1. Muskuloskelal Trama
    Is injury to musle, bone, or soft tissue
  2. Contusion
    Bleeding into soft tissue least serious form of musculoskelal injury. From a blunt force such as a kick or striking a body part against a hard object . The skin remain intact but small blood vessals rupter and bleed in soft tissue
  3. Hematoma
    A contusion with a large amount of bleeding , Manisfestations include swelling and dicoloration of the skin. The blood in the softe tissue results in purple /blue called a bruise as it reabsorbs it becomes brown/ yellow untill it diappears
  4. Strain
    Strectching injury to muscle or muscle tendon unit, cause by mechanical overloading. A muscle that is forced to extend past it elasticity will deovelope microscopic tears. EX: Lifting objects that are heavy with out bending knees or a sudden acceleration- decerations, as in a motor vehicle crash can cause strains, common sites are lower back, hamstings on bk of thigh
  5. Strain Manifestaions
    Pain Limited motions, muslce spasms, swelling, possible muscle weakness, severe strains that partically or completely tear the muscle or tendon can be disabling with signifiant bleeding , swelling and brusing around muscle
  6. Sprain
    Injury to a ligament surronding a joint. Forces going in the opposit directions cause the ligament to over stretch or tear, The Ligament may be partially or completly torn, can happen on any joint. but more common in the ankle and knee
  7. Sprain Manifestations
    loss of the fuctional ablity of the joint ,a feeling of a pop or tear, discoloration, pain, rapids swelling. Motion increases the joint pain. the intensity of the manifestations depends on the severity of the sprain.
  8. Treatment/ Nursing care For soft tissue Injury
    • R.I.C.E For the 1ST 24hrs
    • Rest & Immobilize
    • Ice- ice constricts blood vessels which reduces swelling after 24° with soft tissue injuries you want an á in blood flow to help remove damaged tissue so heat can be applied to increase circulation to promote healing
    • Compression dressing- wrap with an Ace wrap; or with a cotton wrap with an Ace wrap over that; or splint the injury – keeps tissue constricted so there is less swelling and supports the ligaments that are around the joint
    • Elevation- above the level of the heart, the injured body part needs to be elevated so that the excess fluid can drain back into the body

  9. DX for soft tissue Injury
    Docter may order x-ray- to rule out Fracture

    MRI - if necessary - to see deeper tissue to determine the extent of the tissue damage.
  10. Meds used for soft injury
    Analgesics , Tylenol for the pain and NSAIDS for pain ,reduce swelling and inflammation
  11. Other treatments for Soft tissue Injury
    The injured extremity may be immobilized with a splint cast, or sling with no weight limitaions on weight bearing

    Surgery-may be done to repair torn ligaments, muscle or tendons for severe sprains and strains

    PT- may be recommended for rehab , the time required for healing depends on the severuty of injury
  12. Nursing Dx for Doft tissue Injury
    Acute pain

    Impaired Pysical mobility

    Self care deficit

    Risk for impaired skin integrity
  13. Dislocation
    • Affects the joint it self or the soft tissue supporting the joint.
    • its an injury in which the ends of the bones are displaced out of their nomal position and join articulation s lost.
    • Dislocation usually follows trama such as a fall or blow, they commonly occur during contact sports such as football.
    • Pathologic dislocations result from disease of a joint include infection Rheumatiod athritis, Paralysis, neuromuscular disease they occur frequent in the shoulder.
  14. Subluxation
    A partial dislocation in which the bones of the joint remain in partial contact .
  15. Assessment of a dislocation
    • monitor neurovascular status by assessing the Five Ps.
    • Pain.
    • Pallor.
    • Pulse.
    • Paralysis.
    • Parethesia
    • Maintain immobilzation after reduction , it helps from Dislocating again .
    • Educate pt and reduce pain.
  16. Fracture
    Any Break in the continuity of a bone.

