Musculoskeletal Flashcards by Erin Harris

What is a lab level affected by gout?

Serum uric acid; will be increased

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Autoimmune reaction starting in the synovial tissue and involves formation of pannus

Rheumatoid arthritis

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What could cause persistant swelling, no stiffness, and full range of motion in someone with a hx of rheumatic disease?

an inflammatory process

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Crest Syndrome (limited scleroderma)

autoimmune disorder characterized by skin tightening and hardening; stands for calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasias

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Allopurinol (Zyloprim)

Used to lower uric acid levels in patients with gout; can cause bone marrow suppresion leading to low platelets

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Education for a pt on steroids

Take as ordered and wean off of them. Should only be used short term. A side effect of long term use is moon face.

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What is Polymyalgia Rheumatica(PMR)?

A rheumatic condition that causes muscle pain and stiffness. Primarily occurs in Caucasians; associated with the genetic marker HLA-DR4; immunoglobulin deposits may occur

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An exacerbation of gout can be caused by these:

alcohol and red meat

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Giant cell arteritis

an inflammatory autoimmune disease that effects the large and medium arteries of the head and neck

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Lab tests to diagnose Giant Cell Arteritis

Erythrocyte sedimentation rate and C-Reactive Protein

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Scleroderma

excessive collagen production causing the hardening and thickening of skin and organs

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Priority assessment of this system to see if there is systemic involvement of scleroderma

GI-common and significant

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Rheumatic disorder that could effect the mood, behavior, and LOC of a patient

Systemic lupus erythematosus (SLE) d/t possible inflammation and damage to the brain

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In the early stages of rheumatoid arthritis, a pt may be prescribed

Methotrexate; it can decrease the activity of the immune system which may slow joint damage and help with pain

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An increased thoracic curvature of the spine

Kyphosis

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What is paget disease?

A disease that causes abnormal bone remodeling (the bone breaks down and remodels at an abnormal rate); enlarged and weakened bones

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What lab can you expect to be effected with Paget Disease?

Serum calcium d/t abnormal bone breakdown and remodeling

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What lab level can you expect to be high with cancer that has metastasized to the bone?

Alkaline Phosphate as it increases with bone cell activity and there is typically an increase of osteoblasts with bone cancer

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Abnormal labs that may lead to the diagnosis of hypophosphatasia?

low alkaline phosphatase and very high B6

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A complication of Hypophosphatasia

Craniosynostosis which is the premature fusion of the cranial sutures leading to increasing intracranial pressure

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Treatment for musculoskeletal injuries

RICE; Rest, Ice, Compression, and Elevation

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Education for pt needing to ice an injury

Cold packs should be used no longer than 20 minutes at a time with a barrier to protect the skin

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Fracture that is bent to one side and not complete

greenstick; common in pediatrics

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Immediate treatment of an open fracture

Sterile dressing

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1st thing to do for a fracture

Immobilize it to prevent further damage

Complication of a fracture

Fat embolism

Symptoms of a fat embolism

chest pain, increased heart rate and resp rate, febrile and hypoxic, personality changes, restlessness, irritability, and confusion following fracture

Signs of fat embolism in the lungs

hypoxia, tachypnea, tachycardia, and SOB

5 P's

pulselessness, pallor, paresthesia, pain, and paralysis

What is compartment syndrome?

increasing pressure in a muscle compartment leading to restricted blood flow and tissue damage; severe pain, numbness, tingling, and weakness

Treatment for compartment syndrome

Fasciotomy; cutting through the fascia (connective tissue surrounding the muscle) to relieve pressure on the compartment

Early complications following femur fracture

DVT, Compartment syndrome, and Fat embolism

If the 5 Ps are assessed, the nurse should

notify the physician immediately; pt can lose the limb within an hour

Potential complications of splint or brace

pressure injury, hot spot, compartment syndrome

If a hot spot is assessed, what could be occurring?

an infection; s/s hot, swelling, redness, fever, drainage with foul odor

When assisting with plaster cast,

use palms of hands for even pressure, not fingers

Education for pt with itching under cast

no foreign objects, hair dryer on cool- scratching could cause infection

With external fixation

there will be pins on the outside of the skin; monitor for infection and clean with chlorohexidine

