Musculoskeletal Disorders Flashcards
(65 cards)
1
Q
Health Assessment
A
- Chief complaint, onset, duration and manifestations
- Effects on function – ADL’s
- Precipitatingfactors
- Pain – 5th vital sign
- Inspect and palpate bones/ joints deformity, tenderness, swelling, warmth and ROM
- Gait, posture, sitting, ability to walk
- Muscle strength
2
Q
Diagnostic Tests
A
- Xray
- CT
- MRI
- Bone density
- Bone Scan
- Arthroscopy & arthrocentesis
- Blood Work: Calcium, phosphate, alkaline phosphate, Uric acid, RF
3
Q
Preventing Trauma
A
Prevention is key Teach importance of using safety equipment Older client - At highest risk for falls - Safety in the home
4
Q
Soft Tissue Trauma: Nursing Care, Assessment
A
- Mechanism of injury
- Protective devices
- Pain assessment
- Inspection for redness, swelling, deformity
- Range of motion
- Palpation for warmth, tenderness, crepitus
5
Q
Soft Tissue Trauma: Nursing Care; Decrease Swelling and Pain (PRICE)
A
To decrease swelling and pain - PRICE • Protect • Rest • Ice • Compression • Elevation - Heat after several days - NSAIDs • Impaired physical mobility
6
Q
Soft Tissue Trauma: Nursing Care, Teaching
A
- Promote comfort
- Prevent further injury
- Allow healing
7
Q
Joint Trauma: Nursing Care
A
• Assessment of pain,neuromuscular status • Traction to maintain alignment • Implement care to prevent complications of immobility • Teaching - Immobilization recommendations - Skin care - Pain control - Rehabilitation exercises
8
Q
Dislocations
A
- Manual traction to reduce dislocation
- Narcotics
- Musclerelaxants
- Conscious sedation to control pain and manipulate the joint back into place
9
Q
Fractures: Nursing Care
A
• Needs prompt treatment • Goal of treatment: - Anatomic realignment of bone fragments (reduction) - Immobilization to maintain alignment Restoration of normal function
10
Q
Fractures: Emergency Care
A
- Immobilize before moving client
- Joint above and below
- Check pulse, colour, movement, sensation before splinting
- Sterile dressing for open wounds
11
Q
Nursing Management: Nursing Assessment
A
Brief history of the accident
Mechanism of injury
Special emphasis focused on assessment of the region distal to the site of injury
12
Q
Fractures: Nursing Care, Assessment; Neurovascular
A
Pain Pulses Sensation Skin color Temperature Motion Edema Motor Function
13
Q
Collaborative Care: Fracture Reduction; Closed Reduction, Open Reduction
A
Closed reduction
Non‐surgical, manual realignment casts
Open reduction
Correction of bone alignment through a surgical incision
14
Q
Casts
A
- Rigid device to immobilize bones and promote healing
- Plaster or fiber glass
- Joints above and below fracture
- Type of cast depends on type of fracture
15
Q
Collaborative Care: Fracture Immobilization; Traction
A
Application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction
Prevent or reduce pain and muscle spasm Immobilization
Reduction
Treat a pathological condition
Prevent deformity
16
Q
Traction
A
- Manual
- Skin
- Skeletal
- Straight
- Balanced suspension
17
Q
Collaborative Care: Fracture Immobilization; Internal/ External Fixation
A
Internal Fixation
- ORIF
- Pins, plates, intramedullary rods, and screws
- Surgically inserted at the time of realignment
External fixation
- Metallic device composed of pins that are inserted into the bone and attached to external rods
18
Q
Fractures: Other Interventions
A
- Analgesics
- NSAIDs
- Parenteral pain medications
- Stool softeners
- Anti‐ulcerdrugs
- Electrical bone stimulation
19
Q
Fractures: Nursing Care
A
• Pain • Impaired Mobility • Risk for Ineffective Tissue Perfusion • Evaluate effectiveness - Pain control - Safety and mobility - Tissue perfusion
20
Q
Fractures: Teaching, Risk for Falls
A
Teaching - Care at home - Safety assessment - Ambulation with Assistive devices • Risk for falls - Fall prevention - High risk for hip fractures • Decreased bone mass and muscle strength • Slowed reflexes • Medications affecting cognition and balance • Osteoporosis
21
Q
Hip Fracture
A
• Break in the femur at the head, neck, or trochanter regions
- Intracapsular
- Extracapsular
• Pain, shortening, and external rotation of the affected lower extremity
22
Q
Hip Fracture
A
- Buck’s traction
- ORIF
- Arthroplasty
- Total hip replacement
23
Q
Hip Fracture Nursing Care
A
- Hip precautions
- Abductor pillow
- Isometric exercises
- Physical therapy
- Hip chair
- TED stockings and anticoagulants
- Skin integrity
24
Q
Hip Fractures: Nursing Diagnosis
A
- Pain
- Impaired Physical Mobility
- Impaired Skin Integrity
25
Amputation: Nursing Care; Goals/ Nursing Diagnosis
