Musculoskeletal System Flashcards
1
Q
Musculoskeletal System
-Main fx(s)
A
1-Support
2-Protection of vital organs
3-Movement
4-Blood cell production
5-Mineral storage
2
Q
Musculoskeletal System
-Consists of
A
1-Bones
2-Ligaments
3-Fascia
4-Bursae
3
Q
Bones
-What are they?
A
- Provide supporting framework
to body and protect underlying
organs & tissues - Participate in red & white
blood cell production - Serve as a site for storage of
inorganic minerals (Ca++,
PO4-) & contain organic
material (collagen) - Dynamic tissue (osteoblasts,
osteoclasts)
4
Q
Ligaments
-What are they?
A
- Connect bones to bones
- More elastic than tendons
- Have poor blood supply
5
Q
Fascia definition
A
Thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place
per John’s Hopkins
6
Q
Bursae definition
A
Closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction b/w tissues of the body
per John’s Hopkins
7
Q
Tendons
-What are they?
A
- Attach muscles to bones
- Have poor blood supply
8
Q
_ and _ have poor blood supply which delays healing
A
Ligaments and tendons have poor blood supply which delays healing
9
Q
Assessment
-Inspection
A
- Always start w/ your initial contact w/ the patient
- Look for symmetry, general body built
10
Q
Assessment
-Palpation
A
- If injury is the presenting problem, proceed with caution
- Palpation of soft tissue & joints allows for assessment of skin
temperature, swelling, tenderness & crepitation
11
Q
Assessment
-Movement
A
- Observe/Evaluate ROM
12
Q
Grading Muscle Strength
-5/5
A
Normal strength (moves against full resistance)
13
Q
Grading Muscle Strength
-4/5
A
Moderate strength (moves against some resistance)
14
Q
Grading Muscle Strength
-3/5
A
Eg. Person can raise hand off table w/o any resistance applied
15
Q
Grading Muscle Strength
-2/5
A
Eg. Person able to slide hand across table but not lift it
16
Q
Grading Muscle Strength
-1/5
A
Flicker
17
Q
Grading Muscle Strength
-0/5
A
Paralysis
18
Q
Injuries to the Musculoskeletal System
-Usually associated with abnormal stretching or twisting?
A
Sprains & strains
19
Q
Sprain definiton
A
Injury to the ligaments surrounding a joint
-Ligament: connect bones to bones at joint
-Tendons: Attach muscles to bones
20
Q
Sprains classified according to?
A
The amount of ligament fibers torn
21
Q
Sprain classification
-1st degree
A
Tears of only few fibers
22
Q
Sprain classification
-2nd degree
A
Partial disruption of the involved tissue w/ more swelling & tenderness
23
Q
Sprain classification
-3rd degree
A
Complete tearing of the ligament
24
Q
Strain definition
A
Stretching of a muscle & its fascial sheath
25
Strain
-Clinical manifestation(s)
Pain, edema, decreased function & bruising
26
Strains & sprains
-Nurs management
1-Health promotion/prevention
2-RICE
* **R**est
* **I**ce
* **C**ompression
* **E**levation above heart level
3-Analgesia
* NSAIDS=decrease prostaglandins that contribute to inflammation & pain; increase risk for GI bleeding in older adults or if in excessive quantity
* Opioids, if severe
27
Injuries to the Musculoskeletal System
-Subluxation & dislocation
Subluxation:
* Partial dislocation
Dislocation:
* Needs to be attended promptly
* The longer the timeframe before reduction, the greater the possibility
of developing Avascular Necrosis
* Avascular Necrosis = bone cell death as a result of inadequate blood
supply
* The hip & shoulder are particularly at risk for this
28
Subluxation & dislocation
-Nurs care
* Pain management
* Support/protect the injured part
29
Injuries to the Musculoskeletal System
-Fractures
* Disruption or break in continuity of structure of bone
* Majority of fractures from traumatic injuries
* Some fractures secondary to disease process
* Cancer or osteoporosis
* Can be open or closed
* Complete or incomplete
* Displaced or nondisplaced
30
Fracture classification according to?
