Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
144 Cards in this Set
- Front
- Back
|
Musculoskeletal Trauma RN Focus Areas (4)
|
1-Mobility needs
2- Profusion needs 3- Comfort needs (pain) 4- Infection needs (asepsis) |
|
|
Problems with profusion r/t musculoskeletal trauma often result in
|
neuromuscular/ neurovascular junction dysfunction
|
|
|
Musculoskeletal injuries can result in
|
-Fractures
-Dislocation -Soft tissue injuries (sprains/strains) |
|
|
Accidental injuries is the leading cause of death in
|
Children and young adults
*Safety education and accident prevention is a must |
|
|
Safety Teachings should include:
|
-Proper placement or avoidance of THROW RUGS
-Proper use of equipment -Avoidance of hazards in workplace -Wearing proper shoes -Clear pathway when ambulating |
|
|
(2) common soft tissue injuries
|
1-Sprain
2-Strain |
|
|
Sprain
(def) |
injury to the tendinoligamentous structures surrounding the joint
|
|
|
Strain
(def) |
Excessive stretching of a muscle and its fascial sheath
*Often involves the tendon |
|
|
Sprains and Strains are often "self-resolving" allowing patients full function within
|
3-6 weeks
|
|
|
S/S of strains and sprains
|
-Pain (from continual usage)
-Edema (due to tiny hemorrhages) -Decrease in function and contusion |
|
|
Sever sprains are those that include:
|
1-The ligament pulls loose fro a fragment of the bone
2-Hemarthrosis (bleeding into the joint cavity) 3-Possible complete rupture of the muscle requiring surgical intervention |
|
|
Ottawa Rules for X-ray
|
-Age
-Ability to flex -Location of tenderness -Ability to bear weight |
|
|
Health promotion to prevent soft tissue injuries
|
-Encourage stretching/warm up before exercising
-Encourage stretching, balancing and endurance exercises -Use of elastic support bandages* -Adhesive taping wrapping* *Both of these practices are controversial |
|
|
ACUTE INTERVENTION for musculoskeletal trauma
|
RICE
R- Rest I- ICE C- Compression E- Elevate |
|
|
(RICE) interventions for Musculoskeletal Trauma
|
A. Stop the activity
B. Apply ice to the injury (vesoconstriction prevents swelling) C. Compression of the injury (prevents further injury) D. Elevate the extremity (above the heart) E. Provide analgesics for pain |
|
|
Guidelines for Ice Application to Acute Musculoskeletal Injury
|
Apply for 20-30 minutes for 24-48 hours with rest between sessions
|
|
|
Elevation of the injured extremity promotes
|
Venous return and prevention of edema
|
|
|
POST ACUTE Musculoskeletal Trauma care occurs when?
|
48-72 hours
|
|
|
POST ACUTE trauma includes:
|
A. Apply warm moist heat for 20-30 minutes
B. Allow for "cool down" time between (due to desensitizing) C. NSAIDS for pain control D. Use of the limb if protected (ace wrap) |
|
|
Subluxation
(def) |
partial or incomplete displacement of the joint surface
|
|
|
Joints most likely dislocated
|
-thumb
-elbow -shoulder -hip *most due to MVA |
|
|
Dislocation is considered an emergency due to
|
POSSIBILITY of AVASCULAR NECROSIS
|
|
|
Avascular Necrosis
(def) |
-Lack of vascular flow
-Bone causes compression of arterial circulation causing a lack of blood flow to tissues |
|
|
Elevation of the injured extremity promotes
|
Venous return and prevention of edema
|
|
|
Diagnostic test to determine displacement
|
X-ray
|
|
|
POST ACUTE Musculoskeletal Trauma care occurs when?