    • Happens when the bone is subjected to more kinetic energy than it can absorb.
    • Fractures may result from a direct blow.
    • A crushing force(compression).
    • a sudden twisting motion.
    • A severe muscle contraction.
    • Or a disease that has weakend the bone.
  17. Classifications of fractures

    Skin is intacted, no break in skin
  18. FX

    Compound/ open
    • Skin Intergrity interrupted/ Bone breaks throught the skin.
    • Problem- Allows bacteria to enter the injured area and increase the risk of complications.
  19. FX

    entire width of the bone
  20. FX

    Part of the bone
  21. FX

    Bone breaks in many peices
  22. fx

    The bone is crushed
  23. fx


    The bones maintain their anatomic alignment
  24. fx

    Unstable /displaced
    when bones move out of their anatomic alighment
  25. Manifestations
    (Type of evidence, signs and symptoms of Fracture)
    • May have soft tissue injures,that involve mucles,, arteries,veins. nerves, or skin.
    • May have alteration in circulation sensation etc.numbness, swelling, pain.
    • May have obvious deformity, shortening of extremity.
    • pt may have felt the breakage of the bone , cracking or popping.
    • Crepitus- grating of bones
  26. FX Healing
    Fx healing progesses over four phases.

    X-RAY may lag 1 to 2 weeks behind the healing process.
  27. FX healing #1

    Inflammatory -bleeding at site
    When Bone fractures, blood vessals with in the bone and surrounding soft tissue tear and begin to bleed forming a hematoma. Necrotic bone tissue adjacent to the frature causes an intense inflammatory response chracterized by vasodilation,excuadate formation and white cell migration to fracture site.
  28. Fx Healing #2

    Fibrocartilaginous callus formation
    • With in 48hrs , fibroblast and new capillaries growing into the fracture form granulation tissue that gradually replaces the hematoma.
    • Phagocytes remove cell debris. Osteoblasts (bone forming cells) migrate to the fracture site, where they build a web of collegen fibers from both sides of the fractured bone.
    • chondroblasts lay down patches of cartilage as a base for bone growth.
    • This fibrocartilaginous callus connects bone fragments, splinting the fracture and maintaining bone alignment.
    • It cannot yet, however support weight bearing.
  29. Fx Healing #3

    Boney callus formation
    • Begins 3 to 4 weeks after injury and continuse 2 to 3 monthes.
    • osteoblast continue to form collagen fibers and bone matrix, which are gradually minerallized with calcium and mineral salts. Osteoclasts migrate to the repair site to remove damage and excess bone inthe callus. Fibrocartilaginous callus is gradually replaced with spongy bone.
    • This process progresses from the outer surface of the bone toward the fracture site.
  30. Fx healing #4
    Bone remodeling
    • excess callus is removed and new bone is laid down along the fracture line.
    • As the bone heals and again in subjected to the mechnical stress of everyday use, osteoblast and osteoclasts remodel the repair site along the lines of force.
    • Spongy bone is replaced by compact bone and the remodeled area closeley resembles the original, unbroken bone.
  31. Healing of fx influenced by
    • age, health, other conditons, treatment sought, physical activity,nutrition, type of fracture, locaiton of fracture, smoking (vasoconstriction), Healing time varies with the individual Ex: uncomplicated are fx arm of foot can heal in 6-8 wks
    • Hip 12-16 wks
  32. Fx and dislocation Emergency care
    • Immobilization.
    • Once pt is in a secure location he/she is assessed for immobility or deformities of bone.
    • Maintain tissue perfusion, extremities are assessed for presence and equality of of pulses , movmemen and sensation.
    • Open wound , are covered in sterile dressing and bleeding is controlled with a pressure dressing.
  33. Diagnostic test For fx and dislocations
    • HX of incident and assessment -what and how it happen.
    • x-ray of bones, identify fractures.