Location
31
Fracture location(s)
1-Transverse
1-Spiral
3-Greenstick
4-Comminuted
5-Oblique
6-Pathologic
7-Stress
32
Fractures
-Clinical manifestations
* Edema & swelling
* Localized pain & point tenderness
* Decreased function
* Muscle spasms
* Inability to bear weight or use
* Guarding against movement
* May or may not have deformity
* Ecchymosis & crepitation
## Footnote
Immobilize affected limb if you suspect fracture!!!!
33
Fractures
-Edema & swelling
* Resulting from disruption of soft tissue or bleeding into the surrounding tissue.
* If it occurs in a closed space, it can occlude circulation & damage nerves - may lead to COMPARTMENT SYNDROME
* Compartment Syndrome:
-An elevation of pressure within a closed fascial compartment
-Can be caused by hemorrhage and/or edema within a closed space or by external compression or arterial occlusion
## Footnote
Notify the Provider, external compression should be avoided. May require fasciotomy if symptoms not resolved within 30 min.
34
Fractures nurs assessment
-Objective data
* Apprehension
* Guarding
* Point tenderness
* Skin lacerations, color changes
* Hematoma, edema
* Restricted or lost function
* Deformities; abnormal angulation
* Shortening, rotation, or crepitation
* Imaging findings
35
Fractures nurs assessment
-Neurovascular assessment
* Peripheral vascular
-Color & temperature
-Capillary refill
-Pulses- decreased or absent
-Edema, hematoma
* Peripheral neurologic
-Sensation & motor function-Paresthesias, absent, decreased or increased sensation, muscle weakness
36
Fractures
-Factors influencing healing?
* Displacement & site of fracture (fx)
* Type of fx: Open & comminuted fractures take longest
* Blood supply to area
* Immobilization
* Internal fixation devices
* Infection or poor nutrition
* Age
* Smoking
37
Fractures
-Nurs care
1-Reduction
2-Immobilization
3-Resoration of function
38
Fracture Reduction
-Closed reduction
* Correction or setting of a fractured bone w/o surgery
* Ex: hip or shoulder
39
Fracture Reduction
-Open reduction aka ORIF
* Surgical incision
-Internal fixation-plates, pins & screws, intramedullary nail
-Risk for infection
-Early ROM of joint to prevent adhesions
-Facilitates early ambulation
40
Fracture Reduction
-External fixation aka Ex fix
* Metal pins & rods
* Applies traction
* Compresses fracture fragments
* Immobilizes & holds fracture fragments in place w/ pins
* Pin site care done every shift & pin sites usually wrapped w/ gauge
41
Fracture Immobilization
-Cast care
* Common after Closed Reduction
* Frequent neurovascular assessments
* Apply ice for first 24 hours
* Elevate above heart for first 48 hours
* Exercise joints above & below
* Use hair dryer on cool setting for itching
42
Fracture Immobilization
-Cast care pt edu
* Do not get wet but if do, dry thoroughly after getting wet
* Report increasing pain despite elevation, ice & analgesia
* Report swelling associated w/ pain & discoloration OR movement
* Report burning, tingling, sores, or foul odors under cast
* Don’t insert anything into cast or remove anything
* Use hair dryer on cool if itchy
43
Fractures
-Hip
* Common in older adults
* Can see shortening & external rotation of affected extremity
* Can be treated w/ ORIF - w/ nail or plate, pins, screws
* Total hip replacement = replacement of both the ball & socket (head of the femur & acetabulum)
* Hemiarthroplasty-replacement of ball (head of femur) only
44
Hip surgery
-Postop care
* Maintain hip abduction w/ pillows
* Teach patient not to cross legs, internally rotate legs, or bend over at the waist (tying shoes). Teach to keep knees spread apart.
