovial joint surfaces
most common form of arthritis
risk factors- middle ages, obesity, knee arthritis, sports, work injuries, repetitive joint injuries, genetics (defective cartilage or joints)
clinical manifestations osteoarthritis
Early morning stiffness & joint pain, crepitus
Pain occurs during activity and relieved with rest
deficits in ROM
joint enlargement
heberden’s nodes (raised bony growths over distal interphalangeal joints of hand)
bouchard’s nodes (raised bony growths over proximal interphalangeal joints of hand)
total knee replacement
continuous passive motion (8hr/day)
teach s&s of infection, DVT
physical therapy
prophylactic antibiotics
total hip replacement
maintain 90º flexion of hip for 4-6 weeks
sit in straight and high chairs with arms
abduction pillow
avoid internal rotation of toes, crossing legs, twisting to reach objects, driving, tub baths, for 4-6 weeks
elevated toilet seat
complications of THR and TKR
calf and groin DVT
pulmonary embolism (prophylaxis LMW heparin)
infection (wound drainage, fever, pain, odor)
long term complications: joint stiffness, post-traumatic arthritis, avascular necrosis, nonfunctional union after fracture, malunion
arthocentesis
surgical puncture of the joint
pin assessment and care
check every 8 hours
ice for first 24-48 hours (only one hour at a time to prevent edema)
sterile cotton tipped swab used to clean one pin at a time
bucks traction
may be used before surgery
returns bone fragments to original position
partial weight bearing
no fowler position, joint ROM every shift
