Nurs210 - Olol - Test 2 - Musculoskeletal Problems

Front 1

Functions of the Bones

Back 1

-Form structure and provide support
-Protect vital organs from injury
-Store minerals
-Site for hematopoiesis
-Serves to move body parts by providing points of attachment for muscles

Front 2

Bone Cells

Back 2

-Osteoblasts
-Osteocytes
-Osteoclasts

Front 3

Osteoblasts

Back 3

cells that form bone

Front 4

Osteocytes

Back 4

-Cells that maintain bone matrix.
-Mature bone cells

Front 5

Osteoclasts

Back 5

-Cells that resorb bone.
-Responsible for bone modeling

Front 6

Gerontological Considerations

Back 6

-Many of the functional problems of the adult are related to changes of the musculoskeletal system
-Alterations may affect the older adult's ability to complete self-care tasks and pursue customary activities
-Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility
-Risks for falls increases

Front 7

Bone remodeling

Back 7

-Removal of old bones by osteoclasts (resorption) and the deposition of new bone by osteoblasts
-Adult bones do not normally increase in size but instead undergo constant remodeling
- 1500 ml of calcium daily needed

Front 8

Bone Remodeling Process

Back 8

-Bone reabsorption and bone deposits occur
-Involves combined action of osteocytes, osteoclasts, osteoblasts
-Hormonal stimulus controlled by negative feedback mechanism that regulates bone calcium level

Front 9

Hormone Regulation

Back 9

-When blood calcium decreases, parathyroid hormone (PTH) released
-Osteoclast activity stimulated and bone reabsorption so calcium released from bone matrix
-Calcium levels rise and PTH release ends
-When blood calcium rises, secretion of calcitonin from thyroid gland, inhibits bone reabsorption
-Causes deposits of calcium salts in bone matrix

Front 10

Classification of Bones by Type

Back 10

-Long bones
-Short bones
-Flat bones
-Irregular bones

Front 11

Long bones

Back 11

arms, legs, fingers, toes

Front 12

Short bones

Back 12

wrist and ankle

Front 13

Flat bones

Back 13

skull, sternum, ribs

Front 14

Irregular bones

Back 14

vertebrae, scapulae, pelvic girdle

Front 15

Soft Tissue Injury

Back 15

-Sprain
-Strain
-Joint dislocation
-Subluxation

Front 16

Sprain

Back 16

-injury to ligaments and other soft tissue at a joint

Front 17

Strain

Back 17

-a musculotendenious injury which is excessive stretching of a muscle. leads to edema, swelling, pain, decrease in function and bruising

Front 18

Joint dislocation

Back 18

-loss of articulation where the joint ends in the bone capsule following tissue trauma. could be congenital. causes pain, limited motion, and the diagnosis test is an Xray

Front 19

Subluxation

Back 19

-partial separation or dislocation of joint surfaces

Front 20

Nursing Care of Soft Tissue Injury

Back 20

-Pain relief
-Correction of dislocation
-Prevention of complications
-Immobilization with sling for several weeks
-Rehabilitation
-Hip: Usually requires immediate reduction in emergency room to prevent necrosis to head of femur and sciatic and femoral nerve damage

Front 21

Nursing Diagnosis of Soft Tissue Injury

Back 21

-Acute Pain
-Impaired Physical Mobility
-Risk for Injury

Front 22

Fractures

Back 22

Disruptions in the continuity of bone as a result of trauma or disease

Front 23

Types of Fractures

Back 23

-Simple or Closed
-Compound or Open
-Complete Fracture
-Incomplete
-Impacted Fracture
-Comminuted
-Transverse
-Oblique
-Spiral

Front 24

Simple or Closed Fracture

Back 24

-does not cause a break in the skin

Front 25

Compound or Open Fracture

Back 25

-a fracture in which damage also involves the skin or mucous membranes
Grade 1=clean wound less than 1c long
Grade 2- larger wound without extensive tissue damage
Grade 3= highly extensive tissue damage, most severe

Front 26

Complete Fracture

Back 26

-involves a break across the entire cross-section of bone, and is displaced from its normal position.

Front 27

Incomplete Fracture

Back 27

-partial break, no break in skin (greenstick) also called Greenstick - one side of the bone may be broken and the other side bent

Front 28

Impacted Fracture

Back 28

-fracture of the bone fragment is driven into another bone fragment.