* Monitor for sudden severe pain, loss of function, a lump in the buttocks, leg shortening & external rotation=prosthetic dislocation
* Do not turn patient on affected side
* Can have a significant blood loss → monitor CBC
45
Fractures
-Postop care
* Monitor vitals
* General principles of postoperative nursing care
* Minimize pain & discomfort
* Monitor for bleeding or drainage
-Aseptic technique
-Blood salvage & reinfusion
* Frequent neurovascular assessments
-Monitor circulation, sensation, movement
-Monitor compartment syndrome
46
Fractures
-Complications
1. Compartment Syndrome
2. Infection, if open or surgical repair
3. Delayed healing, nonunion of bones, deformity
4. Venous thromboembolus (ex: surgery on pelvis & lower extremity)
5. Hemorrhage
7. Fat embolism
8. Renal Calculi
47
Compartment Syndrome
-The 6 P's
1. Pain
2. Pallor
3. Pulselessness
4. Paresthesia
5. Paralysis
6. Poikilothermia (inability to maintain a constant core temperature independent of ambient temperature)
48
Complications of fractures
-Compartment Syndrome
* Results from increased pressure within muscle compartments (fascia)
* Occurs in 9.1% of fxs
* Multiple other causes
* Forearm, lower leg primary areas=36% of cases result from tib-fib fxs
* Early recognition via regular neurovascular assessments!
-Notify if pain unrelieved by drugs & out of proportion to injury
-Pain is first symptom & includes pain w/ passive stretching of
muscles in the affected compartment (stretching foot if lower leg)
* Later signs=deterioration in circulation, sensation & movement, swelling
* Permanent neurovascular damage can result as early as 4 hours after onset
* Delay more than 6 hours in dx & fasciotomy leads to permanent weakness
49
Compartment Syndrome tx
* Bivalve or remove cast ASAP
* Fasciotomy (surgical decompression)
* No ICE
* No Elevation
* Monitor for dark tea colored urine-muscle breakdown=myoglobinuria-proteins precipitate in renal tubules & cause acute kidney injury
* Monitor creatinine for renal compromise
50
Complications of fractures
-Renal Calculi
* Immobility alters urinary elimination. W/ upright position, urine flows d/t gravity. If flat in bed, kidneys & ureters are level, cause urinary stasis, increase risk of UTI & renal calculi – calcium stones lodge into renal pelvis or ureters.
* Immobilized pt usually have hypercalcemia causing them to be at risk for renal calculi.
51
Complications of fractures
-Fat Embolism Syndrome aka FES
* Presence of systemic fat globules from fracture that are distributed into tissues & organs after a traumatic skeletal injury
* Caused by fat obstructing the blood vessels
* Contributory factor in many deaths associated w/ fracture
* Most common w/ fracture of long bones, ribs, tibia & pelvic bones
52
Fat Embolism Syndrome
-Mechanical theory
Fat released from marrow & enters circulation where it can obstruct
53
Fat Embolism Syndrome
-Biochemical theory
Hormonal changes caused by trauma stimulate release of fatty acids to form fat emboli
54
Fat Embolism Syndrome
-Clinical manifestations
* Early recognition crucial
* Symptoms 12-24 hrs after injury
* Fat globules travel to lungs cause a hemorrhagic interstitial pneumonitis
* Petechiae – neck, chest wall, axilla, buccal membrane, conjunctiva
* Clinical course of fat embolus may be rapid & acute
* Pt frequently expresses a feeling of impending death & restlessness
* Agitation, Restlessness, Delirium, Convulsions – change in LOC, wheezing, blood tinged sputum, copious production of white sputum, fever especially 12-24 hrs after injury when fat emboli most likely to occur
* In a short time skin color changes from pallor to cyanosis
* Pt may become comatose
55
Fat Embolism Syndrome
-Collaborative care (tx)
* Tx is aimed at prevention
* Careful immobilization of a long bone fracture is probably the most important factor in prevention - IMMEDIATELY DONE
* Cough & deep breathing
56
Fat Embolism Syndrome
-Collaborative care (management)
* Management is symptom-related & supportive
* Oxygen for respiratory distress (intubation may be required for severe respiratory distress)
* Corticosteroids (controversial) & Heparin
57
Fat Embolism Syndrome
-Collaborative care (assisted devices)
* Assistive devices for ambulation that can help reduce or eliminate weight bearing on affected limbs
* CANE: relieve 40% of weight bearing
-Use to support affected area
* WALKER & CRUTCHES: Allow complete non-weight bearing ambulation
58
Joint Replacement Surgery
* Most common are THR also known as THA
* TKA-can replace part or all of knee joint
* Major complications are infection and VTE=antibiotics & anticoagulants given postop
59
Osteomyelitis?
