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Disease Process M-S

Musculoskeletal Disease Process LPN

Rheumatoid Arthritis RA
Rheumatoid Arthritis S/S Malaise, Muscle Weakness, Symmetrical Joint Edema, Tenderness, Limited ROM, Subcutaneous nodules, Fever
Rheumatoid Arthritis Pathophysiology Inflammation of synovial lining
As inflammation continues, the synovial liing thickens, accumulates with fluid, causing pain and swelling RA Pathophysiology
eroded joint cartilage and destroys the bone within the joint Rheumatoid Arthritis (end result)
Symmetrical Both sides of body
RA Diagnostic Tests No Single Test, H&P, Several Labs can help support diagnosis: Rheumatoid factor, decreased RBC's, Decreased C$ compliment, Increased SED Rate, Positive ANA test, Positive C-Reactive Protein.
The Higher the SED Rate The more active the disease
If (RA) disease responds to treatment, the ________ rate decreases SED
RA Medical Management GOALS Control disease through remission, Pain Control, Prevent joint damage, Maintain ROM independence, Joint splints or immobilizers
Anti - Inflammatory Drugs Indomethacin (Indocin), Ibuprofen (Motrin), Tolmetin sodium (Tolectin), Naproxen (Naprosyn), Meloxicam (Mobic), Difunisal (Dolobid), Piroxicam (Feldene), Nabumetone (Relafen), Meclofenamate (Meclofen)
DMARS Disease Modifying Antirheumatic Drugs
NSAIDS Corcorticosteroids Arava, Enbrel
Decrease Joint stiffness with: Heat Therapy
During exacerbation periods of increased inflammation use: Ice Therapy
Non-Medical treatment for RA Fish oil, Magnet therapy, Antioxidants: Vit C, E and beta carotene
RA Nursing Care & Teaching Rest as needed, Sleep 8-10 hours, Change position frequently, Support groups, encourage independence
ROM should be avoided when: Joints are inflamed
Ankylosing Spondylitis Chronic Progressive disorder of sacroiliac and hip joints, and synovial joints of spine.
AKS Autoimmune with familial tendencies
Ankylosing Spondylitis Abbreviation AKS
S/S AKS Morning backache and stiffness of lumbar subsides with activity and returns with inactivity
Arthritis, Sciatica pain, arthralgia, malaise, and weight loss S/S of AKS
Vision loss occurs with Chronic AKS
arthralgia joint discomfort
AKS Diagnostic Tests Spine X-ray, SED Rates elevated, Rh negative, Alkaline Phosphatase levels elevated, Low H&H
Mr. Smiths spine X-Ray reveals that his spine has the appearance of bamboo shoots. What disease could Mr. Smith possibly have Ankylosing Spondylitis
Medical Management of AKS NSAIDS, Postural Exercises, Heat to back, Respiratory exercises
Resp. Complications may occur due to shallow breathing
AKS Nursing Care & Teaching Firm Mattress, No Pillow, Resp. exercises, Take meds as prescribed, teach disease is chronic and irreversible.
Another name for Osteoarthritis DJD
A nonsystemic noninflammatory disorder that causes degeneration of bones and joints Osteoarthritis
Major cause of disability
Osteoarthritis Almost everyone over 40 has some form of this disease, major cause of disability.
Nonsystemic does not effect both sides
Osteoarthritis s/s Pain and stiffness of joint or joints usually precipitated by surgery, trauma, past illness or weight gain.
Joint edema and tenderness and possible deformity Osteoarthritis S/S
(Pt with DJD) distal finger joints may have ________ ________ Heberden's Nodules
Bouchard's Nodes gelatinous cysts or bony outgrowths on the dorsal aspects of the proximal interphalangeal joints.
