student outline musculoskeletal 2 05

7/30/2019 Student Outline Musculoskeletal 2 05

1/21

Musculoskeletal (Part I)

Osteoporosis (porous bones) p. 1223

Causes :

Risk Factors (Unmodifiable)

-Age

-Sex

-Race

-Family history

Risk Factors (Modifiable)

-Calcium deficiency

-Skeletal calcium loss

-High intake of diet sodas

-Smoking

-Lifetime exposure to estrogen

-Excess alcohol intake

-Sedentary lifestyle !

-Medications

1


2/21

Manifestations

-See picture pg 1225 in text-Loss of height

-Progressive curvature of spine

-Low back pain

-Fractures (wrist, spine, hip)

Diagnostic Tests

-X-rays

DEXA scan

Ultrasound

Prevention

Calcium Intake --Women :

--Men :

--Foods:

--Supplements:

Exercise

Healthy Behaviors

Hormone Replacement Therapy

2


3/21

Treatment (Medications)

Biphosphonates --inhibit bone resorption, increase bone density.--reduce hip fracture by 50%!

--Example:Fosamax

Calcitonin -- bone formation; bone resorption.-- Subq or intranasal.

Client Teaching?

Good web sites:www.mayoclinic.com (medical and health information) search osteoporosiswww.nof.org click on osteoporosis listed in left columnwww.fda.gov search boning up on osteoporosis

Osteomyelitis p.1267

Introduction

See picture in text p. 1268: initial infection, acute phase, chronic infection.

3
http://www.mayoclinic.com/http://www.nof.org/http://www.fda.gov/http://www.mayoclinic.com/http://www.nof.org/http://www.fda.gov/


4/21

Causes/Manifestations

Direct contamination

Surgical infection

Adjacent soft tissue infection (contiguous)

Hematogenous

Risk factors:

Signs and Symptoms:

Pain

Swelling, redness, warmth

Purulent exudate (in chronic osteomyelitis)

Systemic:

Fever/chills

Nausea

Malaise

Prognosis

Diagnostic Studies(Refer to text p. 1267 for details of diagnostic studies)

MRICTBone ScanUltrasoundLab: Sed Rate, WBC, Cultures (blood, tissue, needle aspiration)

4


5/21

Treatment

Medications

Surgical debridement

Amputation (last resort)

Nursing Diagnosis?

Teaching?

Good web sites: MEDLINEplus Medical Encyclopedia: Osteomyelitiswww.emedicine.com (more pictures!)http://www.merckmedicus.com ( Best Practice Medicine-

Professional Reference -Osteomyelitis )

Osteoarthritis p. 1239

Introduction

Facts

5
http://www.nlm.nih.gov/medlineplus/ency/article/000437.htmhttp://www.emedicine.com/http://www.emedicine.com/http://www.merckmedicus.com/http://www.merckmedicus.com/http://www.merckmedicus.com/pp/us/hcp/frame_micromedex.jsp?pg=http%3A%2F%2Fmerck.micromedex.com%2Findex.asp%3Fpage%3Dbpm_report%26article_id%3DBPM01ID17%26section%3Dreport%26ss%3D6http://www.merckmedicus.com/pp/us/hcp/frame_micromedex.jsp?pg=http%3A%2F%2Fmerck.micromedex.com%2Findex.asp%3Fpage%3Dbpm_report%26article_id%3DBPM01ID17%26section%3Dreport%26ss%3D6http://www.merckmedicus.com/pp/us/hcp/frame_micromedex.jsp?pg=http%3A%2F%2Fmerck.micromedex.com%2Findex.asp%3Fpage%3Dbpm_report%26article_id%3DBPM01ID17%26section%3Dreport%26ss%3D6http://www.nlm.nih.gov/medlineplus/ency/article/000437.htmhttp://www.emedicine.com/http://www.merckmedicus.com/http://www.merckmedicus.com/pp/us/hcp/frame_micromedex.jsp?pg=http%3A%2F%2Fmerck.micromedex.com%2Findex.asp%3Fpage%3Dbpm_report%26article_id%3DBPM01ID17%26section%3Dreport%26ss%3D6http://www.merckmedicus.com/pp/us/hcp/frame_micromedex.jsp?pg=http%3A%2F%2Fmerck.micromedex.com%2Findex.asp%3Fpage%3Dbpm_report%26article_id%3DBPM01ID17%26section%3Dreport%26ss%3D6