    Additonal tests, CBC and coagulation studies may be used to assess blood loss, renal function, muscle break down and the risk of excessive bleeding or clotting.
  34. Meds Used
    • Pain Meds - Nars msy be given.
    • NSAIDS-beware of bldg, decrease inflammation and pain.
    • Antibiotics-may be give prophylactically, for pt with open/compound fx.
    • Other -Anticoagulants to prevent DVT, stool softners to decrease constipation secondary to narcs and immobility. Antiacids to prevent ulcers
  35. Surgery for fx
    • Goal is to have in ER within 6 hrs.
    • surgery is indicated for a fracture that requires direct visualization and repair.
    • A fracture with common long term complications.
    • A fx that is severly comminuted and threaten vasculer supply.
  36. fx Surgery

    External Fixation
    • simplest type of surgery is an application of an external fixator device consist of a frame connected to pins that are inserted perpendiculaer to the long axis of the bone . The number of pins inserted depends on the type of site fx same # of pins above and below, same care as traction.
    • Pt is monitored for infection and frequent neurovascular assessements . It increases independence while maintaining immobilization.
  37. fx Surgery ,ORIF- Open reduction and internal fixation
    • Place in correct anatomic position
    • Done in surgery ,the bone is exposed and realigned , nails and screws may be used to maintain position .

    Open fx of the extremities are most commonly repaired in this way.
  38. Traction
    Application of straightening or pulling force to maintain or return fractured bones in normal alignment, prevent muscle spasms

    Weights- maintain necessary force, dont remove without docs order
  39. Types of traction

    Temporary, Pulling force in straight line:(bucks extension) most common type , used to immobilize the leg before surgery to repair a hip or proximal femur fx

    Uses traction tape or foam boot applied to the lower leg and attached to a free-hanging weight to immobilize the leg.
  40. types of Traction

    balanced suspension
    invloves more than one force pull to rasie and support the injured extremety off the bed and maintain its alignment . It increses mobilility while maintainig bone position(makes it easier for pt care) (commonly used with femer)
  41. Types of Traction

    Skeletal traction
    • application of pulling force through placement of pins into the bone (Local, spinal, or general anesthetic is provided during pin placement).
    • One or more pulling forces may be applied.
    • Allows more weight to be used using to maitain proper anatomic alighment .

    The risk of infection is greater and may cause more discomfort . (May be used for spine fx)
  42. Complications of Immobility with FX
    • Infections at pin sight.
    • Skin break down.
    • Urination/constipation- paralytic ileus.
    • Kidney stones (Renal calculi) formation from frature deposits.
    • VTE.
    • Pheumonia.
    • Loss of appetite.
  43. Caring for a fx with traction using (Traction)
    • Temp.
    • Rope hang freely.
    • Alignment.
    • Circulation useing 5ps.
    • Type and location.
    • Increase fluid intake.
    • Over head trapeze.
    • No weights on bed or floor.
  44. Casting
    • Ridgid device applied to immobilize bones and promote healing.
    • Extends above and below fx so that the bone will not move during healing, Fx is reduced manually then cast is applied.
    • casts are applied to pts who have relativly stable fx.
  45. Cast types
    Type is determined by the location of fx.

    • Plaster :needs 48hrs to dry stockinette is placed on skin, then the plaster, doesnt reach ttl hardnes untill 48-72 hrs later.
    • Watch weight bearing - can cause increse pressre &pressure ulcers.
    • Swelling, can be from edema.
    • palpating a wet cast with the ginger tips will leave dents that may cause pressure ulcers.

    Fiber glass :is used in ER for nondiplaced fx, dries with an hr
  46. PT teaching about casts
    • Nothing in any cast to scratch.
    • Keep clean and dry.
    • If fiber glass cast get wet use cool setting on hand dryer to dry.
    • warm sensation is normal during drying,dries inside out.
    • Report to doc immediatly if they have any swelling , pain, coolness, color, loss of sensation.
  47. Nursing care for casting
    • Nurses need to perform frequent neurovascular assessments.
    • Palpate the cast for hot spots, that may indicate the presence of infection.
    • Promply report increased or severe pain and changes in the neurovascular (5ps) assessment.
  48. Electrical bone stimulation
    • Promotes healing- it is the application of an electrical current at the fracture site .
    • Painless method of treating fractures that are not healing appropratly.
    • The electrical stress increases the migration of the osteclasts and osteoblasts to the fracture site.
    • Mineral deposting increases promoting healing. accomplished invasivly or non invasivly.

