WEEK 7 Flashcards
alterations in mobility ATI + notes from class
mobility
ability for free movement
immobility
not able to move or motionless
what does the musculoskeletal system include
bones
connective tissue
muscles
joints
The functions of the musculoskeletal system include the following. (6 things)
Maintaining body form and shape
Providing support and mobility
Protecting soft organs
Maintaining hemostasis of calcium, phosphate, and magnesium levels within the body
Formation of blood cells through stem cells in the red or yellow bone marrow
Reserving energy through triglyceride storage in the yellow marrow
how many bones are in the adult human skeleton
206
what is the adult human skeleton system divided into
axial section and appendicular section
what is the axial section of the skeleton composed of
bones along the axis of the body
skull
sternum
ribs
spine
what is the appendicular section of the skeleton composed of
bones of the appendages
clavicle
scapula
humerus
ulna
radius
pelvis
carpals
metacarpals
phalanges
femur
patella
tibia
fibula
tarsals
metatarsals
phalanges
bones are classified based off what
according to their shape
long bones
Long bones, such as the humerus, radius, tibia, and femur, are in the appendicular skeleton. Functionally, the long bones function as levers in mobility
what are long bones usually composed of
diaphysis and epiphysis
diaphysis
Long, cylinder shaped shaft of a bone.
epiphysis
Irregularly shaped ends of the bone.
what is within the shaft of the diaphysis
the medullary cavity, which contains red and yellow bone marrow
The bone marrow in infants is primarily
red
Located at each end of the long bones are the
epiphyses
proximal
closest to center (for mobility that would be torso)
distal
Furthest away from the center; for mobility, this would be away from the torso.
hard part of bone that covers bone structure
periosteum
Short bones include
the carpal bones in the hands, as well as the tarsal bones located in the feet
Short bones are small with a shape like
a cube
Flat bones
bones of the skill, ribs, and scapula (found in the axial skeleton)
Functionally, the flat bones provide
protection for the soft organs
think: skull (brain)
ribs (lungs)
etc
tendons
Connective tissue that connects muscles to bones.
Bone tissue is classified as either
cortical bone or cancellous bone
Cortical bone
compact tissue that is dense and hard
Cortical bone provides strength, protects bones, and gives bones their smooth, white appearance. It also provides sites for muscles and tendons to attach firmly.
cancellous bone
soft and spongy tissue located on the inside of the bone
bone marrow
Marrow is a soft, connective tissue that produces red blood cells
where is red marrow located in adults
skull, ribs, sternum, upper parts of the humerus, the pelvis, and upper parts of the femur
what do other long bones have if they don’t have red marrow
yellow marrow
which does not contribute to hematopoiesis
Yellow marrow is composed primarily of
adipose tissue and stores triglycerides
hematopoiesis
The development of blood cells.
Bones maintain both their strength and flexibility through
collagen fibers
this flexibility is needed to prevent bones from easily breaking due to the forces applied on them through day-to-day activities
what does each bone have its own of
neurovascular supply
Bones contain several types of cells, including
osteoblasts
osteocytes
osteoclasts
osteoblasts
Single-nucleus cells that promote bone formation and remodeling through synthesis and mineralization.
The osteoblasts have several functions, including
forming a collagen compound to create the matrix and releasing calcium and phosphate into the matrix
what does the matrix allow
bones to be hard and not brittle
what hormones do osteoblasts produce
parathyroid hormone and estrogen
osteocytes
Highly specific bone cells that are responsible for the maintenance of the bony matrix, maintain biomineral content.
Osteocytes are derived from
osteoblasts
what do osteocytes help with
bone tissue formation, regulation, and breakdown
osteoclasts
Multi-nucleated cells that resorb bone.
