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NUSC 2P14 > Week 9: Musculoskeletal Disorders > Flashcards

Week 9: Musculoskeletal Disorders Flashcards

1
Q

Structure and Function Bone

A

-Support: to keep the body from collapsing
-Movement: work as levers with attached muscles
-Protection: of the body’s internal structures
-Blood cell production
-Mineral storage

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2
Q

Structure and Function Joints

A

-Place where the ends of two bones are in proximity and move in relation to each other
-Classified according to the degree of movement they allow

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3
Q

Structure and Function Cartilage

A

-Rigid connective tissue
-Serves as a support for soft tissue & provides the articular surface for joint movement

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4
Q

Structure and Function Muscles

A

Skeletal
-movement of the skeleton and other organs
-half of a person’s body weight
Smooth
-walls of hollow structures (airways, arteries, GI tract, bladder, uterus)
Cardiac
-pumps the heart

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5
Q

Structure and Function Ligaments & Tendons

A

-Dense, fibrous connective tissue
-Ligaments: connect bones to bones, elastic and flexible
-Tendons: attach muscles to bones; stronger than ligaments
-Both have poor blood supply: longer healing time

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6
Q

Structure and Function Fasciae

A

-Layers of connective tissue
-Surrounds muscles allowing them to act independently and glide over each other during contraction

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7
Q

Structure and Function Bursae

A

-Small sacs of connective tissue lined with synovial membrane and containing synovial fluid
-Located at bony prominences to relieve pressure and prevent friction between moving parts

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8
Q

Skeletal Muscle

A

Structural Unit = muscle fibre (cell)
-Myofibrils
-Contractile units (sarcomeres)

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9
Q

Neuromuscular Junction

A

-Where the axon of the neuron meets the muscle fibre (cell)
-Requires a nerve impulse to contract the muscle
-Acetylcholine released triggers the release of Ca+
-Contraction occurs

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10
Q

Age Related Considerations

A

Many functional problems experienced by the aging adult relate to changes of the MSK system
*Decreased Ability to perform ADL
-Chronic pain and immobility
*Loss of muscle mass & strength, change in balance & in proprioception
-Increased potential for falls
*Increased bone resorption & decreased bone formation
-Loss of bone density, osteoporosis
*Tendons & ligaments become less flexible
-Joints & limbs become more rigid

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11
Q

Assessment- Subjective Data

A

Current Health:
-Joints,muscles, bones
-Functional abilities (ADLs)
-Self care behaviours
-Consider aging adult issues
Symptoms:
-Pain, weakness
-Deformity
-Limitation of movement
-Stiffness, joint crepitation
Past health Hx, Illness, Hospitalization:
-Physical trauma
-Arthritic and connective tissue diseases
-Previous MSK surgeries or treatments
Medications
-Prescribed
-OTC
-Herbal, nutritional supplements
-Use of corticosteroids
-Analgesics
-Estrogen replacement

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12
Q

Assessment- Objective Data

A

Normal Physical Assessment of the MSK
- Full range of motion of all joints without pain or laxity (hypermobility)
-No joint swelling, deformity, or crepitation
-Normal spinal curvatures
-No tenderness on palpation of spine
-No muscle atrophy or asymmetry
-Muscle strength of 5

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13
Q

Diagnostics

A

Radiology: x-ray, CT, MRI
Arthroscopy: fibre optic examination the interior of joint cavity
Muscle Enzymes: Creatine kinase r/t muscle damage
Bone Mineral Density: measure bone mass
Electromyogram: measures electrical system of the muscle

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14
Q

Fractures

A

-The nurse has an important role in the prevention of complications, and promotion of function in patients with fractures and orthopaedic surgery
-The most common cause of MSK injuries is a traumatic event resulting in fracture, dislocation, & associated soft tissue injury

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15
Q

Fractures Classifications

A

Open: skin broken & soft tissue exposed

Closed: skin intact

Complete: break is completely through bone

Incomplete: bone is still in one piece but break occurs across the bone shaft

Displaced: two ends separated from one another

Nondisplaced: bone is aligned and periosteum is intact

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16
Q

Greenstick Fracture

A

Occurs when a bone bends and cracks, instead of breaking completely into separate pieces

