Alterations unit 3 musculoskeletal

Complications of fractures

-Acute compartment syndrome - Hypovolemic shock -Fat embolism syndrome - Venous thromboembolism - Infection -Chronic: ischemic necrosis and delayed union

exercise for OA

-Aerobic -Range-of-motion -Quadriceps strengthening

Stages of osteoarthritis

-Early stages: rest relieves pain -Later stages: pain with rest and trouble sleeping due to increased joint pain

Physical Assessment/Signs and Symptoms for amputations

-Monitor neurovascular status. -Skin color, temp, sensation, pulses, capillary refill -Skin flap at end of residual limb should not be discolored

In what populations are most cases of sle seen?

-Most cases in women of childbearing years -More common in African Americans, Asian Americans, Hispanics, and Native Americans than in whites

MUSCULOSKELETAL CHANGES ASSOCIATED WITH AGING

•Decreased bone density •Synovial joint cartilage can become less elastic and compressible •Muscle tissue atrophies *Decreased coordination, loss of muscle strength, gait changes, & risk for falls with injury

Manifestations of SLE

•Dermatologic Problems •Vascular skin lesions •Most commonly in sun-exposed areas •Butterfly rash •Occurs in 55% to 85% of cases •Discoid lesions •Subacute cutaneous lupus •Oral/nasopharyngeal ulcers •Alopecia

Lab assessments after a fracture

•Hgb and Hct •ESR •WBC

Compartment syndrome

-Serious condition in which increased pressure within one or more compartments causes reduced circulation to the area •Can begin in 6-8 hrs after injury or up to 2 days to appear •Pathophysiologic changes sometimes referred to as ischemia-edema cycle

What does SLE impact?

-Skin -Joints -Serous membranes -Renal system -Hematologic system -Neurologic system

After how long from the onset of compartment syndrome is the limb useless?

24-48

After how long from the onset of compartment syndrome is the damage irreversible?

4-6 hrs

Risk factors for osteoarthritis

Aging Obesity Genetics Joint injury Occupation (those that use same joints continuously, for example athletes) Decreased estrogen at menopause

Nursing interventions for hip fracture

Ambulation, place large pillow between legs when turning, avoid extreme hip flexion, avoid turning the pt on the affected side until approved by surgeon; weight bearing pending surgery done

Osteoclasts

Bone-destroying cells, reabsorb bone

Which information should be included in the teaching plan for a client with osteoporosis? Select all that apply. -Choose good calcium sources such as figs, broccoli, and almonds. -Limit smoking to 1/2 pack or less per day. -Try swimming as a good exercise to maintain bone mass. -Avoid clutter and throw rugs to prevent falls -Maintain a diet with adequate amounts of Vitamin D, as in milk and cereals.

Choose good calcium sources such as figs, broccoli, and almonds. Avoid clutter and throw rugs to prevent falls Maintain a diet with adequate amounts of Vitamin D, as in milk and cereals.

Osteoporosis

Chronic, a progressive metabolic bone disease marked by low bone mass.Deterioration of bone tissue leads to increased bone fragility

RHEUMATOID ARTHRITIS

Chronic, systemic autoimmune disease Inflammation of connective tissue in diarthrodial (synovial) joints Periods of remission and exacerbation

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which activity should the nurse instruct the client to avoid? -Rising straight from a chair to a standing position -Using an abductor splint while lying on the side -Crossing the legs while sitting down -Sitting on a raised commode seat

Crossing the legs while sitting down

A client with a right knee injury is scheduled for an MRI. The nurse is preparing the client for the imaging test. Which question would be a priority to ask the client? -Have you ever had an MRI before? -Do you have trouble laying still? -Do you have any type of metal in or on your body? -What medications do you take on a regular basis?

Do you have any type of metal in or on your body?

ARTHROSCOPY

Fiberoptic tube is inserted into a joint for direct visualization. •Patient must have mobility in the joint being examined; exercises are prescribed for ROM. •Evaluate the neurovascular status of the affected limb frequently.

Skin traction (Buck's traction)

For hip and knee contractures, muscle spasms, and alignment of hip fractures Weight used during skin traction should not be more than 5 to 10 pounds to prevent injury to the skin

Diagnostic studies for osteoporosis

History and physical exam •X-ray and lab studies not diagnostic •Bone mineral density (BMD) •Quantitative ultrasound (QUS) •Dual-energy x-ray absorptiometry (DXA)

The nurse is assessing a client for neurologic impairment after a total knee replacement. Which finding indicates impaired nerve function in the affected extremity? -Diminished capillary refill -Coolness to the touch -Inability to move -Decreased distal pulse

Inability to move

Osteomyelitis

Infection in bony tissue

Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? -Local joint pain -Anemia -Weight loss -Osteoporosis

Local joint pain

Types of amputations

May be elective or traumatic

Do musculoskeletal disorders impact more women or men?

More women

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Multisystem inflammatory autoimmune disease Complex multifactorial disorder Genetic, Hormonal, Environmental, and Immunologic

Are there systemic manifestations of OA?

