Nursing Care of Acute Musculoskeletal Disorders Flashcards
Prevention of musculoskeletal disorders include
public education (helmets, seat belts, DUIs) and healthy bones, joints, muscles, diet and exercise
What laboratory tests would you assess for a pt with musculoskeletal disorder?
Serum ca, PO4 (phosphate), alk phos and CBC
What diagnostic tests would you assess for a pt with musculoskeletal disorder?
X-ray, CT, MRI, arthroscopy and bone scans
What other general assessment would you perform?
Inspection, palpation, gait analysis, use of assistive devices (canes, walkers, splints) and ROM
What general s/sx would you see?
Pain, deformity (abnormal angles), swelling, loss of motor function and change in sensory fxn
Bruise without skin break is known as
Contusion
What is a strain?
Excessive stretching of a muscle or tendon when it is weak or unstable
How would you manage a strain?
Cold and heat applications, exercise and activity limitations, anti-inflammatory drugs, muscle relaxants and possible surgery
What is a sprain?
Excessive stretching of a ligament
How would you manage a sprain?
1st degree: rest, ice for 24 to 48 hrs, compression bandage and elevation
2nd degree: immobilization, partial weight bearing as tear heals
3rd degree: immobilization for 4 to 6 weeks, possible surgery
What is crush syndrome?
Can occur when leg or arm injury includes multiple compartments. It is characterized by acute compartment syndrome, hypovolemia, hyperkalemia, rhabdomyolosis and acute tubular necrosis
What is the treatment for crush syndrome?
Adequate intervenous fluids, low dose dopamine, sodium bicarbonate, kayexalate and hemodialysis
In an emergent situation, what would you assess for a pt in trauma?
Respiratory distress, bleeding and head injury
Discontinuity or a break in the bone is known as
general bone fracture
Temporary displacement of two bones and loss of contact between articular cartilage is known as
dislocation
What is sublaxation?
Contact between articular surfaces is only partially lost
Dislocation and sublaxation are associated with what?
Fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
Dislocation is most common in the
shoulder, hip, knee and fingers
What sequence of events occur in the healing process?
Hematoma formation (24-28 hrs), consolidation, fibrin mesh (10 days to 3 weeks), granulation/new bone (3-6 weeks), callus formation (3-6 months) and remodeling
What are some of the healing variables?
Type and severity of fracture, nutrient supply, amount of gap, degree of immobilization, amount of infection, necrosis, age and concomitant disease
What are the surgery options for fractures?
Open reduction w/ internal fixation (ORIF), amputation, application of external devices
What are electromechanical treatments for fractures?
Closed reduction, splints, casts, wraps, traction, cold, elevation, ROM, weight bearing
What are the two main complications that can occur during musculoskeletal surgery?
Fat embolism and venous thromboembolism
This occurs when fat globules are released from the yellow bone marrow into the bloodstream
Fat embolism syndrome (FES)
Name other complications of fracture surgeries
Compartment syndrome, shock, thrombophlebitis, DVT, emboli, nerve injury, infections, allergy, fracture blisters, delayed union, nonunion and malunion
What is acute compartment syndrome?
It is a serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area
Within 4 to 6 hrs after the onset of ACS, what can happen in an emergent situation?
Neuromuscular damage becomes irreversible and the limb can become useless within 24 to 48 hours
What results can occur in ACS?
Infection, motor weakness, Volkmann’s contractures, myoglobinuric renal failure aka rhabdomyolosis
Other complications of fractures include
infection, ischemic necrosis, fracture blisters, delayed union, nonunion and malunion
Application of a pulling force to the body to provide reduction, alignment and rest at the site is known as
Traction
Traction care includes:
Maintain correct balance between traction pull and countertraction force, care of weights, skin inspection, pin care and assessment of neurovascular status
This is a rigid device that immoblizes the affected body part while allowing other body parts to move
Cast
What are some cast complications?
Infection, circulation, impairment, peripheral nerve damage and complications of immobility
What are some common nursing diagnoses and interventions for casts?
Acute pain, immobility, sensory deficit r/t decreased perfusion, nerve damage, risk of injury, hemorrhage, compartment syndrome, and risk of infection
Interventions for acute pain include:
reduction and immobilization of fracture, assessment of pain, drug therapy (opioid and nonopioid), complementary and alternative therapies
Interventions for infection include:
Strict aseptic technique for dressing changes and wound irrigations, assess for local inflammation, report purulent drainage immediately to hcp, assess for pneumonia and UTI and administer broad spectrum ATB prophylactically
Interventions for physical mobility include:
use of crutches to promote mobility, use of walkers and canes to promote mobility, CPM continuous passive mobilizers, skin care, turn Q2hrs and elevate injured area
Interventions for imbalanced nutrition include:
less than body requirements, diet high in protein, calories, calcium, supplemental vitamins B and C, frequent small feedings and supplements of high protein liquids, and intake of foods high in iron
ATB, analgesics, splints, drainage and surgery are all treatment options for
Osteomyelitis
What are the indications for amputation?
DDD - dead, dangerous and damn nuisance
What are some complications of amputation?
Hemorrhage, infection, phantom limb pain, problems associated with immobility, neuroma and flexion contracture
This is a frequent complication of amputation
Phantom limb pain
What treatment options are there for amputation?
Exercise, ROM to prevent flexion contractures, particularly of the hip and knee, trapeze and overhead frame, firm mattress, prone position every 3 to 4 hours and elevation of lower leg residual limb controversial
