Musculoskeletal Flashcards
Which nerve is affected in Carpal Tunnel Syndrome
Median
What’s Phalen’s maneuver?
Produces paresthesia in the median nerve distribution within 60 seconds. Upside down prayer with nails facing each other.
What is Tinel’s sign?
Tap lightly over median nerve in wrist and inflate a blood pressure cuff in upper arm to patient’s systolic pressure. If there’s pain and tingling, it’s a positive sign
What is an electromyography
Recording of the electrical activity of peripheral nerves by testing muscle activity
Pharmacological therapy for CTS
NSAIDS and corticosteroid injections
Open carpal tunnel release surgery for CTS
Transverse carpal tunnel ligament is cut to provide nerve decompression
Endoscopic carpal tunnel releases surgery for CTS
Free trapped median nerve through an endoscope inserted
Priority nursing interventions for post-op carpal tunnel release
n/v, elevate hand, VS, monitor dressing, pain management
How long should you restrict hand movements and heavy lifting for carpal tunnel?
4-6 weeks
What is gouty arthritis
Systemic disease that involves deposits of urate crystals in the joints & other body tissues leading to inflammation. It is the most common inflammatory arthritis.
Primary gout characteristics
Problem with purine metabolism Too much uric acid for the kidneys to excrete Sodium urate deposits in synovium and other tissues leading to inflammation Middle-age men and post-menopausal woman. More stages
Secondary gout characteristics
Hyperuricemia secondary to disease Renal insufficiency, diuretic therapy, and chemo agents used to decrease uric acid excretion Treating underlying problem Prolonged pain Affects persons of all ages
Clinical stages of gout
Asymptomatic - no obvious signs Acute gouty arthritis - inflammation and excruciating pain in one or more small joints. Increased ESR and usually occurs in the great toe Inter-critical stage - symptom free period Tophacerous gout (chronic) - Urate crystals develop under the skin and within major organs after repeated acute attacks. Kidney stones may form
Acute gout
Joint inflammation Elevated serum uric acid level >6.5 Urinary uric acid levels may or may not be increased Increased BUN/Cr Arthrocentesis - synovial fluid aspiration to detect the uric crystals on the affected joints
Chronic gout
Presence of tophi-sodium urate crystal deposits (irregular shape, may break if skin is irritated, improperly managed gout). Outer ear, arms, and fingers near the joints Renal calculi/dysfunction
What is colchicine (colsalide)
Used in acute gout to decrease inflammation by preventing the migraines of leukocytes to the inflamed site. Take with food.
Name meds for acute gout
Colchicine (colsalide)
Indomethacin (indocin)
Ibuprofen (motrin)
Corticosteroids
Meds for chronic gout
Xanthine oxidase inhibitors (allopurino (zyloprim), Febuxostat (uloric))
Uricosuric (probenecid (benemid))
combination drugs (colbenemid).
Nutrition therapy for gout
Avoid excessive alcohol, avoid fad diets, low purine diets (avoid shellfish, fish), limit protein foods, increase fluid intake, avoid aspirin & diuretics, avoid excessive stress (can cause exacerbations).
What are isometric exercises
Building muscle strength, but not lengthening the muscle. Leaning against a wall and pressing against it or pressing the right hand against the side of the face with resistance.
How to decrease kyphotic pressure
Use arm support on chairs and encourage proper body mechanics
What is ALP
Alkaline phosphatase - Musculoskeletal damage causes a rise in it. As a part of the aging process, older generation has a higher ALP
Which tests do you require to stabilize the joint for 12 hours?
Arthrogram (picks up tears in the joint capsule by injecting air or radiopaque contrast into the joint which allows visualization)
calcitonin vs pth
calcitonin decreases calcium, pth increases it (inverse)
PTH action on body
reduces renal excretion of calcium and facilitates absorption from the intestines
Calcitonin action on body
Inhibits bone resorption by stopping the break down of bone calcium that would increase serum calcium levels.
Why are steroids bad for bones
They have a negative affect on calcium metabolism. It promotes bone loss
What are glucosamine and chondroitin?
medications that treat arthritis
Hypocalcemia effects
More excitable membranes (increased skeletal and smooth muscle contraction) - cramps, seizures, paresthesia, trousseau’s and chvoslek’s signs - CV: arrhythmia, irregular heartbeats, MI
IV calcium should be administered how fast?
SLOWLY - it’s a severe tissue irritant.
How do you move a client with fragile bones
With a lifting sheet and not pulling on their extremities
Thiazide diuretics relationship with calcium
increases the absorption
Hypercalcemia s/s
Decreased excitability and decreased depolarization
CV: cardiac arrest, faster clotting, cardiac depression, dysrhythmias,
NM: loss of consciousness, confusion, coma
GI: constipation, n/v, anorexia, decreased motility
How often do you perform n/v checks with fractures
q1h
How big are the weights for skin traction? skeletal?
skin: 5-10, skeletal: 15-30
In regards to complications in fractures, are sensory changes an early sign or late? how about motor?
changes in sensory is an early sign of complication, motor is a late sign.
Also: paint out of proportion to the injury is a later sign of complication
Teachings to prevent hip dislocation
Do not sit or stand for prolonged periods
Do not cross legs beyond the midline of the body, do not cross them at all.
Do not bend at your hips more than 90 degrees
Use an ambulatory aid
No BLTs (bending, lifting, turning)
Sit in a 90 degree chair rather than a slouched chari
Pelvic fracture #1 concern
Hemorrhage
Management of osteomyelitis
Nonsurgical:
IV antibiotics
Wound irrigation
pain mangaement
Hyperbaric oxygen therapy
Standard vs contact precautions (depends on the drainage)
Surgical:
Sequestrectomy - allowing revascularization of necrotic tissue and promoting healing to the bone
Bone grafting - using bone material to fill the gap
Muscle flap - using cadavers or even using other small bones from other locations to fill in the bone from amother area
FES early detection (Fat embolism syndrome)
Other symptoms?
AMS (decreased LOC, anxiety, restlessness, drowsiness) is #1
SOB, chest pain, dyspnea, increased pulse, RR, tachycardia, Decreased O2
Latest sign- petechiae
Diagnosing FES
CXR (snowstorm infiltrate)
increased ESR
Decreased serum calcium, RBCs, and platelets
Increased serum lipase
Free fat in urine
Treating FES
Immobilize and give oxygen
What is compartment syndrome?
What are the risk factors?
What are the interventions?
Increased pressure within one or more compartments (where muscle, nerve, etc reside) causing reduced circulation to the area. It is a medical emergency. Risk factors include fractures, severe burns, insect bites, severe IV infiltration, tight dressings and cast dressings. Interventions include lowering the extremity to get tissue perfusion and blood flow.
What is rhabdomyolysis
How do you treat it?
Results from a large injury to skeletal muscles causing a release of myoglobin into the circulation
Caused by burns, compression/crush injury, seizures, cocaine abuse, infections.
Treatment: massive IV infusion to prevent myoglobins from creating renal damage, correct hyperkalemia, mannitol to enhance renal prefusion, dialysis, and BM
