Exam 2 Musculoskeletal Disorders Flashcards Preview

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Flashcards in Exam 2 Musculoskeletal Disorders Deck (52):
1

Physical Assessment: Look at
1) I____
2) In____ (S/S)
3) F_____ (2)
4) L___ (1)
5) G____ (looking for _____)

1) Injury (common injuries of small children)
2) Inflammation
3) Feet (Flat footed, Club feet)
4) Legs (Bowed Legs)
5) Gait (symmetry)

2

Flat feet are normal till age ____
Bowed legs normal till age ____

2
3

3

Palpate for
1) Full _____
2) ____ Tenderness - is indicative of _____

ALWAYS LOOK TO RULE OUT ______*

1) ROM
2) Point (fractures)

ABUSE!

4

Normal Findings
- ____ ROM of (3) bilaterally
- stable _____
- No _____
- No _____ to right ankle

- ROM of hips, knees, ankles
- Gait
- Ataxia
- Tenderness

5

Abnormal Findings
- _____ to _____ aspect of right ankle
- Pain with ______
- Moderate ______

- Tenderness, Lateral
- Extension
- Swelling

6

Soft Tissue Injury = (3)

Sprains, Strains, Contusions
(no bony involvement)

7

Sprains =

= Twisting of a joint, damage to ligaments

8

Strains =

= Tearing or pulling of muscle, may also effect tendons

9

Contusions =

= Bruises to the muscle (educate pt that they will change color)

10

Causes of Soft Tissue Injuries (3)

Falls, Athletics, Accidents

11

S/S of Soft Tissue Injury 5 __'s

5 P's
Pain
Pulses
Pallor
Paresthesia
Paralysis

12

S/S of Soft Tissue Injuries by types
1) Sprain = REEHP
2) Strain = IE
3) Contusion = ID

1) Redness, Edema, Ecchymosis, Heat, Pain
2) Inflammation, Ecchymosis
3) Inflammation, Discoloration

13

Nursing Interventions for Soft Tissue Injuries
1) ______ to rule out fracture
2) _____*
3) What medication?
4) _____ therapy

1) X-Ray
2) RICE*
3) NSAIDS (motrin, advil)
4) Physical Therapy

14

Rest = S____, C____, B____
Ice = ___x/day, __ min
Compression = ___-bandage/s___
Elevation = above the ______

Slings, Crutches, Bedrest
3 x/day, 20 min
Ace-bandage/Splint
Heart

15

Fractures =

Any break to the bone
(accidental or non-accidental)

16

S/S of Fracture
1) I_____
2) B_____
3) P______
4) ______ ROM
5) Non- ____ bearing

1) Inflammation
2) Bruising
3) Pallor
4) Limited ROM
5) Non-weight bearing (not willing to walk on it)

17

Assessment for Fractures
1) __-____
2) _____ (EBP transitioning to use this to check for fractures bc X-Ray has radiation)

1) X-Ray
2) US

18

Treatment for Fractures
1) C_____
2) C____ measures
3) Tr_____
4) ______ fixation devices
5) Te____

1) Casting
2) Comfort
3) Traction
4) External fixation devices
5) Teaching

19

Casting
- Help keep ____/d____
- Explain that it gets ___ when ____
- May take time to ____

- calm/distracting
- warm when forming
- dry

20

Comfort Measure (1)
Traction (1)

Sedation
Pulling

21

External fixation devices =

What is a complication of these devices?

= Bone screwed into external

Osteomyelitis (bone infection-higher risk for open fractures)

22

Teaching
- Do not ___ anything in the cast
- ____ formation (on skin directly above fracture)
- Check for ___ refill

- Stick
- Callus
- Cap refill

23

Club Foot =

Malalignment of feet, which resists being moved into proper alignment

24

Causes of Club Foot (3)

Fetal Positioning
Intrauterine restriction (ex. multiple gestations)
Boys > Girls

25

S/S of Club Foot
- Appears _____
- Unable to:

- Abnormal
- Unable to return to proper alignment

26

Assessment of Club Foot (2)
Treatment (3)

- X-ray/Ultrasound
- Serial Casting (constant reapplication due to rapid growth), Surgery, Physical Therapy

27

Developmental Dysplasia of the Hip =

Subluxation (slight misalignment) or complete dislocation of hip

28

Causes of DDH (2)

Fetal Positioning
Girls > Boy

29

Physical Appearance of DDH
(Asymmetry of what 2 things)

- Asymmetry of thigh folds
- Asymmetry of femur lengths (knees up and see if one is higher)

30

Tests for DDH (2)


A normal hip would test negative for these maneuvers

Barlow's = push knees in and back to feel hip come out (a clunk)

Ortalani's = after hips go out, push knees out and hips should go back in

31

Assessment of DDH
1) Based on ____ exam
2) Radiology tests (2)

1) Screening
2) X-Ray/Ultrasound

32

Treatment for DDH (2*)

Pavlik harness*
Spica Casting*

33

Pavlik Harness =
-should only be used if baby is how old?
- No l___/p___
- Frequent visits for ____
- They should be in the harness how long each day?