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17
Q

Fracture Clinical Manifestations

A

-Immediate localized pain, edema, swelling
-Decreased or loss of function
-Client guards and protects the area
-Deformity is a cardinal sign of fracture
(may not be obvious)

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18
Q

Fracture Healing 1.) Fracture Hematoma

A

-First 72 hours
-Bleeding creates a hematoma surrounding the ends of the fragments

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19
Q

Fracture Healing 2.) Granulation Tissue

A

-3 to 14 days post injury
-Hematoma converts to granulation tissue consisting of new blood vessels, fibroblasts, & osteoblasts
-Promotes healing

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20
Q

Fracture Healing 3.) Callus Formation

A

-Appears by the end of 2nd week
-Minerals and new bone matrix are deposited & woven around fracture parts
-Callus is composed of cartilage, osteoblasts, calcium, & phosphorus

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21
Q

Fracture Healing 4.) Ossification

A

-3wks to 6mos
-The bone is knitting together & stronger
-Cast may be removed
-# is still evident

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22
Q

Fracture Healing 5.) Consolidation

A

-Ossification continues

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23
Q

Fracture Healing 6.) Remodelling

A

Gradual return to pre-injury structural strength

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24
Q

Collaborative Care Goals

A

Reduction-
anatomical realignment of bone fragments

Immobilization-
to maintain realignment

Restoration-
of normal or near-normal function of the injured part

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25
Q

Fracture Reduction- Closed

A

-Nonsurgical, manual realignment of bone fragments to previous anatomical position
-Traction & countertraction applied to restore position, length, and alignment
-Under local or general anesthesia
-Immobilize the injured part to maintain alignment until healing occurs

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26
Q

Fracture Reduction- Open

A

-Surgical correction of bone alignment
-Often includes internal fixation (ORIF) using wires, screws, pins, plates, rods, or nails
-May involve external fixation of metal pins inserted into the bone & fixated to external rods
Main disadvantages:
-Possibility of infection
-Complications associated with anaesthesia
-Effects of pre-existing medical conditions

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27
Q

Nursing Diagnoses & Goals

A

-Impaired physical mobility r/t joint stiffness & pain
-Risk for peripheral neurovascular dysfunction r/t fracture
-Acute pain r/t physical injury
-Readiness for enhanced self-health management

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28
Q

Overall Goals

A

-Have physiological healing with no associated complications
-Obtain satisfactory pain relief
- Achieve maximal rehabilitation potential

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29
Q

Nursing Management- Pre OP

A

Inform Clients of:
-Immobilization
-Assistive devices that will be used
-Expected activity limitations after surgery

Assure clients that their needs will be met

Assure clients that pain medication will be available

*Antibiotics are used prophylactically before surgery

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30
Q

Nursing Management- Post OP

A

Apply general principles of post-op nursing care & infection prevention:
-Pin care cleaning: 1⁄2 strength H2O2 with normal saline is often used

Perform neurovascular assessments of affected extremity:
-Peripheral vascular: colour, temp, cap refill, pulses, edema
-Peripheral neurological: sensation, motor function, pain

Minimize Pain & Discomfort
-Through proper alignment & positioning
-Analgesics as ordered

On Discharge
-Instruct pt & family on meticulous skin care

During the post-op phase, the client will have antibiotics administered intravenously for 3–7 days

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31
Q

Collaborative Care- Nutrition

A

Protein:
Ample protein
1g/kg of body weight

Vitamins:
Vitamins B, C, D
Protein & vitamin C deficiencies interfere with tissue healing

Minerals:
Calcium, phosphorus, magnesium
Immobility & callus formation increase calcium needs

Meals:
3 meals/day
Provides necessary nutrients
Prevent constipation with high-fibre diet incl fruit & veggies

Fluids
Adequate fluid intake 2000–3000ml/day

32
Q

Fracture Reduction- Traction

A

Traction applies a pulling force on a fractured extremity to attain realignment, while countertraction pulls in the opposite direction – two types:

