Muscoskeletal Ÿ Swelling can occur and affect distal

Ÿ Bones store calcium, phosphorous, and fat neurovascular function

cells, Ÿ Should see calous on xray w/I 3 weeks
Ÿ Osteo” “ blasts=bone forming, Healing factors
cytes=mature bone cells, clasts=break bone Ÿ Age
down Ÿ Did it get set
Ÿ Cartlage = avascular, cover opposing ends of Ÿ Blood supply to area
bones w/I the symposia joint, function = Ÿ Immobilization
biomechanical Ÿ Implants
Ÿ Isotonic = shortening w/ active movement Ÿ Infection BAD!!!
Ÿ Isometric = muscle contraction w/o Assessing
shortening Ÿ Bilaterally compare
Ÿ Is kinetic = muscle contractions w/ Ÿ Swelling
resistance Ÿ Ecchy mosis
Ÿ Calcium = req. for muscle contraction Ÿ Deformity (length, possible rotation)
Ÿ Ligaments = bones to bones Ÿ Distal neurovascular function ; pain, pallor,
Ÿ Tendons = muscle to bones paresthesia (numb tingle), pulses,
Ÿ Facia = separates muscle, smooth gliding paralysis (any loss of motion
and muscle action Ÿ Ability to take deep breath
Ÿ Bursae = sacs of connective tissue, lined w/ Ÿ Limb temp
synovial membranes and containing Ÿ Decreased movement
synovial fluid, a cushion
Ÿ Muscle spasm
Ped development
Ÿ Guarding
Ÿ Ossification starts in embryo, ends age 18-
21 Ÿ Rom
Ÿ Eriostemon thicker, fractures stable, less Ÿ Tx already received?
diplacement Ÿ Past med hx and meds (pathological?, hx of
Ÿ Highly vascular zed (speeds healing) cancer?, sft tissue injury?)
Immediate treatment
Ÿ Flexible bones
Ÿ ABC’s
Ÿ Epiphysis plate injury affects growth
Ÿ Immobilization (check pulse b4 and after)
Ÿ Can have underlying injury w/o fracture
Geriatric bone Ÿ Elevation
Ÿ Increased bone resorption Ÿ Ice
Ÿ Lower density (decreased osteoblastic) Ÿ Cover open wound sterile solution/sterile4*4
Ÿ Joints, tendons and ligaments harden, not Ÿ Pain meds
flexible, stiffen Sub care
Ÿ Bone density = osteoporosis Ÿ Xray
Fracture Ÿ Lab tests
Ÿ Open = sft tissue wound over fracture Ÿ Cbc, pt, ptt
(compound) Ÿ H&H(femur, pelvis, multiples, blood
Ÿ Cosed = in tact sft tissue (simple) thinner)
Ÿ Edema (restricts circulation), pain and Ÿ Ct if plane film do not view enough
tenderness, Immobilizing
Ÿ Muscle spasm can displace fracture, give Ÿ Splint - early to allow edema
pain med and muscle ralaxer Ÿ Casts - dnt cast a fresh fracture
Ÿ Deformity must be fixed, ecchy mosis is Ÿ Bivalving - cut cast in half, allows tissue to
normal, swell, see affected area, dnt pinch the
Ÿ Important to use it again patients skin
Fracture pathophys Ÿ Cast syndrome = condition occurs if the
Ÿ Splint the fracture body cast is applied to tightly and
Ÿ Muscle contraction can pull bones out of compresses the superior mesenteric artery
alignment against the duodenum.. Pt has ab pain, ab
pressure, nausea, vomiting, decreased bowel
Ÿ Bleeding into sft tissue is common
sounds, window over umbilicus, tx w/
 gastric deompression w/ a ng tube and integrity of bone structure aeb limited rom,
suction, pos removal of cast, decreased inability to purposefully move
blood can cuase ischemia in ab area, assess Ÿ Ineffective therapeutic regimen management
pain r/t lack of knowledge aeb questions
Post cast care Ÿ Risk for peripheral neurovascular
Ÿ Educate s/s of neurovascular compromise dysfunction r/t vascular insufficiency and
Ÿ Exercise joints above and below the cast nerve compression secondary to edema
Ÿ Ice directly over fracture site for first 24 Ÿ Acute pain r/t edema, movement of bone
hours fragments aeb pain descriptions, crying etc
Open Reduction Nursing implementation
Ÿ Through surgical incission Ÿ Skin prep in vital to decreased risk for