|
48-72 hours
|
|
|
Goal for SUbluxation and Dislocation
|
Realignment is accomplished with closed reduction; local or general anesthesia
|
|
|
POST ACUTE trauma includes:
|
A. Apply warm moist heat for 20-30 minutes
B. Allow for "cool down" time between (due to desensitizing) C. NSAIDS for pain control D. Use of the limb if protected (ace wrap) |
|
|
RN management for Dislocation/ Subluxation
|
A. Pain management (promote healing/movement)
B. Support and protect the site C. Restriction of movement (prevent further injury) D. Eventually gentle ROM E. Risk for repeated dislocations |
|
|
Subluxation
(def) |
partial or incomplete displacement of the joint surface
|
|
|
Joints most likely dislocated
|
-thumb
-elbow -shoulder -hip *most due to MVA |
|
|
Dislocation is considered an emergency due to
|
POSSIBILITY of AVASCULAR NECROSIS
|
|
|
Avascular Necrosis
(def) |
-Lack of vascular flow
-Bone causes compression of arterial circulation causing a lack of blood flow to tissues |
|
|
Diagnostic test to determine displacement
|
X-ray
|
|
|
Goal for SUbluxation and Dislocation
|
Realignment is accomplished with closed reduction; local or general anesthesia
|
|
|
RN management for Dislocation/ Subluxation
|
A. Pain management (promote healing/movement)
B. Support and protect the site C. Restriction of movement (prevent further injury) D. Eventually gentle ROM E. Risk for repeated dislocations |
|
|
Meniscus Injuries
|
-associated with ligament sprains
-usually occur in athletes -caused by rotation stress -edema usually absent -pain elicited by flexion, internal rotation and extension -Pt states "popped, clicked, locked or gave way" -arthritis may be long term result |
|
|
Management of musculoskeletal trauma
|
-Remind pt to complete warm up exercises
-evaluate injury within 24 hours -apply ice, immobilize, partial weight with crutches -knee brace, immobilizer will reduce pain -involve pt -surgery |
|
|
Fracture
(def) |
a break in the continuity of the structure of the bone
|
|
|
(2) Types/Causes of Fractures:
|
1. Traumatic (non-pathological)
2. Pathological (non-traumatic) |
|
|
Pathological (non-traumatic) Fracture Example
|
Old lady with osteoperosis (patho) bumps hip and break it
|
|
|
Traumatic (non-pathological) Fracture Example
|
Healthy person falls and breaks femur
|
|
|
Stable fracture
(def) |
fracture that is over with/done
|
|
|
Unstable fracture
(def) |
Fracture that is still evolving
|
|
|
Open fracture
(def) |
fracture that has broken thru the skin
(Compound fracture) |
|
|
Assessment for Fractures
|
-hx of injury
-s/s -location of pain -decreased function -inability to bear weight -guarding/protecting site |
|
|
If a pt has a fracture that the RN is UNABLE TO ASSESS
|
Assess the area distal to the fracture for pulses, temp, cap. refill, neuro
*If pt injured R knee, assess R foot |
|
|
RN intervention for Fractures
|
-Treat life threatening injuries first (Cardio/resp etc.)
-Ensure ABC's -Control external bleeding with direct pressure --CHECK NEURO STATUS DISTAL TO INJURY -Elevate the limb -IMMOBILIZE (don't attempt to straighten the limb) -Apply ice -Determine if recent tetanus toxoid vaccination |
|
|
NEUROVASCULAR ASSESSMENT should include:
|
A. Color
B. Temp C. Cap refill D. Peripheral pulses E. Edema F. Sensation G. Motor Function H. Pain (assess last) *Check both extremities |
|
|
PAIN ASSESSMENT
|
PERFORM LAST and INCLUDE:
-location -quality -intensity |
|
|
Fracture Healing starts immediately, takes up to 1 yr to resolve and includes:
|
A. Hematoma (in the first 72 hours)
B. Granulation tissue (3-4 days) C. Callus formation (second week) D. Ossification/ Bone regeneration ( 3 wks- 6 mo) E. Consolidation (fracture is healed) F. Remodeling ( up to 1 year) |
|
|
Hematoma formation following a fracture occurs
|
within 72 hours and prevents bleeding
*keep pt from moving it so it wont dislodge |
|
|
Factors influencing Fracture Healing
|
-age
-displacement of fracture (heals faster if not displaced) -blood supply (cant perfuse, cant use) -immobilization -infections -implants -hormones |
|
|
Fractures that do not heal within expected time
|
delayed union
|
|
|
Fractures that do not heal at all
|
non-union
|
|
|
Causes of non-union and delayed union
|
-movement of fracture fragments
