musculoskeletal (class 5) Flashcards
complications of immobility:
musculoskeletal: joint stiffness, contractures, foot drop, bone demineralization, muscle spasms/atrophy, osteoporosis.
Respiratory: risk for pneumonia, decrease chest expansion, decrease cough reflex.
Cardiovascular: orthostatic hypotension, DVT, decreased venous return.
GENITOURINARY: urine retention/incontinence, impotence, inability to ejaculate, decreased vaginal lubrication.
GASTROINTESTINAL: stool incontinence, constipation/parylytic ileus, stress related ulcers.
INTEGUMENTARY: pressure ulcers.
spinal cord injury:
injury occurs to either: vertebrae & ligaments, blood vessels, damage to vertebrae ligaments, blood vessels makes spinal cord unstable incrasing possibility of compression or stretching of cord with further movement. rarely is spinal cord completely severed.
primary injury to SC
the initial mechanical distruption of axons
secondary injury of SC
ongoing, progressive damage that occurs to spinal cord neurons from: further swelling, demyelination, necrosis.
paralysis
partial or complete loss of muscle function
complete SCI
complete interuption of motor & sensory pahtways. results in total loss of motor & sensory function below level of injury.
incomplete SCI
parial interruption of motor or sensory pathways. variable loss of funcion below the level of injury.
paresis
parial paralysis/weakness.
upper motor neurons
responsible for volunrtary movement.
injury leads to: increased muscle tone/spastic paralysis. decreased muscle strength. inability to carry out skilled movement. hyperactive reflexes.
lower motor neuron
responsible for innervation and contraction of skeletal muscles.
injury leads to: decreased muscle tone, muscle atropy/flaccidity/weakness, loss of reflexes, loss of voluntary & involuntary movements. partial to full paralysis depending on how many motoro neurons affected
paraplegia
damage to thoracic, lubmbar, or sacral area of the cord. loss or impairment of motor and/or sensory function the trunk, legs, and pelvic organs. arms are spared. T6 level injury=use of arms & upper chest. L1 level injury use of all but legs. full independence in self care in w/c.
tetraplegia(quadriplegia)
C1-C4 injury: c1-c2 injuries could result in death. often fatal at scene. respiratory paralysis common. ventilator, head& neck movemtn only. require 24hr care. below c4 may not be ventilator dependent. c6 shoulder movement.
IM INJECTIONS
given above the level of injury. reduced use and blood flow to muscles can result in impaired drug absorption, increased risk of local irritation and trauma, may result in ulceration of tissue.
autonomic dysreflexia
what is it?:
exaggerated sympathetic response in SCI patient at or above T6 injuries. triggered by stimult that normally causes abdominal pain.
pathophysiology: stimuli is unable to ascend the cord. causes stimulation of sympathetic nerves below level of injured cord resulting in massive vasoconstriction. vagus nerve causes bradycardia & vasodilation about level of injury.
autonomic dysreflexia
triggers: full bladder, fecal impaction, pressure ulcers, dressing changes, ingrown toenails, surgical procedures, labor contractions.
s/s: pounding HA, bradycardia & HTN, vasodilation with warm flushed skin, pale cold dry skin below level of injury.
autonomic dysreflexia
1st raise HOB sit patient up. identify cause. remove stockings or boots to decrease BP. may be hypotensive after simulus removed.
Halo traction
external fixation device. used to provide stabilization. 4 pins inserted into the skull & ring attached to pastic vest.
PROS: greated mobility, self-care, participation in rehad programs.
amputations
partial or total removal of extremity.
cause: PVD, PVD risk factors: smoking, DM, HTN, hyperlipidemia. peripheral neuropahty, untreated infections, trauma.
amputations
post-ip complications: infection, hemorrhage, delayed healing, phantom limb pain, contractures.
Nursing interventions: keep incision clean & dry, maintain stump dressings decrease edema, medicate for pain, AKA patients avoid prolonged sitting, BKA elevate stump keeping joint extended.
bone tumors
benign bone tumors: more common, grow slowly, do not often destroy surrounding tissue.
malignant: primary: rare <0.2% of all adult cancers. secondary: more common, grow rapidly.
3 Main symptoms:
1. pain: develop slowly, lasts > week, constant or intermittent, may be worse at night.
2. mass: firm swelling or lump on the bone, slightly tender, palpable.
3. impaired function: may interfere wiht normal movement and/or cause a fracture.
osteoporosis
non-modifiable risk factors
older age, family hx of osteoporosis, female, thin and/or having a small frame.
osteoporosis modifiable risk factors
low estrogen, low testosterone, low lifetime calcium intake, vit D deficiency, medications: corticosteroids, some anticonvulsants. lifestyle: inactivity, cigarette smoking, excess alcohol use.
osteoporosis complications
fractures: spontaneous & everyday activities. hip and vertebral fractures increase risk of death and disability.
osteoporosis diagnosis
bone mineral density test. estimate skeletal mass or density
duel-energy xray absorptiometry highly accurate, measures bone density of spine or hip.
osteoporosis treatment
early identifiction of risk, stop or slow process, alleviate symptoms, exercise.
calcium, vitamin D, biphosphonates, estrogen replacement, calcitonin.
bursitis
inflammation of a bursa, shoulder, elbow and hip most common can also occur in the knee heel and base of big toe. pain and decreased ROM
tendonitis
inflammation of a tendon, tendonitis is most often caused by repetitive, minor impact or acute injury. pain and tenderness.
