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Musculoskeletal
Week 1
| Term | Definition |
|---|---|
| Osteomyelitis Patho | Infection of bone that can be acute, sub acute or chronic. Most common is staph aureus |
| Hematogenous osteomyelitis | Spread from another area of the body via the bloodstream (seen more in children) |
| Nonhematogenous osteomyelitis | Open fracture or trauma to the bone (seen more in adults) |
| Osteomyelitis risk factors | age younger than 20 and older than 50 Open wounds after injury or trauma Surgeries with joint involvement Puncture and pressure wounds Chronic conditions (sickle cell, diabetes, dialysis etc) |
| Clinical manifestations of osteomyelitis | Pain not relieved by rest Swelling Tenderness Warmth Nausea Fever Malaise |
| Osteomyelitis diagnostics: Labs | CBC Blood cultures CRP (inflammation marker, doesn't indicate infection specifically) |
| Osteomyelitis diagnostics: Other | Biopsy (bleeding complication) CT (preg test first; adiation and harsh dye on kidneys) Bone scan MRI (no radiation but no metal) |
| Osteomyelitis medications | antibiotics (abx: start broad such as penicillin, cephalosporins, fluoroquinolones. IV for 4-6 weeks with a bridge to oral) Pain control (opioids) Multivitamins |
| Osteomyelitis complications | Sepsis Amputations Tumors (chronic) |
| 6 P's of neurovascular assessment | Pain Poikilothermic (abnormal temp fluctuations) Paresthesia (nerve compression) Paralysis Pulselessness Pallor |
| Osteomyelitis nursing interventions | Meds Thermal therapy gentle range of motion safe movement nutritional and home support teaching |
| Amputations | severing or removal of body part / can be traumatic or elective |
| Closed amputation | skin flap is sutured over the end of the residual limb to close site |
| Open amputation | used when active infection is present; no skin flap initially and then closed at a later date |
| Amputation risk factors | Traumatic injury Thermal injury Malignancy Chronic disease and infection |
| Medical management: traumatic amputation | Life threatening; control bleeding Tourniquet no longer than 6 hours Labs (H and H, platelets) Trauma assessment blood transfusion |
| Medical management: elective amputation | last resort; imaging to determine extent of damage. Cultures and hyperbaric oxygen. Percutaneous transluminal angioplasty anticoags prosthetics |
| Complications of amputation | severe bleeding (hypovolemic shock) death infection / sepsis contractures Neuromas Flexion contracture Delayed wound healing phantom limb therapy |
| Amputation assessment | vitals and labs neurovascular pain wound / incision site psychosocial |
| Nursing interventions for amputations | Large bore IV access transfusions / meds Ice ROM Nutrition Splint application Prevent post op complications monitor for non healing and infection (leads to osteomyelitis) |
| Fractures | disruption or break in the continuity of the bone |
| Closed or simple fracture | Does not break skin surface |
| Open or compound fracture | Disrupts skin integrity and causes an open wound / tissue injury |
| Displaced fracture | fracture has bone fragments that are not in alignment |
| Non displaced fracture | fracture has bone fragments that remain in alignment |
| Pathological fracture | fracture from weak bone due to disease process |
| Fatigue or stress fracture | Excess strain occurs from recreational or athletic activities |
| Fracture diagnostics | History and physical Xray CT / MRI Bone scan Labs |
| Fractures assessment | Vitals trauma assessment physical exam Meds Pain Imaging Labs (CBC, CMP, coags) I and O Proper position application of traction and splinting |
| Fracture reduction | Closed: bone is manipulated using a pulling force called traction to manually realign bone then once reduced immobilization is used Open: visualization of fracture through an incision in the skin (plates, screws, rods). Can be internal or external |
| Pin care for fracture reduction | external: pin care is done every 8-12 hours and weeping of clear fluid is expected first 48-72 hours |
| traction | Manual: Pulling force is applied by the hands of the provider Skin Skeletal |
| Skeletal traction | secured to bone with screws and weight is applied can have heavier weights (15-30 lbs) and longer traction time than skin (halo) |
| Skin traction | pulling force is applied by weight attached by rope to skin with tape, straps, boots or cuffs (5-10 lbs: bucks traction) |
| Fractures nursing interventions | Assess neurovascular status (first 24 hours check every hour, then after every 4 hours) maintain body alignment and realign if in pain avoid lifting or removing weights; free hanging and not on floor replace weights if they displace and notify dr |
