musculoskeletal system Flashcards
What are 5 manifestations of NV compromise?
Pain
Pallor
Pulse
Paralysis
Parasthesia
What are the important labs for musculoskeletal system?
CK (muscle damage)
AST (muscle damage)
ALD (inflammation)
Calcium
Vitamin D
What diagnostics will be used for the musculoskeletal system?
X-ray (fractures)
CT (bones/trauma, allergies)
MRI (soft tissue/tumor)
Arthrogram
Arthroscopy (tube in joint, visualize)
Biopsy (infection in bone)
Electromyography (muscle strength)
Ultrasound
What are some age related changes in the musculoskeletal system?
osteopenia (decr bone density)
osteoporosis(severe decr bone density)
Kyphosis (spinal curvature)
Osteoarthritis (joint inflammation)
Decr ROM
Muscle atrophy
Slowed movements
Health promotion for the musculoskeletal system?
vitamin D supplement
Calcium supplement
weight bearing exercises
substance abuse
alcohol abuse
no smoking
What is Gout?
urate crystals in joints/ tissues leading to inflammation
Primary Gout?
issue with purine metabolism
uric acid production> excretion
middle aged men
inflammation
postmenopause women
obesity
Secondary Gout?
hyperuricemia (disease)
diuretic therapy
chemotherapy
renal insufficiency
underlying health issue
all ages
What occurs in the asymptomatic stage of Gout?
no obvious symptoms
incr in uric acid levels (>6.5mg/dL)
What occurs in an acute attack of Gout?
inflammation + joint pain
incr ESR
incr BUN/creatinine
Is acute Gout reversible?
yes with lifestyle changes and increased fluid intake
What occurs in the interstitial stage of Gout?
symptom free period
What occurs in a chronic attack of Gout?
crystals form + swelling
breaks through skin (infection risk)
kidney stones
joint inflammation
renal calculi/dysfunction
Is chronic Gout reversible?
no
What should those with Gout avoid?
alcohol/beer
fad diets
purine food (fish)
aspirin
diuretics
acid foods
red meat/organ meat
processed food
stress
protein
shrimp/scallops
what are the medications used for Gout?
Allopurinol
Probenecid
Colchicine
Naproxen
What is Allopurinol for?
alloPurinol = Prevents Gout
1) STOP taking = MILD RASH
(rash ALL Over=ALLOpurinol=deadly)
2) INCREASE fluids
AVOID kidney/liver disease
monitor liver and renal function
What is Colchicine for?
Colchicine = aCute attacks
What is Probenecid for?
Probenecid = inPlace of alloPurinol allergy
What is Naproxen for?
Pain management
What are signs and symptoms of Gout?
Pain (wakes you at night)
swelling
tophi
warmth
bone deformity
joint damage
renal calculi
What is Osteoporosis?
reduction in bone density
change in bone structure
Memory trick for Osteoporosis
osteoPORosis = PORous bones
decr bone mass = decr bone density
incr bone resorption = incr bone loss
decr Calcium
Risk factors for Osteoporosis?
Female gender
-older age
-postmenopausal
-Caucasian & asian
Bad habits
-caffeine intake
-smoking/alcohol abuse
Medications
-Anticonvulsants
-steroids
-Barbituates
Diseases
-hyperparathyroidism
-cushing syndrome
-diabetes
Other
-thin/frail
Decr calcium/vitamin D
decr wt bearing exercises
Clinical manifestations of Osteoporosis?
porous bones
frequent fractures
reduced height
kyphosis
protruding abdomen
fatigue
Primary Osteoporosis
Women
-after menopause
-decr estrogen
Men
-decr testosterone
Secondary Osteoporosis
Corticosteroids
diabetes
hyperthyroidism
HIV
cirrhosis
diuretics
immunosuppressants
caffeine
phosphorus
carbonated drinks
Diagnostic tests for Osteoporosis
Dual energy X-ray
-fracture
-decr bone density
Bone mineral density
T score (-2.5 >)
-base is 30yr old
VItamin D levels
-20mg/mL
Serum Calcium levels
-8.6-10.3mg/dL
Treatment for Osteoporosis?
Calcium + Vitamin D (1/3 at bedtime)
sunshine
wt. bearing exercise
Medication for Osteoporosis?
Raloxifene
Bisphosphonates
-alendronate
-risedronate
Calcitonin
Calcium
What is Raloxifene for?
hormones
incr risk of DVT, stroke, heart disease, cancer
What is Bisphosphonates for?