myositis
inflammation of a muscle. injury, infection, or autoimmune causes. S/S fatigue after activity, tripping or falling, difficulty swallowing, or breathing.
treat: rest, cold, anti-inflammatory meds.
synovitis
inflammation of synovial membrane of a joint, common w/ knee injury. swelling decreased mobility pain effusion in joint.
treatment: synovectomy (reduces inflammation) rest, ice.
osteomyelitis risk factors
older adult. hemodialysis & IV drug users. joint replacement & fracture stabilizing hardware.
osteomyelits causes:
penetrating wound, bacteremia, skin breakdown with vascular insufficiency, usually by staph aureus.
osteomyeleitis symptoms:
local: swelling, redness, warmth, pain.
systemic: fever, malaise, tachycardia, anorexia.
osteomyelitis diagnosis
bone scan, US, MR. Blood test: ESR & WBC elevated. blood and tissue cultures, biopsy.
osteomyelitis treatment
IV antibiotics 4-6 wk, oral cipro for chronic, surgery, debridement is primary treatment with chronic osteomyelitis
osteoarthritis risk factors
increasing age, genetics, obesity, inactivity, repetitive joint use.
pathophysiology: progess loss of joint cartilage causing increased friction in joint=pain, stiffness, loss of joint motion and gait disturbances. bone on bone over time.
osteoarthritis symptoms
onset is gradual and slow progession. pain and stiffness. pain may be relieved by rest. joint stiffness after long periods of rest. ROM of joint decreased. grating sound or crepitus with movement. herberdens nodes on distal phalangeal joints.
osteoarthritis diagnosis
patient history, physical exam, xray of joints.
osteoarthritis treatments
mild analgesics: tylenol for long temr use. NSAIDS reduce inflammation not for long term use. COX-2 inhibitors less GI risk good for intolerant to NSAIDS. topical creams: less systemic adverse effects proved to help. rest, exercises, steroid lidocain injections, surgery, assistive devices, weight loss.
acute gout
inflammation of joint usually great toe, pain wakes you up at night.. joint hot, swollen, very tender, fever. last hours to days. elevated uric acid )8.5, WBC, & sedimentation rate.
advanced gout
occurs when hyperuricemia is not treated. urate deposits call tophi seen most common in helix of ear, tendons of fingers, tissues surrounding joints.
gout complications
kidney stones from urate can lead to kidney failure. tophi may develop in tissure of heart and spinal epidrual compressing nerves.
gout treatment
acute treatment: NSAIDS-reduce swelling, colchincine-stops urate crystal deposits. steroids.
prophylactic:
clchincine, allopurinol- lowers urate levels, dietary & lifestyle modifications. high purine foods: beer/grain liquors, red meant organ meats, spinach asparagus cauliflower, seafood especially shellfish.
LUPUS risk factors
women 10:1 ratio to men. family history. environmental. women who use estrogen contraceptives.
Lupus what is it?
chronic inflammatory disease that occurs when your bodys immune system attacks your own tissues and organs.
lupus pathophysiology
autoantibodies produced > targer specific tissues > inflammatory response > destructive enzymes produced causing tissue damage. causes multisystem effects on body.
lupus clinical manifestations
extreme fatigue, unexplained fever, swollen joints & muscle pain, red butterfly rash across cheeks and bridge of nose. photosensitivity, avoid sun.
lupus complications
renal failure and stroke
lupus treatments
mild: little to no treatment besides supportive care tylenol NSAIDS aspirin.
skin& arthritic manifestations: hydroxycholoroquine, effective in reducing frequency of acute episodes retinal toxicity and blindness side effects.
sever lupus: high dose coritocsteroids to manage symptoms & prevent organ damage. may need steroids long temr.
immunosuppressive meds: monitor infections, labs, kidney, & liver function.
polymyositis
autoimmune systemic connective tissue disorder causing inflammation of connective tissue and muscle fibers.
polymyositis risk factors
unknown cause. women > men
polymyositis manifestations
skeletal muscle weakness is main symptom. pelvie and neck muscles particularly. muscle pain and tenderness. weakness progresses over weeks to months. dusky red rash on face and upper trunk.
polymyositis diagnosis & treatment
no specific test for diagnosis, creatine kinase elevated 25-170 normal ranges.
rest, corticosteroids, immunosuppressive agents.
Rheumatoid arthritis (RA)
chronic systemic autoimmune disease causing inflammation of connective tissure primarily in joints, cause unknown.
RA risk factors
thought to be genetic, emotial stress cause flare ups, women 3:1 to men, heavy smoking, speculated that infectious agent such as a virus plays a role in initiating abnormal immune response.
RA, clinical manifestations
joint swelling, stiffness, tenderness, warmth, ROM limited in affected joint. deformity of joints, joints feel sponge-like on palpation.
RA diagnostic tests
elevated c-reactive protein & esr, anti CPA blood test, more specific marker for RA. synovial fluid from joint cloudy. xrays of joints most specific test for RA.
RA treatment goals
no cure relieve pain, reduce inflammation, slow or stop joint damage, improve well-being and function.
RA meds
NSAIDS & steroids reduce inflammation and pain, disease modifying anti-rheumatic drugs slow bone erosion, improve ROM, monitor for blood dyscrasias.
RA treatment
PT & OT, assistive devies and splints. nutrition.
surgery
synovectomy: to relive pain and reduce inflammation, arthrodesis to stabilize joints wrists, ankles, cervical. arthroplasty imprved mobility decrease pain.
osteotomy to change alignment or correct deformity.