-infection -poor nut -systemic disease |
|
|
Methods to stimulate bone healing
|
-electrical stimulation and pulse electromagnetic fields (PEMF)
*electrodes are applied over the skin or cast for 10-12 hours daily (usually while sleeping) |
|
|
Goals of fracture healing
|
A. anatomic realignment (reduction= shorten back to where it was)
B. immobilization of fracture (prevent further injury) C. restore normal/ near normal function of limb (will never be what it was before) |
|
|
Closed Reduction
|
-Non-surgical (done by orthopedist)
-Manual realignment -Traction is applied to restore position, length and alignment -local or general anesthesia -brace or splint applied after *IMMOBILIZE |
|
|
Open Reduction a
|
-Surgical incision (done by surgeon)
-fixation with screws, pins, rods, nails -post-op infection possible -complications with anesthesia -previous medical conditions may impair *MOVE ASAP |
|
|
Open Reduction with Internal Fixation (ORIF)
|
-EARLY INITIATION OF ROM IS INDICATED (dont want it to solidify)
-(CPM) Continuous Passive Motion machine may be used -promotes faster ambulation -prevents extra-articular and intra-articular adhesions and faster healing -decrease risk of complications due to immobilization |
|
|
Musculoskeletal Trauma Nutritional Management
|
-Prevent constipation by increased activity and high fluid intake (fracture bedpan)
-2500 ml/day -high bulk/roughage, fruits and vegetables -stool softeners, laxatives, warm fluids and suppositories *RECOMMEND SITTIN or DANGLING or STANDING |
|
|
Traction
(def) |
the application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction
|
|
|
Purpose of Traction
|
-Prevent or reduce muscle spasms
-IMMOBILIZATION of a joint or body part -reduce a fracture or dislocation -treat a pathologic joint condition |
|
|
Traction is indicated to:
|
-Provide immobilization to prevent soft tissue injury
-Reduce muscle spasms with low back pain or cervical whiplash -Expand a joint space during arthroscopic surgery -Expand joint space before major reconstruction |
|
|
Skin Traction
|
-Does not require surgery
-for short term alignment of bones/joints -maybe used until surgery is scheduled (48-72 hrs) -Tape, boots, or splints APPLIED DIRECTLY TO SKIN -WEIGHT LIMITS 5-10 lbs. |
|
|
Skeletal Traction
|
-Must go to surgery
-Applied for longer periods than skin traction -Aligns bones, joints, treats joint contractures/congenital hip dysplasia -Pins, wires inserted into the bone -WEIGHT USUALLY 5-45 lbs -INFECTION (where pins have been placed) and prolonged immobility are disadvantages |
|
|
RN Traction Considerations:
|
-ENSURE PROPER AMOUNT OF WEIGHT IS HUNG
-ENSURE WEIGHT ARE FREE HANGING AND NOT HITTING FLOOR -proper body alignment (supine) -foot board to prevent foot drop -elevate end of bed to prevent sliding -don't interrupt traction |
|
|
BUCKS TRACTION
|
-#1 SKIN TRACTION USED
-5-10 lbs -free hanging -ropes not tangled -splint device (attached to skin) -elevated -foot away from footboard -does not require counter-traction |
|
|
When you think of SKELETAL TRACTION/EXTERNAL FIXATORS think:
|
-METAL
-PUNCTURE HOLES -INFECTION |
|
|
External Fixators
(def) |
metallic device composed of metal pins which are inserted into the bone and attached to external rods that stabilize the fracture
|
|
|
External Fixators are often used when
|
-Compound or multiple fractures occur
-prevention of limb amputation -long term process (monitor for infection) |
|
|
Cleaning pins of external fixators
|
half-strength hydrogen peroxide and normal saline
|
|
|
Casts
|
-Common treatment following closed reduction
-Allows for normal ADL's |
|
|
Types of casts
|
A. Natural (Plaster of paris)
B. Synthetic acrylic, fiberglass free -Incorporated the joints above and below the fracture -Assists with joint stabilization |
|
|
Plaster of Paris Casts
|
-Set in 15 minutes
-NOT STRONG ENOUGH FOR WEIGHT BEARING UNITL SET FOR 24 HOURS -dont cover with blanket -avoid direct pressure on any hard surface -"petaled" around rough edges |
|
|
Synthetic casting
|
-Modeled to fit torso/extremity
-Light weight and allow for immediate mobility |
|
|
Considerations for lower extremity casts/dressings (ACE bandage)
|
should be elevated on pillows above the heart for the first 24 hours
|
|
|
Prefabricated knee/ankle splints
