Week 9: Musculoskeletal System and Conditions (Ch 30)

Fracture

break or disruption in continuity of bone

complete fracture

bone is divided into two distinct sections

incomplete fracture

bone not broken into two sections, break is only through of the bone

open/compound fracture

skin surface over the broken bone is compromised

infection risk

closed/simple fracture

does not extend through the skin, no visible wound

pathological/spontaneous fracture

minimal or no trauma

weak bones from disease (osteopenia/cancer)

fatigue/stress fracture

repetitive excessive stress on a bone

seen with athletes

compression fracture

force on long axis of bone

seen in vertebrae in pt w osteoporosis

comminuted fracture

bone shattered

Displaced fracture

bone fragments are separated and not aligned.

oblique fracture

A fracture that occurs at an angle across the bone, typically due to a sharp angle of force

spiral fracture

A type of fracture that occurs when a twisting force is applied to the bone, resulting in a ragged break that encircles the bone.

impacted fracture

A fracture where one bone fragment is driven into another, often due to compressive forces.

greenstick fracture

seen in children

bone bends and partially breaks (break not through)

acute complications of fractures (6)

vte, infection, acute compartment syndrome, crush syndrome, hemorrhage/hypovolemic shock, fat embolism syndrome

acute compartment syndrome

a broken bone impacts muscle, swelling increases pressure, decreasing ciruclation to area, crushing nerves potenailly leading to necrosis

severe pain

what is the first intervention to acute compartment syndrome? other interventions/treatment?

elevate limb to return blood flow

call doctor to perform a fasciotomy (scalpel to release pressure)

crush syndrome

broken bone damages BV resulting in severe bleeding, inc pressure, hemorrhage

fat embolism syndrome

inside bones contain fat globules

a fracture releasees these into circulation

may get stuck resulting in a PE or stroke

chronic complications of fractures- complex regional pain syndrome

dysfunction of the CNS/PNS that leads to severe, persistent pain

results from fractures or other traumatic ms injury and commonly occurs in the feet and hands

avascular necrosis

death of bone tissue from decreased bf

health promotion and matinence of fractures (4)

osteoporosis screening= dexiscan

fall prevention, home safety

dangers of drinking/driving

helmets, seatbelts

history assessment of fractures (3)

determine cause, events leading up to injury

substance use (opioids)

occupational/recreational activities

physical/psychosocial assessment of fractures (4)

check for trauma to other body systems (distractor), assess all body systems

check urine for blood

swelling, skin color, peripheral pulses

coping, support, accessibility of house

physical assessment- imaging for fractures

x rays- where fracture is

CT- for complex areas like hip/pelvis/spine

MRI- soft tissue injuries

labratory assessment of fractures

hbg/hct (low if bleeding)

ESR- nonspecific inflammation marker (high)

WBC- high with bone/skin inf

serum Ca2+ and phosphorus- high as broken pieces of bone are reabsorbed into blood

analyze cues for fractures (4)

acute pain, muscle spasms, edema/swelling

decreased mobility

potentional for neurovascular comp, impaired perfusion

potentional to inf due to wound firom open fracture

interventions for fractures (2 actions, 2 steps to prevent)

managing acute pain

increase mobility

prevent/monitor neurovacular compromise (swelling—> check cap refill, temp, pulse)

prevent infections (open fracture, cover w sterile dressing and antibiotis)

closed reduction devices- action, use, duration

immobilize bone to heal in partial breaks

wear 24 hours a day, remove to shower

typivally used for 6 wks

closed reduction devices- fiberglass synthetic cast

full break

placed in ER, doc office, OR

immonilize bone to heal

skeletal traction- for? action? result?