No

A client is admitted to the surgical floor with an open tibial fracture. The nurse is aware of what possible complication of this type of fracture ? -Surgery -Osteomyelitis -Generalized edema -Inability for the bone to heal

Osteomyelitis

What is the biggest risk factor for a hip fracture?

Osteoporosis

6 ps of compartment syndrome

Pain, Pressure, Paralysis, Paresthesia, Pallor, & Pulselessness (rare)

The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction? -Preserve normal length of the leg -Prevent skin breakdown -Prevent movement in bed -Reduce and immobilize the fracture

Reduce and immobilize the fracture

Voluntary muscle

Skeletal

Osteoarthritis

Slowly progressive noninflammatory disorder of the diarthrodial joints •Gradual loss of articular cartilage •Formation of osteophytes •Not normal part of aging process •Cartilage destruction

Imagining tests for diagnosing musculoskeletal changes

Standard radiography •MRI •Ultrasound

Care of a client in traction

T- Temperature (Extremity, Infection) R - Ropes hang freely A - Alignment C - Circulation Check (5 P's) T- Type & Location of fracture I - Increase fluide intake O - Overhead trapeze N - No weights on bed or floor

skeletal traction

The most effective means of traction, applying to a bone with wire pins or tongs

T/F Osteoarthritis is a unilateral disease process, whereas Rheumatoid arthritis is a bilateral disease process.

True

Is RA symmetrical?

Yes

Closed or simple fracture

a completely internal break that does not involve a break in the skin

Does OA manifest asymmetrical or symmetrically?

asymmetrical

Osteoblasts

bone forming cells

Complete fracture

bone is broken all the way through

Compression fracture

bone is crushed

Incomplete fracture

bone is not broken all the way through

Open/compound fracture

broken bone penetrates through the skin

Involuntary muscles

cardiac and smooth

What should be assessed for with cast care?

foul odor, drainage, paleness or cyanosis, numbness & tingling, increased pain, burning under cast, change in temp. from warm to cold, pulselessness, excessive edema above or below the cast, decreased movement, increase in the amount of drainage or change in the integrity of the cast

Complications of amputations

hemorrhage, infection, phantom limb pain, neuroma, flexion contracture

what is Most common & frequently seen injuries in older adults

hip fracture

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint

Why do people generally go for elective amputations?

perfusion complications (e.g., diabetes mellitus, peripheral vascular disease, arterisoclerosis).

3 types of muscle

skeletal, cardiac, smooth

Risk factors for osteoporosis

•Advancing age (>65 yr) •Female gender •Low body weight •White or Asian •Current cigarette smoking •Prior fracture •Sedentary lifestyle •Estrogen deficiency •Family history •Diet low in calcium/vitamin D deficiency •Excessive use of alcohol (>2 drinks/day) •Specific diseases •Certain drugs(corticosteroids

What does SLE impact?

•Affects •Skin •Joints •Serous membranes •Pleura •Pericardium •Renal system •Hematologic system •Neurologic system

treating osteomyelitis

•Antibiotic therapy •Pain Management •Hyperbaric oxygen therapy •Surgical management: •Sequestrectomy •Amputation

ETIOLOGY AND PATHOPHYSIOLOGY OF RA

•Autoimmune etiology •Combination of genetics and environmental triggers •Antigen triggers formation of abnormal immunoglobulin G (IgG) •Autoantibodies develop against the abnormal IgG •Rheumatoid factor (RF)

Causes of osteomyelitis

•Blunt or penetrating trauma •Underlying infection •Long-term catheter use: PICC & hemodialysis •IV drug abusers •Poor dental hygiene •Bone surgery

Clinical manifestations of osteomyelitis

•Bone pain, worse with movement •Fever •Tenderness, swelling, redness, warmth around infected bone •Poor distal circulation •Increased WBC

Diagnostic studies for RA

•Laboratory studies •Rheumatoid factor (RF) •ESR and C-reactive protein (CRP) •Antinuclear antibody (ANA) •Antibodies to citrullinated peptide (anti-CCP) •Synovial fluid analysis •X-rays of involved joints •Bone scan

How is SLE diagnosed

•No specific test •SLE is diagnosed primarily on criteria relating to patient history, physical examination, and laboratory findings •ANA is present in 97% of persons with the disease

Manifestations of osteoporosis

•Occurs most commonly in spine, hips, and wrists •Back pain •Spontaneous fractures •Gradual loss of height •Kyphosis

Manifestations of RA

•Onset typically insidious•Fatigue, anorexia, weight loss, generalized stiffness•May report history of precipitating event•Infection, stress, exertion, childbirth, surgery, emotional upset

Preventing Osteoporosis

•Regular weight-bearing exercise(walking, light weight-lifting) •Calcium •Vitamin D

Lab tests for diagnosing musculoskeletal changes

•Serum calcium and phosphorus• Alkaline phosphatase,• CK-MM