|
-easy to use and remove to assess swelling and skin breakdown
-allow for ROM |
|
|
Cast Care
|
-Conduct frequent neurovascular assessments
-Elevate limb above heart for the first 48 hours -Apply ice to prevent edema -Exercise above and below fracture -don't place objects inside cast |
|
|
Post Cast Care
|
-Removed in outpatient setting
-Removed with oscillating blade saw (wont cut skin) -skin will have altered appearance -don't rub skin to remove dead skin Tepid water and mild soap, pat skin dry and apply lotion |
|
|
Weight Bearing may be:
|
A. non-weight bearing
B. Touch-down/toe-touch (contact with floor but no weight bearing) C. Partial-weight beraing (25-50%) D. Weight bearing as tolerated or full weight *MUST BEAR WEIGHT TO GET FULL HEALING EFFECT ( ca+, Vit D, Blood perfusion) |
|
|
Common gait patterns
|
-Two-point
-Four-point -Swing-gait -swing-through-gait *A transfer belt should be used in ambulation |
|
|
"Crutch paralysis"
|
caused by bearing weight on the axilla endangering the nerovascular bundle
|
|
|
CRUTCHES SHOULD BE FITTED
|
2 INCHES BELOW THE AXILLA
*SHOULD LEAN INTO CRUTCHES, NOT BE HELD UP BY THEM |
|
|
Fracture Complications may be either
|
1. Direct (bone infection, bone union, avascular necrosis)
2. Indirect (blood and nerve damage resulting in compartment syndrome, venous thrombosis, fat embolism and shock) |
|
|
Compartment syndrome is manifested by
|
an increased compartmental pressure within a confined myofascial complex
*Compromise in the neurovascular function |
|
|
2 Types of Compartment Syndrome
|
A. Decreased compartment (Shriveled)
B. Increased Compartment (Swelling) |
|
|
Compartment Syndrome is often associated with:
|
-trauma
-fractures -soft tissue damage -crushing injury -IV therapy r/t infultration -venomous snake bite |
|
|
Compartment syndrome is
|
100% preventable
|
|
|
SIX P'S OF IMPENDING COMPARTMENT SYNDROME
|
-PARASTHESIA (numbness, tingling)
-PAIN (distal to injury, unresponsive to pain med) -PALLOR (coolness, loss of color) -PARALYSIS (loss of function) -PULSELESSNESS (diminished) -PRESSURE (increased in the compartment) |
|
|
Acute Intervention Of Compartment Syndrome
|
-THE EXTREMITY SHOULD NOT BE ELEVATED ABOVE HEART
-AVOID COLD COMPRESS -REMOVE OR LOOSEN BANDAGE -CAST MAY NEED TO BE CUT -REDUCTION IN TRACTION WEIGHT |
|
|
If all compartment syndrome interventions fail...
|
a fasciotomy may be necessary
|
|
|
Fasciotomy
|
-MEDICAL EMERGENCY
-Last ditch before amputation -take off all external parts to allow fluid to drain (filet a fish) |
|
|
Fat Embolism Syndrome
(def) |
the presence of systemic fat globules from fractures that are distributed into tissue and organs post traumatic skeletal injury
|
|
|
Bones most associated with FES are:
|
-Long bones, ribs, pelvis, tibia
-Joint replacement -Spinal fusion -Liposuction -Crush injuries -Bone marrow transplant *Marrow/fat can leak out into circulation system (fat conforms to the lumen area and completely blocks off blood flow) |
|
|
(2) Theories of FES
|
1. Mechanical (fat released by marrow of injured bone)
2. Biochemical (catecholamines released from trauma mobilize fatty acids and form fat globules that lodge in lungs) |
|
|
FES Clinical Manifestations
|
-Initially occur within 12-72 hours
-Chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, decreased partial pressure of arterial 02 (Pa02) -Memory loss, restlessness, confusion, headache, elevated temp -IMPENDING DOOM -Petechiae of the neck, anterior chest wall, buccal membrane, conjunctiva |
|
|
Central cyanosis and petechiae
|
SERIOUS PROBLEM
|
|
|
FES Collaborative Care
|
-Treatment is indicated at prevention
-Careful immobilization of long bone fractures -Support and fluid resuscitation -Blood replacement as indicated by lab values -Reposition the client as little as possible before the fracture is immobilized and stabilized -Administer 02 as ordered -Intubation may be necessary if the client's condition deteriorates *Most people survive FES |
|
|
Fractures of the Hip
|
-Fracture of the proximal third of the femur
-Common in older adults -200,000 occur annually -by 90, 33% women and 17% men will sustain a fracture -10-20% die within the first year -long term care or rehab for older adults |
|
|
Intracapsular Fractures
|
-Fractures within the hip joint