The osteoclasts’ functions include
resorption of bone tissue, breakdown of bone, dissolution of minerals, and release of minerals into the blood stream
Each bone is completely remodeled every
10 yrs
Calcium is an essential mineral required for many activities, including
muscle contraction and blood clotting
The parathyroid hormone responds to
low serum calcium levels by causing the release of calcium from the bone, which raises serum calcium levels
Calcitonin, a thyroid hormone, responds to
high serum calcium levels by causing the deposit of excess calcium into the bones
Human growth hormone (HGH) is the primary hormone
that stimulates bone growth in children
what are the most common joint
synovial
abduction
Movement of limb away from the midpoint.
adduction
Movement of limb towards the midline.
circumduction
Circular movement.
Functions of the muscles include
maintaining posture and balance, preventing skeletal deformation, and keeping joints stable
All muscle tissues have the characteristics of
excitability
excitability
Ability for the muscle to contract through the use of action potential.
There are other characteristics of muscles including
elasticity, extensibility, and contractility
elasticity
Ability for muscle to return to original shape.
extensibility
Ability for muscle to stretch.
contractility
Ability for muscle to tighten.
Sequence of Muscle Contraction
signal
ACh release
Enters tubules
Filament interaction
Fibers shorten
Impaired muscle tone is due to
a loss of control in the nervous system and may be attributed to hypertonia or hypotonia
hypertonia
Excesses muscle tone, usually caused by a loss of neuromuscular control.
hypotonia
Lack of muscle tone, usually caused by a loss of neuromuscular control.
musculoskeletal alterations include
sprains
strains
fractures
as well as disease of the bones, joints, and muscles
conditions effecting the bones
osteoporosis
osteopenia
an example of a condition that would affect the muscles is
sarcopenia
sarcopenia
Loss of muscle mass, usually due to aging.
Movement disorders such as
Huntington’s disease and Wilson’s disease may be connected to an inherited or genetic cause
can cause excessive or limited movement
neuro conditions that can lead to immobility
Huntington’s disease
Wilson’s disease
Parkinson’s disease
ataxia
MSA
dyskinesia
physical and psychosocial issues contributing to alterations in mobility
pain
critically ill
worry about being a burden
depression
anger
low confidence
A client undergoing a surgical procedure, regardless of the cause, is at risk for developing problems with
mobility
Chronic neurologic problems such as
Parkinson’s disease may lead to immobility
Immobility can lead to
an increased risk of comorbidities such as cardiovascular disease, venous thromboembolism, respiratory complications, and respiratory conditions
venous thromboembolism
Blood clot formation in a vein that can migrate to become lodged in the pulmonary vessels.
Effects of Immobility: nervous system
confusion
depression
loss of confidence
loss of cognitive function
Effects of Immobility: cardiovascular system
decreased cardiac output
venous statis
ortho hypotension
DVT
venous stasis
Pooling of blood in the veins due to immobility. This reduces venous blood returning to the heart.
deep vein thrombosis (DVT)
A blood clot in the veins, generally of the legs.
can go to lungs and THAT is a pulmonary embolism !
Effects of Immobility: pulmonary system
Pneumonia
Decreased cough reflex
Pulmonary secretion pooling
Hypoventilation
Atelectasis
Decreased lung expansion
Effects of Immobility: GI sytem
Swallowing difficulties
Incontinence
Constipation
Fecal impaction
Bowel dysfunction
Anorexia
Increased intestinal gas
Heartburn
Aspiration
Malnutrition
Effects of Immobility: GU system
Incontinence
Urinary tract infections (UTIs)
Urinary retention
Effects of Immobility: integumentary system
Skin breakdown
Pressure injuries
Infections
Abrasions
Tissue damage
Inflammation over bony prominences
Friction and shear
what age does bone density begin to decrease
age 30
Clients experiencing menopause may have
accelerated loss of bone mass, making their bones more fragile
Loss of muscle mass can be overcome or delayed with
regular physical activity
Ways to prevent falls at home include
repairing broken or uneven steps, removing throw rugs, and clearing other clutter
define synovitis
Inflammation of the synovial membrane.