= keeps legs abducted to keep trochanter in the acetabulum

- less than 6 months old
- no lotion/powder
- adjustments (do not let parents adjust!)
- 24/7, with 1 hour off to shower

34

Spica Casting =

- should be used if baby is how old? or if what fails?

= covers from armpits around chest to ankles

- older than 6 months, or if harness fails

35

Legg Calve Perthes =

Cause =

= necrosis of femur and at times, acetabulum; blood supply returns but damage to bone is done

= Blood does not go to the head of the femur (and sometimes the acetabulum)

36

S/S of Legg-Calve-Perthes
1) P____
2) L_____ (that worsens with ___)

1) Pain
2) Limp (worsens with activity)

37

Assessment of Legg-Calve-Perthes
1) __-___/___ scan/M___
2) ____ diagnosis is key

1) X-Ray/Bone scane/MRI
(MRI to see how far its progressed, one appears necrotic/broken down)

2) Early diagnosis is key

38

Treatment fo Legg-Calve-Perthes
-What medication?
- _____ bearing
- _____ extension to _____ (assess 5 P's)

- NSAID's
- NON-weight bearing (crutches)
- Buck extension to immobilize

39

Slipped Capital Femoral Epiphysis =

= Head of femur separated from the rest of the femur at the growth plate

40

Causes of Slipped Capital Femoral Epiphysis
1) ____weight
2) T_____ (at ___ ___)

1) Overweight
2) Teenagers (at growth spurt)

41

S/S of SCFE
1) Hip ______
2) Painful ____
3) L____
4) _____ hip flexion
5) Pain increases when toes turned _____
6) Position of comfort =

1) tenderness
2) ROM
3) Limp
4) decreased
5) inward
6) external rotation of affected leg

42

Assessment of SCFE
1) History suggests - ____ pre-teen
2) _____ definitive

1) Obese preteen
2) X-ray

43

Treatment for SCFE
1) _____ immediately
2) _______ of the joint

1) Surgery (don't want to delay growth)
2) Immobilization

44

Scoliosis =

More common in girls or boys?
Happens during when?

= Lateral curvature and rotation of the spine

Girls > Boys
During pubertal growth

45

S/S of Scoliosis
- uneven ____
- one scapula/clavicle ____ than the other
- Hip/rib ______
- Severe = ____/____ compromise
- Back ____

- posture
- higher
- asymmetry
- cardiac/respiratory
- pain

46

Assessment of Scoliosis
1) How to screen?
2) Monitor ___ ____ during exam

Treatment
1) is based on ___ and c_____
2) Bracing = is it a cure?
3) S_____

1) Tell pt to bend over at hips and touch toes
2) physical appearance

1) age, curvature
2) NOT curative, help prevent worsening
3) surgery

47

Duchenne Muscular Dystrophy =

Cause = ______*
Greater in boys or girls?

= Progressive loss of function due to muscular loss (but not cognition)

Hereditary*
Boys > Girls bc X linked

48

S/S of Duchenne Muscular Dystrophy
1) Initially growth/development is?
2) What age do they start to lose function that was previously attained?
3) What type of functions do they start to lose first?
4) ____ sign* develops (what is it?)
5) What will they need by teenage years?

1) normal
2) 3 yo
3) small functions -> gross motor
4) Gower's* (get up like an old man)
5) wheelchair

49

Assessment of Duchenne Muscular Dystrophy
- Monitor using ____ tools
- ____* tests bc its ______

Treatment of Duchenne Muscular Dystrophy
- Is there a cure?
- Preserve _____, vital ____ function, and _____ as long as possible

- screening
- DNA* bc its hereditary

- NO cure
- ambulation, organ function, independence

50

Osteomyelitis =

Caused by =

= Bacterial infection in the bone

= introduced via a skin break or the vascular system

51

S/S of Osteomyelitis
1) F_____
2) C_____ a lot
3) R_____, W____, S_____, P_____
4) L______

Looks _____

1) Fever
2) Crying
3) Redness, warmth, swelling, pain
4) Limping


Cellulitic

52

Nursing Interventions for Osteomyelitis
1) Draw ____
2) Hang _____* as ordered
3) Prep for _____ PRN
4) Prep for scans (4)

1) Labs
2) Antibiotics*
3) Surgery
4) X-ray, MRI, CT, bone scans