Musculoskeletal

cardiac muscle

•Striated, involuntary, controlled by the autonomic nervous system

scoliosis

•Structural alteration in curvature of the spine • •Affects ~ 6 million people in the US • •Heart and lung problems

tear of knee ligament

•Swelling stiffness and pain •Treatment can be nonsurgical or surgical. • Post-surgical healing of ligament takes place in 6 to 9 months.

synarthrodial joints

•Synarthrodial (immovable) examples, joints between the root of the tooth and maxilla and mandible, and sutures between skull bones.

Electromyography (EMG)

•Used to diagnose neuromuscular disorders •Low electrical currents are passed through flat electrodes placed along the nerves •Some tests might need needle insertion into the muscles

Surgical

•Vertebroplasty •Kyphoplasty

Prosthesis: Shrinkage Interventions

•Wrapping of elastic bandages in figure 8 •Gradual pushing of the residual limb against a harder surface •Keep the stump clean and dry, do not apply lotions •Dry the prosthesis socket completely before applying to the limb. Community support resources Remove the elastic bandage and re-wrap the stump every 4-6 hours. Applying pressure at end of the residual limb helps toughen the limb. Stump shrinking socks can be used too.

Volkmann's contracture

•is a deformity of the hand, fingers, and wrist, caused by injury to muscles of the forearm.

crush syndrome

•is a reperfusion injury that leads to traumatic rhabdomyolysis. Once pressure is released, the muscle cells contents, such as potassium and myoglobin, are released systemically.

Fracture Risk Assessment Tool (FRAX)

•predicts an individual's 10 years of fracture risk of major bones including hip or spine, forearm, and shoulder. This works well, especially for patients not referred for Bone density.

Bleeding: shock Infection Fat embolism syndrome •Venous thromboembolism_ DVT and Pulmonary Embolism •Compartment Syndrome •Rhabdomyolysis •Chronic complications—ischemic necrosis (avascular necrosis [AVN] or osteonecrosis)

complications of fractures include

•Spinal deformity •Fractures - fall risk •Cardiomyopathy •GI dysfunction

complications of muscular dystrophy include

•Sepsis commonly indicated by hypotension and positive blood culture •DVT •Squamous cell carcinoma •Amputation

complications of osteomyelitis

Osteoporosis

•Chronic metabolic disease, in which bone loss causes decreased density and possible fracture •Osteopenia (low bone mass), which occurs when osteoclastic activity is greater than osteoblastic activity

tendon

•Connects muscle to bone •Provide movement

ligament

•Connects one bone to another •Add joint stability

metastasis

•Death usually occurs due to metastasis to other organs

etiology and genetic risk for osteoporosis

•Diabetes, Cushing's Syndrome, Growth hormone deficiency •Genetic considerations •Smoking •Low physical activity •Nutritional intake/alcohol intake •Medications (Glucocorticoids, thyroxine)

Nonsurgical management of bone cancer

•Drug therapy •Radiation therapy: Look for any injury to the skin

fascia

•Encloses, stabilizes and separates muscles and internal organs

acute compartment syndrome

•Increased pressure within one or more compartments causes massive compromise of circulation to the area •Pressure build-up due to blood or fluid accumulation •Compression of blood vessels and nerves

smooth muscle

•Non-striated, involuntary, responsible for contractions of organs.

Rhabdomyolosis

•Pay attention to any discoloration in urine and flank pain. Protein analysis for urine is performed.

Management of osteomyelitis

•Penicillin and Cephalosporin •MRSA- Vancomycin •PICC line may be needed as antibiotic therapy lasts for several weeks •CRP levels help to monitor infection •Hyperbaric oxygen therapy to increase tissue perfusion

diarthrodial joints

(synovial or freely movable) examples, knee, shoulder.

