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Nursing Theory IV > Musculoskeletal Disorders > Flashcards

Musculoskeletal Disorders Flashcards

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1
Q

Health Assessment

A
  • Chief complaint, onset, duration and manifestations
  • Effects on function – ADL’s
  • Precipitatingfactors
  • Pain – 5th vital sign
  • Inspect and palpate bones/ joints deformity, tenderness, swelling, warmth and ROM
  • Gait, posture, sitting, ability to walk
  • Muscle strength
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2
Q

Diagnostic Tests

A
  • Xray
  • CT
  • MRI
  • Bone density
  • Bone Scan
  • Arthroscopy & arthrocentesis
  • Blood Work: Calcium, phosphate, alkaline phosphate, Uric acid, RF
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3
Q

Preventing Trauma

A 
Prevention is key
Teach importance of using safety equipment
Older client
- At highest risk for falls
- Safety in the home
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4
Q

Soft Tissue Trauma: Nursing Care, Assessment

A
  • Mechanism of injury
  • Protective devices
  • Pain assessment
  • Inspection for redness, swelling, deformity
  • Range of motion
  • Palpation for warmth, tenderness, crepitus
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5
Q

Soft Tissue Trauma: Nursing Care; Decrease Swelling and Pain (PRICE)

A 
To decrease swelling and pain 
- PRICE
• Protect
• Rest
• Ice
• Compression 
• Elevation
- Heat after several days
- NSAIDs
• Impaired physical mobility
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6
Q

Soft Tissue Trauma: Nursing Care, Teaching

A
  • Promote comfort
  • Prevent further injury
  • Allow healing
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7
Q

Joint Trauma: Nursing Care

A 
• Assessment of pain,neuromuscular status
• Traction to maintain alignment
• Implement care to prevent complications of immobility
• Teaching
- Immobilization recommendations 
- Skin care
- Pain control
- Rehabilitation exercises
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8
Q

Dislocations

A
  • Manual traction to reduce dislocation
  • Narcotics
  • Musclerelaxants
  • Conscious sedation to control pain and manipulate the joint back into place
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9
Q

Fractures: Nursing Care

A 
• Needs prompt treatment 
• Goal of treatment:
- Anatomic realignment of bone fragments (reduction)
- Immobilization to maintain alignment 
Restoration of normal function
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10
Q

Fractures: Emergency Care

A
  • Immobilize before moving client
  • Joint above and below
  • Check pulse, colour, movement, sensation before splinting
  • Sterile dressing for open wounds
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11
Q

Nursing Management: Nursing Assessment

A

Brief history of the accident
Mechanism of injury
Special emphasis focused on assessment of the region distal to the site of injury

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12
Q

Fractures: Nursing Care, Assessment; Neurovascular

A 
Pain
Pulses
Sensation
Skin color
Temperature
Motion
Edema
Motor Function
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13
Q

Collaborative Care: Fracture Reduction; Closed Reduction, Open Reduction

A

Closed reduction
Non‐surgical, manual realignment casts
Open reduction
Correction of bone alignment through a surgical incision

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14
Q

Casts

A
  • Rigid device to immobilize bones and promote healing
  • Plaster or fiber glass
  • Joints above and below fracture
  • Type of cast depends on type of fracture
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15
Q

Collaborative Care: Fracture Immobilization; Traction

A

Application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction
Prevent or reduce pain and muscle spasm Immobilization
Reduction
Treat a pathological condition
Prevent deformity

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16
Q

Traction

A
  • Manual
  • Skin
  • Skeletal
  • Straight
  • Balanced suspension
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17
Q

Collaborative Care: Fracture Immobilization; Internal/ External Fixation

A

Internal Fixation
- ORIF
- Pins, plates, intramedullary rods, and screws
- Surgically inserted at the time of realignment
External fixation
- Metallic device composed of pins that are inserted into the bone and attached to external rods