Osteoarthritis Disgnostic x-ray's may show joint degeneration
Osteoarthritis Medical Management Exercise balanced with rest periods, NSAIDS, Cortisone injections or low oral doses, Glucosamine, Joint replacement
Osteoarthritis Nursing Care & Teaching Encourage activities and ADL's, Splints if needed, NSAID and Steroid Precautions and care, Heat, Weight Control, Gait training if needed, Safety
NSAID & Steroid Precautions: GI Bleeding, take with food, watch for tarry stools
Accumulation of uric acid in bloodstream can lead to what condition Gout
Gout Inability to metabolize purines: -Heredity -Medications -Unknown Causes
King's Disease aka: Gout
Gout may result in Gouty Arthritis which is: inflammation of a joint
Gout S/S Pain of joint Inflammation, heat and redness at joint May be intermittent for up to 10 days Tophi around rim of ears
Gout usually affects: the great toe
Tophi is caused from: sodium urate deposits
Mr. Jones has little nodules around the rim of his ears. This may be a sign of? Gout (Tophi)
Mr. Laymen has a history of eating organ meats and drinking alcohol. Mr. Laymen may be at risk for: Gout
Gout Diagnostics: Elevated serum uric acid levels, SED rate elevation, Possible kidney stones
Food's that should be avoided in a pt. with Gout: organ meats, alcohol, anchovies, herring, mackerel and scallops
Medical Management of pt. with Gout Colchicine orally or IV, Zyloprim, Anti-inflammatory drugs such as Indocin
Gout: Nursing Care & Teaching Take meds as prescribed, Assess for renal calculi, Increase fluid intake, I & O, Bed cradle, Bed rest and joint immobilization, Low purine diet, Teach meds may be long term
Osteoporosis Reduction of bone mass
Mrs. Premium a 60 year old women is complaining of backache, and gait instability. Mrs. Premium may have: Osteoporosis
Osteoporosis is most common in menopausal women because: Calcium leaves bones probably d/t decreased estrogen levels
S/S of Osteoporosis Backache, Frequent fractures, decreased height, dowagers hum, gait instability.
Diagnostic Osteoporosis: Clinical s/s, bone density test, other labs to r/o other diseases (CBC, Lytes plus, etc)
Medical Management of Osteoporosis Calcium Supplements, Vitamin D, weight bearing exercises
Medicines to help Osteoporosis Fosama, Actonel, and Forteo
Fosamax bone reabsorption inhibitor, can cause serious esophageal and stomach irritation.
Actonel Bone reabsorptoin inhibitor
Forteo prevents osteoblast sloughing. Taken sub-q daily
Sit up right 30 minutes after ingesting this medication Fosamax
Decreased height can be caused by: Dowagers hump
Veterbroplasty high pressure, uses cement.
Kyphoplasty non high pressure, uses balloon and cement
P/O Care Veterbroplasty Lay Flat 4 hrs. in prone position Check dressing
Nursing Care & Teaching: Osteoporosis encourage activity, proper diet high in calcium, safety accommodations, weight bearing exercises, encourage follow up visits and follow reime
Dietary Calcium Needs 1000 - 1500 mg qd
Calcium mineral that can slow bone loss and may decrease fractures.
green vegetables, milk products, calcium-fortified orange juice and soy milk food sources for calcium
Helps calcium absorption and stimulates bone formation Vitamin D
Osteomyelitis Infection of bone or bone marrow, Staph common causative agent.
Spread through blood stream from another site in body and "settle" in a bone Osteomyelitis
S/S of Osteomyelitis Bone pain & tenderness, possible wound drainage
Diagnostics of Osteomyelitis H & P, SED Rate, CBC, Blood cultures, Bone scan, CT, MRI
Medical management of Osteomyelitis IV Antibiotics, Bed Rest, Possible surgery for necrotic bone tissue.
Nursing Care & Teaching Osteomyelitis Reposition gently, Monitor Vitals, Pain control, Wound care using sterile technique, Teach s/s infection, Teach necessity of following medication regime
Elevated Temp possible infection
Fibromyalgia Syndrome Chronic musculoskeletal pain disorder of unknown etiology.