* Severe infection of bone, bone marrow & surrounding soft tissue
* Most common microorganism is Staphylococcus aureus but can be caused by variety of organisms (MRSA, Pseudomonas & Enterobacteriaceae)
* Indirect entry (hematogenous)
-Young boys
-Blunt trauma
-Vascular insufficiency disorders
-IVDU
-GI & respiratory infections
* Direct entry
-Via open wound/open fractures, orthopedic surgeries
-Foreign object-joint prosthesis
60
Osteomyelitis
-Clinical manifestations (acute)
* Acute
-Infection of <1 month in duration
61
Osteomyelitis
-Clinical manifestations (local)
* Local manifestations
-Pain unrelieved by rest; worsens w/ activity
-Swelling, tenderness, warmth
-Restricted movement
62
Osteomyelitis
-Clinical manifestations (systemic)
* Systemic manifestations
-Fever
-Night sweats
-Chills
-Restlessness
-Nausea
-Malaise
-Drainage (late)
63
Osteomyelitis
-Clinical manifestations (chronic)
* Chronic:
-Infection lasting longer >1 month or has failed to respond to initial course of antibiotic therapy
-Continuous & persistent, or process of exacerbations & remissions
64
Chronic osteomyelitis of femur
* Systemic signs diminished
* Local signs of infection more common
* Pain, swelling, warmth
* Granulation tissue turns to scar tissue → avascular → ideal site for microorganisms to grow → away from antibiotic penetration
65
Osteomyelitis
-Collaborative care
* Surgical removal infected bone
* Extended use of antibiotics-4-6 week minimum
* Antibiotic-impregnated polymethyl methacrylate bead chains=antibiotic spacers inserted into infected bone
* Intermittent or constant antibiotic irrigation of bone
* Casts or braces
* Negative-pressure wound therapy=wound vac
* Hyperbaric oxygen therapy
* Removal of prosthetic devices (hardware)
* Muscle flaps, skin grafting, bone grafts
* Amputation
66
Amputation
-Preop teaching/edu
* Phantom pain
* Pain management
* Need for grieve/psychological support
* Need for rehab & prosthesis
67
Amputation
-Postop management/edu
* Maintain aseptic technique during wound care
* Use of rigid or compression dressings to minimize edema
* Monitor for s/s of infection
* Prevention of flexion contractures
68
Osteoporosis
-Who are at risk?
* 1 in 2 Americans over 50 years old will be at risk for fractures r/t osteoporosis
* 44 million Americans (55% over age 50) will either have or is at risk of Osteoporosis
* 80% of those w/ osteoporosis are female (National Osteoporosis Foundation 2010)
69
Osteoporosis
-Prevention
* Encourage those at risk to be screened
* Assess diet for calcium & vit D intake
* Those w/ lactose intolerance should seek alternative source of calcium
* Weight bearing exercise
* Maintain optimal urinary function
* Minimize alcohol intake & quit smoking
* Home safety assessment for fall risk
70
Osteoporosis tx
* Calcium supplement w/ Vit D (take on empty stomach or with orange juice)
* Bisphosphates, Alendronate, RANKL inhibitor (monoclonal antibody)
