Musculoskeletal Problems Flashcards
(130 cards)
1
Q
What is osteoporosis?
A
Skeletal disease that is characterized by low bone mass and deterioration of the bone tissue
2
Q
Osteoporosis prevention
A
No smoking
Limit alcohol Nd caffeine
Exercise
Balanced diet: foods rich in calcium
3
Q
Osteoporosis management
A
Stop or slow processes and relieve symptoms/complications
Well balanced diet, calcium rich foods, high fiber
Exercise and physical activity
4
Q
What are the three Osteoporosis medications
A
Calcium supplements
Fosamax (alendronate) bisohosphonates
Calcitonin (Miacalcin)
5
Q
Nursing interventions and side effects of calcium supplements
A
Take calcium with meals or with vitamin C
Recommend that daily dose should be split and not taken as a single dose
Side effects: abdominal distention & constipation
6
Q
FOSOMAX
MOA
Nursing interventions/teaching
Side effects
A
Slows or stops bone loss
NI/teaching:
Take 1st thing in the morning, at least 30 min. Before breakfast
Take with one full glass of water
Notify MD if pt experiences:
Difficulty swallowing, cp, pain under ribs/back, new/worsening heartburn, upper stomach pain/ coughing up blood
7
Q
CALCITONIN
MOA
A
Hormone that slows bone loss
8
Q
Other osteoporosis treatment:
A
Estrogen replacement theory
Estrogen with progestin
Evista : mimics estrogen effect on bones
9
Q
What Is gout?
What are purines
A
A condition where there is an imbalance in purine metabolism, which increases Uric acid in the joints and leads to formation of Uric acid crystals (⬆️ inflammation)
Purines are natural substances found in body cells and many foods
10
Q
What is pathophysiology?
A
The study of the functional changes in the body that occur in response to disease or injury
11
Q
Nursing management for gout
A
Bed rest, joint immobilization Diet: decrease purines (meats, salmon, shrimp,etc) Ice; decrease pain & inflammation Teach: Triggers (crash diets) Weight Early recognition
12
Q
Acute management medications (gout)
A
Colchicines
NSAID
Glucocorticoid
Joint aspiration
13
Q
Colchicines
MOA & side effects
A
Decreases deposition of UA and decreases inflammatory reaction to urate crystals
Side effects: gi related: diarrhea,cramps,nausea
14
Q
Chronic management/meds of gout
A
Allopurinol
Probenecid
Lifestyle changes
15
Q
Allopurinol
MOA
Nursing
Side effects
A
MOA:
Inhibits the enzyme needed for conversion of purines to Uric acid, decreases serum levels
Side effects: gi, rashes, bone marrow suppression
Teaching: encourage patient to drink 2-3L of fluid to decrease the risk of renal stones, avoid alcohol
**careful with cardiac issues (liquid)
16
Q
Probenecid
MOA
Side effects
Teaching
A
MOA: inhibits the proximal tubule re absorption of urate, increasing the urinary excretion of UA
Side effects: gi, rash, h/a
Teaching: multiple drug interactions, encourage fluids to decrease risk of stone formations, take with food to decrease gi upset, monitor creatine clearance
17
Q
Complications of gout
A
Joint and pain stiffness
Tophi: accumulation of clumps of Uric acid in body tissues
HTN
18
Q
What is osteomalacia
A
Metallic bone disease-refers to softening of bones often caused by a vitamin D deficiency
19
Q
What is osteomalacia called in children
A
Rickets
20
Q
Patho of Osteomalacia
A
Disturbance of Calcium and phosphorus balance due to Vitamin D deficiency
- inadequate mineralization of bone
- bone becomes soft & demineralized
- affects all bones especially spine, pelvis, & lower extremities
21
Q
At risk for osteomalacia ..?
