Musculoskeletal System (PNP) Flashcards
Rheumatoid Arthritis(systemic)
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)
osteoarthritis
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
Ankylosing spondylitis(etiology)
- chronic progressive disorder of sacroiliac and hip joints, synovial joints of spine, and adjacent soft tissue
- seen more in young men
- hereditary
Ankylosing Spondylitis(Signs & Symptoms)
- inflamation of spine
- bones grow together
- ligaments ossify
- enlarged heart, pericarditis
- kyphosis
- ibd(irritable bowel disease)
- vision loss
Ankylosing Spondylitis(assessment)
- low back pain
- stiffness
- tenderness in spine and sacroiliac
- peripheral joint edema
- decrease ROM
Ankylosing Spondylitis((medical management)
- analgesics
- NSAIDS
- surgery to replace fused joints
Ankylosing Spondylitis(nursing intervention)
- maintain alignment of spine
- postural and breathing exercise
- lye on abdomen for 15-30min QID to extend spine
- back braces
- firm braces
- warm compresses
Gout(etiology)
- 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
Gout(signs/symptoms)
- onset occurs at night
- severe pain, inflammation,edema,
- erythema of join
- episodes lasts from hours to days
- one episode or repeated attacks
Gout(assessment)
- 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)
Gout(medical management)
- cholchicine
- phenylbutazone-anti-inflammatory
- indomethacin
- steroids
- allopurinol
Gout(nursing intervention)
- protect affected joint with bed cradle
- warm and cold compresses
- elevate joint
- increase fluids
patient teaching
- follow prescribed diet
- medication as ordered
Osteoporosis(etiology)
- 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
Osteoporosis(signs and symptoms)
- develops slowly and progresses
- bones become porous and brittle due to decreased calcium in diet
Osteoporosis(assessment)
- pathological fractures
- difficulty weight bearing
- loss of height, kyphosis
Osteoporosis(diagnostic test)
- bone density test(dexa scan)
- check calcium level
Osteoporosis(medical management)
- 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
Osteoporosis(nursing intervention)
- increase calcium diet
- decrease caffeine, smoking
- safety measures
- walking, biking, swimming=excellent ways to build bones
Osteomyelitis(etiology)
- serious bone infection
- acute:results from compound bone fracture that exposes to the bone to infection
- inflammation,ischemia,necrosis
Osteomyelitis(signs/symptoms)
- pain,fever,flushed appearance
- skin over affected area(warm,erythema,edema)
- increased wbc
- positive culture
- elevated ESR
Osteomyelitis(medical management)
- iv antibiotics(4-8weeks)
- early detection
- drains
- complete immobilization of body parts
- pain management
- increased protein,carbohydrates,calcium, and fluids
chronic osteomyelitis
- antibiotics are ineffective
- abscess forms
- micro-organisms may be drug resistant
- sign/symptoms: purulent drainage,pain,edema,weakened bone
Herniated intervertebral disk(etiology)
-disk of cartilage btw two vertebrae weakens and presses on spinal nerves/ spinal cord
Herniated intervertebral disk(signs/symptoms)
- back,shoulder,neck pain
- neurological dysfunction
- radicular pain(that radiates)
Herniated intervertebral disk(risk factors)
- age, smoking,
- degenerative joint disease(osteoarthritis)
- osteoporosis
- heavy lifting
Herniated intervertebral disk(nursing interventions)
- pain medication
- increase protein and vitamin diet
- routine post-op care
- neurovascular checks
- check dressing OOB day 1
Hip and knee Arthroplasty
- 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
Amputation
- 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
contusions
- 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
sprains
- injury to ligaments surrounding joints causing them to stretch and tear
- may involve bleeding into joints
- REST ICE ELEVATION COMPRESSION
- common sprain in ankles
strains
- 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
whiplash
- 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
dislocations
- 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
complete fx
-fracture line extends entirely through the bone
closed fx
overlying skin intact(simple fx)
open fx
overlying skin is broken(compound)
greenstick fx
incomplete fx, fracture line extends only partially through bone. still secure on one side
comminuted fx
bone splinters into 3 or more fragments
spiral fx
breaks coils around bone, results from twisting, child abuse
fractures(signs and symptoms)
- 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
Fractures(medical management)
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
ORIF(open reduction internal fixation)
- open the skin to fix
- reduction put bone in place
- internal fixation - putting screws etc.. back into place
fractures(nursing intervention)
- 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)
fracture of the hip(etiology)
- 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
fracture of hip(nursing care)
- 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
fracture of the vertebrae
- 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