SKIN TRACTION:
-Short term
-Tape, boots, or splints

SKELETAL TRACTION:
-Long term pull
-Inserts pin or wire into the bone

Forces must be pulling in opposite direction to prevent client from sliding to end or side of bed

Countertraction commonly supplied by client’s body weight or augmented by elevating end of bed

33
Q

Nursing Management- Traction

A

-Inspect exposed skin regularly when slings are
used with traction
-Ulcers may result from pressure over bony prominence created by wrinkled sheets or bedclothes
-Persistent skin pressure may impair blood flow & cause injury to peripheral neurovascular structures
-Imperative that the nurse maintains traction constantly & does NOT interrupt weight applied to traction
-Position changes, ROM exercises on unaffected joints, deep breathing

34
Q

Nursing Management

A

Rapid deconditioning of cardiopulmonary system:
-Results from prolonged bed rest
-Orthostatic hypotension & diminished lung capacity
-Monitor for DVT
Renal Calculi
-Can develop as a result of bone demineralization
-Encourage fluid intake of 2500 mL/day

35
Q

Fracture Immobilization- Cast

A

-Temporary circumferential immobilization device commonly applied following a closed reduction
-Allows client to perform many normal ADLs
-Plaster or fiberglass (used more often)
-Application incorporates joints above and below fracture
-Restricts tendon and ligament movement
-Assisting with joint stabilization while fracture heals

36
Q

Casts- Nursing Care

A

-Frequent neurovascular assessments are critical
-Teach pt about signs of cast complications and to report them
-Elevate the extremity above the level of the heart to promote venous return & prevent edema (NOT if compartment syndrome)
-Encourage pt to move fingers & non-immobilized joints of the upper extremity

37
Q

Ambulation

A

-Reinforce physiotherapist’s instructions
-The nurse should know the patient’s weight-bearing status and the correct technique if the patient is using an assistive device
-Decision about what device to use is made by health care provider: cane, crutches, walker
-The involved limb is usually advanced at the same time or immediately after advance of the device
-A cane is held in the hand opposite the involved extremity (serves role of unstable leg)

38
Q

Ambulation

A

-Transfer belt should be placed around client’s waist to provide stability during learning stages
-Discourage client from relying on furniture or another person for support
-With inadequate upper limb strength or poorly fitted crutches, the client bears weight at the axilla rather than at the hands, endangering the neurovascular bundle that passes across the
axilla

39
Q

Fractures- Complications

A

-Majority heal without complications
-Damage to underlying organs & vascular structures
-Complications of fracture or immobility

DIRECT COMPLICATIONS:
-Problems with bone infection, bone union, avascular necrosis (AVN)

INDIRECT COMPLICATIONS:
-Blood vessels and nerve damage
-Compartment syndrome
-Venous thromboembolism
-Fat embolism
-Rhabdomyolysis (breakdown of skeletal muscle)
-Hypovolemic shock

40
Q

Complications- Compartment Syndrome

A

-A condition in which swelling & increased pressure within a limited space (compartment) press on and compromise the function of blood vessels, nerves, and tendons that run through that compartment
-Causes capillary perfusion to be reduced below the level necessary for tissue viability
-Two types of compartment syndrome

41
Q

Decreased Compartment Size

A

Resulting from restrictive dressing, splints, casts, excessive traction, or premature closure of fascia

42
Q

Increased Compartment Contents

A

-Related to bleeding, edema, IV filtration
Edema
Compromised arterial flow
Ischemia
Muscles & nerve cells are destroyed
Loss of function

43
Q

Compartment Syndrome- Assessment

A

Pain:
-distal to injury not relieved by opioids
-Pain on passive stretch of muscle through compartment

Pressure:
-Increase in compartment

Paresthesia
-Numbness and tingling

Pallor:
-Coolness and loss of normal colour of extremity

Paralysis:
-Loss of function

Pulselessness:
-Diminished/absent peripheral pulses

44
Q

Compartment Syndrome- Collab Care

A

Early recognition & treatment essential
-Ischemia can occur within 4–8 hours after onset

