Musculoskeletal System Flashcards
Dislocation
Complete loss of contact between the surfaces of two bones
Subluxation
Partial loss of contact between two bones
Sprain
Ligament tears
Avulsion
Complete separation of a tendon or ligament from its attachment
Fractures
Types
- Transverse
- Linear
- Spiral
- Greenstick
- Oblique, nondisplaced
- Oblique, displaced
- Comminuted
Fracture treatment
* Pain management
* RICE: Rest, Ice, Compression, Elevation
* Immobilization: Cast, Splint, Brace
○ Monitor the casted extremity closely for perfusion!!
* Traction
○ Used temporarily for proper alignment and healing
Traction
T - Temperature - Monitor the temperature of the extremity
R - Ropes - The ropes should be hanging freely
A - Alignment - Ensure proper alignment of the extremity
C - Circulation - Circulation checks on extremity are #1! The 6 P’s!
T - Tension - No tension on the skin. HIGH RISK FOR SKIN BREAKDOWN!!
I - Intake - Monitor I&O’s
O - Overhead trapeze - Bar overhead to help with range of motion
N - NO weights on the floor! - DON’T release the traction!
Osteoporosis
About
○ Metabolic disease characterized by bone demineralization, loss of calcium and phosphorus salts leading to fragile bones and then further risk for fractures
○ Bone resorption accelerates as bone formation slows
○ Most commonly occurs in wrist, hip and vertebra
○ May be asymptomatic until the bones become fragile and a minor injury
causes a fracture
Risk Factors
○ Early menopause
○ Smoking
○ Family history
○ Female gender
○ Excessive use of ETOH
○ Sedentary lifestyle
○ Thin, small frame
○ Increasing age
Interventions
○ Assess risk for injury and prevent injury in client’s environment
○ Provide personal care to client to reduce injuries
§ Move client gently, assist with ambulation if unsteady, gentle ROM
○ Provide client instructions to promote optimal level of health and function
§ Good body mechanics, exercises to strengthen core, avoid activities that causes vertebral compression, encourage diet high in calcium, vitamin D, iron and protein
○ Avoid Alcohol
Rheumatoid Arthritis
About
* Chronic systemic inflammatory disease
* Leads to destruction of connective tissue and synovial membrane within the joints
* Weakens the joint, leading to dislocation and deformity of the joint
* Pannus forms at the junction of synovial tissue and articular cartilage and projects into the joint space which causes necrosis
* RA exacerbations or “flares” occur during periods of fatigue and stress (emotional or physical)
Assessment findings
* Inflammation, tenderness, stiffness of the joint
* Decreased ROM in joints
* Moderate to severe pain with morning stiffness lasting longer than 30 minutes
* Joint deformities
* Spongy, soft feeling in joints
* Elevated ESR and positive rheumatoid factor
* X-ray shows joint deterioration
* Synovial fluid shows inflammation
Treatment
* Medications: NSAIDs, disease-modifying anti-inflammatory drugs and glucocorticoids
- methotrexate
* Preserve joint function
* Heat or cold therapy as prescribed
* Encourage consistent exercise program
* Avoid weight bearing on inflamed joints
Surgical: Synovectomy, arthrodesis, joint replacement
Methotrexate
Indication
* Rheumatoid arthritis
Action
* Reduce joint destruction and slow disease progression by interfering in immune and inflammatory responses
Nursing Considerations
* Lifelong therapy; treats symptoms but disease continues to progress
* Must treat RA aggressively: start a DMARD early—within 3 months of RA
* Can be possible to delay or even prevent serious joint injury
Osteoarthritis
About
* Age related disorder
* Cartilage decreases
* Bones become sclerosed
* Bones spurs form: Osteophytes
Causes
* Most common in: Hands, Knees, Hips, Spine
* Age (most common in over 40 year olds)
* Overweight
* Strenuous work environment
Nursing Interventions
* Low impact Physical exercise
○ Walking, aerobics, strength training
○ Avoid running, jump rope, etc. - puts too much pressure on the joints
* Encourage weight loss
* Corticosteroids
* Analgesics: NSAIDs, Acetaminophen
Gout
About
* Body cannot control uric acid production or exertion
* High uric acid builds up in the body
* Uric acid crystallizes and deposits in connective tissue
* Causes inflammation and destruction of joints
* Most common location: Great toe
* Complication: Gouty arthritis
Assessment findings
* Pain gets worse as the day goes on
* Inflammation
* Redness
* Decreased mobility
○ Very stiff
○ Intense pain with pressure
* Tophi
○ Large clumps of uric acid crystals that have accumulated over time
○ White/yellow
○ Can permanent damage joints
* High uric acid level
Nursing Interventions
* Alternate cold and warm compresses
* Hydration
* Bed rest
* NSAIDs
* Corticosteroids
* Allopurinol
○ Prevents future attacks - does not treat current symptoms
○ Decreases production of uric acids
* Low purine diet
Allopurinol
Indication
* Gout
Action
* Inhibits xanthine oxidase to prevent uric acid from forming
Nursing Considerations
* Monitor for side effects of leukopenia, fever, and rash
* Dosage must be individualized
* Teach to avoid foods high in purine
○ Beer, wine, cheeses, beans, anchovies, sardines, liver, kidneys, and cream
Contractures
About
* Permanent muscle shortening caused by muscle spasticity
Foot drop
· Plantar flexion contracture
· Prevent with boots!
Myopathy
About
* Primary muscle disorder causing weakness and atrophy
Assessment findings
* Decreased muscle strength
* Decreased muscle tone
Causes
* Drugs
* Alcohol abuse
* Idiopathic
Rhabdomyolysis
About
* Injury to the skeletal muscles by burn, trauma or compartment syndrome
* Muscles release their intercellular contents into the blood becoming toxic in circulation
○ Myoglobin, Creatinine kinase, potassium, phosphorus
* Major kidney damage as nephrons try to filter the toxins out
Assessment
* Vomiting
* Muscle weakness
* Bruising
* Fatigue
* Dark urine
Treatment
* Fluids: NS, hydration and flusing the kidneys
* Diuretics: dec swelling, inc UOP, flush out toxins
* Dialysis: If K too high or kidneys unable to clear toxins on their own
* *Bed rest
* Monitor electrolytes and CK
○ telemetry