Fibromyalagia Syndrome Abbreviation FMS
A non life threatening, but life altering disease that affects more women than men between 20-50 Fibromyalagia Syndrome
S/S of FMS Generalized aching of multiple sites, low back stiffness (worse in am), fatigue, s/s exacerbated by humidity, cold weather, physical or mental fatigue, and stress. c/o of edematous feeling of hands with no visible signs.
Diagnostics of Fibromyalagia Syndrome H&P, R/O other diseases, sed rate wnl, Pt. usually also suffers from IBS or tension headaches.
Medical Management of FMS Control pain - use of tricyclic antidepressants helpful (Elavil)
Nursing Care & Teaching: Fibromyalagia Medicate for pain, individualize exercise and relaxation regime, encourage rest as needed, not psychiatric disturbance.
Medications: Fibromyalagia Syndrome Amitriptyline (Elavil, Endep), Cyclobenzaprine (Flexeril), Clonazepam (Klonopin)
Sleep Hygiene (Fibromyalagia Syndrome) Maintain regular sleep patterns by going to bed and awaking the same time each day. Avoid long naps, take a hot bath within 2 hours of bedtime.
Control environmental factors by avoiding large meals 2 to 3 hours before bedtime and keeping sleep environment dark, quiet and comfortable Sleep Hygiene (Fibromyalagia Syndrome)
Sleep Hygiene (Fibromyalagia Syndrome) Exercise Regularly each day, Recognize the effects of drugs on sleep such as nicotine, alcohol and caffeine
Knee Arthroplasty Knee joint replacement to restore motion, relieve pain, or correct deformity
Knee arthroplasty aka TKA
Partial (unicompartmental) TKA Unicompartmental will last 5-15 years and will eventually need total knee done. Minimal blood loss Walks 3-4 hrs. post op No disruption of knee cap Spinal or general 60-90 min surgery
Total Knee Longer surgery with higher risks More extensive post-op care, pain control, and recovery phase
Total Knee Complications: pneumonia and embolism
S/S of Knee Arthroplasty Knee pain esp. with movement, talking and weight bearing
Diagnostics of Knee Arthroplasty X-Rays, Evaluation of pt, must be done prior to surgery.
Mrs. Jones x-ray reveals narrowing of the joint. Mrs. Jones possible diagnosis may be: Knee Arthroplasty
Mrs. Chong's x-ray reveals degeneration of the joint around her knee. Mrs. Chong has also been having problems bearing weight on her leg. What possible diagnosis may this be: TKA
Nursing Care and Teaching of Knee Arthroplasty Position leg for venous return, wound care, neurovascular checks, check behind knee for bruising, hematomas, hemovac drain care, CPM machine with settings as ordered, Pain Control, PT teaching crutches, cane, walker, Observe 4 complications, safety
Observe for ___________________ after TKA osteomyelitis
Necessities after TKA prophylactic antibiotics before dental cleaning and surgery for the next 2 years.
Hip Arthroplasty Used for degeneration of hip joint
Variations of Hip Arthroplasty Vitallium or plastic
S/S of Hip Arthroplasty Limited ROM, Pain with weight bearing
Diagnostics: Hip Arthroplasty X-rays show degeneration, assess rehabilitation ability and overall health of pt. prior to surgery
Post Op Care: Hip Arthroplasty Monitor Vitals, Pain Control, Dressing Care, Hemovac care, TEDS and SCD's, Neurovascular checks, Bed Rest 24-48 hrs, Chair for short periods
Cement Used during Hip Arthroplasty light touch bearing after bed rest expires
Non Cement used during Hip Arthroplasty non weight bearing
Hip Arthroplasty: Avoid adduction and bending more then: 90 degrees
Hip Arthroplasty Restrictions: First 10 days Avoid hip flexion beyond 60 degrees
Hip Arthroplasty Restrictions: First 2-3 months Avoid hip flexion beyond 90 degrees
Hip Arthroplasty Restrictions: First 2 to 3 months Avoid adduction of the affected leg beyond midline
Hip Arthroplasty Restrictions: Avoid positioning on the operative side in bed, Maintain abduction of the hip by using a wedge-shaped foam bolster or pillows arranged in a wedge.