Front 29

Comminuted Fracture

Back 29

-the bone has splintered into several fragments

Front 30

Transverse Fracture

Back 30

- the break is straight across the bone shaft

Front 31

Oblique Fracture

Back 31

-occurs at an angle across the bone (less stable than a transverse fracture)

Front 32

Spiral Fracture

Back 32

-twist around the shaft of the bone

Front 33

Signs and Symptoms of Fractures

Back 33

-pain
-loss of limb function
-obvious deformity
-crepitus
-swelling and ecchymosis
-s/s shock
- x-ray evidence

Front 34

Crepitus

Back 34

Definition: a grating sound heard by rubbing bony fragments together or a grating sensation felt, also by rubbing bony fragments together

Front 35

Emergency Care of Fracture

Back 35

-Immobilization above and below deformity
-Splint to maintain normal anatomical alignment
-Prevent further dislocation or damage
-Maintenance of tissue perfusion
-Control bleeding with pressure dressing
-Assess pulses, movement, sensation
-Infection - open wounds should be covered

Front 36

Healing of Fracture

Back 36

-Age
-Physical condition of patient
-Type of fracture
-Uncomplicated fracture of arm or foot- 6-8 weeks
-Hip- 12-16 weeks

Front 37

Reduce / Immobilize fracture

Back 37

-closed reduction
-open reduction
-traction

Front 38

Closed reduction

Back 38

manual traction or manipulation

Front 39

Open reduction

Back 39

Operative procedure to achieve bone alignment - nails, wires, pins, prosthetic implants

Front 40

Traction

Back 40

Force applied in two directions to obtain alignment and to reduce muscle spasm

Front 41

Medications for Fractures

Back 41

-pain
-NSAIDS
-Stool softeners
-Antibiotics
-Anticoagulants

Front 42

Treatment of Fractures

Back 42

-external fixation
-internal fixation
-traction
-casting

Front 43

External fixation

Back 43

frame connected to pins inserted into long axis of bone

Front 44

Internal fixation

*

Back 44

(ORIF) reducing fracture and applying hardware (pins, nails, screws, plates) to hold bones in place

Hint 44

ORIF = Open Reduction Internal Fixation

Front 45

Traction

Back 45

Application of straightening or pulling force to maintain or return fractured bones in normal alignment; prevent muscle spasms

Front 46

Casting

Back 46

Rigid device applied to immobilize bones and promote healing

Front 47

2 types of Tractions

*

Back 47

-Skin Traction
-Skeletal Traction

Hint 47

Skin Trac: used to control muscle spasms and to immobilize an area b4 surgery: types: Bucks, Surgical Head Halter, Pelvic Belt (for back pain)
Skeletal traction: applied directly to the bone with metal pins and wires-used to treat fractures of the cervical spine, femur or tibia
Bucks traction: needs 2 people to put on - 5-10 lb wgts

Front 48

For Patients Receiving Traction

Back 48

-Check correct body alignment
-Check ropes in pulley
-Check weights hanging freely
-Skin Assessment
-Provide Pin Site Care

Front 49

Casts (what it is made of)

Back 49

-Plaster: 48 hours needed to dry
-Fiberglass: dries within one hour

Front 50

Types of Casts

Back 50

-short arm cast
-long arm cast
-body jacket cast
-single hip cast
-double hip spica cast
-long leg cast
-short leg cast

Front 51

QUESTION: Identify patient/family teaching instructions for a client discharged home with a cast

Back 51

-At the completion of the home care instruction, the patient or caregiver will be able to:
• Describe techniques to promote cast drying (eg, do not cover, leave exposed to circulating air; handle damp plaster cast with palms of hands and do not rest the cast on hard surfaces or sharp edges that can dent soft cast)
• Describe approaches to controlling swelling and pain (eg, elevate casted extremity to heart level, apply intermittent ice bag if prescribed, take analgesics as prescribed)
• Report pain uncontrolled by elevating the casted limb and by analgesics (may be an indicator of impaired tissue perfusion–compartment syndrome or pressure ulcer)
• Demonstrate ability to transfer (eg, from a bed to a chair)
• Use mobility aids safely
• Avoid excessive use of injured extremity; observe prescribed weight-bearing limits
• Manage minor irritations from cast (eg, for skin irritation from cast edge, pad rough edges with tape; to relieve itching, blow cool air from hair drier)
• Demonstrate exercises to promote circulation and minimize disuse syndrome
• State indicators of complications to report promptly to physician (eg, uncontrolled swelling and pain; cool, pale fingers or toes; paresthesia; paralysis; purulent drainage staining casts; signs of systemic infection; cast breaks)
• Describe care of extremity following cast removal (eg, skin care; gradual resumption of normal activities to protect limb from undue stresses; management of swelling)