Exercise After Amputation And Prevention of Contracture

•ROM •Trapeze and overhead frame •Prone position every 3 to 4 hours •Firm mattress •Do not use the pillow under the amputated part •Splint on the amputated part to reduce the edema

low-grade fever

**RA has a ________ and excessive fatigue.

Look for signs of infections, and breathing problems that would contraindicate surgery. Teaching about mobility expectations, weight-bearing, physical activity, pain med. Administrations. SCDs, Drains to be expected, food, urination, Ice application after surgery, Incentive spirometers used after surgery to enhance lung movement and prevent pneumatic pneumonia.

before joint surgery,

-Calcitonin -parathyroid hormone - growth hormone -Glucocorticoid -estrogens -thyroxine

bone growth and metabolism are affected by which hormones

calcium, phosphorus, and vitamin D

bone growth and metabolism are affected by which nutrients

fat embolism

A disruption to blood supply is caused by fat globules in a blood vessel.

4

A nurse is caring for a client who is scheduled for electromyography. The client asks the nurse about the purpose of the procedure. Which of the following responses should the nurse give? 1)"It involves the administration of a radioisotope to view bone structures." 2)"It involves an injection of a radiopaque contrast agent into a joint cavity." 3)"It involves the use of x-rays to approximate bone mineral density." 4) "It involves the placement of thin needles into the muscles with the recording of responses to stimuli."

4

A nurse is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care? 1.Keep the head of the bed at a 30° angle. 2.Place the client in protective isolation. 3.Assist the patient to be in a sitting position. 4.Don't allow the patient to bend the spine

1, 3, 5

A nurse is preparing a client who is postoperative following a below-the-knee amputation for a leg prosthesis fitting. Which of the following actions should the nurse take? Select all that apply 1)Wrap the stump with an elastic bandage in a figure-eight configuration. 2)Avoid analgesics for pain 3)ROM exercises 4)Use spine position every 3 hours 5)Encourage gradual lifting of stump from hard surfaces

3

A nurse is reviewing risk factors for osteoporosis with a group of nursing students. The nurse should include which of the following types of medication therapy is a risk factor for osteoporosis? 1.Cardiac glycosides 2.Anti-coagulants 3.Levothyroxine 4.NSAIDs

X-Ray, CT

A nurse receives a sixty years old female patient in ER who has fell down during skiing. The person holds her left arm, has pain, swelling, dyspnea, and few lacerations and bruise on her chest. The nurse suspects a fracture in the arm, and anticipates the doctor's orders for _______________ and ____________________ tests for this patient?

Morton's Neuroma

Acute burning pain in the web area

•Change in bone alignment/length of the extremity •Pain •Decreased ROM •Crepitus •Swelling at the fracture site

Assessment of Patients with fracture

Neeurovascular asseessment

CMS: Check for Circulation, motion, and sensation Intense pain àacute compartment syndrome could be happening Remember 6 P's

decreases

Calcitonin ______ osteoclastic activity in bone

Paget's Disease of Bone (PDB)

Chronic metabolic disorder in which bone is excessively broken down and reformed ( but not formed right). •Structurally disorganized bone •Bones may suppress nerves •Genetic considerations

infection motor weakness volkmann's contracture crush syndrome

Complications of compartment syndrome include

•Progressive muscle weakness and muscle wasting •Chronic pain (back and legs) •Big risk for falls related to muscle weakness •GI dysfunction is often associated due to a lack of mobility Also...trouble running/jumping, waddling gait

clinical manifestations of muscular dystrophy

alcohol

Excessive _______ interferes with the balance of calcium. Calcium balance may be further disrupted by _____ ability to interfere with the production of vitamin D.

1, 2, 1,1

Fat embolism syndrome is a fatal complication of Orthopedic injury/ surgery. Which one of the following symptoms is seen earliest and which one is seen late in the fat embolism syndrome? (Put "1" next to early symptoms and or "2" next to late symptoms). 1.Difficulty breathing 2.Petechia 3.Hypoxemia Tachypnea

Muscular Dystrophies

Faulty action of a muscle protein/gene called Dystrophin, which is responsible for muscle repair.

CT scan

combines a series of x-ray views from different angles to produce cross sectional images of bones and soft tissues within the body. The addition of contrast material can be used to identify blockages or other blood vessel abnormalities.

