TLO 2.8 Musculoskeletal - Adult Flashcards
What is an electromyogram?
Nursing consideration?
Conduction test that measures electrical activity of muscles at rest and during contraction
Pt is awake
Pt lies supine
Involves some discomfort from needle insertion
Avoid stimulant’s 3 hours prior
Normally there is no electrical activity at rest
What is a lumbar puncture?
Nursing consideration?
Post procedure?
Needle is inserted between L3-L4, CSF is aspired. Can diagnosis viral infections, multiple sclerosis, meningitis and various others
Pt should void prior
Sterile procedure
Pt position on side in fetal position with back bowed
Signed consent
Monitor puncture site
Pt lay flat for 4-8 hours after
Encourage fluids
Monitor for headache
What is myelogram?
Nursing considerations?
Used to identify tumors or herniated disks of the spinal cord. Lumbar puncture is done and contrast is injected into subarachnoid space. Xrays then taken
Drink additional fluids day prior then NPO 4 hr prior test
Assess for allergy to seafood iodine or dye
Pt to void immediately before tests
Medications: hold antidepressant, anticoagulants, antipsychotics several days before test
Pt lay flat several hours post procedure
Monitor site
What is CT Scan?
Nursing Considerations?
Computer created cross sectional images of; bones, blood vessels, soft tissues inside body
Assess for dye allergy
Non-iodated contrast if on oral antidiabetic (Metformin due to lactic acidosis) meds
Pt should have myelogram first then CT scan if both ordered
Increase fluids after procedure
What is Arthroscopy?
Nursing considerations?
Insertion of endoscope into interior surfaces of a joint to visualize structure and contents. Can be used for exploratory surgery.
Performed in outpatient setting Strict asepsis used NPO Assess med list prior Post procedure monitor site, ice if prescribed, avoid excessive use of joint 2-3 days
What is a Muscle Biopsy?
Two types?
Why is it done?
Removal of small piece of muscle tissue for exam
Needle biopsy
Open biopsy
To detect muscular disorders, metabolic defects of muscle. Determine difference between nerve and muscle disorders
What is an Magnetic Resonance Imaging (MRI)?
Nursing consideration?
Radio waves and magnetic files to increase visualization of body or muscular structures and soft tissue. Gadolinium can be injected to increase visualization (dye doesn’t contain iodine)
Must lie still, can be loud
Painless procedure
Assess for claustrophobia, sedation
No metallic implants (pacemakers, body piercings, jewelry)
Tattoos alter images blues and black especially
What is Compartment syndrome?
Treatment?
is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells
Muscles, nerves, blood vessels enclosed by fascia
Fascia do not expand
Fascia: is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. The tissue does more than provide internal structure; fascia has nerves that make it almost as sensitive as skin
Fasciotomy: wound left open to heal
Compartment syndrome injury occurs?
Swelling in confined space causes: burning tingling loss of sensation diminished reflexes weakness severe pain cyanosis
Compartment syndrome
Early manifestation
Late manifestation
Early:
Pain, normal or decreased peripheral pulse
Late:
Cyanosis, tinging, loss of sensation, weakness, severe pain
Hip fracture risks?
Common in older adults mostly due to falls
Dementia
Visual impairments
Neurologic/Musculoskeletal impairments
Over age 65 risk increase w/ each decade of life
Postmenopausal women (higher osteroposis)
Women who smoke r/t decreased bone density
Types of fracture hips
Intracapsular: involves the head and neck of femur
Extracapsular: involves the trochanteric region
**both interrupt blood supply to the bone
Fractured hip assessment findings
Inability to walk
Pain
Shortening and external rotation of affected low extremity
Fractured hip treatment
Traction initially to decrease muscle spasms
Surgery: ORIF (open reduction and internal fixation), Hemiarthroplasty, total hip arthroplasty
Traction
Why is it used?
Muscle spasm usually occur with fractures
Spasms pull bones out of alignment
Traction applies straightening/pulling force to reduce (align) the fractured bone
Types of traction
Bucks (boot)
Skin
Manual
Skeletal (pins applied directly to bone)
Traction nursing responsibilities
Assess: Temperature of extremity Ropes/weights hang freely, not on floor/bed Alignment of extremity Circulation check 5 P's Overhead trapeze for mobility Prevent skin breakdown from immobility Pt's foot not flush with footboard of bed
**Pt body weight provide counter traction
What are the 5 P’s of circulation?
Pulse Pallor Pain Paresthesia (tingling) Paralysis
Surgical Term
Reduction?
Process of putting bone back together either open or closed
Surgical Term
Fixation
Securing bone in place with pins, screws, nails, plates
Can be internal or external fixator
Surgical Term
Arthroplasty
Surgical procedure to restore function of a join
Can be done by resurfacing or replacing joint
What is Joint Arthroplasty?
May involve reconstruction or replacement of a joint
most are un-cemented made of porous ceramic, requires a long non-weight baring period until prosthesis is fixed in place to bone growth
Cemented prosthesis patients can become mobile sooner
What is an Open Reduction Internal Fixation (ORIF)?
Fixation occurs by securing femur in place with pins, screws, nail or plates
What is a Hemirarthoplasty?
Replacement of EITHER the femoral head or the acetabulum with a metal prosthesis
What is a Total Hip Arthroplasty?