hip or femur fracture

pulling force to a part of the body

allow alignment

fixation devices (2)

operative procedure

internal- open reduction, metal pins/screws/rods/plates/prosthetic inside body

external- closed reduction, when pt have soft tissue injury (open fracture), pins/wires thru skin/bone, then connected to an external frame to stabilize, care w iodine at site

preventing/monitoring neurovascular compromise (fractures)

perform neurovascular assessments

be aware of s/s of acute compartment syndrome

6 P’s

6 P’s of fractures

pain

pressure (skin taight)

paralysis

paresthesia

pallor

pulselessness

preventing infection of fractures

use aspetic technique for dressing changes/wound irrigation

monitor vs, wound appearance/drainage

notify provider if inflammation, purulent drainage noted

pt may need antibiotics, VAC system

care coordination/transition management for fractures

home care- stairs, driving, bathroom access, scatter rugs, shower tub

self management education- verbal/written instructions, wound care, recognize s/s, nutrition, follow up care

health care resources- home health nurse

evaluation of fractures

adequate pain control 2-3 on 0-10 scale

free inf

adequate bf

free of conseuqnces of dec mobility

osteoporosis definition

chronic disease of cellular regulation

osteoporosis patho (3)

bone loss= decreased density (fracture risk), fragility fracture from osteoporosis (women over >50 from dec estrogen)

decreased BMD (bone mineral density)

loss in height (as much as 6 in)

osteomalacia

soft bones from lack of vit d

osteopenia

loss of bone mass

dowager’s hump

abnormal curvature of the spine resulting from osteoporosis, leading to a stooped posture

osteoporosis etiology (2)

genetic, lifestyle, environmental factors (non modifiable)

nutrition- lack of calcium and vit d, protein deficiency

osteoporosis health promotion/disease prevention (5)

teach women appropriate health/lifestyle practices

remind men >50 and menopause women of hearly t score screening

nutrition- vit d

stop smoking, acoid alcohol, limit carbonated beverafes

lose weight, exercise (weight bearing)

what foods should people with osteoporosis eat? what major factor contributes?

dairy, leafy green veggies, sun exposure

osteoporosis physicsal/psychosocial assessment (3)

kyphosis/dowager’s hump

bone density tests, fracture history

psychosocial- body image

osteoporosis laboratory assessment

serum calcium and vit d3

osteoporosis imaging assessment

x rays of spine/long bones

DXA scan= T score

QCT scan

vertebral imaging

MRI

DXA Scan- bone mineral density T Score of +1 to -1

normal bone density

DXA Scan- bone mineral density T Score of -1 to -2.5

osteopenia

DXA Scan- bone mineral density T Score of more than -2.5

osteoporosis

what can combat the effects of decalcification of bone?

exercise, calcium, meds

osteoporosis interventions (3)

nutrition therapy- fruits, veggies, low fat, high dairy, low caffiene

lifestyle changes- resistance/cardio

drug- biphosphonates, calcium (4,000/day max), vit d

biphosphonates- exemplar, action, pt teaching

alendronate

slow bone resorption

take on empty stomach in AM w full glass of water (8oz) once a week

take before at least 30 minutes before the first food and remain upright

osteoporosis evaluation

follow up w DXA screening

makes lifestyle changes

no bone fragility fracture

osteomalacia

soft bones because of vit d deficiency

osteomyelitis- define, types

infection in bony tissue caused by bacteria, virus, fungi

exogenous (open fracture/surgery), endogenous (inf in blood)

osteomyelitis physical s/s

bone pain, fever

erythema and heat in area of inf bone

osteomyelitis labs

elevated wbc

ESR may elevate later in disease

osteomyelitis chronic s/s

foot ulcers w localized pain

osteomyelitis nonsurgical management

meds

iv antibiotics

pain meds

antipyretics

osteomyelitis surgical management

debriedment w antibiotics

IND (incision/drainage)

osteoarthritis- note, define, sign

most common arthritis

joint pain and loss of function characterized by progressive deterioration and loss of cartilage

osteophytes

osteophytes

bone spurs that form in response to cartilage degeneration or osteoarthritis

cause pain, reduced mobility, and nerve compression

osteoarthritis patho

cartilage degenerates, bone/cartilage float into joint= crepitis

osteoarthritis primary and secondary risks

primary- aging and genetics

secondary- joint injury, obesity, repetitive stress to joints

what are the most common joints affected by osteoarthritis?

