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Musculoskeletal

Musculoskeletal System - Fractures

antagonistic muscle groups working against each other
synergistic muscle groups working together
muscle tone normal state of balanced muscle tension
ligaments bind joints together and connect bones and cartilage
tendons connect muscles to bone
cartilage a supportive tissue; located in joints, thorax, trachea, nose, and ears
ossification hardening of bones
catabolism eating away of dead flesh
ateleclasis collapsing of the lung
urinary stasis UTI
renal calculi kidney stones
acute care Metabolic: provide high protein, high-calorie diet with vitamin B & C supplements. Respiratory: have patients cough & breathe deep every 1 to 2 hours.
cardio-vasular changes orthostatic hypotension, increased cardiac workload, thrombus formation
musculoskeletal changes patient loses lean body mass, muscle weakness/atrophy, disuse osteoporosis, joint contracture
urinary elimination & integumentary changes urinary stasis, renal calculi, integumentary changes, pressure ulcers-inflammation, ischemia, less collagen
health promotion weight bearing exercises (like walking)
steroids suck calcium and contributes to skin breakdown
fractures secondary to the disease process cancer/osteoporosis
open fracture skin broken with bone and soft tissue exposed
complete fracture break is completely through the bone
incomplete bone is still in one piece but the break occurs across the bone shaft
transverse the break is straight across the bone (horizontal)
oblique diagonal break
greenstick break is not all the way through (picture a broken, green twig)
closed fracture skin is intact
fracture, 1st stage of healing fracture hematoma = initial 72 hours (bleeding, elevate, rest, ice)
fracture, 2nd stage of healing granulation = 3 to 4 days post injury (basis for new bone)
fracture, 3rd stage of healing callus
fracture, 4th stage of healing ossification = hardening of the bone
fracture, 5th stage of healing consolidation
fracture, 6th stage of healing remodeling (up to a year after the injury)
closed reduction nonsurgical, manual realignment of bone fragments, traction and counter traction
open reduction correction of bone alignment through surgical incision
primary intention surgical wounds are brought together
ORIF open reduction with internal fixation
CPM continuous passive motion (machine that stops adhesions - scar tissue)
traction provides immobilization to prevent soft tissue damage, reduce muscle spasm, short term treatment, weights 5 to 10 pounds
pin care clean with hydrogen peroxide and water
Buck's traction a running skin traction that can be used temporarily to immobilize a fracture of the hip/femur until it is possible to do surgery
setting time for plaster 15 minutes
petaling plaster cutting the edges to avoid skin irritation
cast syndrome chills, fever, nausea, vomitting, odour, or drainage on or under the cast
initial fracture care elevate extremity above heart level for 24 to 48 hours (or edema might result)
cast care apply ice directly over fracture for 24 hours, move joints above and below cast regularly, don't bear weight on it for 48 hours
compartment syndrome, card 1 compartment syndrome occurs when injured tissue swells within the fascia and connective tissues inside a limb causing an increase in the pressure within that “compartment”.
compartment syndrome, card 2 pressure within the closed fascia “compartment” becomes a tourniquet for the surrounding tissue within the compartment.
6 P's pain, pallor, pressure, pulses, paresthesia, paralysis
6 P's pain, pallor, pressure, pulses, paresthesia, paralysis
postoperative management vitals every 15 minutes the first hour, then every 1/2 hour for the next 2 hours
significant increase in size of drainage area increased size of drainage should be reported
prolonged best rest results in orthostatic hypotension, decreased lung capacity
NWBA non-weight-bearing ambulation
TTWB touch-down/toe-touch weight bearing
DVT deep vein thrombosis - one complication of a fracture
osteomyelitis infection of the bone
compartment syndrome and ischemia can occur within 4 to 8 hours after onset
compartment syndrome, card 3 severe pain despite pain meds, extremity SHOULD NOT be elevated above the heart (no cold compress)
fractures that cause fat embolism the most long bones, ribs, tibia, and pelvis (24 to 48 hours after injury)
osteoporosis metabolic bone disease (porous bone, low bone mass, structural deterioration of bone tissue) - non-inflammatory (bone on bone)
most affected by osteoporosis one in two women and one in eight men (more common in women)
risk factors of osteoporosis cigarette smoking, sedentary, insufficient calcium, steroids (long use), thyroid replacement, anti-seizure drugs, low T
peak bone mass achieved before age 20
areas of osteoporosis spine, hips, and wrists (mostly)
diseases associated with osteoporosis intestinal malabsorption, kidney disease, RA, alcoholism, cirrhosis, diabetes mellitus
BMD bone mineral density
osteopenia happens before osteoporsis
RA causes swelling & inflammation around the joints, affects the whole body - including organs
on hands of people with OA Heberden’s nodes are a permanent condition and often make your fingers look misshapen.
