Musculoskeletal System Flashcards
A _____ is where two or more bones come together to allow for movement
Joint
Examples of synovial joints
Shoulder, knee
__________ attach muscles to bones
Tendons
_________ attach bones to bones
Ligaments
Minerals and hormones essential for bone growth/health
Calcium, vitamin D, phosphorous, PTH, calcitonin, growth hormone
Parathyroid hormone (PTH) pulls calcium out of the bones and into the bloodstream which _________ calcium levels
Increases
_________ is a hormone that counteracts the activity of PTH by inhibiting osteoclast activity and decreases reabsorption of calcium at the kidneys which decreases blood calcium levels
Calcitonin
Aspiration of synovial fluid from joint cavity
Arthrocentesis
Insertion of narrow tube with camera to visualize internal structure of joint and allows for collection of biopsies
Arthroscopy
Knee arthroscopy nursing consideration
Patient needs to be able to bend their knee at least 40 degrees and there cannot be an active infection in that knee
Procedure that uses low levels of X-rays to measure a patients bone mass for the diagnosis of osteoporosis
Dual x-ray absorptiometry (DXA)
Diagnostic used to identify fractures, bone cancer, and bone infections
Nuclear scans
Describe nuclear scan process
Administration of radioactive substance or isotope is administered 4-6 hrs before the procedure; nuclear scan will show a hot spot of where radiation has gathered revealing affected site; nuclear scans can be repeated at 24, 48, and 72 hours
Diagnostic used to evaluate muscle weakness by which needles are inserted into muscles and muscle activity is recorded
Electromyograpy (EMG)
Progressive degeneration of the articulate cartilage in a joint causing inflammation, development of bone spurs, and decreased mobility
Osteoarthritis
Osteoarthritis risk factors
Older age, female gender, smoking, obesity, repetitive stress on joints
S/S of osteoarthritis
Joint pain and stiffness, enlarged joints, crepitus, heberden’s nodes (higher up on finger) and bouchard’s nodes (lower on finger closer to body)
Osteoarthritis treatment
NSAIDs, topical medications such as voltaren gel (topical nsaid), topical capsaicin, glucosamine supplement (decreases inflammation and further degeneration of articulation cartilage), injections into synovial joint (corticosteroids, hyaluronic acid)
Osteoarthritis patient education
Balance rest with activity, weight loss if applicable, encourage strength training and physical therapy, yoga and tai chi are good exercises for osteoarthritis, apply ice for ACUTE exacerbations and heat for stiffness, use of splinting and assistive devices
Autoimmune disorder in which antibodies attack synovium leading to swelling, inflammation, and destruction of articulated cartilage and bone
Rheumatoid arthritis (RA)
T or F: rheumatoid arthritis is characterized by periods of exacerbation and remission
True
RA risk factors
Females, ages 20-50, family hx
S/S of RA
Bilateral and symmetrical joint pain and swelling, morning stiffness, ankylosis (joint fixation and deformity), swan neck and boutinniere deformities; swan neck is characterized by flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. The boutinniere deformity causes hyperextension of the distal joint and flexion of the proximal joint. Ulnar shift is occurs when all fingers start to bend towards pinky finger; subcutaneous nodules; fever, red sclera, lymphadenopathy (swelling of lymph nodes)
Abnormal labs with RA
Positive rheumatoid factor, positive ANA titer, elevated WBCs, CRP, and ESR
RA treatment
Immunosuppressants (prednisone, methotrexate), NSAIDs, hydroxychloroquine, Plasmapharesis, PT and OT
RA nursing care
Monitor for complications such as Sjögren’s syndrome
S/S of Sjögren’s syndrome
Excessively dry eyes and dry mouth
RA patient education
Take warm shower in morning to relieve morning stiffness, engage in physical activity to preserve ROM, use assistive devices as needed for safety
Osteoarthritis vs RA: pain
Osteoarthritis: end of day pain; patient will have more pain with activity that is relieved with rest. After sleeping all night, patient will feel better in the morning
RA: patients will have morning stiffness and pain that is relieved through activity
The replacement of a diseased joint with a prosthetic joint