Synovitis may be caused by a
by a contusion or sprain, repetitive motion, or disease processes such as rheumatologic diseases or infection
manifestations of synovitis
painful joints that worsen with movement and !swelling at night!
full extension of the limb is not possible without pain
diagnostics for synovitis
ultrasound, possible MRI, and aspiration of synovial fluid
treatment and management of synovitis
managed symptomatically
uses heat or ice to reduce pain
may need anti-inflamm agents
arthritis definition
inflammatory condition in the joints
manifestations of arthritis
joint pain and stiffness, swelling, and decreased mobility
causes of arthritis
aging, autoimmune disorders, viral and bacterial infections, or damage to the articular cartilage
and sometimes cause can be unknown
joint effusion
Fluid accumulation in the intra-articular space.
In larger joints, such as the knee joint, the effusion may be caused by
overuse, trauma, changes in osteoarthritis, and infections
gout
Presence of uric acid crystals in a joint, usually in the toe. A form of arthritis.
Allopurinol- RASH notify PCP (prevent gout)
Colchicine- acute gout reaction
manifestations of joint effusion
swelling of the affected joint, restricted movement, and pain
Management of arthritis includes
If the client who has mobility problems develops a raised temperature, it may be an indication of a
septic joint from septic arthritis
Management of arthritis includes
immobilization of the joint with a brace, anti-inflammatory agents or acetaminophen, and cold packs
diagnostics for arthritis
radiographic imaging (x-rays) of the affected joint, looking at both the anterior-posterior and lateral views
arthrocentesis
A procedure to remove synovial fluid for testing.
muscle atrophy define
loss of muscle tissue from disuse
Causes of muscle atrophy include
prolonged bedrest, aging, or medical conditions, such as multiple sclerosis or stroke.
and prolongs immbolization of a limb
osteoporosis define
softening of the bones often associated with aging, specifically with post-menopausal clients
Osteoporosis is generally
asymptomatic disorder and is not often diagnosed until a fracture occurs
kyphosis
hunchback
When osteoporosis causes thoracic compression, it can lead to
kyphosis, cervical lordosis, and shortness of breath and compression on the abdominal cavity
labs and diagnostics for osteoporosis
DXA, plain X-ray
Other evaluations will include serum levels of calcium, magnesium, phosphorous, liver enzymes, PTH levels, thyroid levels, and tests to rule out cancer
osteoarthritis
most common disease of the joints. It is a chronic degenerative disease typified by loss of joint cartilage
Osteoarthritis in the cervical or lumbar vertebrae may lead to
back or leg pain, aggravated by walking
Many of the complications result from the stasis of the blood. Complications such as
pressure injuries, atelectasis, alterations in elimination, and venous thromboembolism are all are results of the stasis of blood
atelectasis
Collapse of alveoli in the lungs often caused by effects of anesthesia or as a complication of immobility.
Older clients are at the greatest risk for development of
pneumonia due to anatomical changes associated with aging
Injuries to soft tissues are often described as
strains, sprains, and contusions
Etiology and Risk Factors: soft tissue injuries
exercise or sports activities
sudden fall
overuse injury
contusions
A bruise caused by a direct blow.
most frequently affected joints with soft tissue injuries
ankles
knees
wrists
Older adults are at risk for a soft tissue injuries due to
proprioception issues, impaired reflexes, and osteoporosis
how to avoid soft tissue injuries
yoga
cardio (jogging)
strength training
warm up before
plenty of water
cool down period
why are older adults at risk for soft tissue injuries
decrease in protective reflexes, vision losses, and changes in equilibrium
Clinical Presentation: soft tissue injuries
pain
tenderness
swelling of the injured area
ice therapy (4 important things to remember!)
