* A/C Exam 3: Musculoskeletal

What should patients with acute lower back pain avoid

- Bending - Lifting - Twisting - Prolonged siting

What type of microorganism causes osteomyelitis

- Staph - E. coli - Strep - Pseudomonas - Salmonella

Musculoskeletal diagnostic studies

- X-ray - Dexa Scan - CT scann - Bone Scan - Arthroscopy

Diagnostic studies used for intervertebral disk damage

- X-rays - MRI - CT scan - EMG (nerve impulse tracking)

Nursing diagnoses related to fractures

- acute pain - impaired physical mobility - risk for peripheral neurovascular dysfunction

Characteristics of the peripheral vascular assessment

- color - temperature - capillary refill - peripheral pulses - edema

clinical manifestations of Osteoarthritis

- joint pain - crepitation - affects joints asymmetrically - joint stiffness after a period of rest (worse in morning) - worse with stormy weather - Loss of functioning from Heberden's and Bouchard's nodes

Risk factors for back pain

- lack of muscle tone - excess body weight - poor posture - stress

Six P's of compartment syndrome

- numbness/ tingling - pain distal and not relieved with analgesics - pallor - pressure increase in compartment - paralysis - pulselessness

nursing intervention for a patient with osteomyelitis

- pain assessment - dressing changes - position changes - avoid exercise - avoid heat to affected joint - patient teaching

Nursing management for ORIF

- recovery after surgery requires vital signs, neurovascular assessment, and assessment for compartment syndrome - Dressing wound care

Goal of join replacement therapy

- relieve pain - improve joint motion - correct deformity

Characteristics of the peripheral neurological assessment

- sensation - motor function - pain

transvere fracture

Break is across the bone horizontally

What occurs as bacteria multiplies in osteomyelitis

Causes an increase in pressure leading to ischemia resulting in bone death

Compartment Syndrome

Condition that results from restrictive dressings, splints, casts, or traction causing obstruction of blood flow leading to necrosis causing possible loss of limb

What are bone scans used for the diagnosis of

Malignancies

Comminuted fracture

Bone broken in 2+ places

What occurs in a compound fracture

Bone comes out of the skin

When does chronic osteomyelitis occur

When a bone infection last longer than one month

What is the second most common pain complaint

back pain

Nursing care for a patient with traction

maintain the traction constantly and do not interrupt the weight applied to the traction

What does a Dexa Scan measure

bone mineral density

Nursing care for a patient with acute lower back pain

- Analgesics and NSAIDs - muscle relaxants - massage - alternating heat/cold - possible opipids

What is the goal for fracture treatment

- Anatomic realignment - immobilization to maintain alignment - restoration of normal or near normal functioning

Reasonings for joint replacement therapy

- Arthritis - Trauma - painful conditions resulting in functional disability

Nursing care for casts

- Case care - Neurovascular assessment - pain relief

Causes of chronic back pain

- Degenerative Disk Disease (DDD) - Lack of exercise/ obesity - prior injury - structural and postural abnormalities - systemic diseases

Treatments for osteomyelitis

- IV antibiotics - Surgery - HBO

What nursing assessments are crucial for cast patients

- Peripheral neurological assessment - Peripheral vascular assessment

Pre- bone scan care

- Radioisotope dose given 2 hrs prior - bladder empty - 1 hr lying supine

Closed reduction nursing management

- Relief of pain - support and protection of the injured joint

What diagnostic tests are used for osteomyelitis

- bone or soft tissue biopsy - blood and/or wound culture - elevated WBC and ESR

When may surgery be used for intervertebral disk damage

- conservative treatment unsuccessful - nerve pain becomes worse - loss of bladder or bowel control

S/S of local acute osteomyelitis

- constant bone pain - swelling - tenderness - warmth at infection site

Clinical manifestations of intervertebral disk damage

- lower back pain that may radiate - depressed or absent reflexes - paresthesia or muscle weakness - multiple nerve root compression may manifest with bowel or bladder incontinence

Nursing care for a post op intervertebral disk damage patient

- maintain proper spin alignment - 1-2 day bed rest - logrolling - pain management - CSF leakage - peripheral neurological assessments