Regular neurovascular assessments

Urine output must be assessed for possibility of muscle damage
-Myoglobin

Myoglobin released from damaged muscle cells precipitates as a gel-like substance

Causes obstruction in renal tubules
May result in acute tubular necrosis
May result in AKI

Common Signs of Myoglobinuria
-Dark reddish brown urine
-Signs and symptoms of AKI

45
Q

Compartment Syndrome- Collab Care

A

Extremity should NOT be elevated above heart level
-Elevation may raise venous pressure and slow arterial perfusion

May be necessary to remove or loosen bandage or split cast

Reduction in traction weight may reduce external circumferential pressures

Surgical decompression (fasciotomy) may be necessary
-Left open for several days
-Ensures adequate soft tissue decompression

46
Q

Complications- Venous Thrombo-Embolism

A

-Veins of lower extremities and pelvis are highly susceptible to thrombosis, esp. hip fractures
-Venous stasis is aggravated by inactivity of muscles that normally assist in the pumping
action of venous blood
-Prophylactic anticoagulant drugs may be ordered
-Wear compression gradient stockings

47
Q

Complications- Fat Embolism Syndrome (FES)

A
  • Presence of systemic fat globules from fractures that are distributed into tissues
    & organs after a traumatic skeletal injury
    -FES is fatal in 5% to 15% of patients
    -May follow total joint replacement, spinal fusion, crash injury
    -Fractures most often causing FES are those of long bones, ribs, tibia, and pelvis
48
Q

FES Collaborative Care

A

-Early recognition crucial in preventing potentially lethal course
-Most clients manifest symptoms 24– 48 hours after injury
-Fat globules move to the lungs causing pneumonitis
-Look for acute respiratory distress syndrome (ARDS)
-S&S of hypoxia
-Pt expresses feeling of impending disaster
-Skin colour changes from pallor to cyanosis
-Client may become comatose

49
Q

FES Treatment

A

-Treatment is directed at prevention
-Careful immobilization of a long bone fracture is the most important element
-Management is symptom related and supportive
-Fluid resuscitation to prevent hypovolemic shock
-Encourage deep breathing & coughing
-Reposition the client as little as possible before fracture immobilization r/t danger of dislodging fat droplets into the general circulation
-Oxygen to treat hypoxia

50
Q

Hip Fracture

A

-Refers to a fracture of the proximal third of the femur

Intracapsular (within the joint):
-osteoporosis & minor trauma

Extracapsular (outside the joint):
-severe direct trauma or fall

Common among the elderly and serious
-Particularly women aged 75+

Requires one of the longest hospital stays
-Averaging > 12 days

51
Q

Hip Fractures

A

-Displaced femoral neck #s cause serious disruption of the blood supply to the femoral head (can result in vascular necrosis)
-Risk for life-threatening post-op complications:
(pneumonia, thrombi, UTIs)
-Also at risk for:
(constipation, confusion, pressure ulcers)

52
Q

Nursing Management (Hip Fracture)

A

-In planning tx of the hip fracture, consider the pt’s chronic health problems
(diabetes, cardiac, and pulmonary disease)
-Surgery within 48h or risk ↑ mortality in pts 85+

53
Q

Hip Fracture- Log Rolling

A

-Keep affected leg abducted and prevent external rotation of hip

54
Q

Amputation

A

-Removal of all or part of the extremity by trauma or surgery
-Severe damage due to trauma
-To prevent spread of cancer
-To prevent spread of gangrene r/t PVD
-Majority are aged 55+

GOAL: to preserve extremity length & function

55
Q

Amputation

A

-Tremendous psychological & social implications for the pt
-Pt should be warned about phantom limb sensation and pain

56
Q

Amputation

A

-Proper residual limb bandaging fosters shaping and moulding for eventual prosthesis fitting
Applied immediately after surgery to:
-support the soft tissues
-Reduce edema
-Hasten healing
-Minimize pain
-Promote residual limb shrinkage and maturation

57
Q

Arthritis

A

-Inflammation of a joint or joints
-Most forms of arthritis affect women more frequently than men
-Osteoarthritis is the most common chronic condition of the joints
-Rheumatoid arthritis is the most serious and most disabling