Nursing interventions with Buck's traction

DO NOT ADJUST(physician only); weight should be hanging freely

When assessing a pt's traction

the knots in the rope should NOT be resting against the pulleys

Caring for a pt in traction

weights are hanging freely, assess client's alignment, assess pain level, and place trapeze in the bed for client use

If chlorhexidine solution can not be used, use

Saline

Inspect pin sites

every 1-2 hours

A suspected hip fracture may appear with

one leg shorter than the other and external rotation

With hip fractures, turn every:

2 hours!!!

Complications from immobilization following fracture

Blood clot, PE, infection, pneumonia

How to prevent complications following fracture:

turn, cough, deep breath at least every 2 hours and encourage incentive spirometer

After an amputation, monitor closely for

signs of hemorrhage

This item should be kept at the bedside following amputation

Tourniquet

Treatment for phantom pain

take opioid analgesics as ordered

Diagnostic test for osteoporosis

DEXA scan (measures bone density)

DEXA Scan

Hip and spine are most common scan areas, bone pain may indicate need, and Females 40-49 should have baseline scan

Prevention of osteoporosis

Calcium and Vitamin D

Incomplete dislocation of a joint

Subluxation

5 manifestations of a fracture

acute pain, loss of function, deformity, crepitus, swelling/discoloration

2 complications of a cast or splin

Compartment syndrome and pressure injuries

Counterforce to ensure proper alignment in traction

pts body weight and positioning

To prevent contractures after amputation, place the pt in this position

Prone

Surgical treatment of fracture using pins, wires, screws, or plates

open reduction and internal fixation

Grading scale for severity of sprains

1st, 2nd, and 3rd degree

Skin traction should be monitored for these 3 complications

skin breakdown, nerve damage, and circulatory impairment

Nursing goals for wound healing in amputation patients

proper bandaging, massage, and toughening of the residual limb

A complete dislocation is considered a medical emergency due to the risk of these complications

loss of mobility and neurovascular compromise

Support active participation by amputees to:

foster independence and improve mobility

This condition involves pain radiating down the leg, caused by nerve compression

sciatica

This prevents hip dislocation after total hip arthroplasty

abduction pillow

This test evaluates nerve root involvement by lifting the leg straight while in supine

straight leg raising test

Cornerstone of osteoporosis treatment, helping to slow bone loss

bisphosphonates

After taking a bisphosphonate

Sit upright for 30min

This infection of the bone is usually caused by S. Aureus

Osteomyelitis

A positive tinel sign suggests this condition

carpal tunnel syndrome

Elevating the hand to heart level is essential in reducing swelling after this surgery

hand or wrist

S/S of this condition is localized pain, kyphosis, and shortened stature in pts with osteoporosis

vertebral compression fracture

Pts with septic arthritis often present with these systemic features

chills and fecer

Common blood thinners used after total joint arthroplasty to prevent DVT

Lovenox, Heparin, Eliquis, Xarelto

Tinel Sign test

light tapping over median nerve to test for numbness and pain

Muscle relaxant used for lower back pain

Flexaril-DO NOT OPERATE HEAVY EQUIPMENT

Malignant bone tumor is most common and often fatal

osteosarcoma

Progressive musculoskeletal disease linked to shortening of palmar fascia causing deformity of the fingers

Dupuytren's disease

Bed rest position with hips and knees flexed to alleviate low back pain

lateral or curled position

Post op Neurovascular checks for the first 24 hours

every 1-2 hours

Medication prescribed for low back pain with nerve damage or radiculopathy

Gabapentin

Type of benign bone tumor that can cause local tissue destruction despite being slow growing

osteoclastoma (giant cell tumor)

Joint disease characterized by narrow joint spaces and osteophyte formation

osteoarthritis

Post op, drains are typically removed during this time frame to reduce infection risk

24-48 hours

Condition that can occur as a complication of chronic osteomyelitis and presents with low grade fever

chronic infection