    Not used in the presence of infection andfor upper extremities if pt has a pace maker.
  49. Invasive Electrical bone stimulation
    Surgeon inserts a cathode and a lead wire is attached to an internal or exernal generator wich delivers eletricity to the cathode 24 hrs a day.
  50. non evasive inductive stimulation
    a treatment coil encircles the cast or skin directly over fracture site the coil is attached to an external generator that runs on batteries - electricity goes through skin to fracture site time varies from 3-10 hrs/day
  51. complications- from cast, or otherpedic injuries

    Compartment syndrome:
    • Excess pressure in limited space, compression of nerves, blood vessals and muscle in a closed space.
    • Results from hemmorage, edema from injury or swelling with to tight cast.

    May result in ishemia,acute renal failure because the muscle cells break down and release myoglobin a protein toxic to kidney tubles.

    Unresolved compartment symdrome can lead to volkmanns contracture, a uncommon complication in elbow and forearm fractures, arterial blood flow decreases leading to ischemia,degeration and contration of the forearm muscles.
  52. Symtoms of Compartment symdrome
    increasing pain distal(because not enough o2 to area distally) can result in tissue death / loss limb, parathesis, diminshed reflexes, normal or decreased pedal pulses, cyanosis, sepsis,
  53. Interventions of compartment syndrome
    • bivalve cast(leave cast on but spread both sides).
    • fascitomy must be done- surgical incison of the muscle fascia to relieve pressure with in the compartment, incison is left open.
    • Elevate but call doc immediatly and measure if not casted .
  54. Fat embolism syndrome (FES)
    • Fat globules lodge in pulmonary capillaries
    • Manisfestation usually develope in a few hrs to a week after injury.They result from occlusion of the blood supply and the pressence of fatty acids

    • Risk factors - longbone fx, hip replacement and other major trauma are principle risk factors for fes.
  55. Signs and symptons or FES
    Neurologic dysfunction, confusion, restlessness, pulmonarty insufficiency, petechial rash (red or purple discoloration on the skin) that dont blanch when applying pressure , on chest, axilla and upper arms

    FES may result in acute respiratory distress-from pulmonary edema , impaired surfactant production,atelectasis
  56. Prevention of FES
    • stabilizaton fx, monitor.
    • early stablization of long bone fractures , prompt treatment to maintain pulmonary function.
    • In severe cases pt may have to be intubated.
    • Fluid balance is closely monitored.
    • steriods to decrease inflammatory respone of the lung tissues , reduce brochspasms
  57. VTE (Venous thrombus event)
    blood clot forms in lining of large vein accompained by inflammation of vein wall
  58. Three risk factors for VTE
    • Venous stasis (decreased blood flow).
    • injury to bld vessals.
    • altered bld coagulation.
    • vte is asymtomatic causes swelling, pain, tenderness, cramping of affected extremity.
  59. DX of VTE
    Done by using a dopple ultrasonography uses sound wave to form an image.

    MRI or venogram may be required for dx.
  60. Prevention of VTE
    • ealy immobillization of the fracture and early ambulation of the pt are imparative.
    • prophylactic anticoagulation lovenox, heparin.
    • antiembolism stockings, compression devices (PCDs)
  61. Infection
    • Any complication that decreses blood supply increase the risk of infection.
    • more likely with compound open fx from contanmination at time at injury or at time surgery.
    • (clostridium) may lead to gangrene cellulitis.
    • Infection may lead to osteomylitis-inf with in bone that can lead to tissue death and necrosis.
  62. Delayed or non union
    • Prolonged healing of bones beyond usual time period or n healing at all .
    • Risk factors - poor nutrition, inadequate immobilization such as not following doc orders.
    • poor alignment of fracture.
    • prolonged reduction time by not seeing doc in time.
    • infection or necrosis (poor bld supply, may have been casted wrong.
    • Age, Kids heal faster than older.
    • immunosuppression, chemo, immunosuppressants drugs(corticosteriods)
    • Smoking, sever bone trauma.
  63. Treatment of delayed or non union
    Surgery:bone grafting , internal fixation

    If infectin present , bone will be surgically debrided

    Rebreak or recast

    Electronic stimulation(TENS unit)

    Growth horomones.
  64. Reflex sympathetic dystrophy aka CRPS complex regional pain syndrome.
    Poorly understood conditon, may occur after a musculoskeletal or nerve trauma. it causes extremity pain that is severe, diffuse and burning.