Abductor pillow esp. with repositioning, getting OOB, or in chair. Raised toliet seat, high fiber diet, encourage fluids, teach s/s infection Hip Arthroplasty Nursing Care & Teaching
Fractured Hip Most common type of fracture in older adults due to falls.
S/S of Fractured Hip When injury occurred, may have limited ROM, severe pain, shortening of leg, pt may have felt a "pop", may have ecchymosis or erythema at site
Diagnostics Fractured Hip X-Ray
Medical Management: Fractured Hip Surgical Repair, Initial immobilization of extremity until surgery.
Proper Weight, Circ Checks, Observe skin Breakdown Buck's Traction
Post op ORIF Care Vitals, JP Drain care, Wound and Dressing care, I&O, TED's SCD's, Heparin, Lovenox, coumadin care
Heparin Lab test PTT
Coumadin Lab Test PT INR
Nursing Care for Fractured Hip Pain Control, Traction care if applicable, Post op ORIF Care, Bleeding precautions if on anticoagulants
Closed Fracture (Simple) No Break in the skin
Open Fracture (Compound) Protrude through skin
Fractures occur from trauma, osteoporosis, metastatic Ca, or tumors
Greenstick incomplete - not through entire bone, still secure on one side. Common in Children
Complete fracture extends through entire bone
Comminuted bone is splintered with fragments. More than 1 fracture line
Impacted telescope fracture. One bone is forced into another.
Transverse break runs directly across bone
Oblique break runs along slant to the length of the bone
Spiral break coils around bone. Results from a twisting force.
Colle's fracture of distal portion of radius within 1" of joint of wrist
Pott's distal end of fibula by chipping off piece of medial malleolus
Healing of Bone (osteoblasts) form new bone
Healing of Bone (fibroclasts) form fibrin network
Healing of Bone (Callus) bony deposits, form around fracture site
Healing of Bone (Collagen) strengthens area
Hematoma can form at fractured bone: True or False True
WBC's will surround site Healing of Bone
Bones are: living, vascular, have their own nerves
S/S of Fractured Bones: Pain, Loss of Normal Function, Possible Deformity, Change in curvature of bone alignment, Ecchymosis, edema at site, Paralysis or loss of sensation at site
Diagnostics of Fractured bones Radiographic Studies
Medical Management: Fractured Bones Immobilization, Surgery, Closed Reduction, Cleanse and possible culture of wound, Possible tetanus injection, Possible antibiotics,
Methods of Immobilization of Fractured Bones Casts, Splints, Traction
Casts immobilization devices made up of layers or plaster of paris, fiberglass, or plastic roller bandages.
Cast Brace alternative appliance to the traditional leg cast. Provides support and stability of the plaster cast with additional support and mobility provided by a hinged brace.
Buck's Traction form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated.
Traction (pull) is in a horizontal plane with affected extremity. Used to maintain the reduction of a hip fracture before surgery. Buck's Traction
Russell's Traction Knee sling is used to provide support to affected leg. It allows more movement in bed and permits flexion of the knee joint
Commonly used to treat hip and knee fractures Russell's Traction
Bryant's Traction Used in pediatrics for small children with fractured femurs.
Legs are extended at a 90-degree angle to the trunk of the body, and the weight of the lower body pulls the bone fragments of the fractured leg into aligment Bryant's Traction
Skin Traction accomplished by using weight that pulls on spinge rubber, molsekin, elastic bandage with adherent, or plastic materials attached to the skin below the site of the fracture, with the pull exerted on the limb.
Skeletal Traction applied directly to a bone. Wires and surgical pins are inserted through the bone distal to the fracture site while the patient is under local or general anesthesia.