Internal fixators infection prior to surgery
Ÿ Higher risk of infection and complications Ÿ Neurovascular checks q2hr
r/t anesthesia Ÿ Proper alignment
Ÿ Allows quicker use Ÿ Wound drainage devices
Ÿ Earlier ROM Ÿ Dressing changes as needed
Ÿ Faster reconstruction of cartlidge and Ÿ Turning q2 hrs (monitor skin)
healing Ÿ Fluids to avoid renal calculi, constipation
Ÿ Post traumatic arthritis less common and uti
Ÿ Decrease comp assoc w/ immobility Ÿ Pain meds before pt
External fixators Ÿ Cpm assistance
Ÿ Limb lengthening procedures too Ÿ Pin care
Ÿ Pins turned Ÿ Isometric eercises
Ÿ ORIF - open reduction internal fixation Expected outcome
Traction Ÿ Normal peripheral neurovascular status
Ÿ Immobilizes the joint Ÿ Tolerate pain
Ÿ Reduces muscle spasms Ÿ No evience of wound infection
Ÿ Treats path joint conditions Ÿ No evidence of skin breakdown
Ÿ Apply pulling force on a fractured extremity Ÿ Safe use of assistive devices
Ÿ Realigns Ÿ Loses minmal muscle bulk
Ÿ Assess ropes, pins, weight position, 5 ps , Ÿ Performs adls indepently
infection signs and skin breakdown Ÿ No s/s of dvt
Ÿ Weights should never be on the floor! Discharge planning
Bucks Traction Ÿ Signs of peripheral vascular dysfunctions
Ÿ 48-72 hrs short term Ÿ Signs of infection
Ÿ Decreases muscle spasms Ÿ Activity limitations and time limits
Ÿ Broken pelvis Ÿ Cast of wound care
Skeletal Traction Ÿ Review meds
Ÿ Longer time Preventative teaching
Ÿ Wires and pin into bone Ÿ Safety equipment
Ÿ Larger amt of weighted traction Ÿ Aviod safety hazards
Ÿ Align bones, treat joints, congenital hip Ÿ Avoid alcohol
dysplasia Complications of fractures
Ÿ Critical assessment of infection and pin Ÿ Shock - treat pt not just the obvious injury
loosening Ÿ Hemmorrhage = t with o2, iv, immobilize,
Ÿ Infections s/s = exudates, erythematic, elevate, ice,
tenderness, pain Ÿ Neurovascular compromise
Ÿ Pin care = half strength hydrogen peroxide Ÿ Compartment syndrome = earliest sign is
with normal saline, one swab per pin pain that is out of proportion to the injury
Ÿ Risk for infection, impaired skin integrity, and unrelieved by meds
impaired immobility Myglobinuric
Nursing dx Ÿ Myoglobinuric renal failure = halmark sign
Ÿ Impaired physical mobility r/t loss of crush syndrome
Ÿ Myoglobinuria = reddish brown urine, Ÿ s/s fever, night sweats, chills, nausea,
hypocalcaemia malaise, bone pain unrelieved by rest
Ÿ Tx elevate above heart, remove cast worsened with activity, swelling, tender,
Ÿ Cut skin (fasciotomy) warm. Late sign is drainage from sinus tract
Ÿ Amputation or fracture site
DVT Ÿ Chronic last longer than 4 weeks
Ÿ Diagnosed by Doppler Ÿ Periods of exaerbation
Pulmonary Embolism Ÿ Granulation turns to scar
Ÿ Sudden dyspnea Ÿ Abx dnt work
Ÿ Tachypnea Ÿ Bone scan
Ÿ Chest pain Ÿ Bioby
Ÿ Pallor Ÿ Mri ct
Ÿ Decreased mental statis Ÿ Cbs, elevated sed rate, s7s
Ÿ Agitation Nonunion and Malunion
Ÿ Fear and anxiety (doom) Ÿ Bone doesn’t heal
Fat embolism Ÿ May rebrake and set
Ÿ Pulmonary hypertension develops in 24- Colles Fracture
48hrs Ÿ Fracture of distal radium and styloid process
Ÿ Long bone fracture of ulna
Ÿ Pulm emboli symptoms w/ hight fever and Ÿ FOOSH injury
petechial rash around neck and anterior Ÿ Women over 50
chest wall Ÿ Pronounced swelling, pain
Ÿ Change in loc Ÿ Dinner fork deformity
Ÿ Conjunctiva of the eye Ÿ Reduced by md
Ÿ Tx is at prevention (immobiliazation) Ÿ Comp is vascular insufficiency as a result of
Ÿ Fluids to provent shock edema
Ÿ Replace blood loss Ÿ Carbal tunnel can be later comp.