A
Deficient of activation of vitamin D
Malabsorption/malnutrition
Excessive calcium loss –> kidney failure
Gi disorders (celiac, pancreatitis,sm. bowel resection)
Renal disorders -> acidosis(pulls calcium to regulate pH
Hyperparathyroidism-skeletal decalcification
Medications -anti seizure (Dilantin/phenobarbital)
22
Q
Signs & symptoms of osteomalacia
A
Bone pain and tenderness Muscle weakness Malaise, fatigue, unsteady gait Deformities Multiple fractures in advanced stage
23
Q
Normal calcium levels?
A
8.8-10.3
24
Q
Normal phosphorus levels?
A
2.5-4.5
25
Diagnoses of osteomalacia ?
Dec serum calcium and phosphorus
X-Ray
Bone biopsy
26
Nursing care for osteomalacia
Emotional support
Assessment
Exposure to sunlight (increase Vit D)
Diet: increase calcium, vitamin D, protein
27
What is osteoarthritis ?
Chronic joint disease characterized by progressive degenerative changes of articulate cartilage in synovial joints
*most common of joint disorders
Wear & tear arthritis
Usually occurs with weight bearing joints
28
Risk factors for osteoarthritis
Increasing age, gender, obesity, previous joint damage, repetitive use, genetics, Hispanic & African American women
29
Patho of OA
Result of many factors with damage to cartilage
Balance is disturbed:cartilage breaks down faster than it is regenerated
Result: bone on bone contact
30
What is the difference between osteoarthritis and rheumatoid arthritis ?
OA: most common, degenerative jt dx, breakdown of joint cartilage
-not autoimmune but may occur at the end result of an auto immune disorder where joint destruction occurs --limited to the affected joints & no systemic symptoms
Rheumatoid arthritis: most crippling or disabling, autoimmune dx, chronic inflammatory type of arthritis
31
Signs and symptoms of OA?
```
Pain (joint) - relieved with rest
Stiffness in morning
Functional impairment
Bony nodules
Other: crepitus, tenderness, joint enlargement
```
32
Diagnostics of OA
Physical findings
Lab test
X-Ray-- to show narrowing joint space
33
Management of degenerative joint disorders (osteoarthritis)
```
Prevention/ nursing care/ education
Balance of activity and rest -- strength training
-swimming
Heat/cold application
-hot showers
Orthotic devices: PT, OT, REHAB
- walking aids, splints, braces
Complementary/alternative therapies (CAM)
-massage,yoga
```
34
Medications for OA
Initially: acetaminophen, some react well to NSAIDS, or COX 2 Inhibitors
Also topical analgesics: capsaicin
-cortizone shot-- teach-- depends on severity
35
When would a patient get a surgery and what are the different kinds ?
Surgery because of moderate to severe pain and if pain is so severe or because of loss of function
Osteotomy: alter distribution of weight within joint
Arthroplasty: diseased joint components are replaced
36
What Is a herniated disc?
A problem with one of the rubbery cushions between the individual bones (vertebra) that stack up to make the spine
37
Pathophysiology of herniation of a lumbar disc
(Cartilaginous plate between the vertebral bodies)
- -in a capsule & the center of the disc is a nucleus pulposus
- --> the nucleus protrudes into the fibrous ring around the disc (herniated disc)
* nerve compression
38
Risk factors of herniated discs
Age/ degenerative changes
Weight
Occupation/repeated stress
Trauma
39
Signs and symptoms of a herniated disc
```
Low back pain with muscle spasms
Arm or leg pain
Radiation of pain into one hip and leg (sciatica)
Radiculopathy
Muscle weakness
Sensory loss
(Incontinence/retention)
(Decreases impulses/reflexes)
```
40
Complication of Herniated disc
Worsening pain/numbness/weakness
Cauda equina- sciatic leg pain/severe back pain, altered sensation over saddle are ( genitals, uretha, anus, inner thighs) urine retention or incontinence
--->> SURGERY(emergency)
41
Diagnoses of herniated disc
MRI/CT Scan
Myelogram
EMG
Neurological exam to determine if reflex, sensory, motor impairment are present
42
Management of herniated disc
```
Bed rest, immobilization
Ice at time of injury to decrease inflammation
Moist heat/ massage
PT/strengthening exercises
Patient teaching/ prevention
Coping and support
```
43
Medications for herniated disc
```
NSAIDS
muscle relaxants
Neurontin
Cox 2 inhibitors
Narcotics
Amitriptyline
Cortisone injections
```
44
What is the goal of surgery for a herniated disc?