Front 52

Cast Care: DO NOT

Back 52

-Do not get plaster cast wet
-Do not remove any padding
-Do not insert any foreign object inside cast
-Do not bear weight on new cast for 48 hours
-Do not cover cast with plastic for prolonged periods

Front 53

Cast Care: DO

*

Back 53

-Apply ice directly over fracture site for first 24 hours (avoid getting cast wet)
-Check with healthcare provider before getting fiberglass cast wet
-Dry cast thoroughly after exposure to water (blot dry; hair dryer at low setting)
-Elevate extremity above heart for first 24 hours
-Move joints above and below cast regularly
-Keep appointment to have cast and fracture checked

Hint 53

use Atarax for itching when wearing cast

Front 54

Cast Signs to Report

Back 54

-Increasing pain
-Swelling associated with and discoloration of toes or fingers
-Pain during movement
-Burning or tingling under cast
-Sores or foul odor under cast

Front 55

Nursing Care: Fracture

Back 55

-Pain relief measures
-Elevate
-Nutrition
-Prevent complications of immobility

Front 56

Five P's

Back 56

Pallor
Pain
Pulses
Parasthesia
Paralysis

Front 57

Complications of Fractures

Back 57

-Compartment syndrome
-Shock
-Fat embolism
-DVT
-Infection
-delayed union
-Nonunion
-Disseminated Intravascular Coagulopathy
-Avascular necrosis

Front 58

Compartment Syndrome

*

Back 58

an anatomic compartment in an area of the body encased by bone or fascia that contains muscles, nerves, and blood vessels. human body has 46-when the pressure within is greater than normal-The result of Vascular insufficiency and nerve compression from a too tight cast- must monitor circulation, motion and sensation of the affected extremety

Hint 58

3 types:
=Acute:sudden or severe decrease in bl. Flow in tissues distal to an area of injury that results in ischemic neucrosis. Pain occurs with passive ROM.
=Chronic: pain, aching, tightness in muscle group that is subject to stress or exercise.
=Crush: caused by massive external compression or crushing of a compartment-can lead to renal failure-
when the cast is too tight, elevate extremety to heart level, cut or release cast if not relieved in 1 hr, then surgery is required

Front 59

Shock

Back 59

-hypovolemic shock, resulting from hemorrage, trmt is to stabilize fracture to stop hemorraging, & to restore circulation

Front 60

Fat embolism

Back 60

-fat deposits in the circulation following fractures of the long bone so the emboli blocks the pulmonary or cerebral vessels. The onset of symptoms is rapid and occurs 24-72 hrs after surgery but can take up to 1 wk post surgery. s/s: hypoxia, tachycardia, tachypnea, resp. distress, crackles, wheezing, fever, resp. alkalosis into resp. acidosis. Xray will show snow storm filtrate that can lead to heart failure. Changes in mental status, delirium, agitation , coma. Mgmt: immobilize fracture immediately: infection can cause necrosis, sepsis, infection (fever, inflammation, elevated wbc, malaise, redness, tenderness)

Front 61

DVT

Back 61

-reduced skeletal muscle contractions and bed rest in pt with fractures of the lower extremities and pelvis are at high risk- In hip fractures this is the most common complication - Nursing Interventions are: encourage intake of fluids and ankle and foot exercises. Elastic compression stockings, etc assess at least every 4 hrs for signs of DVT, tenderness, warmth, redness and swelling

Front 62

Infection

Back 62

-In an open fracture there is a risk for osteomyelitis, tetanus, and gas gangrene. contaminated fractures are left unsutured and dressed with sterile gauze to permit edema and wound drainage.

Front 63

Delayed Union

Back 63

-when healing does not occur at a normal rate for the location and type of fracture. distraction of bone fragments, systemic or local infection, poor nutrition, or comorbiidity (ie. DM)-eventually heals

Front 64

Nonunion

Back 64

-results from failure of the ends of a fractured bone to unite

Front 65

Disseminated Intravascular Coagulopathy (DIC)

Back 65

-systemic disorder that results in widespread hemorrage. Unexpected bleeding after surgery
Nurse monitor for s/s of infection: tenderness, elevated temp, purilent drainage, etc. Trmt: antibiotics

Front 66

Avascular necrosis

Back 66

-bone loses blood supply and dies. s.s.: pain, limited movement, trmt: bone graph prostetic replacement.