Use of Pins, screws and wires, surgically placed to align bone for healing Skeletal traction
Nursing Care: Fractured bone Skin Care, Neurovascular Checks, Immobility Care, Traction should not be painful, Proper pin care if skeletal traction, Assess for 7 P's, Proper cast, splint, traction care, Assist in adaptations ADL's, Exercise unaffected Limbs, Elevate effected part
7 P's Pain, Pallor, Parasthesia, Paralysis, Polar Temperature, Puffiness or edema, Pulseness
Fractured Vertebrae Occur from trauma, osteoporosis, cancer. Displaces vertebrae structure. May cause pressure on spinal column. Bone fragments may also injure spinal cord.
S/S Fractured Vertebrae Pain, Partial or complete Immobility
Diagnostics Fractured Vertebrae X-Rays, CT, MRI
Medical Management: Fractured Vertebrae Stabilize vertebrae, anticoagulant therapy, muscle relaxants.
Stabilize Vertebrae Corset Brace Back Support Cast Brace Halo
Muscle Relaxants cease muscle spasms
Nursing Care & Teaching; Fractured Vertebrae Log Roll, Elevate HOB no more then 30 degrees, use firm mattress, sit in straight back chair no longer then 30 mins, teach to use leg muscles, not back muscles, observe for spinal cord involvement or nerve compression.
Skeleton traction or Halo Care Cleanse screw areas as ordered Observe for s/s infection
Fractured Pelvis Trauma, Can damage internal organs, May hemorrhage from internal damage, Na develop fat embolism
S/S of Fractured Pelvis Unable to weight bear, Possible hematuria if bladder trauma, shortening of one leg, s/s shock, restlessness, pain
Diagnostics: Fractured Pelvis X-Rays, s/s, H&P
Medical Management: Fractured Pelvis Bed rest 3 weeks, walk with crutches in 6 weeks, possible external traction, possible body cast.
Nursing Care & Teaching; Fractured Pelvis Reposition, Trapeze bed frame, Circ. Checks, I&O, Skin Integrity precautions, possible foley, Observe for shock
Observe for Signs of Shock VS, restlessness, increase abdominal girth, increased abdominal pressure
Compartment Syndrome Progressive development of arterial vessel compression and decreased blood supply to the area
Occurs because of tight cast or muscle ischemia (esp. first 6 hrs) Compartment Syndrome
Compartment Syndrome AKA Acute Compartment
Acute Compartment Paralysis, sensory loss, contractures and permanent disability can occur within 24-48 hours.
S/S of Compartment Syndrome Increase in sharp pain to area unrelieved by analgesics, Signs of circulation impairment
Signs of Circulation Impairment slow capillary refill, coolness, numbness, tingling, pallor, pulselessness
Medical Management of Compartment Syndrome Fasciotomy to remove pressure and reestablish blood supply. Must be done with in 30 minutes. Incision will be left open to heal secondary infection
Nursing Care & Teaching: Compartment Syndrome Observe for further circulatory compromise, Pain control, observe site for s/s infection, proper positioning of extremity, observe for Volkmann's contracture
Volkmann's Contracture a permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers.
Shock: Subjective Data Monitoring Pt's level of consciousness. Restlessness, complaints of anxiety, complaints of weakness
Shock: Objective Data VS, Hypotension, tachycardia, tachypnea, as progesses: hypothermia. Pallor, cool, moist skin. Oliguria
Oliguria decreased urinary output
Medical Management: Shock Restore blood volume, IV Fluids, Resp. assistance, VS, Pulmonary Edema, Shock trousers may be applied.
Nursing Care & Teaching: Shock IV Fluid Administration, VS monitored every hour, Pt should remain flat in bed, Pt must be kept warm, external heat should be avoided
Shock can be fatal within a few hours of injury, therefore immediate attention is required.