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18
Q

Fractures: Other Interventions

A
  • Analgesics
  • NSAIDs
  • Parenteral pain medications
  • Stool softeners
  • Anti‐ulcerdrugs
  • Electrical bone stimulation
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19
Q

Fractures: Nursing Care

A 
• Pain
• Impaired Mobility
• Risk for Ineffective Tissue Perfusion 
• Evaluate effectiveness
- Pain control
- Safety and mobility
- Tissue perfusion
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20
Q

Fractures: Teaching, Risk for Falls

A 
Teaching
- Care at home
- Safety assessment
- Ambulation with Assistive devices
• Risk for falls
- Fall prevention
- High risk for hip fractures
• Decreased bone mass and muscle strength
• Slowed reflexes
• Medications affecting cognition and balance 
• Osteoporosis
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21
Q

Hip Fracture

A

• Break in the femur at the head, neck, or trochanter regions
- Intracapsular
- Extracapsular
• Pain, shortening, and external rotation of the affected lower extremity

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22
Q

Hip Fracture

A
  • Buck’s traction
  • ORIF
  • Arthroplasty
  • Total hip replacement
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23
Q

Hip Fracture Nursing Care

A
  • Hip precautions
  • Abductor pillow
  • Isometric exercises
  • Physical therapy
  • Hip chair
  • TED stockings and anticoagulants
  • Skin integrity
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24
Q

Hip Fractures: Nursing Diagnosis

A
  • Pain
  • Impaired Physical Mobility
  • Impaired Skin Integrity
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25
Q

Amputation: Nursing Care; Goals/ Nursing Diagnosis

A 
Goals:
- Physiological healing with no associated complications Pain relief
- Achieve maximal rehabilitation potential
Nursing Diagnosis:
- Pain
- Risk for Infection
- Risk for Dysfunctional Grieving
- Disturbed Body Image 
- Impaired Physical Mobility
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26
Q

Nursing Care: Amputaiton

A
  • Assess pain
  • Strategies for acute and chronic pain
  • Drug and non‐drug interventions for pain
  • Assistive devices
  • Rest periods
  • Emotional support
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27
Q

Amputation: Phantom Pain

A

Splint and support
Reposition
Encourage distraction, meditation, deep breathing and relaxation exercises

28
Q

Amputation: Risk for Infection

A

Protect from contamination
Give antibiotics
Teach stump wrapping
Elevated WBC

29
Q

Collaborative Care: Drug Therapy; Amputation

A

Muscle relaxant
Tetanus‐diphtheria toxoid or immunoglobulin
Bone‐penetrating antibiotic
- Cephalosporin

30
Q

Amputation: Teaching

A
  • Knowledge to care for needs

- Home management

31
Q

Osteomyelitis Collaborative Care

A

• Vigorous and prolonged IV antibiotic therapy is the treatment of choice for acute osteomyelitis, as long as bone ischemia has not yet occurred

32
Q

Collaborative Care: Antibiotics

A 
– penicillin
– cephalexin (Keflex)
– cefazolin (Ancef)
– cefoxitin (Mefoxin)
– gentamicin (Garamycin) 
– tobramycin (Nebcin)
33
Q

Collaborative Care: Antibiotics; Osteomyelitis

A

– Oral fluoroquinolone (ciprofloxacin [Cipro]) for 6‐8 weeks may be prescribed for chronic osteomyelitis or as a follow‐up of IV therapy
– Response to drug therapy is monitored through bone scans and ESR tests

34
Q

Collaborative Care: Surgical Treatment; Osteomyelitis

A

– Removal of the poorly vascularized tissue and dead bone
– Antibiotic‐impregnated polymethymethacrylate bead chains may be implanted at this time to aid in combating the infection

35
Q

Collaborative Care: Surgical Treatment; Osteomyelitis

A

– After debridement the wound may be closed, and a suction irrigation system is inserted
– Intermittent or constant irrigation of the affected bone with antibiotics may also be initiated
– Protection of the limb or surgical site with casts or braces is frequently done