Front 67

Osteoarthritis (OA)/ Degenerative Joint Disease

Back 67

-Most common of all forms of arthritis
-Loss of articular cartilage in articulating joints and hypertrophy of bones at articular margins
-affects more than 60 million adult Americans

Front 68

Incidence of Osteoarthritis

Back 68

-Males more often than females until age 55 when incidence twice as high in females
-Men more likely to have OA in hips
-Women in the hands

Front 69

Risk Factors of OA

Back 69

-Age
-May be inherited
-Excessive weight (hips and knees)
-Inactivity
-Strenuous, repetitive exercise (sports)
-Hormonal factors (decreased estrogen) in post menopausal women

Front 70

Pathophysiology of OA

Back 70

-Cartilage lining joints degenerates
-Loses tensile strength
-loss of cartilage results in bone thickening
-reduction in the ability to absorb energy in joint

Front 71

Clinical Manifestations of OA

Back 71

-onset gradual, insidious, slowly progressive
-pain and stiffness in one or both joints
-Deep pain aggravated by motion and relieved by rest
-pain may be referred to other places
-decreased range of motion
-bony growth which causes joint enlargement

Front 72

Diagnostic Tests of OA

Back 72

-History and physical examination
-Changes in x-rays
-Synovial fluid analysis

Front 73

Medications of OA

Back 73

-NSAIDS
-Celebrex / Vioxx?
-Steroid injection

Front 74

Conservative Treatment of OA

Back 74

-physical therapy
-rest of involved joint
-weight loss
-analgesic therapy
-anti-inflammatory therapy

Front 75

Addtitional treatments of OA

Back 75

-arthroscopy
-osteotomy
-joint arthroplasty
-nutritional supplements
-total joint replacement
-herbal therapy
-yoga

Front 76

Total Hip Replacement

Back 76

-the replacement of a severely damaged hip with an artificial joint. Nrsg Intvt: monitor for dislocation of the hip prosthesis, excessive wound drainage, thromboembolism, infection and heel pressure ulcer. also heterotopic ossification (formation of bone in the periprosthetic space), avascular necrosis and loosening of the prosthesis

Front 77

Hip Fractures

Back 77

-Common in Older Adults
-More than 200,000 hip fractures occur annually by age 80
-seen more frequently in females than men because of osteoporosis and low bone density

Front 78

Pre-existing Medical Problems (hip fractures)

Back 78

-Diabetes mellitus
-HBP
-cardiac decomposition
-Pulmonary disease
-Arthritis
-Surgery often delayed until medical conditions stabilized

Front 79

Clinical Manifestations (hip fractures)

Back 79

-external rotation
-muscle spasms
-shortening of the affected extremity
-severe pain
-tenderness in the region of the fracture site

Front 80

Treatment (hip fractures)

Back 80

-pain
-spasms
-pre-operative teaching
-over head trapeze bar
-ORIF

Front 81

QUESTION: Identify strategies for reducing hip fractures in the elderly.

Back 81

ANSWER:
-Calcium supplements
-Vitamin D supplements
-Estrogen replacement
-Planned interventions

Front 82

Joint Replacement

Back 82

A surgical procedure in which a mechanical device, designed to act as a joint, is used to replace diseased joint

Front 83

Commonly Replaced joints

Back 83

-hip
-knee
-shoulder

Front 84

Principles (joint replacement)

Back 84

-Prostheses may be ingrown or cemented
-Accurate fitting is essential
-Must be healthy bone stock for adequate healing

Front 85

Benefits (joint replacement)

Back 85

-Provides excellent pain relief in 85% to 90% of the clients who undergo the surgery
-Improved joint motion
-Improves emotional well-being
-Primary post operative problem is Infection

Front 86

Clinical Manifestations (joint replacement)

Back 86

-joint pathology
-arthritis
-fracture
-pain not relieved with medication
-poor range of motion in affected joint

Front 87

Surgery (joint replacement)

Back 87

-problems originate from functional disability
-most common orthopedic surgery performed

Front 88

Nursing Diagnosis (joint replacement)

Back 88

-Potential for infection related to
-Pain related to
-Potential for injury to affected limb related to

Front 89

Nursing Interventions (joint replacement)

Back 89

-Monitor incision site (bleeding, drainage, suture line, suction device, infection)
-Functioning of extremity - check circulation, sensation, movement of extremity distal to replacement
-Proper alignment of affected extremity
-Abductor appliance (hip replacement), CPM device
-Monitor I&O every shift; include suction drainage
-Encourage fluid intake
-Encourage self-care activities

Front 90

Coordinate Rehabilitation (joint replacement)

Back 90

-OOB ASAP
-Keep out of bed as much as possible
-Keep abductor pillow in place while in bed (hip replacement)
-Use elevated toilet seat and chairs with high seats (hip and knee replacements) prevents dislocation
-Do not flex hip more than 90 degrees
-Discharge planning (rehab)