Fat Embolism Embolism of tissue fat with platelets that circulate in pulmonary capillaries. More common with multiple fractures or fractures of long bones within 48 hrs. after injury. Rare, but life threatening
Fat Emolism: Fat droplets occlude circulation and lead to ____________ hypoxia
S/S of Fat Embolism Mental disturbances, Restlessness, stupor, coma, Chest pain esp. with inspiration, s/s hypoxia, crackles or wheezes, possible arrhythmia
Fat Embolism, if travels to brain Mental Disturbances
Fat Embolism, if travels to lungs Chest pain, esp. with inspiration
Fat Embolism, if travels to heart Possible Arrhythmia
Diagnostics: Fat Embolism ABG's reveal hypoxia, Fat present in blood and urine, SED rate elevated, Platelets decreased
Medical Management: Fat Embolism IV Fluids to prevent shock and decrease the concentration of fat int he blood stream. Steroid - decrease inflammation. O2
Nursing Care and Teaching: Fat Embolism Observe for resp. distress, O2, Elevate HOB, Pulse Oximeter, I&O
Gas Gangrene Severe infection of skeletal muscle by gram positive bacilli esp. Clostridium. More prone in those with compound fractures or lacerated wounds. Injury produces exotoxins that destroy tissue.
Onset Sudden and occur 1-14 days after injury Gas Gangrene
Gas Gangrene Organisms are: anaerobic and form spores
Gas Gangrene: As bacteria multiply causes; Hemolysis, Vessel thrombosis, Damage to myocardium, liver, kidneys and brain
S/S of Gas Gangrene Sudden, sever pain at site. Gas bubbles at site of wound. Cellulitis. Crepitation at sites, System signs of infection, foul smalling wound discharge
Crepitation sounds that resemble the crackling noise heard when rubbing hair between 2 fingers or throwing salt on an open fire
Diagnosis: Gas Gangrene Cultures (may get aerobic and anaerobic, s/s
Aerobic Oxygen-requiring
Anaerobic Non Oxygen-requiring
Medical Management: Gas Gangrene IV Antibiotics, Open Wound to get more oxygen to area, Hyperbaric chamber, Possible amputation
Antibiotics: Gas Gangrene Penicillin G, Cephalosporins: Cefazolin (cephazolin; Ancef, Kefzol) Cefadroxil (cefadroxyl; Duricef) Cefalexin (cephalexin; Keflex)
Nursing Care & Teaching: Gas Gangrene Wound care, Proper antibiotics administration, Isolation; all equipment used and linen should be autoclaved
Contusions Most common soft tissue injury. An injury from a blow or blun force will cause local bleeding under the skin and possibly a hematoma.
Hematoma sac filled with blood
Sprains injury can result from a wrenching or hyperextension of a joint, tearing the capsule and ligaments. Can involve hemarthrosis. Common site include knee, ankle, and cervical spine
Hemarthrosis bleeding into a joint
Whiplash injury to cervical spine, classified under cervical spine syndrome
Ankle Sprains is often referred to as a twisted ankle and is caused by a wrenching or twisting of the foor and ankle
S/S of Sprains Edematous area, with spasms of muscles, pain on passive movement of the joint
Strains injury characterized by microscopic muscle tears as a result of overstretching muscles and tendons.
Acute Strain results when muscles and tendons are overstretched in a forceful movement, such as unaccustomed vigorous exercise
Dislocations Subluxation, partial or complete, of joint capsule. Congenital (hip) Disease process trauma
S/S of Dislocations Pain, Dislocation may or may not be visable, May have erythema, edema, or ecchymosis at site, Does not have free movement of joint.
Dislocations Focal Assessments Neurovascular Chest must be done to determine if circulation is compromised.
Diagnostics: Dislocations H&P with s/s, X-Ray
Medical Management: Dislocations Closed Reduction, Open Reduction
Closed Reduction "Pop" it back into place
Open Reduction Surgically fixate the bone by "poping" it back into place or by using screws to put the bone back into place.