36
Q

Collaborative Care: Osteomyelitis

A
  • Hyperbaric oxygen therapy of 100% oxygen may be administered in chronic osteomyelitis
  • Orthopedic devices may need to be removed
  • Myocutaneous flaps or skin and bone grafting may be necessary if destruction is extensive
37
Q

Nursing Assessment: Subjective Data; Osteomyelitis

A 
Past health history
– Bone trauma, open fracture, wounds, infections
Medications
– Use of analgesics or antibiotics
Surgery or other treatment 
– Bone surgery
– IV drug abuse
38
Q

Nursing Assessment: Subjective Data; Osteomyelitis

A 
Health perception
– IV drug abuse, malaise
Nutritional‐metabolic
– Anorexia, weight loss, chills
Activity‐exercise
– Weakness, paralysis, muscle spasms around affected bone
39
Q

Nursing Assessment: Subjective Data; Osteomyelitis

A

Cognitive‐perceptual
– Local tenderness over affected area
Coping‐stress tolerance
– Irritability, withdrawal, dependency, anger

40
Q

Nursing Assessment: Objective Data; Osteomyelitis

A
  • Restlessness
  • High, spiking temperature
  • Diaphoresis
  • Erythema, warmth, edema at infected bone
  • Restricted movement
  • Wound drainage
  • Spontaneous fractures
41
Q

Nursing Assessment: Objective Data; Osteomyelitis Possible Findings

A
  • Leukocytosis
  • Positive blood and/or wound cultures
  • Elevated ESR
  • Presence of sequestrum and involucrum
42
Q

Osteomyelitis: Nursing Diagnoses

A
  • Acute pain
  • Impaired physical mobility
  • Ineffective therapeutic regimen management
43
Q

Osteomyelitis: Planning; Overall goals

A

– Satisfactory pain and fever control
– No complications
– Cooperation with treatment plan
– Maintenance of a positive outlook on the outcome of the disease

44
Q

Osteomyelitis: Nursing Implementation; Acute Intervention

A

• Immobilization indicated to decrease pain
• Avoid excessive manipulation
• Pain assessment and intervention
– NSAIDs
– Narcotic analgesics
– Muscle relaxants
– Non‐pharmacological approaches to pain (e.g., relaxation breathing) should be encouraged by the nurse

45
Q

Osteomyelitis: Nursing Implementation; Acute Intervention

A

• Wound management
– removal of devitalized tissue
– maintaining a moist wound balance
• Bed rest in the early stages for an acute infection
• Good body alignment and frequent position changes

46
Q

Osteoporosis Nursing Management: Overall goals

A

Maintain or improve joint function
Use joint protection measures
Achieve independence of self‐care
Use pharmacological strategies to manage pain

47
Q

Osteoporosis: Collaborative Care; Good/ Poor sources of calcium

A 
• Good sources of calcium
– Milk and milk products 
– Green leafy vegetables 
– Seafood
– Almonds
– Hazelnuts
• Poor sources of calcium 
– Eggs
– Beef
– Poultry 
– Pork
– Apple 
– Banana 
– Potato
48
Q

Osteoporosis: Collaborative Care

A
  • Supplemental vitamin D may be recommended
  • Exercise should be encouraged to build up and maintain bone mass
  • Clients should be instructed to quit smoking or cut down on alcohol intake to decrease losing bone mass
49
Q

Osteoporosis: Collaborative Care; Drug Therapy

A

Estrogen replacement after menopause 
Calcitonin
Bisphosphonates

50
Q

Osteoarthritis: Collaborative Care; Goals

A
  • Pain and inflammation management
  • Prevent disability
  • Maintain and improve joint function
51
Q

Osteoarthritis: Nursing Management; Assessment

A
  • Type, location, severity, frequency, and duration of joint pain and stiffness
  • Pain‐relieving practices
52
Q

