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VEEB > Musculoskeletal System (PNP) > Flashcards

Musculoskeletal System (PNP) Flashcards

1
Q

Rheumatoid Arthritis(systemic)

A

etiology:

  • most painful and crippling form
  • 75% are women, 20-50yrs(young person disease)
  • autoimmune
  • chronic inflammation of synovial membrane and joints

S/S:

  • inflames synovial joints
  • cartilage gets eaten away
  • bone rubs on bone
  • joint calcifies
  • remission and exacerbation
  • maliase/fatigue
  • loss of appetite
  • fever
  • edema,erythema,warmth of joints
  • decrease ROM(stifness), pain/tenderness

Diagnostic test:

  • sedimentation rate is postitive
  • h&p, looking for joint pain, morning stifness,muscle weakness,fatigue
  • rhematoid factor is positive in 80% abnormal protein
  • synovial fluid is suppose to be clear, if yellow indicates arthritis

medical management:

  • maintain function
  • get into remission
  • decrease inflammation
  • drug therapy-NSDAIDs, aspirin, antinflammatories(steriods)
  • PT,OT

nursing intervention:

  • rest due to fatigue
  • exercise to prevent joints from freezing
  • ROM w/ frequent rest periods
  • hot packs-warm soaks
  • parafifn wax

patient teaching:

  • understand medication
  • major side effect of antinflammatory: gi distress/bleeding
  • check stools for dark tarry stools
  • safety: use of cane and walkers
  • morning stiffnes(warm shower in morning)
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2
Q

osteoarthritis

A

etiology:
- related to aging
- specific to joint or two
- wear and tear
- degenerative joint disease
- primary-dont know cause
- secondary-can figure cause cause excess weight on weight bearing joints
- non-systemic inflammatory disease
- bones,cartilage, and joints degenerate
- wear and tear

s/s:

  • related to aging
  • affects joints in hands,knees,hip,cervical an lumbar vertebrae
  • stiffness and pain
  • muscle spasms
  • decreased grip strength
  • joint edema
  • tenderness
  • deformities

diagnostic test:
herberden nodes(distal joints in fingers)
bouchard nodes fingers- hard bony enlargements
-history/physical, X-rays, orthroscope

medical management:

  • excercise and rest periods
  • heat application
  • walkers, canes,
  • larges doses of asa,nsaids,steroids
  • joint replacement or arthroplasty(knee replacement)

nursing intervention:

  • maintain ADLs
  • weight reduction
  • check for Gi bleeding
  • guiac stools

patient teaching:

  • know medication
  • can cause gi bleeding
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3
Q

Ankylosing spondylitis(etiology)

A
  • chronic progressive disorder of sacroiliac and hip joints, synovial joints of spine, and adjacent soft tissue
  • seen more in young men
  • hereditary
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4
Q

Ankylosing Spondylitis(Signs & Symptoms)

A
  • inflamation of spine
  • bones grow together
  • ligaments ossify
  • enlarged heart, pericarditis
  • kyphosis
  • ibd(irritable bowel disease)
  • vision loss
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5
Q

Ankylosing Spondylitis(assessment)

A
  • low back pain
  • stiffness
  • tenderness in spine and sacroiliac
  • peripheral joint edema
  • decrease ROM
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6
Q

Ankylosing Spondylitis((medical management)

A
  • analgesics
  • NSAIDS
  • surgery to replace fused joints
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7
Q

Ankylosing Spondylitis(nursing intervention)

A
  • maintain alignment of spine
  • postural and breathing exercise
  • lye on abdomen for 15-30min QID to extend spine
  • back braces
  • firm braces
  • warm compresses
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8
Q

Gout(etiology)

A
  • metabolic disease
  • body unable to metabolize purines
  • uric acid accumulates in blood
  • crystal deposits in joints cause inflammation
  • occur more often in men
  • involves big toe,knee,ankle
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9
Q

Gout(signs/symptoms)

A
  • onset occurs at night
  • severe pain, inflammation,edema,
  • erythema of join
  • episodes lasts from hours to days
  • one episode or repeated attacks
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10
Q