    Females and older age are riskfactors
  65. Reflex sym dystrophy s/s
    • persistant pain, hyperethesias(increase in sensitvity), swelling, changes in skin color.
    • extremities appear inflamed and edematous, later cool and pale , muscle wasting , nail changes, bone abnomalities.
  66. Treatment of reflex sympathtic dystrophy
    sympathetic nervous system blocking agent often alleviates the manifestations
  67. Nursing care of all orth injuries
    • M.anagment of diagnosis us primarily based on off the physical examinatin and x-rays.
    • pain-elevate , have them describe pain, locatio, contol pain and elevate.
    • impaired physical mobility-get stuff next to bed (cane, walker).
    • check for impaired tissue perfusion by checking cap refill, sensations, presssure ulcers.
    • Neurovascular compromise.
    • pain that is not relieved by analgesics.
    • assessment of clients response to trauma-does client needd assitance or assitve devices.
  68. Health Promotion
    • Maintain good bone health -drink milk.
    • Get Screening for osteoporosis.
    • excersise, weight bearing, walking, running, lift weights.
    • avoid excess weight , calcium intake.
  69. Nursing DX comlplications from orth injuries
    • acute pain
    • risk for peripheral neurovascular dysfunction thats why 5ps are checked every 1-2 hrs along with ability to differnciate between sharp and dull touch and the presence of paresthesis and paraysis q1-2, parathesis asa result of pressure of pressure on nerves may indicate compartment sydrome.
    • risk for infection for open fx and any break in skin integrity.
    • Impaired physical mobility, pressure ulcers, sensory reception impariment.
    • immobilization alter gait, teach ROM.
    • Neurovascular compromise may be indicated by pain that is not relieved by analgesics- so nurse assesses for deep throbbing ,unrelenting pain.
  70. Home care for orth injuries
    • Cast care- Puting stuff inside cast &dont wet.
    • follow dr. directions regarding weight bearing.
    • Do ROM of unaffected joints

    • Eleveate -to decrease swelling and pain, promotes venous return and decreases edema.
    • Discharge planning-pt needed quipment, cast, crutches, walker.
  71. Amputations
    Partial or total removal of body part for acute or chronic reasons.
  72. Amputation causes
    • PVD- Peripheral vascular disease. (Poor circulation.)
    • Trauma.
    • other- Frost bite, burns, electocution
  73. Amputations Underlying causes
    • Is either acute or chronic.
    • Acute trauma situations the limb is partically or completly severed leading to tissue death.

    • Chronic disease process- circulation is impaired, venous pooling begins, proteins leak into the interstitium, and edema develops.
    • Edema increases the risk of injury and further decreases circulation.
    • Stasis ulcers develop and readily beome infected because impaired healing and altered immune processes allow bacteria to proliferate. the presence of progressive infection further compromise circulation and ultimatly leads to gangrene which requires amputation.
  74. Goals of an amputation
    • Alleviate symptoms, take care of pain and sores.
    • Maintain healthy tissue.
    • Increase functional outcome, best outcome after surgery.
    • When possible, the joints are preserved because they allow greater funcition of the extremitity.
  75. Amputation site healing
    • For prosthesis to fit well, the amputation site must heal properly.
    • prevent infection, elevate limb in the first 24hrs but not after.
    • Assess circulation to the stump.
    • rigid or compression dressing is applied to prevent infection and minimize edema.
    • Stump is wrapped in ACE wrap to allow a cornical shape to form , applied from distal to proximal extremity-helps shape stump for prosthetic.
  76. Amputations complications

    • pt with tramatic amputation hasa greater risk of infection than one who has a planned amputation. The infection can be local or systemic.
    • Local- includes drainage odor and redness and increase discomfort a suture line.
    • Systemic- include fever, and increased heat rare, a decrease in blood pressure, chills and positive wound or blood cultures.
  77. Amputation complications

    Delayed healing
    • if circualtion isnt good.
    • or infection present, pre existing illness, electrolyte imbalance,diets that lack proper nutrition,smoking because it causes (vasoconstriction) and decreasing blood flow to the stump.
    • VTE and compromised venous return ,which may result from prolonged immobilization.
  78. Amputation complication

    Chronic stump pain
    result of neuroma formation, causing severe burning pain.