58
Q

Osteoarthritis (OA)

A

-Slowly progressive non-inflammatory disorder of the synovial joints
-Gradual loss of articular cartilage with
formation of bony outgrowths (spurs) at the
joint margins
-Pain & stiffness r/t cartilage loss and joint surfaces rubbing against each other

59
Q

Osteoarthritis (no cure)

A

Focus of Care:
-Managing pain and inflammation
-Preventing disability
-Maintaining and improving joint function

Treatments:
-rest & splints
-Heat applications to relieve stiffness
-Weight reduction and exercise
-Acupuncture and massage

MEDS:
-Acetaminophen
-ASA
-Topical salicylates, capsaicin, diclofenac
-NSAIDs
-Corticosteroids
-Methotrexate
-Humira, Remicade

60
Q

Rheumatoid Arthritis (RA)

A

-Chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the synovial joints
(diagnosis by RF in bloodwork)
-Marked by periods of remission and exacerbation
-Pain, stiffness, limitation of motion, and signs of inflammation
-Joint symptoms occur symmetrically and frequently affect the small joints of the hands & feet

RA can affect nearly every system in the body

61
Q

Rheumatoid Arthritis Treatment

A

Medication is the cornerstone of RA tx
-Methotrexate preferred for early tx
-Other meds s/a OA

Other Treatments:
-Rest
-Joint protection
-Heat (for stiffness) and cold (for inflammation)
-Gentle ROM exercises; aquatic exercise

62
Q

Pressure Injuries

A

-Localized injury to the skin or underlying soft tissue, usually over a bony prominence, as a result of excessive or prolonged pressure, shear, and tissue deformation
-Pressure injuries are generally considered an indicator of the quality of care, and most are regarded as avoidable
-Financial burden on health care system
-Impact on mortality, morbidity, & quality of life

63
Q

Common Sites Pressure Injuries

A

Sacrum
Ischium
Trochanter
Coccyx
Heels
Malleolus

64
Q

Pressure Injury Factors

A

-Amount of pressure
-Duration of pressure
-Pt’s tissue tolerance to pressure and/or shearing

65
Q

Nursing Assessment

A

-Assess for pressure risk on admission
-Thorough head-to-toe skin assessment
-Use an assessment tool: Braden Scale
Dx: reduced skin/tissue integrity

66
Q

Braden Scale

A

The higher the score the better
Sensory: perception of pressure discomfort

Moisture: degree to which skin is exposed to moisture

Activity: degree of physical activity

Mobility: ability to change and control body position

Nutrition: usual food intake pattern

Friction & Shear: ability to move without sliding

67
Q

Pressure Injuries

A

-Staged according to the deepest level of tissue damage
-When slough or eschar present, not possible to stage until debrided
-When full-thickness pressure injuries heal, fat, muscle, and dermis are replaced with granulation tissue
(original integrity of the tissue is lost)

68
Q

Pressure Injury- Deep Tissue

A

-Intact or nonintact skin with localized area of persistent non- blanchable, deep red, maroon, purple discoloration
-Pain & temperature change often precede skin
colour changes
-Discoloration may appear differently in darkly pigmented skin

69
Q

Pressure Injury- Stage 1

A

Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin

70
Q

Pressure Injury- Stage 2

A

Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also appear as an intact or ruptured serum-filled blister

71
Q

Pressure Injury- Stage 3

A

Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present.
Slough or eschar, or both, may be visible

72
Q

Pressure Injury- Stage 4

A

Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. Slough, eschar, or both may be visible

73
Q

Pressure Injury- Unstageable

A

Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a stage 3 or stage 4 pressure injury is revealed

74
Q

Nursing Management (Pressure Injury)

A

-Pressure relief
-Pain management
-Wound Care
-Adequate nutrition

75
Q

Pressure Injury- Assess & Measure

A

*Measure in cm
-Head to toe
-Side to toe
-Depth
*Tunnelling or undermining
-Assess with cotton swab
*Chart it like a clock

NUSC 2P14 (7 decks)

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