Nursing Care & Teaching: Dislocations Reduce edema and discomfort, Immobilization as ordered, Ice 1st 24 hrs. then heat, Circ checks
Carpal Tunnel Syndrome Painful disorder of wrist and hand d/t compression of median nerve of the wrist. Result of injury or disease, More prone in people who use their hands with repetition, Also seen late in pregnancy
S/S of Carpal Tunnel Syndrome Parethesia, Hypoparethesia, Pain (may get better with vigorous shaking of hands, but will eventually intensify, esp. at night), may have muscle atrophy.
Diagnostics: Carpal Tunnel Syndrome EMG, MRI, Physical exam and H&P
EMG: Carpal Tunnel Syndrome decrease response of muscle to stimulation
Parasthesia Increased Senstation
Hypoparesthesia Decreased Sensation
Medical Management: Carpal Tunnel Syndrome If mild, may try splint, immobilizer or brace Surgery
Nursing Care & Teaching: Carpal Tunnel Syndrome Immobilizer or splint use
Post Op: Carpal Tunnel Syndrome ROM, Elevate hand for 24 hrs, Circ. Checks, Active ROM, Pain Control, May resume activity in 2-3 days
Herniated Disc Rupture of fibrous cartilage surrounding intervetbral disc. Displacement of disc may put pressure on nerve root. Can occur from trauma, twisting, lifting, or disease process.
S/S of Herniated Disc Back or cervical pain, possible paresthesia or tinging, sciatica, or weakness or extremity where nerve route travels
Diagnostics: Herniated Disc Complete physical Exam, CT, MRI
Medical Management: Herniated Disc Bed rest, pain control, traction, surgery
Surgery: Herniated Disc Lanimectomy, Spinal Fusion, Discectomy, Endoscopic spinal microsurgery, chemonucleolysis
Airbag Injury chemical burns, ocular trauma, cervical injury, soft tissue injury and upper extremity and chest trauma
Laminectomy removal of the bony arc hes or one or more vertebrae performed to relieve compression of the spinal cord caused by done displacement from an injury or degeneration of a disk or to remove a displaced vertebral disk
Spinal Fusion removal of the lamina and several herniated nuclei pulposi
Diskectomy only extruded disk material is removed
Endosopic spinal microsurgery Special scopes used to remove herniated discs with minimal damage to surrounding tissues.
Chemonucleolysis guiding a needle into the nucleus pulposus to inject chymopapain. Only to be used in pt's with no nerve damage.
Post Op: Herniated Disc Observe drg. for drainage. Look for CSF, Observe for infection, Pain Control, Monitor for resp. distress or parlytic ileus, may have lifting restrictions, teach proper posture and bending
Tumors of the Bone may be benign or malignant, If malignant, may be primary or secondary
Osteogenic Sarcoma seen in young people, Metastasizes to blood and lungs, affects males more then women, usually of humerus, tibia or fibula
S/S of Tumors of the Bone Bone weakness: healthy bone cells are replaced by cancer cells, Pain, esp. when weight bearing, Spontaneous fractures
Diagnostics: Tumors of the Bone X-Ray, Bone Scan, Bone Biopsy, CBC (may effect bone marrow)
Bone Biopsy: Closed done in room with local anesthesia and needle
Bone Biopsy: Open done in OR. Incision made. Sterile dressing. Observe site for bleeding and hematoma. Do not move for 8-12 hrs. (bone is vascular)
Bone Scan test detecting metastatic and inflammatory bone disease.
Nursing Care & Teaching: Tumors of the Bone (Post Op) Neurovascular checks, VS, Pain Control, PT/OT, Home health care, Dressing Care
Amputation Removal of partial or complete extremity
Needs for Amputation Disease process, infection, necrosis, trauma, congenital deformities
Spontaneous amputation limb should be placed in plastic bag and bag placed on ice
AKA Above the Knee Amputation
BKA Below the Knee Amputation
Diagnostics: Amputation Assessment of Area, Complete physical with labs
Nursing Care & Teaching Post OP Amputation VS, Observe for bleeding, circ checks, pain control, phantom pains, support stump appropriately, do not remove initial dressing - only reinforce, Incision care, proper stump wrapping, Hemovac care, Antibiotics as ordered, Support Pt & Family.