    Interventions to relieve pain include- Transcutaneous electrical nerve stimulation (TENS) unit, surgical stump reconstuction, meds, nerve blocks.
  79. Amputation complications

    Phantom limb pain
    Phantom sensations difficult to treat Neurontin and lyrica may help treat.

    Also treated with TENS, surgical procedures.
  80. Amputation complications

    • an abnormal flexion and fixation of a joint caused by muscle atrophy or shortining .
    • contracture of the joint above the amputation is a common complication.
    • Have pt lie prone and do ROM to avoid.
    • Avoid prolonged sitting in WC can lead to hip contracture.
  81. Nursing dx for Amputations
    • Altered body image.
    • Grief, pain, altered skin integrity.
    • At risk for infection, impaired mobility.
  82. Repetitive use injuries

    Carpal tunnel symdrome
    compression of a median nerve in wrist and narrowing of the tunnel as a result of inflammation and swelling of the synovial lining of the tendon sheaths.

    PT c/o numbnesss and tingling n thumb and index finger and lateral vertral surface of the middle finger.
  83. Repetitive use injuries

    • Inflammation of the bursa.
    • A bursa is an enclosed sac found between muscles, tendons, and bony prominences.
    • The busrsae that commonly become inflamed are in the shoulder, hip, knee, and elbow.
    • contant friction between the bursa and the muskuloskeletal tissue around it causes irritation edema and inflammation.
    • The area around the sac is tender and extension & flecxion of the of the near bursa cause pain.
    • The inflamed bursa is hot, red and edematous.
  84. Repetitive injuries
    collaborative care for all of these tissue injures
    • Pain relief.
    • Increasing mobility sparingly.
  85. Repetitive use injuries
    • NSAIDS to decrease inflammation, steroid injection into inflammed area.
    • Narcs for acute flare up and pain.
    • Corticosteriods injections for carpal tunnel.
  86. Repetitive use injuries

    Treatments -conservative managment
    immobilize with splinting , rest, ice, in the 1st 24 -48 hrs to decrease pain and inflammation. Heat application after ice.
  87. Repetitive use injuries.

    • Done if consevative treatment doesnt work.
    • In carpal tunnel, tunnel resection of the carpal ligament to enlarge tunnel.
    • N bursa- calcified deposits are removed from the area surrounding the tendon or bursa.
  88. Repetitive injuries

    Nursing DX
    • Acute pain.
    • impaired physical mobility.
  89. Repetitive injuries

    Home care

    • Avoid activities that increase risk of redeveloping injury.
    • Explain causes of and treatments for repetitive use injury .
    • Assitative device and braces.
  90. Osteoarthritis (OA) degenrative joint disease (djd)
    • Most common form of all arthritis and pain in older adults.
    • Loss of joint cartilage, synovitis(inflammation of the synovium lining the joint), joint, stiffness, and loss of joint motion.
    • Males more often than females, untill age 55 when incidence twice as high in females.
  91. Osteoarthritis (OA) Risk factors
    Age-it incidence and prevalance increases significantly with age. Joint cartilage thins, age related decreases of muscle strength and ligament stretching, as well as slow sensory imput reduce protection of the joint from injury.
  92. Osteoarthritis (OA) Risk factors
    • Excessive weight - increasing body weight significantly increases the load place on the knees during walking.
    • Inactivity -moderate excerise has been shown to decrease the chance of developing OA.
    • Strenuous, repetitve excersise- occupations that require regular bending.
    • Horomonal factors- Female horomones lead to the development of OA.
  93. Osteoarthritis (OA) Pathopys
    • Carlilage lining the joints degenerates, falls apart, wear and tear.
    • Osteophytes(bone spurs) form along edges of joint, small peices may break off leading to mild synovitis.
  94. Osteoarthritis (OA) Sx
    • Onset is Graudual and insidious.
    • Pain and stiffness in 1 or ore joints , pain at night and there may be parethesis.
    • immobility and stiffness, long car rid or sleep may cause joints to stiffin.
    • ROM of the joint decreases as the desease progresses which can lead to falls and grating or crepetis may be noted.
    • Boney over growth may cause joint enlargment and flexion contracture may occur because of joint instability.
  95. Osteoarthritis (OA) collaborative care.
  96. Control discomfort Relieve pain: painful to shake hands, do house hold chores, etc.
    • maintain joint fuction and mobility.
    • Reduce or prevent physical diability.
  97. Osteoarthritis (OA) Conservative treatment
    • Help maintain fuction and mobility to highes level possible.
    • Reguler excersie and weight loss as indicated are primary components.
    • ROM excersises, muscle strengthing excersise, aerobic excersise, walking, quadriceps strenthing, yogo, tai, water based excersises.
    • Heat and ice.
    • A balance between excersise and rest.
    • Use of a cane, crutches, or a walker as needed.
    • Weight loss if needed.
    • Analgesics and anti-inflammatory meds.
  98. Surgery