```
Goals:
- Physiological healing with no associated complications Pain relief
- Achieve maximal rehabilitation potential
Nursing Diagnosis:
- Pain
- Risk for Infection
- Risk for Dysfunctional Grieving
- Disturbed Body Image
- Impaired Physical Mobility
```
26
Nursing Care: Amputaiton
* Assess pain
* Strategies for acute and chronic pain
* Drug and non‐drug interventions for pain
* Assistive devices
* Rest periods
* Emotional support
27
Amputation: Phantom Pain
Splint and support
Reposition
Encourage distraction, meditation, deep breathing and relaxation exercises
28
Amputation: Risk for Infection
Protect from contamination
Give antibiotics
Teach stump wrapping
Elevated WBC
29
Collaborative Care: Drug Therapy; Amputation
Muscle relaxant
Tetanus‐diphtheria toxoid or immunoglobulin
Bone‐penetrating antibiotic
- Cephalosporin
30
Amputation: Teaching
- Knowledge to care for needs
| - Home management
31
Osteomyelitis Collaborative Care
• Vigorous and prolonged IV antibiotic therapy is the treatment of choice for acute osteomyelitis, as long as bone ischemia has not yet occurred
32
Collaborative Care: Antibiotics
```
– penicillin
– cephalexin (Keflex)
– cefazolin (Ancef)
– cefoxitin (Mefoxin)
– gentamicin (Garamycin)
– tobramycin (Nebcin)
```
33
Collaborative Care: Antibiotics; Osteomyelitis
– Oral fluoroquinolone (ciprofloxacin [Cipro]) for 6‐8 weeks may be prescribed for chronic osteomyelitis or as a follow‐up of IV therapy
– Response to drug therapy is monitored through bone scans and ESR tests
34
Collaborative Care: Surgical Treatment; Osteomyelitis
– Removal of the poorly vascularized tissue and dead bone
– Antibiotic‐impregnated polymethymethacrylate bead chains may be implanted at this time to aid in combating the infection
35
Collaborative Care: Surgical Treatment; Osteomyelitis
– After debridement the wound may be closed, and a suction irrigation system is inserted
– Intermittent or constant irrigation of the affected bone with antibiotics may also be initiated
– Protection of the limb or surgical site with casts or braces is frequently done
36
Collaborative Care: Osteomyelitis
* Hyperbaric oxygen therapy of 100% oxygen may be administered in chronic osteomyelitis
* Orthopedic devices may need to be removed
* Myocutaneous flaps or skin and bone grafting may be necessary if destruction is extensive
37
Nursing Assessment: Subjective Data; Osteomyelitis
```
Past health history
– Bone trauma, open fracture, wounds, infections
Medications
– Use of analgesics or antibiotics
Surgery or other treatment
– Bone surgery
– IV drug abuse
```
38
Nursing Assessment: Subjective Data; Osteomyelitis
```
Health perception
– IV drug abuse, malaise
Nutritional‐metabolic
– Anorexia, weight loss, chills
Activity‐exercise
– Weakness, paralysis, muscle spasms around affected bone
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39
Nursing Assessment: Subjective Data; Osteomyelitis
Cognitive‐perceptual
– Local tenderness over affected area
Coping‐stress tolerance
– Irritability, withdrawal, dependency, anger
40
Nursing Assessment: Objective Data; Osteomyelitis
* Restlessness
* High, spiking temperature
* Diaphoresis
* Erythema, warmth, edema at infected bone
* Restricted movement
* Wound drainage
* Spontaneous fractures
41
Nursing Assessment: Objective Data; Osteomyelitis Possible Findings
* Leukocytosis
* Positive blood and/or wound cultures
* Elevated ESR
* Presence of sequestrum and involucrum
42
Osteomyelitis: Nursing Diagnoses
* Acute pain
* Impaired physical mobility
* Ineffective therapeutic regimen management
43
Osteomyelitis: Planning; Overall goals
– Satisfactory pain and fever control
– No complications
– Cooperation with treatment plan
– Maintenance of a positive outlook on the outcome of the disease
44
Osteomyelitis: Nursing Implementation; Acute Intervention
• Immobilization indicated to decrease pain
• Avoid excessive manipulation
• Pain assessment and intervention
– NSAIDs
– Narcotic analgesics
– Muscle relaxants
– Non‐pharmacological approaches to pain (e.g., relaxation breathing) should be encouraged by the nurse
45
Osteomyelitis: Nursing Implementation; Acute Intervention
• Wound management
– removal of devitalized tissue
– maintaining a moist wound balance
• Bed rest in the early stages for an acute infection
• Good body alignment and frequent position changes
46
Osteoporosis Nursing Management: Overall goals
Maintain or improve joint function
Use joint protection measures
Achieve independence of self‐care
Use pharmacological strategies to manage pain
47
Osteoporosis: Collaborative Care; Good/ Poor sources of calcium