Osteoarthritis: Collaborative Care

A
  • Heat and cold applications
  • Nutritional therapy and exercise
  • Complementary and alternative therapies
53
Q

Osteoarthritis: Collaborative Care

A

Rest and joint protection
Rest during any periods of acute inflammation
Immobilization not to exceed one week Health Promotion
• Elimination of modifiable risk factors

54
Q

Rheumatoid Arthritis: Nursing Management; Nursing Diagnoses

A
  • Acute and chronic pain
  • Disturbed sleep pattern
  • Impaired physical mobility
  • Self‐care deficits
  • Imbalanced nutrition: less than body requirements
  • Chronic low self‐esteem
55
Q

Rheumatoid Arthritis: Nursing Management; Goals

A

– Reduction of inflammation
– Management of pain
– Maintenance of joint function and prevention or correction of joint deformity with minimal loss of functional ability of the affected joints
– Participate in planning and carrying out the therapeutic regimen
– Maintain a positive self‐image
– Perform self‐care to maximum amount possible

56
Q

Rheumatoid Arthritis: Collaborative Care; PT/ OT

A 
Care of the client with RA 
– Drug therapy and education
Physical therapy
– Joint motion and muscle strength
Occupational therapy
– Upper extremity function
– Assistive devices and strategies
57
Q

RA: Collaborative Care; Drug Therapy

A

• Cornerstone of RA treatment
• Disease‐modifying anti‐rheumatic drugs (DMARDs)
– Potential to lessen the permanent effects of RA

58
Q

RA: Collaborative Care; Drug Therapy

A 
Based on the severity of symptoms 
Salicylates
NSAIDs
Non‐opioid analgesics
Opioid analgesics
Corticosteroids
Immunosuppressants
Antibiotics
59
Q

RA: Collaborative Care; Nutritional Therapy

A

• Balanced nutrition is important
• Weight loss may result
– From loss of appetite
– Inability to shop for and prepare foods
• Corticosteroids or immobility may result in
unwanted weight gain
• Exercise reduces stress on arthritic joints
• Weight slowly adjusts to normal several months after cessation of therapy

60
Q

RA: Ambulatory and Home Care; Rest, Body Alignment

A 
• Body alignment 
– Firmmattress 
– Bedboard
• Positions of extension
– Avoid positions of flexion
• Lying prone for half an hour twice daily 
• Light weight splints
– Rest inflamed joints and prevent deformity 
• Skin care
• Range‐of‐motion exercises
61
Q

RA: Ambulatory and Home Care; Heat and Cold Therapy

A

• Help relieve stiffness, pain, and muscle spasm
• Cold (≤10 to 15 minutes at a time)
– Beneficial during periods of disease exacerbation
• Moist heat (≤20 minutes at a time)
– Relief of chronic stiffness

62
Q

RA: Ambulatory and Home Care; Exercise

A
  • Gentle range‐of‐motion exercises are done daily to keep joints functional
  • Emphasize that usual daily activities do not provide adequate exercise to maintain joint function
  • During acute inflammation, exercise should be limited to 1 to 2 repetitions
63
Q

RA: Ambulatory and Home Care; Joint Protection

A 
• Energy conservation
• Work simplification techniques
– Work should be done in short periods 
– Schedule rest breaks
– Spread work throughout the week
• Time‐saving joint protection devices
64
Q

Gout: Assessment, Interventions

A

• Assessment
– Pain, joint swelling, tophi, uric acid stones, fever, and a history of trauma, injury, or surgery
• Interventions
– Acute Pain
– Impaired Physical Mobility
– Altered Urinary Elimination
– Ineffective Therapeutic Regimen Management

65
Q

Gout: Nursing Interventions

A

– Asymptomatic hyperuricemia requires no medical treatment
– NSAID alone or with colchicine for acute gouty arthritis
– For subsequent attacks: indomethacin, corticosteroids, and corticotrophin
– Avoid foods high in purines

Nursing Theory IV (12 decks)

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