    Joint arthroplasty (total joint)
    • For those wieh significant chronic pain and loss of joint function.
    • Surface of joints are replaced.
    • Some or all of the synovium cartilage, and bone on both sides of the joint are removed .
  99. Osteoarthritis (OA) complementary/ alternative therapies
    • bioelectromagnetic theraphy- surrounds the joint that needs theraphy.
    • Elimination of nighshade family foods -anti-inflammatory diet, potatoes, tomatoes, pepper, tabacco.
    • Nutritonal supplements-glucosamine,zinc, copper, boron, ect may reduce pain.
    • Osteopathic manipulation, holistic help improve ROM.
    • Yoga- its not to much weight bearing and help increase circulation.
  100. Osteoarthritis (OA) Nursing Care
    • Promote comfort.
    • Helping maintain mobility and ADLs,
    • Teaching , and assisting with adaptations to maintain life roles.
  101. Osteoarthritis (OA) nursing DX
    • self care deficit, knowlege deficit.
    • Chronic pain/acute pain.
    • Risk for impaired adjustment.
    • Impaired physical mobility.
  102. low back pain
    Most often due to strain of muscles and tendons of back caused by abnormal stress or over use.

    First figure out the cause.
  103. low back pain

    Varies with cause.
  104. Five causes and type of back pain.

    Local pain.
    cause d by compression or irritaion of sensory nerves, Fratures strains, sprains, are common cause of local pain, tumors also press on pain sensitive structures.
  105. Five causes and type of back pain.

    Radicular pain
    sharp radiating form back to leg along a nerve root may be arravated by movement.
  106. Five causes and type of back pain.

    Muscle spasm pain
    Associated with many sone disorders, orgin may be unclear, pain is dull and may be accompained by a abnormal posture and taunt spinal muscles.
  107. Five causes and type of back pain.

    Reffferd pain
    may originate from abdominal or pelvic viscera.
  108. Five causes and type of back pain.

    Pain of the spinal origin pain
    associated with pathology of the sone such as disk disease or arthritis may be referred to legs or butt.
  109. Back pain clinical maifestations
    • Mild discomfort to chronic debilitating.
    • Acute pain when pt participate in activity thats not usually done (such as lifting or bending).
    • Mechanical injury or trauma.
    • Dengenrative disorders.
    • Systemic disorders.(Osteoprosis).
    • Referred pain (bowel and bladder disorders).
    • Other( depression, fibromyalgia).
  110. Back pain dx
    • Test depends on the suspected dx.
    • Consevative tx for 4 wks then test will be done if it doesnt help.
    • X-ray, CT scans, MRI.
  111. Back pain meds
    • NSAIDS (blocks the protaglandin production and reduce inflammation.
    • Muscle relaxants (flexeril,robaxin, soma).
    • Epidural sterids injections for intense pain.
  112. back pain conservative tx
    • limited rest, early mobilization.
    • Laying down initially- with pillow under knees.
    • Application of heat or ice, alternating between both.
    • alternative meds such as massage.
    • gentle stretching initially, TEN unit, ultrasonagraphy, hydrotheraphy.
  113. Nursing care plan for back pain.
    • Acute pain.
    • Readiness for enhanced knowlege.
    • Readiness for enhanced self heath managment.
  114. Back pain with herniated disc.
    • AKA ruptered disk , herninated nucleus pulposus or slipped disk.
    • rupture of cartilage surrounding the intervertebral disc with the protrusion of nucleus pulposus.

