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Funds Exam5 (from ppts) > Musculoskeletal System > Flashcards

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

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2
Q

Musculoskeletal System
-Consists of

A

1-Bones
2-Ligaments
3-Fascia
4-Bursae

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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)
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4
Q

Ligaments
-What are they?

A
  • Connect bones to bones
  • More elastic than tendons
  • Have poor blood supply
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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

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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

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7
Q

Tendons
-What are they?

A
  • Attach muscles to bones
  • Have poor blood supply
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8
Q

_ and _ have poor blood supply which delays healing

A

Ligaments and tendons have poor blood supply which delays healing

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9
Q

Assessment
-Inspection

A
  • Always start w/ your initial contact w/ the patient
  • Look for symmetry, general body built
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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
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11
Q

Assessment
-Movement

A
  • Observe/Evaluate ROM
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12
Q

Grading Muscle Strength
-5/5

A

Normal strength (moves against full resistance)

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13
Q

Grading Muscle Strength
-4/5

A

Moderate strength (moves against some resistance)

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14
Q

Grading Muscle Strength
-3/5

A

Eg. Person can raise hand off table w/o any resistance applied

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15
Q

Grading Muscle Strength
-2/5

A

Eg. Person able to slide hand across table but not lift it

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16
Q

Grading Muscle Strength
-1/5

A

Flicker

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17
Q

Grading Muscle Strength
-0/5

A

Paralysis

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18
Q

Injuries to the Musculoskeletal System
-Usually associated with abnormal stretching or twisting?

A

Sprains & strains

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19
Q

Sprain definiton

A

Injury to the ligaments surrounding a joint

-Ligament: connect bones to bones at joint
-Tendons: Attach muscles to bones

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20
Q

Sprains classified according to?

A

The amount of ligament fibers torn

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21
Q

Sprain classification
-1st degree

A

Tears of only few fibers

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22
Q

Sprain classification
-2nd degree

A

Partial disruption of the involved tissue w/ more swelling & tenderness

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23
Q

Sprain classification
-3rd degree

A

Complete tearing of the ligament

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24
Q

Strain definition

A

Stretching of a muscle & its fascial sheath

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25
Q

Strain
-Clinical manifestation(s)

A

Pain, edema, decreased function & bruising

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26
Q

Strains & sprains
-Nurs management

A

1-Health promotion/prevention

2-RICE
* Rest
* Ice
* Compression
* Elevation 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

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27
Q

Injuries to the Musculoskeletal System
-Subluxation & dislocation

A

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

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28
Q

Subluxation & dislocation
-Nurs care

A
  • Pain management
  • Support/protect the injured part
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29
Q

Injuries to the Musculoskeletal System
-Fractures

A
  • 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
Q

Fracture classification according to?

A

Location

31
Q

Fracture location(s)

A

1-Transverse
1-Spiral
3-Greenstick
4-Comminuted
5-Oblique
6-Pathologic
7-Stress

32
Q

Fractures
-Clinical manifestations

A
  • 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

Immobilize affected limb if you suspect fracture!!!!

33
Q

Fractures
-Edema & swelling

A
  • 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

Notify the Provider, external compression should be avoided. May require fasciotomy if symptoms not resolved within 30 min.

34
Q

Fractures nurs assessment
-Objective data

A
  • Apprehension
  • Guarding
  • Point tenderness
  • Skin lacerations, color changes
  • Hematoma, edema
  • Restricted or lost function
  • Deformities; abnormal angulation
  • Shortening, rotation, or crepitation
  • Imaging findings
35
Q

Fractures nurs assessment
-Neurovascular assessment

A
  • 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
Q

Fractures
-Factors influencing healing?

A
  • 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
Q

Fractures
-Nurs care

A

1-Reduction
2-Immobilization
3-Resoration of function

38
Q

Fracture Reduction
-Closed reduction

A
  • Correction or setting of a fractured bone w/o surgery
  • Ex: hip or shoulder
39
Q

Fracture Reduction
-Open reduction aka ORIF

A
  • Surgical incision
    -Internal fixation-plates, pins & screws, intramedullary nail
    -Risk for infection
    -Early ROM of joint to prevent adhesions
    -Facilitates early ambulation
40
Q

Fracture Reduction
-External fixation aka Ex fix

A
  • 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
Q

Fracture Immobilization
-Cast care

A
  • 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
Q

Fracture Immobilization
-Cast care pt edu

A
  • 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
Q

Fractures
-Hip

A
  • 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
Q

Hip surgery
-Postop care

A
  • 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
Q

Fractures
-Postop care

A
  • 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
Q

Fractures
-Complications

A
  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
  6. Fat embolism
  7. Renal Calculi
47
Q

Compartment Syndrome
-The 6 P’s

A
  1. Pain
  2. Pallor
  3. Pulselessness
  4. Paresthesia
  5. Paralysis
  6. Poikilothermia (inability to maintain a constant core temperature independent of ambient temperature)
48
Q

Complications of fractures
-Compartment Syndrome

A
  • 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
Q

Compartment Syndrome tx

A
  • 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
Q

Complications of fractures
-Renal Calculi

A
  • 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
Q

Complications of fractures
-Fat Embolism Syndrome aka FES

A
  • 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
Q

Fat Embolism Syndrome
-Mechanical theory

A

Fat released from marrow & enters circulation where it can obstruct

53
Q

Fat Embolism Syndrome
-Biochemical theory

A

Hormonal changes caused by trauma stimulate release of fatty acids to form fat emboli

54
Q

Fat Embolism Syndrome
-Clinical manifestations

A
  • 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
Q

Fat Embolism Syndrome
-Collaborative care (tx)

A
  • 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
Q

Fat Embolism Syndrome
-Collaborative care (management)

A
  • Management is symptom-related & supportive
  • Oxygen for respiratory distress (intubation may be required for severe respiratory distress)
  • Corticosteroids (controversial) & Heparin
57
Q

Fat Embolism Syndrome
-Collaborative care (assisted devices)

A
  • 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
Q

Joint Replacement Surgery

A
  • 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
Q

Osteomyelitis?

A
  • 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
Q

Osteomyelitis
-Clinical manifestations (acute)

A
  • Acute
    -Infection of <1 month in duration
61
Q

Osteomyelitis
-Clinical manifestations (local)

A
  • Local manifestations
    -Pain unrelieved by rest; worsens w/ activity
    -Swelling, tenderness, warmth
    -Restricted movement
62
Q

Osteomyelitis
-Clinical manifestations (systemic)

A
  • Systemic manifestations
    -Fever
    -Night sweats
    -Chills
    -Restlessness
    -Nausea
    -Malaise
    -Drainage (late)
63
Q

Osteomyelitis
-Clinical manifestations (chronic)

A
  • 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
Q

Chronic osteomyelitis of femur

A
  • 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
Q

Osteomyelitis
-Collaborative care

A
  • 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
Q

Amputation
-Preop teaching/edu

A
  • Phantom pain
  • Pain management
  • Need for grieve/psychological support
  • Need for rehab & prosthesis
67
Q

Amputation
-Postop management/edu

A
  • 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
Q

Osteoporosis
-Who are at risk?

A
  • 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
Q

Osteoporosis
-Prevention

A
  • 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
Q

Osteoporosis tx

A
  • Calcium supplement w/ Vit D (take on empty stomach or with orange juice)
  • Bisphosphates, Alendronate, RANKL inhibitor (monoclonal antibody)

Funds Exam5 (from ppts) (11 decks)

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