Arthroplasty (most common include knee, hip, and shoulder)
Contraindications for arthroplasty
Active infection, advanced osteoporosis
Arthroplasty pre-op care
Administration of epoetin Alfa or autologous blood donation several weeks before procedure, remind patient to shower with antiseptic soap to decrease risk for infection
Arthroplasty post-op care
Monitor for DVT or PE, prevent thromboembolism through (SCDs, stockings, anticoagulants, start exercise and activity soon after surgery), monitor for infection, bleeding, and neurovascular compromise (pulses, color, temp, etc)
Arthroplasty patient education
Take antibiotics prior to any dental or invasive procedure (for the rest of life)
Hip replacement post-op care
Abduction device in place, ensure heels are elevated off bed to prevent injuries, provide trapeze device for repositioning, monitor for signs of joint dislocation (increased hip pain, affected leg appears shorter or internally rotated)
Hip replacement patient education
Use elevated toilet seat, avoid low chairs (avoid hip flexion over 90 degrees), do not cross ankles or legs (can cause joint dislocation)
Knee replacement post-op care
Continuous passive motion if ordered, do NOT place pillow or knee gatch beneath the knee (can result in flexion contractures), educate patient to avoid kneeling or deep knee bends following procedure
Metabolic bone disorder causing a decrease in bone mass leading to fragile bones and increased risk for bone fractures
Osteoporosis
What is the precursor to osteoporosis?
Osteopenia
Osteoporosis risk factors
Older age, low body weight, vitamin D or calcium deficiency, smoking, immobility, corticosteroids use, hyperparathyroidism, white and Asian
S/S of osteoporosis
Back pain, height that decreases over time, kyphosis, balance issues
Osteoporosis treatment
Medications: calcitonin, estrogen, Alendronate, Raloxifene (these meds decrease bone resorption)
Osteoporosis patient education
Ensure adequate intake of calcium and vitamin D, engage in weight-bearing exercise (strength training, walking), implement home safety precautions
Bone loss due to vitamin D deficiency (adult equivalent to rickets in children)
Osteomalacia
Osteomalacia risk factors
Insufficient sunlight exposure or insufficient vitamin D intake, disease or disorder that impairs vitamin D absorption such as crohns or celiac disease
Osteomalacia S/S
Bone pain and weakness, waddling gait, increased falls (d/t soft bones)
Osteomalacia labs
Decreased serum calcium and phosphorus, elevated PTH
Osteomalacia treatment
Vitamin D supplementation
Metabolic disorder that causes bones to become soft, structurally disorganized, and weak placing patients at high risk for fractures
Paget’s disease
Paget’s disease risk factors
Older age, European descent, male gender
S/S of Paget’s disease
Bone pain and stiffness, abnormal spinal curvature, fractures, bowing of long bones
Paget’s disease patient education
Engage in gentle exercises to help maintain mobility, implement safety precautions to prevent falls
Infection of the bone
Osteomyelitis
Osteomyelitis risk factors
Deep wounds, recent trauma such as open fracture, orthopedic surgery, diseases such as diabetes
Osteomyelitis S/S
Bone pain, redness, swelling, fever, increased WBCs
Osteomyelitis treatment
Long-term IV antibiotics (often via PICC line), surgical debridement of bone
Metabolic disorder that causes hyperuricemia (elevated uric acid levels) causing formation of uric acid crystals that become deposited in the joints causing joint pain, redness, swelling, and tophi (red, enlarged area on joints)
Gout
Gout most often affects
The great toe
Gout labs
Elevated uric acid levels, synovial fluid from joint via arthrocentesis will show urate crystals
Gout treatment
NSAIDs and ice packs for pain control; colchicine for acute gout attack, allopurinol and probenecid for chronic gout
gout patient education
Avoid alcohol, avoid purine-rich foods (red meat, organ meat, shellfish, fructose drinks), avoid starvation dieting, increase fluid intake, reduce stress
A _________ fracture does not break through the skin
Closed
_________ fractures break through the skin and carry a high risk for infection
Open
What kind of fracture occurs perpendicular to the long axis of the bone?