Hallux valgus

Great toe drifts laterally

scoliosis

History & Assessment •Neurological Problems •Pain, kyphosis •Heart and lung problems Treatment •Progressive exercise /OT •Pain management • Spinal fusion surgery to Straighten vertebrae • Spinal Precautions: • Neurovascular check for extremities •Don't allow a patient to bend the spine •Log roll the patient every 2 hours

osteoclastic

In osteoporosis, the rate of ______ activity is more than the rate of osteoblastic activity

estrogen

Induces a chemical in osteoclasts that causes them to self-destruct and slow the rate of bone destruction. Menopause with the associated loss of _____ makes women more prone to bone loss. Asian and Caucasian women are especially vulnerable to this process.

theory of phantom limb pain

Inflamed nerve fibers around the amputated part still send pain signals to the brain and patients feel that the removed body part is in a distorted position.

plantar fasciitis

Inflammation of the plantar fascia, typically happens with athletes

•Dull Pain •Swelling/ Redness •Decreased ROM •Fractures

common signs and symptoms of benign bone tumors

•Fat embolism •Venous thromboembolism • Nerve damage •Skin breakdown

complications of ORIF surgery are

•Avoid anticoagulants and muscle relaxants prior to the procedure •Inspect needle sites for hematoma formation. •No caffeine 2-3 hrs. before the test. •No skin lotion before the test.

Nursing considerations for electromyography

•Assess for ineffective breathing, decreased cardiac output •Pain management •Fall risk precautions •Mobility •Monitor progression •Psychosocial

Nursing interventions for muscular dystrophy include

•Increase intake of dairy products, sardines, salmon, white beans, cauliflower, and dark-green leafy vegetables.

Nutrition therapy for preventing osteoporosis

X-ray

Obtaining images of a part of the musculoskeletal system is often needed to find a specific injury or confirm the presence of an abnormality. These images assist the practitioner in assessing the full extent of the injury/abnormality that is present so that effective treatment may be initiated

Benign Bone Tumors

Often asymptomatic and may be discovered on a routine x-ray or as a cause of pathologic fracture.

-X-ray, USG -Bone Mineral density -Arthroscopy -Arthrography, CT, MRI, and Bone Scan -Electromyography

Radiographic examinations for bones

calcium

Phenytoin decreases __________ absorbtion

•Hemorrhage (tourniquets at bedside) • Infection/sepsis •Phantom limb pain (Pain meds.) •Flexion contracture

complications of amputations

facial, limb, respiratory, and cardiac muscles.

Progressive deterioration and weakness to BOTH VOLUNTARY AND INVOLUNTARY MUSCLES. Therefore, it affects which four muscles

Parathyroid Stimulating Hormone

Promotes the activity and number of osteoblasts

50°.

Surgical intervention for scoliosis may be required with a Cobb's angle greater than

Fat embolism syndrome

Symptoms, if present, typically occur 24 to 72 hours after the trauma. In fat embolism syndrome, there is the presence of fat globules in the pulmonary circulation. They include shortness of breath, dyspnea, tachypnea, hypoxemia, pleuritic pain, confusion, and a rash (petechia or rash is a late symptom).

DVT and pulmonary embolism

The client is admitted to the rehabilitation unit following a hip fracture 7 days ago. The client has limited mobility and requires full assistance to turn and transfer out of bed. The client is at risk for developing ______________________ and _________________

joint dislocation/nursing considerations

The critical complication that is of concern in Joint replacement surgery is dislocation and/or subluxation or partial dislocation. Dislocation signifies that the prosthesis has become loose and is no longer in alignment with the joint. This condition is immediately recognizable because of asynchrony in leg length or abnormal rotation of the hip. This causes severe pain and the inability to bear weight on the affected joint and/or extremity. •Use an abductor pillow ( hip replacement surgery) to maintain joint alignment. A popping sound signifies bone dislocation after surgery, watch for sudden pain around the area. •Teach weight bearing and gradual increase of activity after surgery

immobilized, aligned

The goal in fracture healing is to keep the limb _________ and bones _______ to let the fracture heal.

conscious or voluntary control of movement of the body or its parts.

The main function of skeletal muscles is

muscular dystrophy

The medical management of _______ focuses on the prevention of progressive deterioration of the disease, supportive measures to assist maximization of functional capacity, and pain management.