*VERY VASCULAR= RISK FOR BLEEDING |
|
|
Types of Intracapsular Fractures
|
1. Capital (head of the femur)
2. Subcapital (just below the head of the femur) 3. Transcervical (neck of the femur) *Associated with osteoporosis (pathologic/non-traumatic) |
|
|
Extracapsular Fractures
|
-Occur outside the joint capsule
|
|
|
Types of Extracapsular Fractures
|
1. Intertrochanteric (occurs between greater and lesser trochanter)
2. Subtrochanteric (occurs in region below lesser trochanter) *Usually caused by sever trauma or falls |
|
|
Clinical manifestations of Hip Fracture
|
A. External rotation (feet out)
B. Muscle spasm C. Shortening of affected area D. Severe pain and tenderness E. Displaced femoral neck fractures can cause serious disruption to the blood supply (avascular necrosis) |
|
|
Preoperative Management of Hip Fracture
|
A. Consider chronic health problems
B. Surgery may be delayed due to health probs C. Severe muscle spasm and pain D. Comfortable positioning E. Proper adjusted traction F. Teaching done in ER G. Ensure TRAPEZE is on bed H. INFORM FAMILY OF POST WEIGHT BEARING STATUS I. Begin discharge plans upon admission |
|
|
Postoperative Management of Hip Fracture
|
A. Monitor V.S., I&O, Cough and Deep Breathing
B. Administer pain med cautiously (want them to ambulate not be woozy/ Pt at 3pm, give med at 2:15) C. Observe dressind D. COMPLETE NEURO ASSESSMENT E. Maintain good alignment F. Keep pillows/ABDUCTOR splint between knees during turning G. AMBULATION BEGINS ON THE FIRST OR SECOND DAY |
|
|
Post op for Femoral heat prosthesis
|
A. positioning should not exceed 90 degrees of flexion, adduction, internal rotation
B. Avoid putting on socks shoes, crossing legs, sitting in low seats (toilet) C. Place large pillow between legs when turning D. AVOID TURNING ON AFFECTED SIDE |
|
|
Gerontologic Risk Factors for Musculoskeletal Trauma
|
A. Older adults are at risk for falls
B. Inability to correct postural imbalance C. Gait and balance disturbances D. Decreased vision or hearing E. Polypharmacy F. Orthostatic Hypotension G. SCATTER RUGS H. Osteoporosis |
|
|
Osteomyelitis
(def) |
severe infection of the bone, bone marrow, and surrounding soft tissue
|
|
|
Organism causing Osteomyelitis
|
Staphylococcus aureus
*Can invade by indirect (hematogenous) or direct (open wound) *Pt will be on antibiotic, infection can spread to HCP |
|
|
Acute Osteomyelitis
|
-initial infection less than one month
-fever, night sweats, chills, restlessness, nausea, malaise |
|
|
Chronic Osteomyelitis
|
-Infection longer than a month
-Constant bone pain, swelling, tenderness, and warmth at the site |
|
|
Diagnostic Studies for Osteomyelitis
|
-Bone or soft tissue biopsy is the definitive method to determine causative agent
-Radionucletide bone scan, MRI, or CT scan |
|
|
Interventions for Osteomyelitis
|
1. VIGOROUS AND PROLONGED IV ANTIBIOTICS, 4 to 6 weeks or longer (switch to oral for home care)
2. Discharged home to complete care or SNF 3. May implant antibiotic beads into the site post surgical 4. Administer pain meds |
|
|
Osteoporosis
|
Characterized by compromised bone strength predisposing an individual to an increase risk for fractures; bone strength is determined by both bone density and quality
|
|
|
Osteoporosis
(WHO def) |
Bone mineral density (BMD) more than 2.5 standard deviations below the normal bone mass of women who are less than 35 years of age
*Controversial because it does not apply to children, men and ethnic groups |
|
|
(True/False)
Osteoporosis is a preventable disease |
True
*preventable in both men and women |
|
|
Osteoporosis is often called
|
"Silent Disease"
*less than 1/3 of the cases have been diagnosed |
|
|
Factors that contribute to Osteoporosis
|
Ca+
Vitamin D Estorgen |
|
|
Osteoporosis Pathogenesis
|
A. May result from bone loss as one ages or a result of sub-optimal bone growth during childhood/adolescence
B. Primary osteoporosis occurs in both genders from normal aging and decreased gonadal functioning; usually after menopause and later in life in men C. Secondary osteoporosis is adults is a result of medications or other diseases |
|
|
Drug induced Osteoporosis can be caused by
|
-Glucocorticords ( Most common)
-TOBACCO -Heparin -Thyroid drugs -Anticonvulsants |
|
|