| Other pin care | one cotton swab per pin to prevent cross contamination typically done once per shift or 1-2 x day monitor for s/s of infection |
| Splints for fractures | Removable Slow for monitoring of swelling support until area can be casted and swelling decreased |
| Cast | more effective because they cannot be removed and applied once swelling is down. Plaster (heavy, not water resistant, take 24-72 hrs to dry) Fiberglass (lighter, water resistant and takes 30 min to dry) |
| Fracture complications | compartment syndrome neurovascular compromise joint dislocation venous or fat thromboembolism hypovolemia (hemorrhage) infection / malunion / nonunion avascular necrosis heterotopic ossification |
| Compartment syndrome | EMERGENCY increased pressure in the extremity leads to tissue hypoxia; external or internal source. Can cause permanent damage. Check neurovasc. constantly, relieve pressure and prepare for surgery |
| Fat Embolism | Rare; most common is following hip fracture or after pelvic fracture surgery. Fatty bone marrow gets into circulation Hallmark: petechiae on the arms, neck and chest notify dr, bed rest, oxygen, steroids, vasopressors, fluid replacement |
| Traumatic rhabdomyolysis | Seen with crush injuries; muscle compression leads to myoglobin release and gets stuck in kidneys = blockage. Hallmark: dark colored urine and flank pain give fluids, monitor myoglobin/CK, BUN/creatinine issue: peaked T waves due to hyperkalemia |
| Nursing interventions for fractures | post op care meds / wound and pin care ICE, elevation, ROM, repositioning, hydration and nutrition |
| Strains | injury to the muscle or tendon (excessive stretching or pulling of a muscle or tenson that is weak) 1st: mild, ROM not affected 2nd: moderate, partial tearing, impairs motor function 3rd: severe rupture; surgical repair |
| Sprains | excessive stretching of a ligament 1st: minimal tear, joint function intact 2nd: joint intact, not complete tear 3rd: complete tear and unable to ambulate |
| Treatment for sprains and strains | RICE (rest 72 hours), ice (20 minutes 3-5xday for first 72 hours), brace if ordered, ROM, medication, surgery |
| Arthroplasty | surgical removal or diseased joint and replacement with prosthetics or artificial components made of metal and/or plastic |
| Total joint arthroplasty | total joint replacement; involves replacement of all components of an articulating joint |
| Hemiarthroplasty | half joint replacement such as femoral neck fractures |
| Arthroplasty notes | can be any joint; eliminate pain, restore movement typical lifespan is 10-15 years arthritis is leading clinical indication can be traditional or minimally invasive usually after medical management |
| Contraindications of arthroplasty | recent / active infection arterial impairment to affected extremity client inability to follow post surgical regimen comorbid conditions (uncontrolled BP/diabetes, osteoporosis, cardiac/resp conditions) |
| Complications of arthroplasty | hypotension bleeding hypovolemia wound infection dislocation venous thromboembolism heterotrophic ossification |
| Nursing interventions for arthroplasty | meds /wound care ambulation (as soon as 6 hours after) antiembolic stockings / turning schedule positions of flexion of knee are limited float heels continuous passive motion machine |
| Bone cancer | can be benign or malignant. Primary bone cancers are more prevalent between ages of 10-30 |
| Clinical manifestations of bone cancer | Pain limping gait swelling redness decreased ROM fractures fever, malaise, weight loss |
| Bone cancer diagnosis | History and exam CT / MRI preferred Bone scan Labs (alk phos, LD, ESR, calcium) bone biopsy (definitive) |
| Bone cancer treatment | Radiation (brachytherapy or external) chemo / surgeries pain control |
| Paget's disease | Second most common bone disease; bone metabolism disorder with accelerated bone modeling. Most common locations are skull, femur, tibia, pelvic bones and spine Risk factors: white, male, over 55, genetics |
| Clinical manifestations of pagets disease | 80% initially asymptomatic depends on severity and location pain and deformity in affected site calcium and phosphate imbalance (neuro/cardiac) |
| Diagnosis of pagets | High alkaline phos Biochemical assays of bone turnover bone scans xray / CT bone biopsy thermography |
| Management of pagets | can be surgical or medical; osteotomy which is surgical removal of bone; decrease pain meds: calcitonin, bisphosphates, zoledronic acid |
| Complications of pagets | enlargement of bone bowleg or knock knee fractures secondary degenerative changes primary bone tumors |
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