Test 4 Musculoskeletal Shi Flashcards
What do osteoblasts do?
Function in bone formation
What do osteocytes do?
Mature bone cells that function in maintanence
Located in the lacunae
What do osteoclasts do?
Multinuclear cells functioning in destroying, reabsorbing, and remodeling bone
Located in Howship Lacunae
Osteogenisis vs Ossification?
Osteogenisis: Process of bone formation
Ossification: Process of formation of the bone matrix and deposition of minerals
Stages of Bone Healing
1: Hematoma formation
2: Fibrocartilaginous callus formation
3: Bony callus formation
4: Remodeling
When does stage 1 of bone healing take place?
1- 2 days after fracture
What happens in stage 2 bone healing?
Fibroblasts and osteoblasts migrate to fracture site
What happens in stage 3 of bone healing?
Ossificaiton begins in 3rd or 4th week
What happens in stage 4 of bone healing?
Osteoclasts remove necrotic bone
What’s a sarcomere?
The contractile unit of skeletal muscle that contains actin and myosin
What provides energy for more strenous muscle activity?
Anaerobic pathways using glucose metabolised from stored glycogen
Physical Assessment of musculoskeletal system
Pain, tenderness, sensation
Posture and Gait
Bone integrity
Joint function
Muscle strength and size
Skin
Neurovascular Status
What are some nursing interventions for an MRI?
May hear a knocking sound
Asses for allergies to contrast testing
Nursing interventinos for arthrography
May feel discomfort and tingling
May experience clicking or cracking in joints 24-48 hours after
Nursing interventions for Bone Scan
Asses for allergies to radioisotopes
Encourage fluids to distribute isotope
Nursing Interventions for arthroscopy
Post precedure wrap joint with compression dressing to control swelling
Monitor neurovascular status
Intruct family to monitor signs and symptoms of complications
Nursing Interventions for arthrocentesis
Remove hair from procedure site
Administer analgesics
Apply ice 24-48 hours after procedure
Nursing interventions for electromyography
Asses for use of anticoagultants, electrodes may cause bleeding
Monitor for active skin infection
Nursing interventions for biopsy
Monitor site for bleeding and edema
Administer analgesics and antibiotics
What kinds of injuries to the muscoluskeletal system are there?
Contusion
Strain
Sprain
Dislocation
Subluxation
What’s a contusion? lol
Soft tissue injury from blunt force
Pain, swelling, discoloration ; ecchymyosise
What’s a strain?
Pulled muscle injury to the musculutendinous unit
Pain
Edema
Muscle spasm
Eccymyosis
Loss of function that is graded 1-3
What’s a sprain?
Injury to ligaments and supporting muscle fiber
Pain
Edema
Tenderness ; severity graded according to ligament damage and joint stability
What’s dislocation?
Articular surface of the joints are not intact
Is an emergency if traumatic
What’s subluxation?
Partial or incomplete dislocation
Doesn’t cause much disformity as a complete one
Mnemonic for managing a soft tissue injury
PRICE
Protect
Rest
Ice
Compress
Elevate
What types of fractures are there?
Closed
Open
Intraarticular: Extends into the joint surface of a bone
Grades of open fractures
1: 1 cm long clean wound
2: Larger wound without extensive damage
3: Highly contaminated extensive soft tissue injury that may need to be amputated
Emergency management of a fracture
Immobilize body part
SPlintint: Joints distal and proximal to the suspected fracture must be supported and immobilized
Asses neurovascular status before and after splinting
Open fracture: Cover with sterile dressing
Do not attempt to reduce fracture
Medical management of fracture
Fracture reduction: Restoration of the fracture fragments to anatomic alignment and positioning
Closed: Uses manipulation and manual traction , traction may be used
Open: Internal fixaiton devices hold phone fragment in position (pins, wires, screws, plates)
Immobilization: Casts, splints, internal fixations
Early complications of fractures
Shock
Fat emolism
Compartment syndrome
VTE/ PE
Delayed complications of fracture
Delayed union, malunion, nonunion
Avascular necrosis of bone
Complex regional pain syndrome
Heterotrophic ossification
What’s compartment syndrome?