Secondary diseases causing osteoporosis
|
-COPD
-Chronic renal failure -liver disease -heart failure -rheumatoid arthritis -cushing's disease -organ transplant |
|
|
Risk Factors for Osteoporosis
|
A. Age * Greatest risk factor for both genders
B. Female C. Estrogen deficiency D. CAUCASIAN RACE E. Low weight/BMI F. FAMILY HX G. SMOKING H. HIstory of prior fractures I. Excessive intake of ETOH J. Caffeine-containing beverages *Pt's at risk should be evaluated every 2 years |
|
|
Clinical presentation of Osteoporosis
|
A. Bone loss is more rapid during first postmenopausal decade
B. Clients are asymptomatic; bone loss can be 35% before complaints C. Fractures of the vertebrae, hip or forearm are early manifestations D. Signs include spinal deformity (kyphosis, scoliosis, and loss of height) E. 1/3 of men with osteoporosis are over 70 F. Age-related hip fractures are less than women until 85 years old G. 2/3 of osteoporosis in men is from secondary causes |
|
|
Diagnostic Tests for Osteoporosis: Bone Mineral Density (BMD) Tests
|
A. Dual-energy absorptiometry (DEXA) * Most accurate for measuring bone density
B. Quantitative ultrasound of the heel ( almost as good as DEXA) C. A T score is assigned, based on expected distribution of BDM for "young Normal" adults of the same sex |
|
|
DEXA test can confirm
|
diagnosis, predict future risk, and monitor response to therapy
*DEXA of the hip is the best predictor of fracture |
|
|
BMD should be ordered
|
every 2 years
|
|
|
T-Scores are expressed as
|
-Standard Deviation (SD)
-Above (+) or below (-) the mean *T-score declines with age and provides cut points for treatment decisions |
|
|
Management of Osteoporosis
|
-Childhood is critical time to develop habits conducive to health
-Sufficient Ca+ intake -Vitamin D -Exercise (daily high and low impact: WEIGHT BEARING) -Avoidance of SMOKING -Education to prevent falls -Regular dental visits -Medications |
|
|
Ca+ supplements should be taken
|
-with meals
-high fiber foods may decrease absorption (milk, ice cream, oatmeal, cottage cheese, collard greens) |
|
|
Vitamin D
|
-Essential for absorption of Ca+
-Sunlight, dairy products, fatty foods, fish oils, breads, cereal |
|
|
Medication Tx for Osteoporosis
|
-Fosamax
-Acetone -Evista -Miacalcin -HRT |
|
|
Bisphosphonates should be taken
|
-with a full glass of h20
-remain upright and eat nothing by mouth for 30 minutes |
|
|
Low Back Pain
|
-Affects 80% of adults in US
-Responsible for lost work hours in adults under 45 -Common in the lumbar region: bears most weight, contains nerve roots, has poor biomechanical structure |
|
|
Risk Factors for Low Back Pain
|
A. Lack of muscle tone
B. Excess body weight C. Poor posture D. Cigarette smoking E. Stress |
|
|
Low back pain is most often due to
|
musculoskeletal problems such as:
-acute lumbosacral strain -instibility of the lumbosacral bony mechanisms -Osteoarthritis -Degenerative disk disease -herniation of the inter vertebral disk |
|
|
Acute Interventions for Low Back Pain
|
-Avoid sleeping in prone position
-Maintain activity limitations -Promote comfort -Educate pt about exercise -Use analgesics as ordered -Use muscle relaxants -Thermotherapy (heat and cold) as ordered -Avoid continual bed rest |
|
|
Causes of chronic Low Back Pain
|
-Degenerative disk disease
-Lack of physical activity -Prior injury -Obesity -Structural or postural abnormalities -Systemic disease *Lasts longer than 3 months *Treatment same as acute interventions |
|
|
Osteogenic Sarcoma
|
-primary bone tumor
-extremely aggressive and rapidly metastasizes to distal sites -Most common tumor affecting children and young adults |
|
|
Clinical Manifestations of Osteosarcoma
|
-Gradual onset of pain and swelling
-Confirmed by biopsy -Elevated serum alkaline phosphatase and Ca+ levels -CT, PET or MRI will be ordered |
|
|
Tx for Osteosarcoma
|
-Chemo
-Surgical resection with limb salvage if possible |
|
|
Goals for Cancer of the Bone
|
-Pain Relief (SEVER PAIN)
-Maintain preferred activities as long as possible -Demonstrate acceptance of body image changes resulting from chemotherapy radiation and surgery -Be free from injury -Verbalize a realistic idea of disease progression and prognosis -Determine the clients quality of life -Treat all symptoms aggressively |