Ÿ Coughing and deep breathing Ÿ Tx closed manipulation and immobilization
Ÿ Little repositioning Ÿ Ice for edema
Ÿ O2 therapy Ÿ Freq neurovascular assessment encourage
Infection active movement of the thumb and fingers
Ÿ BAD movement of the shoulder
Gas Gangrene Humerus Fracture
Ÿ Clostridium Ÿ Common in young
Ÿ Low h/h Ÿ Displacement of humerus shaft, shortened
Ÿ High wbc extremity, abnorm mobility and pain
Ÿ Fever Ÿ Complication is a frozen shoulder
Ÿ Rapid pulse Pelvis fracture
Ÿ Pain Ÿ Highest mortality rate
Ÿ Local puffiness Ÿ Can cause intra abdominal injury,
Ÿ Foul smelling watery exudate hemorrhage, laceration of the urethra,
bladder, colon
Ÿ Crepitus r/t gas under tissue
Ÿ Local swelling, tenderness, deformity,
Ÿ Tx surgically open and debride, irrigate w/
unusual pelvic movement and ecchy mosis
anti-infective, amputaion may be needed
on the abdoment
Osteomyelitis
Ÿ Use extreme care when handling pt
Ÿ Can cause limb length discrepancies,
deformities, or amputation Ÿ Turn only when ordered
Ÿ Sever bone infection Ÿ Assess bowel and urinary tract function and
distal neurovascular status are important
Ÿ MRSA most common type
Ÿ Avoid weight bearing on the affected side
Ÿ Tissue necrosis, and holes in bones hide
until healing is complete
bacteria
Hip Fracture
Ÿ Island surrounded by pus
Ÿ Older adults
Ÿ More in women
Ÿ 80 1 in 5 will have this
Ÿ External rotation (cardinal sign), muscle
spasm, shortening of the affected extremity
and severe pain and tenderness in the region
of the fracture site
Ÿ Fem neck fractures cause serious disruption
of the blood supply to the fem head, causes
avascular necrosis of the femoral head (dead
head)
Ÿ Tx by bucks traction
Ÿ Monitor vitals, I and o, incentive sperometer
Ÿ Fem head prosthesis measures to prevent
disloction must always be used
Fem head prosthesis
Dnt
Ÿ Force hip into greater than 90 degree of
flexion (sitting in chairs or toilet seat)
Ÿ Force hit into adduction
Ÿ Force hip into internal rotation
Ÿ Cross legs
Ÿ Put on own shoews or stockings until 8
weeks after surgery w/o adaption device
Ÿ Sit on chair w/o arm rails
Do
Ÿ Toilet elevator
Ÿ Shower chair
Ÿ Pillow between legs
Ÿ Keep hip in neutral straight position
Ÿ Notify of pain, deformity, loss of function
Ÿ Inform dentist for prophylactic antibiotics
Femoral Shaft Fracture
Ÿ Young adults
Ÿ Severe direct force
Ÿ Considerable blood loss
Ÿ Marked deformity and angulation, short
extremity, inability to move hip knee and
pain
Ÿ Fat emboli can occur
Ÿ Stabalize, skeletal traction8-12 weeks
Ÿ Isometric exercise
Tibia Fractures
Ÿ Are often open fractures
Ÿ Often stress fracture
Ÿ Complications; compartment syndrome, fat
embolism, infection
Ÿ Neurovascular q 2 hrs during the first 48 hrs
Ÿ Non weight bearing for 6-12 weeks