Adverse reaction of antibiotics used for osteomyelitis treatment

- yeast - hearing deficit - neurotoxicity - jaundice - colitis

How soon after arthroplasty will the patient be out of bed

1st day post op

What is the most important change in a patient's neurovascular assessment that should be reported to HCP as a critical sign of arterial insufficiency

pain unrelieved by analgesic - compartment syndrome

What occurs in Intradiscal Electrothermal Therapy (IDET) for lower back pain

A needle is inserted heating denervates the small nerve fibers that have grown in the cracks in the disk

what surgery is performed for joint replacement

Arthroplasty

Spiral fracture

Broken bone with twisted force

Treatment for intervertebral disk damage

Conservative treatment - activity restriction - medication - heat or ice - brace to limit spinal movement - physical therapy - epidural injections

Traction

Device applying a pulling force on a fractured extremity to attain realignment while counteraction pulls in the opposite direction

Fractures

Disruption or break in the continuity of the structure of the bone

T/F: Bucks traction requires pins to be placed

False

T/F: MRIs and CTs are typically ordered for acute lower back pain

False

T/F: You can wear metal during a MRI

False

T/F: someone with a shellfish allergy can have a CT scan

False

How do germs invade the body causing osteomyelitis

Gets into the bone through blood and lodges self into an area of slow circulation -Indirect entry: blunt trauma - Direct entry: open wound

Osteomyelitis

Severe infection of the bone, bone marrow, and surrounding soft tissue

Why is a peripheral vascular assessment so important in patients with broken bones

Potential development of compartment syndrome

How long does acute lower back pain last for

four weeks or less

Greenstick fracture

bone cracks/bends instead of breaking all the way through

T/F: A patient with compartment syndrome may have one or all six Ps

True

T/F: It is important to assess both extremities during assessment

True

T/F: You need to remove traction weights prior to moving the patient

True

T/F: arthritis affects women 2X more than men

True

Are patients given an adduction pillow or abduction pillow after an arthroplasty

abduction pillow - goal is to separate the legs

What are arthroscopy used for the diagnosis of

abnormalities of meniscus, ligaments, and joint capsules - this can also be therapeutic

What should be avoided on the day of a Dexa Scan

calcium supplements

What is the goal of open reduction internal fixation (ORIF)

internal fixation through screws, rods, pins, plates, or nails

What type of anesthesia is used for an arthroscopy

local or general

Goal of closed reduction

non-surgical realignment of dislocated portion of the join in it's original anatomical position

How long does chronic back pain last for

over three months

Arthroplasty

reconstruction or replacement of a joint used to relieve pain, improve ROM, and correct deformity/fracture

Hemiarthroplasty

replacement of a part of a joint

What must be included in prep teaching for a total hip arthroplasty

signs of prosthetic dislocation

Why is traction required for femur fracture patients

the quadriceps constrict when the femur fractures requiring traction for realignment

Why are elevated seats used post athroplasty

to prevent flexion of the hip past 90 degrees

Why is a fasciotomy done

to relieve pressure caused by compartment syndrome

What is traction often used for

Fractured femur

What is the goal of a cast

Immobilization

What will someone's leg with a hip fracture look like

- externally rotated - will be shorter than uninjured leg

What must be avoided post op arthroplasty

- extremes of internal rotation - adduction - 90 degree flexion of the hip

S/S of systemic acute osteomyelitis

- fever - night sweats - chills - restlessness - nausea - malaise

Ways to prevent lower back pain

- health weight - don't sleep in prone position - avoid smoking - obtain regular physical activity - proper body mechanics - sleep on side with knees flexed with a pillow between the knees

Goal for a patient with osteoarthritis

- improve joint function - joint protection - achieve independence - pain management

What must be reported to HCP immediately for patients in casts

- increasing pain - Swelling associated with pain - discoloration of toes/ fingers - pain with movement - burning or tingling under cast - sores or foul odor under the cast

Osteoarthritis

Slowly progressive, noninflammatory disorder of synovial joints

Radio frequency discal nucleoplasty interspinous process decompression system discectomy

decompress nerve root for intervertebral disk damage treatment