    Most common cause of low bk pain.

    Common sites are - lumbar region L4, L5, S1, cervical, c6-c7.
  115. Back pain with herniated disc.

    • Protrusion occurs spontaneously or as a result of trauma or degenrative disorders (osteoarthrthritis)of the spine or aging .
    • Trauma such as lifting heavy objects or fall on butt on back or twisting
    • Abrupt herniation causes intense pain and muscle spasms.
    • Gradual heniation occurs with degenrative changes, pt has a slow onset of pain and neurologic defects mainifestations may be radiculopathy(one or more nerves dont function normally) and or paresthesia.
  116. Back pain with herniated disk


    Lumbar disc
    • pain - in lower back, may have bowel/bladder dysfuntion.
    • Recurrent episodes of pain typically radiates across the buttock and the posteir leg (sciatica)postural deformity.
    • Motor deficits: weakness, problems in sextual function and unrinary eliminaiton, foot drop

    Sensory deficits: paresthesias and numbness, knee and ankle reflexes are decreased or absent.
  117. Back pain with herniated disk


    Cervical disc
    • That herniate laterally.
    • pain in the shoulder, arm, neck (radicular pain)
    • Paresthesis along the dermatome of the compressed nerve root.
    • Muscle spasms, stiff neck decreased arm reflexes.

    Central cervical herniations result in dull intermittent pain, pt may also have lower extremity weakness, unsteady gait,muscle spasms, unrinary elimination problems.
  118. back pain with herniated disk

    • Usually MRI (make sure pt doesnt have any hardware in them),CT scan, do plain x-ray if not done before-check for abnormalities. May also do a EMG- Check electrical of muscles at rest and with voluntary contractions.
    • Myelogram- to rule out tumors.
    • Muscle strength and reflexes are tested with straight leg test.
  119. Herniated disk

    • Analgesics, NSAIDS to reduce swelling and muscle spasms.
    • Muscle relaxants.
  120. Herniated disk

    • Patient is advised to continue normal activties while taking their meds.
    • conservative for 2-6 weeks. Do this approach 1st unless ot is experincing severe neurologic deficits.The goals of treatment are pain relief and healing of the involved disk by fibrosis.
  121. Herniated disk

    Alternative therapies
    Guided imagery, music, Hypnosis, massage, acupuncture.
  122. Herniated disk

    • Most often performed. 24hr hosp stay
    • Removal of a part of the vertebral lamina.
    • Done to relieve pressure of the nerves.
    • Often done with the removal of protruding nucleus pulposus.(Nucleotomy).
  123. Herniated disk


    removal of the necleus pulposus. of an invertebral disk

    • Decompressive laminectomy:(removes bone spurs)
    • If pt has a lot of boney overgrowth/arthritis the surgeon may need to remove bone from both sides of the spinous process usually at 3 or 4 levels (not just one); this is called a decompressive laminectomy because they are decompressing/removing the pressure on the spinal cord some times requires a spinal fusion.
  124. Herniated disk


    Spinal Fusion
    is the insertion of a wedge-shape piece of bone or bone chips between the vertebrae to stabilize them. Bone is usually taken from a pt donor site such as hip bone.

    Pt must wear brace while back heals.
  125. Herniated disk


    anterior Cervical Fusion
    • Surgeon use anterior approach
    • pt shouldnt have any nsaids can cause a hematoma and smoking can interfer with healing or affect airway clearance.

    Be concerned with arms or hands for numbness and tingling which can be never damage.
  126. nursing dx
    • Acute pain.
    • chronic pain.
    • constipation.
    • limited mobility.
    • Self care deficit, esp elderly.
  127. Spondylolisthesis
    a forward dislocation of one vertebra over the one beneath it producing pressure on spinal nerves.
  128. spondylolysis
    small fx on the back of the spine most commonly in low back.
Card Set
Muskuloskeltal Disorders