10-20 min intervals
cause vasoconstriction, decrease swelling
wrapped with a compression wrap (elastic bandage)
elevate injured limb, above the heart ideally
PRICE acronym
protect
rest
ice
compress
elevate
open vs closed fracture
open: creates a break in the skin (at risk for infection)
closed: leaves the skin intact
medical conditions that put client at risk for fractures
osteomyelitis
osteomalacia
osteoporosis
cancer
infection
osteomyelitis
Infection or inflammation of bone tissue.
osteomalacia
A softening of the bones that leads to brittleness.
what condition is the big one leading to fractures
osteoporosis
manifestations of hip fracture
inability to bear weight, hip and groin pain, or the affected leg is outwardly rotated and is visibly shorter than the unaffected leg
Clinical Presentation: fractures
pain at the site of the fracture
swelling
tenderness
shortening of the limb
deformity of the extremity
what are the two types of bones fractures only seen in children
torus
greenstick
most common cause of hip fractures
falls
A client with an open fracture should
receive antibiotics ASAP and may need irrigation surgery
A client in a cast is at risk for development
pressure injuries if swelling occurs
what to eval for if client with fracture is in PERSISTENT pain?
compartment syndrome
how to prevent atelectasis and pneumonia
TDBC
incentive spirometer
complications for fractures
infection
bleeding
neurovascular compromise
compartment syndrome
embolism
If the blood supply to the injury is disrupted
the limb will not be perfused and there is risk for loss of limb
Complex Regional Pain Syndrome
caused by prolonged inflammation and pain. CRPS can be acute or chronic
Manifestations of Complex Regional Pain Syndrome
pain that is spontaneous and extreme, pallor in the affected limb with the limb cool to touch, and the limb may have swelling below the site of injury.
One of the more serious complications of a fractured bone and treatment is
compartment syndrome
define compartment syndrome
increase in pressure within the fascia
pressure builds and compresses the nerves and vascular supply of muscle
what fractures are of the greatest risk for compartment syndrome
forearm
6 p’s with compartment syndrome
pain
paresthesia
paralysis
pallor
pulselessness
poilkothermia
Embolism
serious comp of fractures
pelvic or hip are at the highest risk for pulmonary embolism
A pulmonary embolism is a clot that travels from the site of the injury through the venous system and lodges in the pulmonary vasculature
manifestations of an embolism
acute SOB
chest pain
tachycardia
tachypnea
cough
hemoptysis
The USPSTF recommends screening for osteoporosis for clients over
the age of 65 years who were assigned female at birth
Neurovascular Checks: CMST
Color of the limb
Motion or movement
Sensation
Temperature
initial mang of pain in fractures
PRICE
care of casts
keeping the cast dry
is osteomalacia expected in older adults
no
do you cover boot/splint in the shower or take it off?
take off splint/boot
cover cast with plastic to shower
back pain
pain experienced along the spinal column
The most common causes of back pain
are disorders of the spinal structures such as…
herniated disks, nerve root pain, compression fractures, osteoarthritis, muscle or tendon strain, and spinal stenosis, cancer, infection, and inflammation, Bacterial infections due to a penetrating trauma, or recent surgery may also contribute to back pain
mechanical causes of back pain
herniated disc
nerve root pain
compression fractures
osteoarthritis
muscle or tendon strain
spinal stenosis
spinal stenosis
A narrowing of the spinal canal, which results in spinal nerve compression.
Serious, non-mechanical causes of back pain
abdominal aortic aneurysm, aortic dissection, angina, and meningitis
what if back pain if caused by non-mechanical causes
immediate interventions
Clients at risk for back pain
obese and older clients
Clinical Presentation : back pain
alterations in gait and balance
stiffness
numbness
weakness in back and legs
tender spine and muscles
constipation
difficulty urination
what meds may be used to treat back pain
opioids
client education for lower back pain
good posture
core strengthening exercises
potential Pharmacologic pain management for back pain
non-opioid analgesics
NSAIDs
opioids
corticosteroids
muscle relaxers
back pain: When managing pain, begin with non-pharmacologic treatments.