“-dronate”
alendronate + risedronate
Bisphosphonates Build Bone
Burns esophagus
sit up for 30 min after taking
take on empty stomach
What is Calcitonin for?
inhibit osteoclasts
What is Calcium for?
makes bones strong
Calcium = Constipation
What causes Osteoporosis?
Decr Calcium
multiple causes
decr tesosterone
What causes Osteomalacia?
decr vitamin D
decr calcium
lack of calcification
Cause of Osteoporosis?
bone loss
fracture
Cause of Ostemalacia?
fracture
bone softening
What is Osteoarthritis?
break down of cartilage in joint
Oa = Ouch pain
Bone on Bone rubbing
What are risk factors of Osteoarthritis?
obesity
older age
female
occupation
heavy labor
genetics
trauma
malalignment
joint location
smoking
diabetes
sickle cell
Osteoarthritis clinical manifestations?
joint pain + stiffness
deformity
instability
reduced function
nodes
decr ROM
Diagnostic test for Osteoarthritis?
physical examination
x-ray
MRI (metal)
Arthroscopy (look at joint)
Synovial fluid aspiration
ESR
C-reactive protein
Management of Osteoarthritis?
Lifestyle changes
Wt loss
Joint support
Therapy
Medications
-acetaminophen
-celebrex
-cytotec
-prednisone
surgery
-joint replacement
-NV assessment
-surgical dressing/drains
-ROM
-PT
What is a fracture?
break in the bone
What is the extent of a break?
complete
incomplete
What is the extent of a soft tissue injury?
simple (closed)
compound (open)
What are the main Types of fractures?
Trauma
Pathological
Stress
Compound fracture
bone is through the skin
Greenstick fracture
child prone
Spiral fracture
abuse situations (twisting)
History for a patient with a fracture?
cause
drug use
medical hx
occupation
recreational activities
Diagnostic tests for a fracture?
X-ray
-bone disruption
-changes in alignment
-deformity
CT
-complex fracture
MRI
-soft bone injury
Bone Scan
Interventions for a fracture?
depends on the fracture
surgical or nonsurgical
MAIN GOAL: PREVENT NV COMPROMISE
Best practice for those with a fracture?
ABCs
Inspect for fracture
-dont remove anything
NV assessment
Immobilize area
Recheck NV status
What is a skeletal traction?
Surgical intervention
Insertion of wires/pins in affected bone
bone realignment
What is a skin traction?
Non surgical intervention
boot around affected leg
Decr painful muscle spasms
What is Bucks traction?
pully hanging over bed
keeps bone in line
What is an ORIF?
Open reduction with internal fixation
rods/wires/plates/screws
immobilization
Management after ORIF?
maintain NV status
monitor for S/S
-infection
-bleeding
-fat embolism
-DVT/PE
check dressings
turn/reposition
nutrition
What is an external fixation?
pins/wire through skin/bone
frame and support
fracture with soft tissue injury
management after external fixation?
monitor NV status
monitor for infection
assess bleeding risk
keep affected area elevated
assess skin integrity
Pin care?
Prevent infection
every 8-12hr
leg exercises
one swab per pin (no contamination)
skin reacts to pins for 72 hrs
What fracture is most common in older people?
hip fracture
(over 1/2 unable to live independently)
incr mortality rate
-osteoporosis
-fall risks
Manifestations of a hip fracture?
groin pain
lower back pain
lower knee pain
leg shorter and externally rotated
Diagnostic test for Hip fracture?
X-ray
What are the 2 types of hip fractures?
Intracapsular
-femoral neck (disrupt blood supply)
-Head
Extracapsular
-subtruchanteric
-trochanteric
Treatment for a hip fracture?
ORIF
Hip arthroplasty
Hemiarthroplasty
Bucks traction
Prevention for Hip dislocation
-no sitting/standing for long time
-no cross legs over midline
-no bending hips over 90 degrees
-ambulatory devices when moving
What is a dislocation?
displacement from normal position
-emergency
-NV damage
Treatment for a dislocation?
reduction
put back into place
immobilization
what is the 2nd most common cause of death from trauma?
pelvic fracture
(mv crash/ fall)
Why are pelvic fractures dangerous?
internal trauma/damage
hemorrhage–> hypovolemic shock
-blood in urine
-blood in stool
-abdominal swelling
-arterial bleeding/venous oozing
Pelvic fracture treatment?
non wt bearing
-bedrest
-pain management
wt bearing
-immediate attention
-ORIF
-External fixation
What is osteomyelitis?
infection of bone
Three types of osteomyelitis?