Increased pressure within a muscle compartment restricts blood flow , leading to tissue damage
Rehabilitation of clavicle fractures
Use of clavicular strap or sling
Excersises for wrist, elbow, and fingers asap
Do not elevate arm above shoulder for about 6 weeks
Rehabilitation for humeral neck and shaft fractures
Slings and bracing
Activity limitations until adequate period of immobilization
Rehab for elbow fractures
Monitor regularly for neurovascular compromise and signs of compartment syndrome
Potential for VOlkkman contracture
Active exercise and ROM are encouraged to prevent limitation of joint movement after immobilization and healing (4-6 weeks for nondisplaced, casted) and 1 week for internal fixation
Rehab for Radial, ulnar, hand fractures
Early functional rehab exercises
Active motion exercises of fingers and shoulder
Rehab for pelvic fractures
Managment depends on type and extent of fracture and associated injuries
Stable fractures are treated with a few days of bed rest and symptom management
Early mobilization reduces problems related to immobility
Rehab for hip fractures
Surgery is done to reduce and fixate fracture
Care is similar to someone undergoing surgery for hip
Rehab for femoral shaft fracture
Lower leg, foot, and hip exercises to preserve muscle function and improve circulation
Early ambulation stimulates healing
Physical therapy, ambulation, and weight bearing are prescribed
Active and passive knee exercises are begun as soon as possible to prevent restriction of knee movement
Assessment of patient with Brace, splint, or cast
Asses the 5 P’s
Monitor and treat pain
Problems that can happen with brace, splint, or cast
Acute compartment syndrome: Ischemia and irreversible damage can occur within hours ; notify physician
Pressure injuries: Patient reports a “hot spot” and tightness
Disuse syndrome: Muscle atrophy and loss of strenght
What is traction in relation to the muscle shi?
Pulling force to a part of the body
Reduces spasms
Aligns fractures
Reduces deformity
Used as a short term intervention
Traction needs to be applied in 2 directions ; whenever theres a force applied a counterforce must be applied
2 types: Skin and Skeletal
True or false: Traction must be continous to reduce and immobilize fractures?
TRUE
Nursing intervention for patient in skin traction
Monitor for skin breakdown, nerve damage, and circulatory impairment
Inspect skin 3 times a day
Palpate traction tapes for tenderness
Asses capilarry fill and and temp of skin
Nursing intervention for patient in skeletal traction
Evaluate traction aparatus and patient positioning
Maintain alignment of body
Trapeze to help with movement
Assess pressure points every 8 hours
Regular shifting of positioning
SPecial mattress
Perform active foot exercises and leg exercises every hour
Antiemolism stockings, compression devices
Pin Care
Management of patients in traction
Monitor for Pneumonia, constipation, Anorexia, VTE
Assist with self care
Assessment of patient with hip fracture
Vitals
Respiratory function
Bowel function
Assessment of patient with an amputation
Neurovascular assessment
Coping
Signs of infection
What is osteoarthritis?
Noninflammatory degenerative disorder of the joints
Primary: No prior event or disease related to OA or secondary : resulting from other things
Risk factors for osteoarthritis
Older age
Female
Sports and occupation
Obesity is most modifiable
Manifestations of osteoarthritis
Pain and stiffness
Relieved with rest
Morning stiffness
Mostly in weight bearing joints
What are some ways we can prevent osteoperosis?
Balanced diet with vitamin C and D
Regular weight bearing exercises
Weight training to stimulates bone density
Pharmacological therapy for osteoperosis
Calcium and Vitamin D
Bisphonates
Calcitonin
Estrogen antagonists/ agonists
Parathyroid hormone
Nursing interventions for a patient with spontaneous vertebral fracture related to osteoperosis
Relieving pain
Improving bowel movements: high fiber diet, increased fluids, stool softeners
Preventing injury
What’s osteomalacia?
Metabolic bone disease characterized by inadequate bone mineralization
Can be from deficiency of vitamin D
Causes: GI disorders, renal insufficiency, hyperparathyroidism, dietary insufficiency
Management of osteomalacia
Correct underlying cause
Kidney disease: Supplement calcitriol
Malabsorption: Increase doses of vitamin D and calcium
Exposure to sunlight may be recommended
What’s paget disease?
Disorder of localized bone turnover
Manifestations of paget disease
Skeletal deformities
Pain and tenderness and warmth over bones
Most patients don’t have symptoms
Pharmacological management: NSAIDS, antineoplastic therapy, calcitonin, biphosphanates, pilcamycin
What is osteomyelitis?
Infection of bone
Occurs because of: Extension of soft tissue infection, direct bone contamination, blood born spread from another site infectinon
Causative: MRSA, E. Coli
Assessment of patient with ostemyelitis
Signs and symptoms of infection
With chronic, fever may be low grade and occur in afternoon or evening
Signs and syptoms of adverse reactions and anitbiotic therapy
Planning and goals for patient with osteomyelitis
Relief of pain
Improved physical mobility
Control and eradication of infectino
Knowledge of therapeutic regiment