6/21

Types of Arthritis

Osteoarthritis (Wear and Teartype)

Idiopathic

Secondary

Pathophysiology

Manifestations

Diagnostic Tests

History and physical

X-rays

Treatments

Conservative Treatment

Analgesics

6


7/21

Other

Surgical Treatment

Joint Arthroplasty (reconstruction or replacement)

Total hip replacement

Total knee replacement

IMPORTANT: Excellent information on pre and post-op care of client undergoing total joint replacement on page 1243!)

(Shoulders and elbowssee p. 1242)

Nursing Care Plan

(Review p. 1246!)

Good web sites: http://www.nlm.nih.gov/medlineplus/osteoarthritis.html

(Osteoarthritis information plus interactive tutorial video!)http://www.allaboutarthritis.com http://www.merckmedicus.comhttp://www.arthritis.org (Arthritis Foundation)http://www.niams.nih.gov

7
http://www.nlm.nih.gov/medlineplus/osteoarthritis.htmlhttp://www.allaboutarthritis.com/http://www.arthritis.org/http://www.nlm.nih.gov/medlineplus/osteoarthritis.htmlhttp://www.allaboutarthritis.com/http://www.arthritis.org/


8/21

Rheumatoid Arthritis p.1248

Introduction

Pathophysiology

OA vs. RA

Manifestations

Diagnosis

History and physical exam

Labs: Rheumatoid factors

ESR (sed rate)

Synovial fluid exam

X-rays

TreatmentNo Cure

Goals: Relieve painReduce inflammationStop or slow joint damageImprove well-being and ability to function

8


9/21

Medications:

NSAIDS

Steroids

Disease-modifying drugs

Biologics

Surgery

Joint replacement

Tendon reconstruction

Teaching

Balance between rest and exercise

Care of joints

Stress reduction

Diet

Quackery

Gout (ouch!) p. 1233

Introduction/Pathophysiology

9


10/21

Definition

Primary

Secondary

Cause

Manifestations

Stage 1Asymptomatic Hyperuricemia

Stage 2Acute Gouty Arthritis

Stage 3Chronic (Tophaceous) Gout

Diagnosis

History!

Serum uric acid

WBC

Sed rate

Joint fluid analysis

Treatment

Medications

Pain relief: NSAIDS, narcotics

Colchicine

10


11/21

Steroids (po or intra-articular)

Dietary management

Elevation, hot/cold compresses, fluid intake

Teaching: Prevent future attacks

(See Medication Administration p. 1236)

About medications:

Colchicine therapy ~1 2 years

Allopurinol

Probenecid (Benemid)

Diet (same as above)

Nursing Diagnoses

Good website:http://www.nlm.nih.gov/medlineplus/goutandpseudogout.html (interactive tutorial)

Fractures (except vertebral) p. 1197Review anatomy and physiology, terminology and assessment pages 1179-1189.

Pathophysiology

11
http://www.nlm.nih.gov/medlineplus/goutandpseudogout.htmlhttp://www.nlm.nih.gov/medlineplus/goutandpseudogout.html


12/21

Classifications (Self studyknow these terms!)

Closed/Simple

Open/Compound

Oblique

Spiral

Avulsed

Comminuted

Compressed

Impacted

Depressed

Complete

Incomplete

Stable

Unstable

Manifestations

Pain

Swelling

DeformityNumbness

Hematoma formation (may lead to hypovolemia)

Muscle spasms

12


13/21

Bone Healing

(See Pathology Illustrated: bone healing pages 1195-1196)

Inflammatory phase

Reparative phase

Remodeling phase

Factors which promote bone healing

Local

Systemic

Factors which impair bone healing

Local

Systemic

Emergency CareKey points

Immobilization

Wound care

Assessment of circulation

Diagnostic Procedures

X-rays

Bone Scan

13


14/21

Lab studies

Medications

Pain

Antibiotics

Anticoagulants

Surgical Treatment

When is surgical intervention needed?