Transverse
What kind of fracture occurs when two or more bones are crushed together due to a loading force?
Impacted/compression
A _________ fracture is when the fracture results in two or more pieces
Comminuted
What kind of fracture occurs at an angle?
Oblique
What kind of fracture occurs from a twisting motion and is a definite sign of abuse?
Spiral
Fracture in which only one side of the bone is broken and is most common in children
Greenstick
S/S of fracture
Pain, swelling, ecchymosis, deformity, muscle spasms
Procedure for treatment of fractures in which bones are placed back into normal position without cutting the skin open
Closed reduction
Fracture treatment involving the insertion of screws and pins into the bone and are attached to an external frame
External fixation
Fracture treatment involving cutting open of skin, placement of screws, pins, and rods to correct fracture, followed by closure of skin
Open reduction and internal fixation (ORIF)
Fracture complication in which fat globule that comes out of the bone marrow and travels to the lungs
Fat embolism
Fat embolism is more common with what type of fractures?
Long bone and hip
S/S of fat embolism
Dyspnea, confusion, tachypnea, tachycardia, petechiae, decrease O2 saturation
Fat embolism treatment
Supportive: bed rest, IV fluids, oxygen
Fracture complication resulting in increased pressure in the muscle compartment that impairs circulation to that extremity
Compartment syndrome
S/S of compartment syndrome (hint: 5 P’s)
Intense Pain (even with passive movement and unrelieved with meds), Paresthesia, Paralysis, Pallor, Pulselessness. Additionally, affected extremity will be hard and swollen
Compartment syndrome nursing care/considerations
DO NOT apply cold to area, DO NOT elevate extremity, notify provider
Compartment syndrome treatment
Fasciotomy (deep incision into muscle compartment to relieve pressure), amputation may be necessary
Handling a plaster cast
With palms of hand until dry
Cast nursing care
Elevate cast above level of heart for first 48 hours and apply ice
Cast patient education
Do not stick anything in cast, if itching use a blow dryer on cool setting, notify provider of increased pain, hot spots, malodor, increased drainage, cool digits, and change in distal extremity color
Application of weights to patients skin in order to immobilize affected area, decrease muscle spasms, and realign bones
Skin traction
Bryants traction and bucks traction are examples of
Skin traction
_________ traction is typically used in children for hip dysplasia
Bryants
_________ traction is used in adults for hip fractures
Bucks
Insertion of screws or pins into bones for long bone fractures
Skeletal traction
Traction device used for cervical bone fractures
Halo traction
Traction nursing care
Weights should hang freely (do not pick them up; should not be resting on floor), provide analgesic and muscle relaxants
Cervical traction nursing care
Move patient as unit, never apply pressure to rods, ensure wrench or screwdriver is attached to vest for emergency removal
Prevention of hip flexion contractures
Perform ROM exercises, avoid elevating stump, avoid chair-sitting, lay in prone position for 20-30 min q3-4h
Life-threatening complication that occurs due to certain drugs used in general anesthesia
Malignant hyperthermia
Example of drug that can trigger malignant hyperthermia
Succinylcholine
S/S of malignant hyperthermia
Muscle rigidity, fever, tachycardia, tachypnea, dysrhythmias, hypotension, cyanosis
Altered labs that may be present with malignant hyperthermia
Metabolic acidosis and myoglobin present in urine
Treatment of malignant hyperthermia
Discontinue surgery if possible, administer antidote dantrolene, 100% oxygen, implement cooling measures such as cold IV fluids and ice packs, sodium bicarbonate