Thyroid Stimulating Hormone (TSH) and calcitonin

These two hormones inhibit the activity of osteoclasts. Recent research has found that ______, a hormone produced in the anterior pituitary gland, can promote bone growth independent of its usual thyroid functions. This suggests that _____ or other medications that mimic its effect on bone may be a key factor for possible treatments of osteoporosis or other bone loss conditions.

•Long bones, Short bones, Flat bones

Types of bones

2

What are the other complications of a fracture? Which of the following would indicate an initial neurovascular dysfunction in a patient with a fracture in the tibia? 1.Edema around the fracture site 2.Pallor around the toes 3.Pain in the fractured leg 4.Broken skin around the fracture area

•Age •Gender •Body mass index •History of the previous fracture •Parental history of fracture •Current Cigarette smoking •Alcohol intake •History of arthritis •History of secondary causes •- diabetes, hyperthyroidism, menopause, malabsorption, malnutrition 10. Current use of corticosteroids

What is assessed in FRAX?

4

What is the priority nursing intervention after a patient has an arthroscopy? 1)Check the vital signs 2)Encourage to be NPO 3)Monitor for inflammation 4)Check the client's pulse distally and assess the toes

Nictotine

_______ impairs Ca absorption. _______ intake causes vascular constriction, thereby decreasing blood flow to bones and depriving them of getting nutrients including calcium

Glucocorticoids

_______ such as prednisone have been shown to decrease the rate of muscle deterioration and increase restorative functional abilities

10-30 minutes

________ of exposure to sunshine between 10a-3p gives you Vit. D.

Neurovascular

__________ assessment for the organs involved in the fracture and the other body parts around the fractured part.

*Biphosphonates

__________ slow down and prevent bone loss by decreasing osteoclastic activity. These are used to treat loss of bone mineral density. Teach the patient to take these empty stomach with at least 8 Oz. of water while sitting upright to prevent esophageal irritation/reflux. Don't allow the patient to eat anything till 30 minutes after taking the medications.

fracture

a break or disruption in the continuity of a bone.

fascia

a layer of interconnected fibers of connective tissue with elastic properties that encloses, stabilizes, and separates muscles and internal organs.

MRI

a radiological imaging test that uses a magnetic field and radio wave energy to create pictures of internal structures of the body. The pictures from an ____ often provide more detail than those from other imaging methods.

•Neurovascular assessment •Pain management •Apply ice around the surgical area ( reduces swelling) •Don't allow to bend the hip • Allow sitting in a chair with feet on the floor •Care of drainage •Weight-bearing Precautions • Physical Therapy

after joint surgery:

•Diminished bone density •Decreased cartilage mass •Calcification •Connective tissues lose water content •Sarcopenia - decreased muscle fibers, size, and contractility

age related changes to the bones

athroscopic surgery

allows visualization inside of the joint to diagnose, repair, and/or remove loose or foreign materials.

ligaments

are fibrous connective tissues present at joints to help provide stability to the joint. These fibrous bands, composed of tough collagen fibers, run directly from one bone to another to reinforce the joint and help prevent undesired directional movements.

osteoarthritis/ rheumatoid

arthroplasty and joint replacement treats

tendon rupture: achilles

•Rupture of the _____ tendon •For severe damage, surgical repair is followed by the leg immobilized in a cast for 6 to 8 weeks. •Tendon transplant may be needed.

Ewing sarcoma

cancer from bone cells and soft tissue

rhabdomyosarcoma

cancer from skeletal muscle cells

Osteosarcoma

cancer typically found in the distal femur, but can be found anywhere

polyester

cast is cotton: light weight, smooth, adherent

fiberglass

cast is smooth and lightweight and poros

carpel tunnel syndrome

caused by pressure on the median nerve

•Joint stiffness, Joint pain, muscle spasm •Affects weight-bearing •Bone deformity •Difficulty in performing activities of daily Life •Crepitus

clinical manifestations for osteoarthritis

sprain

•STRETCHING OF LIGAMENT

strains

•STRETCHING OF MUSCLE OR TENDON

•Acute Pain •Risk for Impaired blood circulation and sensation - Neurovascular checks ( 6 Ps) •Risk for complications - Catch early symptoms •Impaired skin integrity - Prevention of Infection •Impaired mobility -Prevention of pressure ulcers -Activities of daily living •Psychosocial aspects of care