systemic manifestations not present in OA
degenerative joint disease OA
inflammation not characteristic of OA
OA joint pain worsens with joint use
early morning stiffness usually resolves within 30 minutes
overactivity can cause mild joint effusion and temporarily increases stiffness
crepitation grating caused by loose particles of cartilage in joint cavity
asymmetrically OA - joints are not affected the same bilaterally
DIP distal interphalangeal
PIP proximal interphalangeal
MCP metacarpophalangeal joint
MTP metatarsophalangeal
Bouchard's nodes OA red, swollen, tender - visible disfigurement
knee OA often leads to joint malalignment, altered gait
no abnormal labs or biomarkers OA
OA management rest, heat (used more than ice), cold (do not immobilize for more than one week)
RA chronic, systemic autoimmune disease, inflammation of connective tissue, periods of remission
RA time of onset any time of life
RA & women 3 times greater chances of developing RA
RA cause unknown
pannus scars and shortens supporting structures causing joint laxity, subluxation, and contracture
unarrested RA progresses in 4 stages.
RA - stage 1 early - no destructive changes on x-ray
RA - stage 2 moderate - x-ray evidence of osteoporosis with or without bone or cartilage destruction - no joint deformities
RA - stage 3 x-ray evidence with evidence of cartilage and bone destruction, deformity
RA - stage 4 fibrous or bony ankylosis, stage III criteria
RA onset insidious, fatigue, anorexia, weight loss, generalized stiffness (precipitating events - might be mumps or diabetes 1)
RA - affects symmetrical affects small joints of hands and feet
RA - mornings morning stiffness may last from 60 minutes to several hours or longer
RA - finger may become spindle shaped from synovial hypertrophy and thickening of joint capsule
RA - joint pain increases with motion, varies in intensity, may not be proportional to degree of inflammation
RA progression inflammation and fibrosis of joint capsule & supporting structures may lead to deformity and disability
RA - clinical manifestations atrophy of muscles and destruction of tendons around joint cause one another to slip past each other
RA - deformities ulnar drift, Boutonmere deformity, Hallux valgus, Swan neck deformity
three most common RA manifestations rheumatoid nodules (non-tender, granuloma type), Sjogren's syndrome (itchy, dry eyes with diminished tears & salivary glands), Felty syndrome ( inflammatory eye disorder, splenomegaly - large spleen, enlarged lymph nodes, pulmonary disease)
RA complications diminished grasp, cataracts, progressive hoarseness from nodes, pericarditis, cardiomyopathy, carpal tunnel syndrome
RA - labs positive RF, titers rise during active disease (ANA titers), ESR is elevated (estimated sedimentation rate), elevated C-reactive protein
straw colored fluid RA
increased WBC can be elevated up to 25,ooo in RA
RA timeline & criteria 6 weeks with morning stiffness lasting more than an hour and swelling in three or more joints, symmetric joint swelling, rheumatoid nodules
RA care PT to help maintain joint motion and muscle strength, OT to help with extremity function and joint protection, warm shower or water on joints, firm mattress or bed board, extension positions, heat (not to exceed 20 minutes)
pain process transduction (initiates the action potential), transmission (sends impulse across sensory pain nerve fiber), perception, modulation (release of neurotransmitters - endorphins, histamine, substance P, bradykinin)
pain neurotransmitters prostaglandins, bradykinin, potassium, histamine, substance P (vasodilation & edema)
pain -afferent from site of injury to the brain
pain - A-delta fibers send sharp, localized, distinct sensations
pain - unmyelinated C fibers slow & small. They send poorly localized, burning, persistent pain
Gate-control theory Pain has emotional & cognitive components aside from the physical sensation. Pain impulses pass through when a gate is open and are blocked when a gate is closed.