To reduce pressure on nerve roots to relieve pain and reverse neurological deficits
45
What is the surgical procedure discectomy?
Removal of the protruding nucleus pulposus
46
Laminectomy
Removal of part of the laminae (posterior arch of the vertebrae) to gain access to the protruding disc
47
Spinal fusion
Spine is stabilized by fusing of contiguous vertebrae with a bone graft
-to stabilize the disc
48
What is a sprain ?
Abnorma stretching or tearing of LIGAMENTS THAT SUPPORTS A JOINT
49
What is a strain?
Abnormal stretching or tearing of a MUSCLE OR TENDON
50
Sprains signs and symptoms
Pain
Swelling
Limited ability to move the affected joint
Bruising
May hear/feel a pop in joint at the time of injury
51
Signs and symptoms of strains
Pain
swelling
limited ability to move the affected muscle
Muscle spasms
52
Management of strains and sprains
```
Resolve in 4-6weeks
Immediate treatment:
-limit movement
-rice
-after 48 hours.. Apply heat
-pain management (mild analgesics/NSAIDS
-gradually increase activity & weight bearing
-assess neurovascular
-Prevention teaching
```
53
Price/rice protocol
```
Protection
Rest
Ice
Compression
Elevation
```
Keep area iced for 15-20 minutes, repeat several times with 15-20 minute break for a few days then apply heat intermittently
54
What is subluxation ?
And treatment
Partial/incomplete displacement of the joint surface
-heals quickly
Tx: pain control and support measures
55
What is dislocation ?
Complete displacement/separation of the articular surfaces of the joint
"Out of joint"
Traumatic: medical emergency
Causes: trauma , congenital
56
Risk factories of dislocation
Falls
Hereditary
Sports
MVA
57
Signs and symptoms of dislocation
```
Deformity, shortening of the extremity
Immovable
Asymmetry of the extremities
Intensely local pain and tenderness
Loss of function
Swelling of the joint
Neurovascular symptoms
```
Check CSM-check capillary refill
58
Management of dislocation
```
Immediate:
-realignment by closed or open reduction
Assess neurovascular
Post care:
-assess VS
-neurovascular
-immobilize with brace,casts,etc
-pain management
-PT
```
59
What are the menusci & their function?
Two semi lunar cartilages located on the sides of the knee
| -function: shock absorbers
60
Causes of meniscal injury
- forceful twist or rotation of knee
- deep squatting
- heavy lifting
- degenerative changes
61
Signs and symptoms of meniscal injury
```
-patient complains of knee "giving way" or "knee locks"
Complain knee is unstable
-feel/hear movement
-reduced movement
-pain
-tenderness
-swelling, stiffness
```
62
Diagnosis of meniscal injury
MRI* to detect torn meniscus
63
Management of meniscal injury
- prevention
- apply ice, immobilize with partial weight bearing
- pain management (NSAIDS,analgesics)
- PT/ROM
- surgical repair
64
What are fractures ?
Complete or incomplete disruption of the continuity of bone structure
-adjacent structures can also be involved
-body Organs can be injured
Causes: trauma, disease processes, -advanced osteoporosis
65
Signs and symptoms of fractures
```
Pain (localized)
Loss of function
Deformity
Shortening of long bones
Crepitus -crumbling sensation
Localized edema and ecchymosis
```
66
When should you call a doctor when dealing with a patient with a fracture ? (What symptoms will appear?)
```
Paralysis
Paraesthesias
Pallor
Pulselessness
Poor perfusion
```
67
Emergency management for fractures
- Immobilize body part
- splinting: joints distal and proximal to suspected fracture site must be supported and immobilized
- Assess neurovascular status before & after
- Open fracture : cover with sterile dressing to prevent germs
- Do not attempt to reduce fracture
- control external bleeding
- apply ice
- emotional support
68
What is a reduction related to a fracture ?