nursing care of a patient with a fracture

skeletal muscle

•Striated voluntary, controlled by central and peripheral

•Serum alkaline phosphatase (ALP) • Urine hydroxyproline levels (24-hour urine) •Low calcium levels •X-rays, bone scan

diagnostic assessment for paget's disease

•Within 4 to 6 hr. after the onset of acute compartment syndrome, neuromuscular damage is irreversible; the limb can become useless within 24 to 48 hr. •Monitor compartment pressures. •Fasciotomy may be performed to relieve pressure. • •Pack and dress the wound after fasciotomy.

emergency care for compartment syndrome

•Avoid a sedentary lifestyle. •Encourage ROM exercises •General weight-bearing exercises

exercise

tendons

fibrous connective tissues that connect muscle to bone or structures such as the eye. Where ligaments provide stability, tendons facilitate movement

phantom limb pain

frequent complication of amputation, most often shortly after surgery. Pain is real, intense burning feeling, crushing sensation, or cramping.

electromyography and muscle biopsy

how do you diagnose muscular dystrophy

•DEXA "dual-energy x-ray absorptiometry" (most common) •Quantitative ultrasound (QUS): Potable device used to determine osteoporosis.

imaging test for osteoporosis includes:

•Hypotension •Bone dislocation

immediate complications of Arthroplasty/ Joint Replacement

falling, body image

individuals with osteoporosis often have a fear of

Osteomyelitis

infection of bone

Osteoarthritis

inflammation of the joints

arthogram

is a series of images taken of a joint after contrast medium has been injected. After administration of local anesthetic, a radiologist or orthopedic provider uses fluoroscopy or ultrasound to accurately inject the appropriate quantity of contrast into the joint. This procedure allows for visualization of soft tissue structures of a joint: the tendons, ligaments, muscles, cartilage, and joint capsule.

Osteoporosis

is often called the silent disease or silent thief because bone density is lost gradually

traction

is the application of a pulling force to the body to provide reduction, alignment, and rest at that site

-Serum calcium, phosphorus, vit D -Alkaline phosphatase, creatine-kinase CK-MM -Aspartate aminotransferase AST, Aldolase ALD -Lactic Dehydrogenase LDH.

lab tests for the bones

•cold and heat applications, exercise and activity limitations, anti-inflammatory drugs, muscle relaxants, and possible surgery

management of a strain

•Bedrest •Analgesic •OT and PT •Closed Reduction and Immobilization: •Bandage •Splint •Cast •Traction (Skin and skeletal traction) •Open Reduction and Internal Fixation (ORIF)

management of fractures

Pain management: analgesics, nonpharmacologic measures Bone resorption and strengthening: calcitonin and bisphosphorus Diet therapy

medical management of paget's disease

•Pain relief: NSAIDS •Anti-inflammatory meds.: Celecoxib, naproxen •Bone and cartilage strength: Glucosamine Sulphate & Chondroitin •Activity modification, nutrition, weight management •Psychosocial aspects

medical treatment for osteoarthritis

DVT, PE inspect legs, compression stockings, SEDs, and mobility/ PT, and administer anticoagulants.

most lethal complications of arthroplasty/joint replacement includes

-Assess for vital signs and anticoagulants before the procedure -NPO 12 hrs. prior to the test -Evaluate the neurovascular status -Analgesics are prescribed. -Apply ice for 1-2 days -Monitor for inflammation. -Ask the patient to notify if any severe pain

nursing considerations for athroscopy

•Warm water or a heating pad helps in OA pain relief •Maintain/ encourage the functional ability •Administer NSAIDs with food •Use raised toilet seats •Use assistive devices like walkers for mobility •Encourage high-energy activities in the morning

nursing considerations for osteoarthritis

•Administer antibiotics •Pain management •Mobility •Monitor for complications (Catch early symptoms)

nursing considerations for osteomyelitis

Recognize that the pain is real. Opioids are not as effective for phantom limb pain Narcotic analgesics works