Gout(assessment)

A
  • dietary history: alcohol,cheese,organ meats, scallops, anchovies
  • edema
  • discoloration
  • increased temp.
  • decrease movement
  • increase HR, RESP RATE, BP
  • decrease urine output
  • crystal stone(kidney stones)
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11
Q

Gout(medical management)

A
  • cholchicine
  • phenylbutazone-anti-inflammatory
  • indomethacin
  • steroids
  • allopurinol
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12
Q

Gout(nursing intervention)

A
  • protect affected joint with bed cradle
  • warm and cold compresses
  • elevate joint
  • increase fluids

patient teaching

  • follow prescribed diet
  • medication as ordered
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13
Q

Osteoporosis(etiology)

A
  • demineralization of bone
  • bone mass decreases
  • women 35-65 yrs
  • related to menopause

contributing factors:
-immobilization, steroids, increased caffeine, decreased calcium in diet, smoking, white and asian and small stature

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14
Q

Osteoporosis(signs and symptoms)

A
  • develops slowly and progresses

- bones become porous and brittle due to decreased calcium in diet

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15
Q

Osteoporosis(assessment)

A
  • pathological fractures
  • difficulty weight bearing
  • loss of height, kyphosis
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16
Q

Osteoporosis(diagnostic test)

A
  • bone density test(dexa scan)

- check calcium level

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17
Q

Osteoporosis(medical management)

A
  • calcium supplement(sardines,green leafy veggie,salmon has alot of calcium
  • weight bearing exercises
  • estrogen
  • fosamax,boniva,actonel(bone reabsorbtion inhibitors-stop you from losing bone
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18
Q

Osteoporosis(nursing intervention)

A
  • increase calcium diet
  • decrease caffeine, smoking
  • safety measures
  • walking, biking, swimming=excellent ways to build bones
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19
Q

Osteomyelitis(etiology)

A
  • serious bone infection
  • acute:results from compound bone fracture that exposes to the bone to infection
  • inflammation,ischemia,necrosis
20
Q

Osteomyelitis(signs/symptoms)

A
  • pain,fever,flushed appearance
  • skin over affected area(warm,erythema,edema)
  • increased wbc
  • positive culture
  • elevated ESR
21
Q

Osteomyelitis(medical management)

A
  • iv antibiotics(4-8weeks)
  • early detection
  • drains
  • complete immobilization of body parts
  • pain management
  • increased protein,carbohydrates,calcium, and fluids
22
Q

chronic osteomyelitis

A
  • antibiotics are ineffective
  • abscess forms
  • micro-organisms may be drug resistant
  • sign/symptoms: purulent drainage,pain,edema,weakened bone
23
Q

Herniated intervertebral disk(etiology)

A

-disk of cartilage btw two vertebrae weakens and presses on spinal nerves/ spinal cord

24
Q

Herniated intervertebral disk(signs/symptoms)

A
  • back,shoulder,neck pain
  • neurological dysfunction
  • radicular pain(that radiates)
25
Q

Herniated intervertebral disk(risk factors)

A
  • age, smoking,
  • degenerative joint disease(osteoarthritis)
  • osteoporosis
  • heavy lifting
26
Q

Herniated intervertebral disk(nursing interventions)

A
  • pain medication
  • increase protein and vitamin diet
  • routine post-op care
  • neurovascular checks
  • check dressing OOB day 1
27
Q

Hip and knee Arthroplasty

A
  • repair or replacement of a joint
  • total hip or total knee replacement

:pre op and post op interventions

  • neurovascular checks qhrly for first 24hra
  • turn toward unoperative side
  • cpm=continous passive motion=machine does range of motion for them, promotes healing, increase circulation
  • premedicate b4 going on machine
  • total hip precautions: no adducting and bending
28
Q