Reduction is a medical procedure to restore fracture or dislocation to the correct alignment
69
Closed reduction
Through manipulation and manual traction
Use of cast,splint, may also be pinning
Goal: maintains the reduction and stabilizes the extremity for bone healing
Educate and support patient prior
70
_Closed reduction post procedure
| Nursing management
```
Vital signs
Neurovascular/neurological
Assess pain
Assess skin
Educate pt
```
71
Open reduction ?
Surgical approach
- fractured fragments are aligned
- use of pins,wires,screws,plates,nails,or rods
- internal or external fixation
72
Post op care for fixation
After reduction:
- immobilize of bone must occur
- accurate assessments
- -VS,neurovascular
- assess drainage,bleeding
- assess drainage systems, output, content
- assess infection
73
What is an intracapsular fracture ? (Hip)
In the femur/neck -- big blood vessel
(Harder to heal because of bad blood supply, because of the blood vessel )
Caused by osteoporosis or minor trauma
Leads to AVN
74
What is an extracapsular fracture (hip)
Outside the joint capsule
Caused by major fall or trauma
Heal more rapidly due to good blood supply
75
Signs & symptoms of hip fractures
```
External rotation
Shortening of affected extremity
Pain and tenderness
Muscle spasm
Ecchymosis
```
76
Management of a hip fracture
Assessments
Assess labs
Bucks traction
Skin traction (short term)
Immobilize fracture before surgery, control muscle spasms and pain
Assess skin, CSM, neuro
Accurate management of traction (hospital protocol)
77
What is bucks traction and what to you have to do as the nurse
* skin traction to the lower leg
- -traction: application of a pulling force to a part of the body
- >prescribed wt depends on pt
Nurse:
-make sure pt is flat on the bed
-assessments: skin,neuro,CSM
Pedal pulse, wiggle toes
78
Pre op management for hip fracture
Check electrolytes: Na, K, Chl, coagulation factors
79
Difference between intracapsular fracture surgery and extracapsular
Intra: hemiarthroplasty ( replacement of femoral head)
Extra: open/closed with screws,plates,rods,pins
80
Post op care of open reduction
```
Keep a pillow between legs
(Keep affected leg abducted)
Encourage self care and neutral hip rotation
PT/assistive devices
Hip precautions
Do not cross legs
Use high seat chairs
assess CSM, hemorrhage, infection dvt
Assess skin, bladder, gi, respiratory
```
81
Post op complications of hip surgery
```
DVT
INFECTION
SKIN BREAKDOWN
hip displacement:
-extremity shortening
-internal/external rotation
-increased pain
-unable to move extremity
-"popping sensation"
```
82
Emergency management of a fracture should include all of the following. THE FIRST PRIORITY IS:
A. Immobilization of the affected injury
B. Splint the fracture
C.assess breathing pattern
D.application of ice
A.immobilization of the affected injury
83
What is the cause of the highest mortality rate for pelvis fractures ?
Bleeding
84
What is a stable pelvic fracture ?
Single fracture with ligaments intact
85
What is the treatment for stable pelvic fractures ?
```
Bed rest
Log roll
Activity as directed
Walker/crutches
Pain management
Fluids&fiber
Interventions to decrease risk of DVT, constipation, pneumonia,skin breakdown
```
86
What is a unstable fracture?
Involves rotation and instability, may also be disruption of ligaments (open book)
87
Treatment for unstable pelvic fracture
```
Immediate intervention
Stabilize & immobilize the pelvis
Control bleeding--laceration of major blood vessel
Avoid catheters
Skeletal traction/spica cast
Surgery
```
88
Nursing care for spica cast
Reposition every 2 hours
Prone for postural drainage if tolerated
Psychological- anxiety
Physiological-decrease gi/gas,abdominal discomfort, abdominal distention,n,v
Decompression
89
Signs and symptoms of pelvic fracture
```
Ecchymosis of pelvis
Abdominal tenderness
Local edema
Numbness/tingling
Unusual pelvic mobility
Inability to bear weight
Assess bowel/bladder
Assess lower extremities
```
90
What are the two most serious complications of a pelvic fracture ?