nursing considerations for phantom limb pain

•DVT and Pulmonary Embolism • Fat embolism

other complications of Arthroplasty/ Joint Replacement

Tylenol, Aspirin, Ibuprofen

pain management for muscular dystrophy is mostly

•Bone pain •Abnormal gait •Fracture

physical assessment for pagets disease

heavy

plaster of paris cast is very

•Leg exercises started immediately •Knee immobilizer •Elevation of the leg on one or two pillows •Application of ice

post-op care for Meniscectomy

*hypotension, bleeding, and hypovolemia due to excessive blood loss during surgery ( Watch for bleeding in dressing, and drainage). *Wound site infection is another potential complication ( Watch for fever inflammation signs)

postoperative complications of arthroplasty/joint replacement includes

•Overweight •Aging •Hereditary •Previous joint damage • Repetitive stress on joints •Smoking

risk factors for osteoarthritis

pain, numbness, tingling, burning

signs and symptoms of carpel tunnel syndrome

•Sequestrectomy (Removal of a dead portion of bone) •Microvascular bone transfers

surgical management of osteomyelitis

•Nerve decompression (removal of bony substances that are causing nerve impingement) •Partial or total joint replacement

surgical management of paget's disease

-Care of weight -Skin inspection -Assessment of neurovascular status -Pin care -Care of immobility -Prevent pressure sores

traction care

skin traction

traction: Skin is closed, so risk of infection is less

skeletal

traction: skin is open, so there is risk for infection.

Beta-blockers, Antidepressants, Antispasmodics, and IV infusions of Calcitonin, Gabapentin

treatment drugs for phantom limb pain

•Pain medications • Curettage ( removal of tumor) • Joint replacement

treatment for benign bone tumors

Splint, ice, warmth, NSAIDs

treatment of of carpel tunnel syndrome

skin and skeletal

types of traction are

•Open reduction with internal fixation (ORIF)

we put Intramedullary rod, pins, a prosthesis, or a fixed sliding plate to fix the fracture and align the broken bones.

•Plaster of Paris, fiberglass, and polyester-cotton

what are cast materials made of

•circulation impairment, peripheral nerve damage, compartment syndrome, complications of immobility

what are the complications of casts

•provide a framework for the body • support surrounding tissue • assists in movement

what are the three functions of bones

•Glucocorticoids (prednisone) •Coenzyme Q10, amino acids, fish oil (supplements) •Pain medication - NSAIDs •Psychosocial care: MD Association, genetic counseling

what are the treatments for muscular dystrophy

•Euro-American, Asian women, Caucasian

which culture is more at risk for osteoporosis

•50yo and older are at risk •Women are at risk more than men

who is more at risk for osteoporosis

hypoxemia, neurological symptoms, petechia

with fat embolism syndrome, Pay attention to

•Pain aggravated by movement •Pain in buttocks •Leg pain due to compression of sciatic nerve when leg is straightened or held up. •Numbness and tingling in legs

with osteoarthritis in the lower back, symptoms are

osteoarthritis

• leads to erosion of cartilage & bone, •Narrowing of joint space •Fissures, ulceration & thinning of cartilage

Meniscectomy

•(removal of torn/injured meniscus- knee cartilage)

amphiarthrodial joints

•(slightly movable) examples, vertebrae, and ribs.

physical aspects of osteoporosis

•Back pain after bending or stooping, sharp and acute onset •Reduction in length from baseline •"Dowagers hump" (kyphosis of the dorsal spine) •Voluntary restriction of spinal movement is suggestive of compression fracture of vertebrae

Assessment of osteomyelitis

•Bone pain •Swelling •Febrile •Erythema • Nausea and night sweats Chronic form afebrile, may not have swelling or erythema

Medical therapy

•Calcium and vitamin D supplements •Calcitonin (Os-Cal, Calcium Citrate, Citracal) •Estrogen or hormone therapy •Selective estrogen receptor modulators •Bisphosphonates: alendronate(Fosamax), ibandronate(Boniva). Common side-effect: stomach upset.

calcium loss.

•Carbonated beverages and excessive coffee cause