External fixation

Internal fixation (ORIF)

Traction

Types of traction

Care of the client in traction

Casts

Selection of candidates and cast style

Nursing Care of client in a cast (key points)

14


15/21

Complications of Fractures

Compartment syndrome

Fat emboli

Deep Vein Thrombosis

Infection

Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome)

Specific Fractures (read pages 1203 1207)

Hip Fracture

Intracapsular

Extracapsular

Hip fracture facts

Surgical repair

Nursing Implications

Prevention/Teaching (Self Study 1207-1208)

15


16/21

Care of client with immobilized fracture

Specific care of client after repair of hip fracture (p. 1211-1212)

Good web sites: HREF="http://orthoinfo.aaos.org/" MACROBUTTON HtmlResAnchor http://orthoinfo.aaos.org (HREF="http://www4.aaos.org/siteserver/knowledge/search/database/search/OrthoInfo/view.asp?id=164&table=fact&topcategory=Ab" MACROBUTTON HtmlResAnchorHow to Use Crutches, Canes and Walkers)

HREF="http://www.cdc.gov/ncipc/factsheets/falls.htm"MACROBUTTON HtmlResAnchor http://www.cdc.gov/ncipc/factsheets/falls.htm

Amputations (p. 1211)

Causes

Peripheral Vascular Disease

Trauma

Infections

Tumors

Levels and Types of Amputations

Upper extremity

Lower extremity

Types of Amputations

16


17/21

Open

Closed

Post Op Site Care

Complications

Infection

Delayed Healing

Chronic Stump Pain and Phantom Pain

Contractures

Prosthesis Selection

Nursing Diagnosis

Important: See A Client with Amputation p. 1218See A Client with BKA p. 1219

17


18/21

Good web article: Care of the Elderly Patient With Lower Extremity Amputation( HREF="http://www.medscape.com/" MACROBUTTON

HtmlResAnchor http://www.medscape.com ) search amputation

See: http://www.cbsnews.com/stories/2004/01/06/earlyshow/living/main591693.shtmlStory of Ferry Crash Survivor with amputations. Click on Video. Very

impressive.

Back Pain ( p. 1280 low back pain; p. 1333 herniated disk)

Focus will be on low back pain; cervical neck pain essentially same information.

Causes and manifestations

Local back pain

Referred pain

Pain of spinal origin

Radicular back pain

Muscle spasm pain

Diagnosis

History and Physical exam

X-ray

18
http://www.cbsnews.com/stories/2004/01/06/earlyshow/living/main591693.shtmlhttp://www.cbsnews.com/stories/2004/01/06/earlyshow/living/main591693.shtmlhttp://www.cbsnews.com/stories/2004/01/06/earlyshow/living/main591693.shtml


19/21

CT and/or MRI

Treatment

Medications

NSAIDS

Muscle relaxants

Pain medications

Steroid injection (epidural)

Other Treatment Modalities:

Physical Therapy

Hot/Cold applications

Balance of rest and movement

Prevention

Exercise, stretching

Weight loss

Good body mechanics (at home and at work)

19


20/21

Herniated Intervertebral Disk (Ruptured Disk) p.1333

Definitions

Cervical

Lumbar

Pathophysiology / Manifestations

A herniated intervertebral disk occurs when the nucleus pulposus protrudesthrough a weakened or torn annulus fibrosus of an intervertebral disk.

Symptoms depend on the level

Pain, neuromuscular symptoms, sensory and/or motor involvement

Diagnosis

X-rays

CT

MRI

Myelogram

Treatment

Conservative Treatment

20


21/21

Surgical Treatment

Laminectomy

Spinal Fusion

See: Nursing Care of Client having Posterior Laminectomy p. 1337Highlights?

See: Nursing Care of Client with Ruptured Intervertebral Disk p. 1340Highlights?

Nursing Diagnoses?

Good web sites: http://www.mayoclinic.com Search for herniated disk.Nice interactive video for HNP.
http://www.mayoclinic.com/http://www.mayoclinic.com/

student outline musculoskeletal 2 05

Documents