rest
massage
PT
stretching
spinal manipulation
immobilization
acupuncture
use of TENS unit
Medications for Back Pain: non-opioid analgesics
Indomethacin
Naproxen
Ketorolac
action: reduce sensation of pain and cools the body
nursing considerations: GI effects (indomethacin); Naproxen has a long half-life
Medications for Back Pain: opioid analgesics
PO: Codeine
Hydromorphone
Morphine
Oxycodone
Transdermal: Fentanyl
Actions: Bind to receptors in the brain, which allows for the sensation of pain to be blocked
Nursing considerations: may cause drowsiness and impaired judgement, respiratory depression, addiction, AVOID ALC
Medications for Back Pain: muscle relaxants
Diazepam
Methocarbamol
Cyclobenzaprine
Actions: Relieves manifestations causing back pain and muscle spasms
Nursing Considerations: may cause drowsiness, confusion, dizziness, habit-forming, AVOID ALC
Medications for Back Pain: antidepressants
Amitriptyline
Desipramine
Imipramine
Actions: Alters the way the brain senses or notices pain
Nursing considerations: may cause dry mouth, constipation, blurred vision, daytime sleepiness, sexual dysfunction, DON’T STOP TAKING ABRUPTLY
Medications for Back Pain: Anti-Epileptics
Gabapentin
Pregabalin
Carbamazepine
Actions: Change electrical signals in the brain, usually for those with nerve damage
Nursing considerations: weight gain or loss, anorexia, skin rash, confusion, depression, drowsiness, DON’T STOP TAKING ABRUPTLY
most common surgery for back pain
laminectomy
a type of back surgery in which the vertebral posterior arch is accessed to remove either a lesion or a herniated disk or to relieve pressure and provide a fusion of the vertebrae
most common cause of limb amputation
Peripheral vascular disease
Risk factors for amputation include
traumatic injuries
uncontrolled diabetes
smoking
amputation with diabetes
lower extremities because of diabetic foot ulcers
Peripheral artery disease can lead to limb loss due to
narrowing or occlusion of the blood vessels, reducing blood flow to the limb
medications for phantom pain
anti-epileptic (Gabapentin)
anti-depressants
Clinical Presentation: decrease perfusion to limb
pale or necrotic limb
absent pulse
area may not be blanche
presence of foul odor (infection or gangrene)
what med class reduces neuropathic pain
anti-epileptic
Client Teaching: care for the amputation site
massaging residual limb
assess the amputation site (including use of mirror to see all areas of the site)
what med can help with perfusion
Aspirin
what med can help with antiplatelet for someone with immobility
Plavix (can cause bruises)
signs of embolism with vital signs
decreases O2
increased HR
increased RR
Sx of pneumonia
fever
tachycardia
cough
crackles in the lungs
decreased lung sounds
sputum in cough
what is the ONLY thing to do to Tx VTE
medications
DO NOT massage, compression stockings, hot/cold as it can lead to pulmonary embolism
things to check with a brace
follow directions for how tight
cap refill (less than 3 seconds)
check surrounding pulses
what labs to assess for with someone who has osteoporosis
calcium
PTH levels
mag
neuropathy pain medications
Gabapentin (Neurontin)
can cause drowsiness and can amplify narcotics (addictive!)
what is something to NOT do when moving a patient who is immobile up in the bed
DO NOT use a trash bag
what condition is at risk for osteomyelitis
diabetes
open foot ulcers lead to bones open therefore lead to an infection/inflammation of the bone tissue
WEAR DIABETIC SHOES
fasciotomy helps with what
compartment syndrome
takes out some of the fascia to decrease pressure
what to give with gas pain with some with alterations in mobility?
Simethicone
mang of sprain and strain (acronym)
RICE
rest
ice
compress
elevate
types of immobilization for fractures
immobilizer
splint
cast
traction
surgical interventions
what are hip fractures usually treated with
surg interventions
open reduction internal fixation
total hip replacement
why is compartment syndrome a medical emergency
When pressure builds up in a muscle compartment, it can block blood flow and prevent muscles and nerves from getting oxygen and nutrients
can lead to necrosis of the muscles and ischemia of the muscles
can lead to amputation if left untreated
what might people with osteomyelitis have
PICC line because of long-term antibiotics