Replacement of BOTH femoral head and acetabulum with a prosthesis
Hip fracture Post-op assessment and nursing interventions
Maintain skin integrity Pain relief Assess circulation to extremity Assess for DVT Monitor incision Hip precautions Prevent hip flexion >90 degree and adduction (for total hip replacement)
Knee replacement and nursing considetation
Exercises are started next day with quadriceps exercises, progressing to straight leg raises
CPM (continuous passive) machine is sometimes used, goal 90 degrees
Premedication prior to therapy May have wound suctions drainage Assess weight bearing status Dorsiflexion of foot to prevent DVT Post op SCD, pharm, DVT prophylaxis
Fractured femur
RISK FACTORS/CAUSATIVE FACTORS
and ASSESSMENT
Large amount of force (MVA, falls,)
Trauma
Pathologic fractures
Common in adult
Edematous painful thigh
Inability to move hip/knee
Pedal pulses, cap comparing to unaffected extremity
Fractured femur
TREATMENT
POST OP ASSESSMENT
Treatment:
skeletal traction
surgical
Assessment:
full weight bearing restricted until bone growth, partial weight bearing to promote bone growth
CMTS (circulation, movement, tingling, sensation)/5P’s, incision/dressing
complications: hypovolemia r/t blood loss, fat embolism, muscle atrophy, ligament damage
gluteal/quad isometric exercises
Osteoarthritis
what is it? risk factors?
Slow progressive loss of joint cartilage
Increasing age genetics excessive weight inactivity repetitive joint use occupation that required frequent kneeling or stopping
Osteoarthritis
ASSESSMENT
Pain/stiffness Deep ache Pain associated with movement/resolved with rest May have paresthesia's Joint enlargement r/t bony overgrowth Decreased ROM
Osteoarthritis
TREATMENT
Nutritional/weight management Rest/joint protection Heat/cold Drug therapy Surgery
Carpel Tunnel Syndrome
what is it?
risk factors?
When the canal through which the flexor tendons pass becomes narrowed: irritation of the medial nerve occurs
Common work related injury thought to be a result of the number of people using computers causing repetitive use
Carpel tunnel syndrome
ASSESSMENT
Patient c/o
Numb/tingling thumb, index finger, lateral ventral surface of middle finger
Affected hand may become weak
Pain interferes with sleep
Pain may be alleviated by shaking or massaging hand
Carpel tunnel syndrome
DIAGNOSIS
Patient history (may reveal occupation that involves repetitive movement)
Phalen’s test: hold the wrist in acute flexion for 60 seconds should have no pain or numbness/tingling
MRI
EMG
Carpel tunnel
MANAGEMENT
Immobilize/splint Reset joint Ice first 24-48 hours May use ice following by heat q4h Steroid injection Surgery: resection of carpal ligament to enlarge the tunnel
Herniated Intervertebral Disc
AKA?
WHAT IS IT?
AKA:
ruptured disc
herniated nucleus pulposus
slipped disc
Discs made of inner nucleus pulposus and outer collar called annulus fibrosus
Herniated occurs when nucleus pulposus protrudes thru weak or torn annulus fibrosus
Disc herniation
RISK FACTORS
More common in men Most between 30-50 Most occur in lumbar L4, L5, S1 Cervical usually involves C6, C7 May be r/t trauma or spontaneous
Disc herniation
ASSESSMENT LUMBAR
pain in lower back pain radiates down posterior leg pain increases with sneezing or coughing pain while lifting leg while dorsiflexing the foot weakness, sexual/urinary function keen/ankle reflexes weak/absent
Disc herniation
ASSESSMENT CERVICAL
Cause: degeneration and trauma (whiplash) pain in shoulders/neck arm paresthesia muscle spasms stiff neck decreased or absent arm reflexes
Ruptured intervertebral disc
C5 TO C6 pain
pain in neck, shoulder anterior arm
paresthesia of forearm, thumb, forefinger, lateral arm
triceps reflex normal to hyperactive
Ruptured intervertebral disc
L5 TO S1 pain
pain in mid-gluteal region, posterior thigh, calf to heel
paresthesia posterior calf, lateral heel, foot/toes
difficulty walking on toes
Ruptured intervertebral disc
L4 AND L5 pain
pain in hip, lower back
muscle spasms
paresthesia over lateral leg web of treat toe
foot drop
with complete root compression, bowel/bladder incontinence
Disc herniation
TREATMENT
Conservative: done for approx. 2-6 wks., PT, meds, injections
Surgery:
Laminectomy
Discectomy
Spinal fusion
Disc herniation
LAMINECTOMY
Most frequently performed
Removal of part of the vertebral lamina
Done to relieve pressure on nerves
Often protruding nucleus pulposus is removed
Disc herniation
DISCECTOMY
Removal of the nucleus pulposus of an intervertebral disc
Can be performed alone or with laminectomy
Disc herniation SPINAL FUSION (scoliosis, stenosis)
Insertion of wedge shaped bone or bone ship between vertebrae to stabilize them
Spinal implant sometimes used made of titanium that has a hollow cylinder with holes. It is packed with grafted bone and placed in space where disc was removed
Spinal surgery post op care
LAMINECTOMY
Log roll to avoid twisting of spine promoting body alignment
Assess for urinary retention, should void w/in 8 hrs
Assess pain, leaking of CSF
Increase mobility as prescribed
Assess CMTS, grips, push/pulls, neuro status
What is CMTS
Circulation
Movement
Tingling
Sensation
What is RICE?
Rest
Ice
Compression
Elevation
