Musculoskeletal part 2 Flashcards
Stages of fracture healing
- Fracture Hematoma
- Granulation tissue
- Callus formation
- Ossification
- Consolidation
- Remodeling
Cast care
Nothing down cast
Ice for 24 hours after cast applied
Elevate position
Neurovascular checks
Check for skin breakdown (hot spots, drainage, odor)
Buck’s traction
No lower leg support
Russel’s traction
Support through entire leg
Balanced suspension
leg in air supported by cables
Traction care (TRACTION)
Temperature
Ropes hang freely
Alignment
Circulation (6 Ps)
Type and location of fracture
Increase fluid intake
Overhead trapeze
No weights on bed or floor
Compartment syndrome
Don’t elevate- keep at level of heart
No ice (vasoconstriction)
Amputation types
Open: stump prepared for prosthesis
Open: usually with infection
Disarticulation: amputation through a joint
Amputation nursing care key points
Impaired skin integrity: pressure areas and wrapping stump properly’
Pain r/t phantom sensation: may need analgesics
Impaired physical mobility:
Joint replacement pre-op nursing care
Splint
NWB (non-weight bearing) techniques
UE strengthening
Pulmonary function
N/V assessment
Joint replacement post-op nursing care
Positioning/turning
Peroneal nerve
Hip flexion/ambulation
Pain
Hemovac
Anticoags/antibiotics
I&O
TED/SCD
Osteomyelitis
Infection of bone marrow/surrounding tissue
Indirect: 1 organism, often under 17 y.o.
Risks for adults include debilitation, age, hemodialysis, sickle cell, IV drug abuse.
DIrect: multiorganism, open wound, implant
Complication: septicemia
Osteomyelitis diagnosis
Labs: high WBC, high ESR (erythrocyte sedimentation rate), high CRP (C-reactive protein)
CT, MRI
Osteomyelitis management
Surgery
Long term antibiotics
Acrylic bead chains
Hyperbaric O2
Osteochondroma
Benign bone tumor: overgrowth of cartilage and bone near end of bone
Osteosarcoma
Malignant bone tumor
Aggressive, gradual pain onset, bone swelling, surgical removal, chemo
Acute vs chronic back pain
Acute: under 4 weeks duration, symptoms come after injury
Chronic: More than 3 months or repeated incapacitating episode
Herniated intervertebral disk treatments
Treatments:
Laminectomy: enlarges and decompresses- to gain access to disk and remove it. (removing bone)
Discectomy: decompress nerve root (removing bulging part of disc)
Spinal fusion: welding two vertebrae together- trading stability for mobility.
Herniated disk post op
Compare circulation to baseline: Look for numbness and tingling
DON’T TWIST; LOG ROLL INSTEAD
can be on PCA, normally PO meds
Oteomalacia/Rickets
Softening of bones from vitamin D deficiency
Osteoporosis risk factors
ACCESS
Alcohol use Corticosteroid use Calcium Low Estrogen Low Smoking Sedentary
Osteoporosis fracture sites
T-8 and below
Kyphosis
Hunch back
Lordosis
Spine collapses in
Osteoporosis testing
H&P
Bone Mineral Density every 15 yr for women:
GOLD STANDARD is Dual energy x-ray on spine, hips, forearms
BMD: Bone Mineral Density test
Start at age 40
Every 15 years for women
-1 to 1 is normal
1- to -2.5 osteopenia
Under 2.5= osteoporosis
Osteoporosis medications
Estrogen after menopause
Calcitonin
Biphosphonates: TAKE W/ GLASS OF WATER IN MORNING AND SIT/STAND FOR 30 MINS AFTER
SERMS
Calcium supplements
Can neutralize gastric acid
Will decrease efficacy of tetracyclines
Thiazide diuretics can cause increase in serum Ca
Watch for hypercalcemia
Calcitonin
Bone resorption inhibitor
Decrease osteoclast activity
Increase calcium excretion
Only for women 5 years past menopause
Can be Subq, IM or nasal spray
Watch for nausea after injections
Biphosphonates
Prevent osteoclasts from breaking down bone
Fosamax
Actonel
Boniva
Reclast
Osteoarthritis (OA)
Non inflammatory Asymmetric Progressive Weight bearing joints and metatarsals Pain worse w/ activity Limited ROM in affected joints Stiffness w/inactivity Joint space narrows Bone on bone (crepitus) Heberden's and Bouchard's nodules
OA treatments
Manage pain/inflammation:
- Acetaminophen/NSAIDS
- Steroids
- Rest
- Immobilize Joint
- Arthroplasty
Second gen COX-2 inhibitor
Celebrex
High risk for cardiovascular disorders
Does not promote bleeding
Watch for dyspepsia, diarrhea, Renal impairment
Rheumatoid Arthritis (RA)
Autoimmune
Starts at YOUNGER AGE
Chronic and systemic inflammation
Affects CT and synovial joints
Teaching: prevent loss of ROM: remain active, stretch joints
Labs: ESR, CRP, Antinuclear Antibody Assay, Arthrocentesis (milky/cloudy)
RA treatment
Corticosteroids
DMARDS (disease modifying antirheumatic drugs): methotrexate
Biologics
Nonbiologic DMARDS
Plaquenil Minocin Leflunomide Azathioprine Gold Salts Sulfasalazine
Biologic DMARDS
Humira Cimzia Orencia Embrel Inflixmab Glimumab
Stuff to monitor during DMARDS
Monitor CBC and Liver function tests
Teach pt to report S&S of infection, bleeding, SOB, dysuria
Avoid alcohol on Minocin
Avoid sunlight
Store Minocin at room temp
OA vs RA
OA: After 40 Gradually develops One side of body first (overuse) Usually no redness, warmth, swelling, malaise 30 min morning stiffness then improve No erosion
RA: between 25-50 Autoimmune Can develop suddenly Joints on both sides of body Redness, warmth, swelling of joints More than 30 min morning stiffness Inflammation causes erosion
Gout
Caused by high uric acid/purine
Treated w/ Colchicine (immediate)
Allopurinol (Long term)
Septic arthritis
Infected Joint cavity
Anklyosing Spondylitis
Chronic inflammation in axial skeleton, onset in 30s
Psoriatic arthritis
From psoriasis
med example: Otezla
Reactive Joint inflammation
From GI or GU infections (chlamydia, salmonella)
treated w/ antibiotics and rest
Synovectomy
Removal of inflamed tissue
Osteotomy
Removal of bone wedge to restore alignment
Arthrodesis
Surgical fusion of joint
Arthroplasty
reconstruction/replacement of joint