reflex arc reflex to pain stimulus
acute pain transient, identifiable, short duration, limited emotional response
chronic - noncancer not protective, no purpose, may or may not have an identifiable cause
chronic episodic occurs sporadically over an extended period of time
inferred pathological musculoskeletal, visceral, or neuropathic
idopathic chronic pain without an identifiable physical or psychological cause
poorest pain care received by people with chronic pain (they doctor shop looking for answers and get accused of being addicts - pseudo-addiction)
symptoms of chronic pain fatigue, insomnia, mood changes - irritable, anger/frustration/depression,
pain tolerance the level of pain a person is willing to accept
pain management systematic (regular intervals to keep the pain at manageable levels)
PCA Patient-Controlled Analgesia (pump the patient uses to self medicate - within predetermined limits). Two nurses must do the programming. Monitor O2 continuously.
A postoperative patient with a PCA evaluate effectiveness by comparing current assessment with baseline pain
monitoring patients using pain medication check for depressed CNS (over sedation, respiratory depression)
activation of large-diameter A fibers closes gate, inhibits transmission to the brain (TENS, massage, ...)
activation of small C fibers opens the gate and allows the perception of pain
PCA by proxy someone other than the patient pushes the pump
adjuvant drugs NSAIDS, antidepressants, anticonvulsants, corticosteroids (amitriptyline, Gabapentin)
opioid - adverse effects euphoria, CNS depression, nausea/vomiting, urinary retention, diaphoresis and flushing, pupil constriction (miosis), constipation, itching
naloxone (Narcan), naltrexone (Revia) used for complete or partial reversal of opioid induced respiratory depression
pain threshold 1st time pain is felt
age related bowel and urinary changes bladder is smaller, loss of sensation, loss of muscle
one cause of dirrhea stress
nocturia night-time urinary eleimination
polyuria lots of urinary elimination
oliguria low amount of urinary output
anuria no urinary output
diuresis increased excretion of urine
diseases affecting urination diabetes mellitus, MS, benign prostatic hyperplasia, cognitive impairment (Alzheimer's), end-stage renal disease uremic syndrome (toxins that can't be removed - they end up oozing out of the pores giving the person a frost-like appearance).
Indication for dialysis renal failure uncontrolled by conservative management, worsening of uremic syndrome (ESRD), severe electrolyte & or fluid abnormalities
factors influencing urination surgical procedures, stress, medications, diagnostic procedures
alterations in urinary elimination BPH (males - benign prostate hyperplasia), UTI, unrinary incontenence, urinary diversion, bladder prolapse (women).
sterile urine collection - catheter scrub connection for 15 seconds and allow it to dry before getting the sample
social isolation disturbed body image
urinary related pain urinary incontinence (functional, stress, urge, overflow)
urinary risk for infection toileting self-care deficit
urinary impaired skin integrity impaired urinary elimination
constipation urinary retention
cholinergic drugs increase bladder contraction and improves emptying
I & O example: IV = 3000mL in the bag. 1800mL has flowed through tube into pt. 1500mL has been voided. 1800 (in) - 1500 (out) = 300 mL = amount of urine over a 10 hour shift.
digestive track mouth, esophagus, stomach, small intestine, large intestine, anus
common bowel problems constipation, impaction, diarrhea, incontinence, flatulence, hemorrhoids
bowel diversion temporary or permanent in the stomach wall = stoma
Ilesotomy usually rt. upper, green liquid stool
colostomy usually lower left, solid stool
dehydration could be a sign constipation
end colostomy permanent
double-barrel colostomy temporary. one produces mucus and one produces stool
anastomosis reverse ostomy. Fast heart rate is a sign of leakage.
enemas no more than 500 cc's (warm - not cold or cramping may happen)
ostomy irrigation cone that fits in the ostomy (not an enema)
new ostomy nutrition low fiber for first weeks, eat slow & chew completely, 10 to 12 glasses of water daily
laxatives can cause the body to become dependent
OA indicators one side (1 knee replaced),weight bearing exercises help, lack of calcium, vertebrae cracks, smoking makes it worse
RA indicators starts at any age, both sides of the body
sign of compartment syndrome lack of a pulse
bucks traction pre-surgical
What does hot & cold due? hot = vasodilation cold = decrease inflammation
monitor pt's on PCA and opiods for change in LOC and decreased respiration. Stop meds and call doc
acute pain is protective, has a cause, short duration, limited tissue damage, emotional response
neuropathic pain treatment usually includes adjuvant analgesics
Created by: Block 1 Theory