Exogenous
Endogenous
Contiguous
what does Exogenous mean?
infection is from outside the body
What does Endogenous mean?
Infection is from inside the body
What does Contiguous mean?
infection from a penetrating wound
S/S of acute osteomyelitis?
pain (constant)
Fever (101)
swelling (affected area)
Tenderness
Erythmea
S/S of chronic osteomyelitis?
Ulceration (foot/ bone surgery)
sinus tract formation (tunneling)
Localized pain
Drainage
Diagnostic tests for osteomyelitis?
MRI
Bone scan
Incr WBC
Incr ESR
+ blood culture
Nonsurgical management of osteomyelitis?
IV abx. therapy
wound irrigation
pain management
hyperbaric oxygen therapy
standard/contact precaution
Surgical management of osteomyelitis?
sequestrectomy
bone grafting
muscle flap
amputation
What is Fat Embolism Syndrome?
Fat release into blood stream from yellow marrow
24-72hr after injury
Early detection of FES?
trouble breathing
-hypoxemia
-SOB
-dyspnea
-incr RR
tachycardia
mental changes
vision changes
fever
perechaie
Diagnostic test fro FES?
X-ray chest (snowstorm infiltrate)
incr ESR
decr calcium
Decr RBC, Plt
incr serum lipase
fat in urine
Treatment for FES?
oxygen
hydration with iv fluids
bed rest
steroid therapy
vasopressor medications
What is a delayed union
fracture that doesn’t heal after 6 mo
what is a nonunion
never heals
what is a malunion
incorrectly heals
Treatment for delayed union?
ORIF
Bone graft
electrical stimulation
What is a DVT?
Blood clot
deep veins of legs
(most common complication for musculoskeletal surgery)
Virchows triad
What is Virchow’s Triad
Stasis of blood flow
endothelial injury
Hypercoagulbility
S/S of DVT?
calf/groin pain
unilateral swelling
hardening
warmth
What are risk factors for a DVT?
cancer/chemo
smoking
obesity
heart disease
hx of VTE
immobility
surgery longer than 30min
oral contraceptive
hormone medications
Diagnostic test for DVT?
Ultrasound
MRI
D-dimer
VQ scan
What is a PE?
complication of DVT
breaks off and goes to lungs
S/S of PE?
sudden onset of dyspnea
sharp stabbing pain in chest
restless
impending doom
cough
hemoptysis
diaphoresis
incr RR
crackles
tachycardia
low grade fever
petechiae
decr O2 stats
Diagnostic tests for PE?
chest X-ray
CT chest
Management of a VTE?
prevent incr in size
prevent further formation
prevent complications
pt/ education
-hydration
-leg exercises
-ambulation
-compression devices
-no oral contraceptives
Treatment of VTE?
Nnsurgical
-ambulation
-elevate
-compression
-medication
Surgical
-thrombectomy
-inferior vena canca filtration
What is avascular necrosis?
death of bone tissue
disrupted blood supply
What is Compartment syndrome?
increased pressure in a “compartment” reducing circulation
MEDICAL EMERGENCY
Early detection of ACS?
pain
pallor
paralysis
paresthesia
pulselessness
palpate
Treatment for ACS?
Fasiotomy
(incision to reduce pressure)
Complications of ACS?
infection
contracture
renal failure
motor weakness
What is Rhabdo?
break down of muscle
Causes of Rhabdo?
burns
compression
crush injury
seizures
cocaine abuse
physical training
thyroid syndrome
infection
autoimmune
stroke
Diagnostic test for Rhabdo?
hyperuricemia
hypocalcemia
hyperkalemia
incr BUN/creatinine
myoglobinuria
CK
What is hypovolemic shock?
look of blood from vascular space
incr HR
decr BP
Treatment of hypovolemic shock?
oxygen therapy
IV therapy/fluids
PRBC
plasma infusion
What is an amputation?
removal of a body part
What is an elective amputation?
pt elects to remove
what is a traumatic amputation
removal accident
Levels of amputation?
above the knee
below the knee
same
mid-foot
toe
hip
hemipelvectomy
Treatment of phantom limb pain?
calcitonin
beta blockers
mirror box
electrical nerve stimulation