hips, knees, vertebrae, hands

osteoarthiris health promotion

proper nutrition (prevent obestyi)

avoid injury

take work breaks

stay active

osteoarthritis history assessment

localized, unilateral joint pain

secondary to diagnosis

older than 60 yrs

osteoarthritis physical assessment/s/s

persistent join pain/stiffness

crepitus

joint effusions

heberden’s nodes/bouchard’s nodes

atrophy of skeletal muscle

psychosocial assessment of osteoarthritis

lifestyle changes

osteoarthritis labs

aspirated join fluid

ESR

hsCRP (non-specific inflammatory marker)

osteoarthritis imaging assessment

xray

mri

heberden’s nodes

distal joint

bouchard’s nodes

proximal joint

collaborative problems in pt w osteoarthritis

persistent pain, decreased mobility

osteoarthritis nonsurgical chronic pain management

drugs

rest, immobilization

positioning

thermal (hot/cold)

weight control

integrative therapies- glucosamine, chondroitin

how do heat/cold therapies work

heat vasodilates, inc bf

cold decreases inflam by constricting bv

what drugs can be used for nonsurgical pain management of osteoarthritis?

NSAIDS (advil/ibupro)

acetaminophen (tylenol)

opioids

dyclophenic 1% topical gel (volteran)

surgical management of osteoarthritis

total joint arthroplasty (TJA) / total joint replacement (TJR)

arthroscopy (hole, clean area/remove filling/cartilage)

post op care for TJR

prevent comp

hip dislocation, use abductor pillow

VTE (ambulation), inf

anemia (estimated blood loss), s/s

neurovascular= circ, motor, sensation

hip flexion after total hip replacement

do not flex hips more than 90 degrees

continuous passive motion machine for total knee replacement

constantly bends knee to prevent scar tissue build up, promote ROM

osteoarthritis care coordination/transition management

home care management= environmental safety

self management/education= well balanced diet

health care resources= PT at home, home care nurse

osteoarthritis outcomes

pain 2-3 or level that is acceptable

no complications from total joint arthroplasty

moves/functions in own environment independently w/w out assistive devices

rheumatoid arthritis definition

common ct disease causing destruction to joints

chronic, progressive systemic inflammatory autoimmune disease that primarily impacts synovial joints

remissions and exacerbations

rheumatoid arthritis patho

transformed autoantibodies (rheumatoid factors) form, attack healthy tissue causing infammation

rheumatoid arthritis etiology/genetic risk

combo of environment and genetics

physical/emotional stresses linked to exacerbations

rheumatoid arthritis incidence/prevalence

euro-american caucasians

young-middle aged women 2-3 times more likely than men

rheumatoid arthritis history assessment of symptom stypes

acute/severe, slow and progressive

rheumatoid arthritis general physical assessment

joint and systemic symptoms

generalized weakness and fatigue

morning stiffness

psychosocial assessment

rheumatoid arthritis labs

rheumatoid factor

anti-ccp

ana

esr

hsCRP

serum complement (c3 and c4) (plt ct)

thrombocytosis can occur w late RA

rheumatoid arthritis early signs

joint stiffness

swelling, pain

fatigue, generalized weakness

low grade fvr

rheumatoid arthritis late signs

joints become progessivley inflamed and painful

SQ nodules

rheumatoid arthritis interventions- main goal, 3 things

managing chronic inflammation/pain

drug therapy

promoting mobility

enhancing self esteem

rheumatoid arthritis systemic complications (6)

wt loss, extreme fatigue

exaverbations

sub q nodules

res/cardiac comp

vasculitis (inflamm of bv)

paresthesias, neuropathy

rheumatoid arthritis non pharm interventions

adequate rest, positioning

ice/heat

plasmapheresis (not common)

complementary/alt therapies (hypnosis/acupuncture)

promote self-management, enhance body image

manage fatigue

rheumatoid arthritis drug therapy

DMARs (disease modifying antirheumatic drugs)- methotrexate, hydroxychloroquine

BRMs- biological response modifiers

NSAIDS

glucocorticoids

immunesupressive agents (prednisone)

gout/gouty arthritis definition/types

urate crystals deposit in joints and other body tissues causing infalm (common in big toe)

primary

secondary- hyperuricemia

gout/gouty arthritis incidence/prevalence

men >50, chronic alc, obesity, thiazide diuretics