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
Compartment Syndrome
About
* There is increased pressure within a confined space: Limbs Especially in a cast!
* Increased pressure compromises circulation
* Without circulation, the distal tissue becomes ischemic
* Tissue and nerve damage occurs
Assessment
* Extremely painful
* Limb feels tight
* Swelling
* Numbness
* Tingling
* Paralysis
* Diminished or absent pulses
* Decreased sensation
Treatment
* FASCIOTOMY
○ Must relieve the pressure in the compartment
○ Cut open the compartment
Fat Embolism
Symptoms
* Hypoxia
* Dyspnea
* Tachypnea
* Confusion
* Altered level of consciousness
* Petechial rash (does not always occur)
Priority Nursing Actions
* Actions to take if a client develops a fat embolism
a. Notify the HCP
b. Administer oxygen
c. Administer IV fluids
d. Monitor vitals and respiratory status
e. Prepare for intubation and mechanical ventilation
f. Document the event, actions take and the client’s response
Osteomyelitis
About
* Infection of the bone
* Usually caused by a staph infection
* Infection can be
○ Exogenous or Endogenous
* Spreads through bone shaft or into bone marrow
Treatment
* Antibiotics