```
• Good sources of calcium
– Milk and milk products
– Green leafy vegetables
– Seafood
– Almonds
– Hazelnuts
• Poor sources of calcium
– Eggs
– Beef
– Poultry
– Pork
– Apple
– Banana
– Potato
```
48
Osteoporosis: Collaborative Care
* Supplemental vitamin D may be recommended
* Exercise should be encouraged to build up and maintain bone mass
* Clients should be instructed to quit smoking or cut down on alcohol intake to decrease losing bone mass
49
Osteoporosis: Collaborative Care; Drug Therapy
Estrogen replacement after menopause
Calcitonin
Bisphosphonates
50
Osteoarthritis: Collaborative Care; Goals
* Pain and inflammation management
* Prevent disability
* Maintain and improve joint function
51
Osteoarthritis: Nursing Management; Assessment
* Type, location, severity, frequency, and duration of joint pain and stiffness
* Pain‐relieving practices
52
Osteoarthritis: Collaborative Care
* Heat and cold applications
* Nutritional therapy and exercise
* Complementary and alternative therapies
53
Osteoarthritis: Collaborative Care
Rest and joint protection
Rest during any periods of acute inflammation
Immobilization not to exceed one week Health Promotion
• Elimination of modifiable risk factors
54
Rheumatoid Arthritis: Nursing Management; Nursing Diagnoses
* Acute and chronic pain
* Disturbed sleep pattern
* Impaired physical mobility
* Self‐care deficits
* Imbalanced nutrition: less than body requirements
* Chronic low self‐esteem
55
Rheumatoid Arthritis: Nursing Management; Goals
– Reduction of inflammation
– Management of pain
– Maintenance of joint function and prevention or correction of joint deformity with minimal loss of functional ability of the affected joints
– Participate in planning and carrying out the therapeutic regimen
– Maintain a positive self‐image
– Perform self‐care to maximum amount possible
56
Rheumatoid Arthritis: Collaborative Care; PT/ OT
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Care of the client with RA
– Drug therapy and education
Physical therapy
– Joint motion and muscle strength
Occupational therapy
– Upper extremity function
– Assistive devices and strategies
```
57
RA: Collaborative Care; Drug Therapy
• Cornerstone of RA treatment
• Disease‐modifying anti‐rheumatic drugs (DMARDs)
– Potential to lessen the permanent effects of RA
58
RA: Collaborative Care; Drug Therapy
```
Based on the severity of symptoms
Salicylates
NSAIDs
Non‐opioid analgesics
Opioid analgesics
Corticosteroids
Immunosuppressants
Antibiotics
```
59
RA: Collaborative Care; Nutritional Therapy
• Balanced nutrition is important
• Weight loss may result
– From loss of appetite
– Inability to shop for and prepare foods
• Corticosteroids or immobility may result in
unwanted weight gain
• Exercise reduces stress on arthritic joints
• Weight slowly adjusts to normal several months after cessation of therapy
60
RA: Ambulatory and Home Care; Rest, Body Alignment
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• Body alignment
– Firmmattress
– Bedboard
• Positions of extension
– Avoid positions of flexion
• Lying prone for half an hour twice daily
• Light weight splints
– Rest inflamed joints and prevent deformity
• Skin care
• Range‐of‐motion exercises
```
61
RA: Ambulatory and Home Care; Heat and Cold Therapy
• Help relieve stiffness, pain, and muscle spasm
• Cold (≤10 to 15 minutes at a time)
– Beneficial during periods of disease exacerbation
• Moist heat (≤20 minutes at a time)
– Relief of chronic stiffness
62
RA: Ambulatory and Home Care; Exercise
* Gentle range‐of‐motion exercises are done daily to keep joints functional
* Emphasize that usual daily activities do not provide adequate exercise to maintain joint function
* During acute inflammation, exercise should be limited to 1 to 2 repetitions
63
RA: Ambulatory and Home Care; Joint Protection
```
• Energy conservation
• Work simplification techniques
– Work should be done in short periods
– Schedule rest breaks
– Spread work throughout the week
• Time‐saving joint protection devices
```
64
Gout: Assessment, Interventions
• Assessment
– Pain, joint swelling, tophi, uric acid stones, fever, and a history of trauma, injury, or surgery
• Interventions
– Acute Pain
– Impaired Physical Mobility
– Altered Urinary Elimination
– Ineffective Therapeutic Regimen Management
65
Gout: Nursing Interventions
– Asymptomatic hyperuricemia requires no medical treatment
– NSAID alone or with colchicine for acute gouty arthritis
– For subsequent attacks: indomethacin, corticosteroids, and corticotrophin
– Avoid foods high in purines
