Musculoskeletal Disorders Flashcards
Skeletal system tissues: Bone, Cartilage, Fibrous connective tissues (ligaments)
What are the Skeletal system functions?
Movement, Protection, Stores Calcium.
What are the Muscular system tissues?
Skeletal Muscle, Fibrous connective tissue (tendons) and Fasciae.
What are the Muscular system functions?
Movement, Heat Production and Returns blood from legs.
What are the Bone tissues?
Osteocytes, Calcium Salts, Collagen, Periosteum and *Osteoblasts produce bone growth and repairs bone.
How does aging effect the musculoskeletal system?
- Decreased muscle mass/Strength
- Decreased elasticity of ligaments, tendons, cartilage.
- Decrease in Intervertebral space
- Change in the posture and gait changes
Nursing interventions for patient history?
Usual pattern of mobility/assistive devices
Psycho-social info
ADL’s
Joint pain assessment: location,duration, precipitating factors etc..
Previous MSK injury/ congenital defects
Nutrition/weight assessment
Potential risk factors
Nursing interventions, physical exam?
Many age related changes
Assess neurovascular integrity (account for dressings, cast, fraction…)
Compare to unaffected extremity
Nursing interventions, physical exam for COLOR?
Adjust for skin color/racial differences-
• FLESHTONE: adequate arterial supply and venous return
- RED: infection or inadequate venous return (depends on the time span from injury)
- PALLOR: inadequate arterial supply
- BLUE: (or CYANOTIC) inadequate arterial supply and venous return.
Physical exam for edema, sensation and motion.
•EDEMA: assess sensory nerves
- Ex: WNL +1 +2 +3 +4 pitting
- MOTION: assess motor nerves
- Ex: WNL limited absent
What is the antidote for heparin?
Prothrombin sulfate
What is the antidote for Warfarin?
Vitamin K
What test would you give before administing, heparin?
Activated partial thromboplastin time (aPTT)
What test would you give before administing, warfarin?
Prothrombin time (PT) and International normalized ratio (INR)
Assess for contrast medium allergies, patient may be NPO, radiographic “slices” of bone or tissue- better image than X-ray.What test is this?
Computed Tomography (CT) also monitor for kidney function due to dye causing kidney failure if damaged test for kidney check BUN, GFR >60 & CK.
Assess for metal/pacemaker in the body,= contraindication, inform patient what to expect. Electromagnets give 3D visualization- best imaging.
Magnetic 🧲 Resonance imaging (MRI) .Also check if is clasophobic
Jelly - like conduction gel may be used, Visualization of bone or tissue using sound waves. Can be used to check for osteoarthritis ( bone inflammation or infection). What test is this?
Ultrasound/ ultrasonography.
Soft tissue injury that occurs when a muscle or tendon is excessively stretched.May results in muscle or tendon tearing .
Strain.
Excessive stretching of ligaments from twisting movements.
Sprain
Ends of the bone are forced from the heir normal position. Any joint can become dislocated. Splint injury immediately,apply ice,DO NOT MOVE EXTREMITY.
Dislocation
Inflammation of the brusa, which is a fluid filled sac that cushions tendons during movement and preventing friction between bone and tendon.
Bursitis ….comes back unless strengthens joint.
What is R.I.C.E??
- R- rest to protect it.
- I- ice to decrease pain, swelling and inflammation.
- C- compression with elastic bandage.
- E- elevating affected area (if appropriate).
Fracture pathophysiology
Deformity, shortening of limbs, shorten ligaments & tendons by spasms,healing time depends on age and particular bone fractured, during all stages of healing it’s essential for pt intakes protein, vitamin C & D, calcium and adequate hydration.
Bone bends and splits, bit does not break clear through. Occurs primarily in children.( Bones are maluable)
GREENSTICK
Bone splitters or shatters into numerous fragments. Traction 3 or more shatters/ splits.
COMMINUTED
One vertebrae collapses ( compresses) into another.
COMPRESSION
Occurs with a twisting motion. Common in child abuse.
SPIRAL
Fracture occurs along the length of the bone.
LONGITUDINAL
Fracture occurs diagonaly
OBLIQUE
Bone fractured horizontally
TRANSVERSE
What are fracture emergency management/management goals?
Immediately immobilization of fractured bones, control bleeding, assess for signs of hypovolemia, cover any open fractures with clean dressing (sterile would be ideal) and reduction or realignment of bone ends.
A Dr manually pulls the bone back into realignment, performed under anesthesia and X- ray later to confirm bone ends are aligned before applying immobilization. Is called what?
CLOSED REDUCTION
Fractures are realigned with full visualization via open incision.Bone ends are held into place by internal fixation hardware ( pins, wires, nails, plates, & rods). Occurs often w/ hip fractures & limb is then immobilized.
OPEN REDUCTION
Used for severe comminuted fractures, external hardware. High risk of infection “osteomyelitis”(pin care - done under strict aper septic
EXTERNAL FIXATOR
Application of pulling force to part of the body to position & hold bone fragments in correct alignment, what is it and the 2 types???
• TRACTION
SKIN TRACTION & SKELETAL TRACTION
Can be applied to the length of the extremity w/ additional to fold over the edge of the cast for skin protection
Stockinette
Rolled padding wrapped around the extremity w/ extra over boney prominences
Sheet wadding
Permits visualization of a specific area or wound, when there is an infection present and needs cast still & to monitor it.
Cast window
Longitudinal cut in both sides of the cast, underlying padding is cut, the cast is spread to relieve construction.
Bivalving
Cast cutter is used, (circular saw that oscillates through plaster) reassure the PT that the saw vibrates only & can’t cut the skin, protect the PT eyes from flying plaster
Removal of cast
Weight in the hands, not on the axiallae to prevent injury to the brachial plexus.
Crutch walking
Is a system using ropes, pulleys and weights to exert a pulling force, applied to either to the skin or to the bone.
TRACTION
What is the purpose of traction?
- Purpose:
• immobilize a fracture
• Maintain proper alignment of an extremity
• Relieve muscle spasms, pain fallowing injury, fracture or surgery.
• prevent tissue injury
(A force acting on the opposite direction) Must be maintained and immobilization of an extremity or reduction of a fracture can only be achieved by continuous traction.
Countertraction
The line of the pull must be maintained by….
- PT centered if the bed in correct alignment.
- Weights hang free (off of the floor)
- Ropes unobstructed in straight alignment
- Knots in the ropes are to not be touched, the pulley or the bed.
Also known as “skin traction” used primarily following hip fracture awaiting surgical repair. Sponge boot is applied to the lower leg and traction weights are applied (5-10lbs). PT on bestest.
Buck’s Traction or aka “Buck’s extension.
Like Buck’s Traction/extension, used for older child and adults to immobilize fracture of tibial plateau, femur or hip, with addiction of a flexed knee, supported in knee sling. FOB is elevated and HOB flat with one pillow or folded bath blanket underneath head. Bestest is maintained.. with lift trapeze for care/ elimination.
Russell Traction
Used for infants and toddlers under 30lbs to immobilize femur or hip fractures.both legs are suspended off of bed.
Bryant’s traction
Used in treatment of herniated Intervertebral disc. Pelvic girdle or binder attached to weights at FOB.
Pelvic traction
Used in treatment of herniated Intervertebral disc . cervical sling attached weight to HOB
Cervical traction
What are the 6 P’s ?
- Pain
- Paresthesia
- Paralysis
- Pallor
- Pulelessness
- Poikilothermia