A.parasthesia and shock
B hemorrhage and shock
C Paralytic ileus & lacerated vertebrae
DThrombophlebitis and infection
B hemorrhage and shock
91
Nursing assessment for a pelvic fracture includes:
A.assessing urine for hematuria
B. Palpating the peripheral pulses
C. Abdominal assessment
D. All of the above
D.all of the above
92
What is osteomyelitis?
Infection in bone or bone marrow
93
What is used to normally treat osteomyelitis
Vancomycin
94
What are the risk factors of osteomyelitis ?
Recent injury/trauma
Circulation disorders
Problems requiring Iv lines/catheters
Conditions that suppress immune system
95
What causes osteomyelitis ?
- organisms
- S.aureus, streptococci, E.coli, pseudomonas,virus,fungus
- henatogenous
- contiguous spread
96
Pathology of osteomyelitis
Infection followed by inflammatory effects
- -> thrombosis can occur and lead to ischemia (lack of blood supply) with bone necrosis (bond death)
- -> new bone growth can occur around the dead bone tissue and lead to chronic osteomyelitis
97
Signs and symptoms of osteomyelitis
Sudden onset
Manifestations of sepsis (origin in blood)
Bone becomes painful, swollen, & tender
Pain increases with movement
Chronic:
Non healing ulcer, may be a sinus with drainage
98
Management of osteomyelitis
```
Early identification& treatment
IV antibiotics/pain management/diet
Immobilization
Surgical debridement
Closed wound drainage system
Home care referrals/PT/OT
teaching/prevention (of a new fracture)
Emotional support
```
99
Osteomyelitis complication
```
Bone death
Impaired growth
Skin cancer
Pathological fracture
Septic arthritis
```
100
(Complication of fractures)
What is septic arthritis
Invasion of joint cavity with microbes
| Occurs hematogenesis, direct trauma,surgical incision
101
Risk factors of septic arthritis
```
Previous trauma,
Surgery
Diabetes
Elders
Treatment with glucocorticoids
Immunosuppression (poor immune system)
Joint surgery & injury
```
**Large joints ( knee hip shoulder)
102
Pathophysiology of septic arthritis
Microbial invasion of synovial membranes
Inflammatory reaction
(Infection)
--swelling & tissue destruction
103
Signs and symptoms of septic arthritis
Extreme painful swollen joint
Decreased ROM
systemic s/s: fever, chills, warm
Careful assessment patient on steroids
104
Diagnosis of septic arthritis
History and physical
aspiration of joint
Blood cultures
CT/MRI
105
Management of septic arthritis
```
Careful assessment
IV broad spectrum antibiotics initially until cultures are returned
IVAB may be required up to 8 weeks
Analgesics
Arthroscopy
Immobilization of joint
PT
Wound irrigation with debridement
Would packing saturated with antibiotics
```
106
What are signs and symptoms of sepsis
```
Pulse increase and bounds
Low BP, increased RR
Fever
Flushed skin
Decreased urinary output
N/v, anorexia
Changes in mental status
Organ dysfunction and failure
```
107
What is hypovolemic shock ?
| -due to fractures
Inadequate circulation of blood volume
| Usually resulted from pelvic fractures and femoral fractures due to the artery being torn and hemorrhaging
108
Signs and symptoms of hypovolemic shock
```
Tachycardia, increased RR, diaphoresis
Decreased cap refill
Decreased BP - narrow pulse pressure
Cool, pale extremities
Anxiety, changes in mental status
Decreased urinary output (decreased volume for kidney to perfuse)
Decreased H and H
```
109
Treatment of hypovolemic shock
```
Stabilize fracture
Identify cause
assess vitals and O2 sats
LS, O2 therapy
IV fluids, plasma expanders
I/O
NPO
HOB elevated, left side suction
Assess labs (CBC, ABG,BUN,Cr)
Transfuse PRBC
BEDREst
```
110
What is compartment syndrome ?