Stable Vertebral Fractures
Ÿ MVC’s, falls, diving, athletic
Ÿ Unstable fx puts you at risk for spinal injury
Ÿ Xrays determine stability
Ÿ Goal; keep spine in good alignment until
union has been accomplished
Ÿ Assess for spinal cord trauma by vitals,
bowel bladder function, motor, sensory
status of perifpheral nerves distal to the
injured region
Ÿ Report promply neurovascular status
deterioration
Ÿ Tx with support, heat, traction, relax muscle,
decrease edema,
Ÿ Upright position and turning of the torso not
allowed
Facial fractures
Ÿ Establish and maintain airway
Ÿ Provide ventilation by removal of foreign
material and blood
Ÿ Suctioning
Ÿ May need alternative airway
Ÿ Should be treated as a cervical injury untill
r/o
Mandible Fracture
Ÿ Focus on patent air way, oral hygiene,
communication, pain management , nutrition
Ÿ Post op airway obstruction and aspiration of
vomit a concern
Ÿ Place on side with head elevated
Ÿ Wire cutters
Dislocation
Ÿ No touching
Subluxation
Ÿ Some contact
Ÿ Ligament disruption usually causes
Ÿ Common in elbow, thumb and shoulder
Ÿ Affected limb may be shorter and there is
usually some deformity
Ÿ May be locked into position
Ÿ Experience 5 up’s
Ÿ Longer the dislocation the more likely
avascular necrosis is
Ÿ Dislocated hip is a medical emergency
Ÿ Closed reduction is usual treatment
Ÿ More likely to happen again
Amputations
Ÿ Closed amputation weight bearing limb
Ÿ Disarticulation through joint
Ÿ Apen amputation leaves surface on limp that
is not covered by skin, control infection
Ÿ Watch for hemmorhage
Ÿ Sterile technique dressing changes
Ÿ Pressure dressings
Ÿ Dnt hang leg over bed,
Ÿ Initial ambulation should be 5 min at a time
Prosthetics
Ÿ Early = allows for earlier ambulation but
 can’t see wound Ÿ Bumpy hands
Ÿ Late = aka, aba Ÿ Prone to kidney stones
Ÿ Clean with mild soap, no water on metal or Ÿ Dx uric acid levels above 6, xrays are
leather normal in early stages
Nursing dx Ÿ Tx colchicines and nsaids, weight reduction,
Ÿ Impaired physical mobility avoid alcohol, red an organ meats, sardines,
Ÿ Risk for infection herring, mussels, liver, kidney, chicken,
Ÿ Disturbed body image salmon, crab, veal, bacon, pork, ham
Ÿ Self care defiit Meds for gout
Ÿ Risk for falls Ÿ Take all with food avoid wine/beer, increase
Ÿ Fear fluids to 3000ml day
Ÿ Impaired skin integrity Antimitotic (Colchicine)
Fibromyalgia Ÿ Only taken at the first warning sign of gout
Ÿ Chronic Ÿ Nausea, vomiting, diarrhea are toxicity signs
Ÿ Nondegenertive Uric Acid Inhibitor (Allopurinol, Zyloprim,
Ÿ no progressive Uloric, febuxostat
Ÿ Noninflammatorywidespread Ÿ Monitor cbc before therapy and monthly to
musculoskeletal pain detect toxicity
Ÿ Burning pain worsens and improves Ÿ Ophthalmic examination are req.
