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