Amputation

A
  • absence or removal of all or part of limb
  • due to injury=traumatic amputation
  • wrap, amputated part in cool moist clothe and put in plastic bag and then put plastic bag in ice
  • planned amputation: for malignancy, infection, gangrene, trauma,peripheral vascular disease
  • wear prosthesis to prevent hip contraction and lying prone(stomach/abdomen)
  • phantom limb pain=nerves are still sending pain messages to brain
  • complication: hemorrhage, stomp doesnt heal, infection
  • teach post op: compression dressing w/ ace bandages, done to protect limb, control edemal pain, shape the stomp
29
Q

contusions

A
  • soft tissue injury from a blunt force or blow
  • causes local bleeding under skin(hematoma)
  • seriousness depends on location
    treatment: REST ICE ELEVATION COMPRESSION, pain medication
30
Q

sprains

A
  • injury to ligaments surrounding joints causing them to stretch and tear
  • may involve bleeding into joints
  • REST ICE ELEVATION COMPRESSION
  • common sprain in ankles
31
Q

strains

A
  • microscopic tears as a result of over stretching muscles and tendons
  • loss of function
  • less severe than sprain
  • pain, edema,ecchymosis,loss of function
  • REST ICE COMPRESSION ELEVATION
32
Q

whiplash

A
  • injury to cervical spine
  • results from sudden acceleration/deceleration
  • symptoms may not be obvious a few days to few weeks
  • s/s: headache, inflammation
  • treatment: heat,neck brace,pain med, muscle relaxants,check hand grasp
33
Q

dislocations

A
  • a ligament gives away so completely that the bone displaces from its socket
  • abnormal bone position, severe pain, edema
  • manipulation of ligaments and joint puts bone back in position
  • neurovascular checks
34
Q

complete fx

A

-fracture line extends entirely through the bone

35
Q

closed fx

A

overlying skin intact(simple fx)

36
Q

open fx

A

overlying skin is broken(compound)

37
Q

greenstick fx

A

incomplete fx, fracture line extends only partially through bone. still secure on one side

38
Q

comminuted fx

A

bone splinters into 3 or more fragments

39
Q

spiral fx

A

breaks coils around bone, results from twisting, child abuse

40
Q

fractures(signs and symptoms)

A
  • pain,edema,warmth,ecchymosis,loss of sensation, shock
  • loss of function, obvious deformity,change in curvature or length of bone
  • crepitus-grafting sound if limb is moved(occurs in osteoporosis
41
Q

Fractures(medical management)

A

diagnosis with X-ray

  • splint affected part
  • maintain body alignment
  • elevate
  • cold pack for 24hrs
  • analgesics
  • neurovascular checks
  • check for shock

secondary management:
-closed fx: closed reduction,traction, ORIF(open reduction internal fixation),immobilize-cast or splint

-open fx: surgical debridement, antibiotics,culture wound,close wound, reduce fx,immobilize, tetnaus toxoid

42
Q

ORIF(open reduction internal fixation)

A
  • open the skin to fix
  • reduction put bone in place
  • internal fixation - putting screws etc.. back into place
43
Q

fractures(nursing intervention)

A
  • same as for surgical patient
  • if lower extremities: weight bearing restrictions and transfers
  • ambulatory asstive devices
  • pain control
  • pin care(keeping site clean around the pin, sterile technique clean with sterile water)
44
Q

fracture of the hip(etiology)

A
  • includes head and neck of femur and trochanter
  • common in elderly
  • shortening and external rotation on effected side
  • may disrupt blood supple to the femur causing necrosis
  • treatment-ORIF or hip replacement
45
Q

fracture of hip(nursing care)

A
  • anticogulants
  • maintain alignment
  • turn to unoperative side
  • avoid hip flexion
  • vital signs
  • trapeze-help with movement
  • compression stocking(prevent bloodclots)
  • neurovascular checks every hour for at least first 24 hours
46
Q

fracture of the vertebrae

A
  • pressure on spinal nerves
  • sharp bone fragments may severe spinal cord
  • stable fx requires support or brace
  • unstable fx- requires skeletal traction, halo traction brace
  • always log roll
  • do not elevate bed higher than 30 degrees

VEEB (25 decks)

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