throughout day Ÿ Avoid alcohol, caffeine, and thiazide
Ÿ Head facial pain tjmj diuretics
Uricosuric Blocks renal tubular reabsorption
Ÿ Nonrestorative sleep
when promotes the excretion of uric acid
Ÿ 11 or more tender points (benemid Anturane)
Ÿ Migranes Ÿ Increase fluids 3000ml/day
Ÿ Depression Osteoarthritis
Ÿ Numbness Ÿ no inflammatory
Ÿ Ibs Ÿ no systemic
Ÿ Increased urinary freq and urgency Ÿ Caused by trauma, mechanical stress,
Ÿ Widespread pain 3 months defined as inflammation, joint instability, neurologic
occurring on both side of the body above disorders, skeletal deformities, hematologic
and below the waiste endocrine disorders, use of selected drugs
Ÿ Tx with pt motivation, analgesicsm nsaidsm Ÿ Ranges from mild discomfort to disability
elavit, flexural, alium, rehab, message, and loss of function
upltrsound heat, cold, limit sugar caffeine Ÿ Dx with bone scan, xray, mri, ct
alcohol Ÿ Manage pain and inflammation, prevent
Chronic fatigue syndrome disability and maintain and improve joint
Ÿ Abnormal immune function function
Ÿ Fatigue Ÿ Nsaids, cortisone injections, hyaluronic
Ÿ r/o other possible causes derivatives, glucosamine, chondroitin, diet
Ÿ Criteria used to dx Ÿ Nurs dx: chronic pain, impaired physical
Ÿ No tx mobility, risk for trauma
Ÿ Nsaids Ÿ Arthroscopy = reconstruction or
Ÿ Tricyclic antidepressants replacement of joint
Ÿ Low dose hydrocortisone Hip Replacement Postoperatively
Ÿ Possible depression Ÿ Large incision
Ÿ Total rest not advised Ÿ Hemovac drain
Gout Ÿ Trapeze
Ÿ Inflammation of the great toes is the most Ÿ Pt w/ gradual activity increase
common initial problem Ÿ Scd’s, ted hose
Ÿ Low grade fever Ÿ Abductor pillow between legs
Ÿ Self limiting in 2-10 days Special Considerations
Ÿ Aspirate joint look for uric crystals Ÿ Avoid internal rotation
Ÿ Avoid greater 90 degree flexion of hip Ÿ Dx DEXA,
Ÿ Will require elevated toilet seat Ÿ High ca foods
Ÿ Need to take abx prophylactic prior to Ÿ Exercise
procedure for rest of life Ÿ Med side effects
Total Knee Replacement Ÿ Stop alcohol and smokes
Ÿ Large midline incision Ÿ Estrogen therapy
Ÿ Compression dressing Ÿ Calcitonin
Ÿ Knee immobilizer Ÿ Biphosphates
Ÿ Jackson pratt/Hemovac drain Ÿ Evista
Ÿ Continous femoral nerve block Biphosphonates =
Ÿ Full weight bearing @ d/c Ÿ take with glass of water
Ÿ Neurovascular function Ÿ 30 min before food or other meds
Ÿ Coughing and deep breathing and incentive Ÿ Upright for 30min after taking
pyrometer training to prevent telecasts Selective Estrogen Receptor (evista)
related to immobility and use of narcotics Ÿ Increased risk for DVT
Ÿ Abx Hormones
Ÿ Dressing changes Teriparatide
Ÿ Anticoagulant education Ÿ Administer at the same time
Ÿ h/h, pt, ptt Ÿ Imp of other tx ca supplements
Ÿ Isometric exercises Ÿ May cuase orthostatic hypotension
Muscoskeletal system disorders meds Ÿ Follow up with bone mineral density test
Ÿ Nsaids = decrease sodium, alcohol, high na, Diagnostic Studies
take with food, Radiosotope studies (bone scan)
Pagets Disease Ÿ Increased uptake is seen in osteomyelitis,
Ÿ New bone larger, disorganized and weaker osteoporosis, primary and metastatic
Ÿ Bone pain malignant lesions of bone and certain
Ÿ Fatigue fratures, decreased uptake is seen in areas of
Ÿ Waddling gait avascular decrosis. Increase fluid after the
Ÿ Shorter, big heads exam
Ÿ Headaches Arthrocentesis
Ÿ Visual deficits loss of hearing, Ÿ Aseptic preparation are used before needle is
inserted into joint and fluid aspirated
Ÿ Can cause spinal cord or nerve root
compression
Ÿ Complication is pathologic fracture
Ÿ Giant cell tumors
Ÿ Alkaline phosphatase are elvated
Ÿ Xray
Ÿ Bone scans
Ÿ Tx; symptomatic and suportive
Ÿ Calcimar
Ÿ Biphosphonate retard bone absorption
Ÿ Ca and d
Ÿ Nsaids
Ÿ Firm mattress
Ÿ Braces
Ÿ No lifting or twisting
Ÿ Pt
Ÿ Vt d, ca, protein
Osteoporosis
Ÿ Silent thief
Ÿ Low bone mass
Ÿ Increased bone fragility