In an extremity is a limb-threatening condition that occurs when perfusion pressure falls below tissue pressure within the closed anatomical compartment
111
Patho of compartment syndrome
Increased pressure in the compartment (edema) -- decreases capillary blood perfusion -- ischemia develops (poor blood flow) --which causes histamine release & increases edema
-->increase in lactic acid--> increase tissue pressure
End result: ischemia, necrosis and loss of muscle and nerve function
112
Causes of compartment syndrome
Decreased compartment size from restrictive dressings, casts, splints, excessive traction
Increased bleeding & edema In compartment
Associated with trauma, fractures, soft tissue injury, crash injuries, snake bites
113
What are the 5 P's?
```
PAIN (deep throbbing)
-out of proportion to injury
-non responsive to opioids (compartment syndrome)
-pain increases with motion
PARALYSIS
PARAESTHESIAS (pins/needles/numbness)
PALLOR
PULSELESSNESS (no pedal pulse)
```
114
Main signs of compartment syndrome
Deep throbbing pain
Which continues despite the use of opioids
And seems out of proportion with injury
*pain increases with passive ROM
115
Management of compartment syndrome
```
Medical emergency !
Assessments !
Loosen bandages/case/ reduce traction
Do not raise extremity above heart level
Surgery
```
116
What is the surgical procedure to relieve tension or pressure by cutting the fascia or fibrous tissue ?
(Compartment syndrome)
Fasciotomy
117
What is fat embolism syndrome ?
Systemic fat globules from fractures are distributed into tissues and organs
(Occurs within 12-48 hours of injury)
118
Risk factors of FES
Joint replacements
Crush injuries
Severe/multiple fractures
Men under 40
119
Patho of FES
- fat globules diffuse from the marrow to circulatory system
- (catecholamines released at time of fracture, mobilizes free fatty acids--> form fat globules
120
Signs and symptoms of FES
```
Rapid onset: respiratory!
Dyspnea
Tachypnea
Crackles
Wheezes
Chest pain
Cough with white sputum
Can lead to change in MS (lack of O2)
```
Cardiac:Tachy, hypotension,
Mental: anxiety, confusion
Renal: decreased urinary output
Skin: Petechiae over upper body, skin is pale
121
Signs and symptoms of DVT
Unilateral edema
Unilateral erythema, warmth
Extremity pain
122
Diagnoses of DVT
Doppler
Duplex scanning
Venogram
123
Treatment of DVT
```
PREVENTION:
Early mobilization,
position changes,
ROM,
TEDS
hydration
Prophylactic anticoagulants (heparin or lovenox)
```
124
What is delayed Union?
And causes ?
Healing does not occur within the expected time frame
Healing occurs but is prolonged
Causes: infection, pulling apart of bone fragments, poor nutrition, poor blood supply
125
What is malunion
Failure of the bone fragments to unite in alignment
126
What is nonunion and what are the causes
Failure of the ends of the fractured bone to unite
Causes: infection, inadequate immobilization, limited bone contact, poor blood supply
127
What are signs and symptoms of malunion and nonunion ?
Persistent pain and tenderness
| Abnormal movement of the fracture
128
Treatment of non Union
1. Surgery
2. electrical stimulation of bone
3. Pulsating electromagnetic fields
129
Post op amputation care
1. Assessment: vitals
2. Pain management
3.dressing/wound care: dressing will depend on MD and type of amputation
-gentle care
Dressing changes initialed by MD
-apply snug but not right
4. Mobility /positioning
5. Control edema
-elevate for first 24 hours
6. Referral to prosthetist
7.care of stump
-assess, wash incision with mild soap and keep dry-no powered like products
8.emotional
9.outpatient/rehab/community
130
Complications of amputations
```
Hemorrhage
Infection
Contractures
Phantom limb pain
Skin breakdown
```