Nursing Care & Teaching Post OP Amputation Safety with everyday living, adaptation equipment, callous stump, PT/OT
Callous Stump ready stump for prosthesis
scoliosis rounding of the thoracic spine
Kyphosis hump-backed appearance
Lordosis increase in the curve at the lumbar space region that throws the shoulders back, making the "lordly or kingly" appearance
Muscular Dystrophy Group of 9 disorders involving loss of muscle tissue and progressive muscle weakness. Some forms appear in childhood, others in adults. Some genetic disposition, although exact cause unknown
Muscular Dystrophy AKA MD
MD muscle tissue is replaced by connective tissue
Life expectancy of PT with MD depends on progression time and type
S/S of Muscular Dystrophy May have difficulty raising arms above head or climbing stairs, developmental delays in motor skills, difficulty walk, frequent falls, ptosis
Ptosis drooping of the eye lid
Medical Management: Muscular Dystrophy Supportive care, Prevent complications
Nursing Care & Teaching: Muscular Dystrophy Resp. assessment and care, ROM, Skin Care, Encourage as much independence as possible while keeping an safe environment. May need braces, devices, therapies, Support groups, Teach to avoid cold and people with infections
Rib Fractures Usually caused by trauma by may be caused by severe coughing, osteoarthritis, bone CA
S/S of Rib Fractures Pain, esp. with inhalation or movement, H&P
Diagnosis of Rib Fractures CXR
Medical Management: Rib Fractures Pain Control: Opiods, NSAIDS, Nerve Block, Rib belts are no longer recommended
Nursing Care & Teaching: Rib Fractures Admin Pain Meds, Resp. Assessment, Encourage cough and deep breathing, Encourage lieing on affected side - will splint area to promote deep breathing, teach s/s pneumonia and atelectasis
Rib Fractures: Resp. Assessment Assess for atelectasis and pneumonia, Obese for flail chest: chest collapses with inspiration and bulges with expiration
Atelectasis Collapsed lung
Arthroscopy Arthrscope inserted by surgeon to visulazie joint (esp. knee and shoulder), Used to detect tears, defects, soft tissue damage and can also repair through scope. Invasive, Local or Light anesthesia
Nursing Care & Teaching: Arthroscopy (Post Op) Will have small dressing or wrap, assess for bleeding, Neuro vascular checks, observe and teach for thrombophlebitis infection, and increased joint pain, Mild analgesia, May have mild restrictions for a few days, May have limited weight bearing for 1 week
Bursitis Bursae becomes inflamed, Usually d/t repetitive movement, sleeping on one side, compressing bursa, arthritis, gout
Bursae fluid filled sac that cushions tendons during movement found in joints of shoulder, elbow, hip, knee, ankle and heel
S/S Bursitis Pain, stiffness or burning of joint, worsening with activity, Limited ROM or "frozen" joint
Diagnosis: Bursitis H&P, CT
Treatment: Bursitis Avoiding activities that aggravate the problem, resting the injured area, icing the area the day of the injury, NSAIDS, teach that bursitis can be prevented with gradual buildup in activities, with limited force and limited repetitions.
Rotator Cuff Injury Inflammation of rotator cuff in shoulder (area may become inflamed or tear away from the bone)
Rotator Cuff group of short tendons that are connected to muscles around the top of the shoulder. Muscle contractions causes these muscles to tighten and move or rotate the shoulder
S/S of Rotator Cuff Injury Shoulder aching, Increased pain at night and with lifting arm, Limited ROM
Diagnosis: Rotator Cuff Injury MRI
Medical Management: Rotator Cuff Injury Range from conservative to surgery, Ice, NSAIDS, PT, Arthroscopic surgery with sling or brace afterward
Created by: Myssi76