Musculoskeletal

It is the breakdown of bones by osteoclasts

bone development

osteoclasts breakdown the bone causing bone resorption

internal visualization of joints

• Pt. has:
• joint swelling
• pain
• crepitus
• joint instability

• teach post procedure exercises or
• refer to PT
• ensure pt. has signed consent
• reinforce explanation of the procedure

• It's done on outpatient basis
• Assess neuro status
• Assess dressing of limb-CSM
• Teach pt to ice and elevate the extremity
• Teach pt. to take PRN analgesics

• excessive swelling
• increased joint pain
• thrombophlebitis
• infection

Infection...notify Dr. immediately of swelling, redness or fever

Mainly hairline bone fx but also....

• tumors
• osteomyelitis
• osteoporosis

2-3 hrs before scan radioactive materials injected in to pt.

dx diseases of brain, liver, bone cancer and breast cancer, arthritis, fractures

Radionucleotides are injected in to the patient 4-6 hrs before scanning.  The radioisotope  migrates toward the above mentioned tissues

Bone pain

• Assess for allergy to radioisotope
• Prego?
• **Kidney Disease

• 30-60 minutes and they must hold still....so may be sedated. 
• Empty your bladder!!!

Drink lots of fluids to excrete radioisotope in urine and feces

bone mass

Clients are give a score that relates their amount of bone density to that of other people in their age group and gender

• Baseline postmenopausal (40 yo)
• Osteoperosis?
• Loss of height?
• Bone pain?
• Fractures?

• Myasthenia Gravis
• Guillian Barre
• Carpel Tunnel
• Neuromuscular Disorders

thin needles are placed in the muscle and attached to electrodes.  Electrical activity is recorded during a muscle contraction.

anticoagulants and muscle relaxers

tape flat electrodes to the skin and shoot a low electrical current through them and the muscle will respond

Nerve conduction study

• Fractures
• Persistent pain
• Posture changes that restrict client activities and ability to perform ADL's

when pressure within one or more of the muscle compartments of an extremity compromises circulation, resulting in ischemia-edema cycle

edema will occur that will reduce blood flow to the area and cause ischemia and compromising neurovascular status.....NECROSIS

• tight cast
• constrictive, bulky dressing
• internal source-accumulation of blood or fluid within the muscle compartment

• 5 P's....
• Pain
• Paralysis
• Paresthesia-tingly
• Pallor
• Pulselesness

4-6 hrs

• Fasciotomy to relieve pressure
• Loosen dressings
• Teach pt to report tingly, numbness

Adults 70-80 y/o

Person with hip or pelvis fx

usually within 48 hrs following long bone fx or with total joint arthroplasty.

fat globules from the bone marrow are released into the vasculature and travel to the sm. blood vessels (lung) resulting in acute respiratory insufficiency and organ perfusion

• Dyspnea
• Chest pain
• Decreased O2 sat
• Decreased mental status
• Resp. Distress
• Tachycardia
• Tachypnea
• Fever

Early-decreased mental acquity (low ABG)

Late-cutaneous petachie on neck, chest, upper arms and abdomen

• Stay in bed
• O2
• Admin. corticosteroids for edema and vasopressors
• Fluid replacement
• Pain management

• TEDS
• Sequentials
• admin anticoagulants
• encourage fluids
• perform ROM

an infection of the bone that begins as an inflammation within the bone secondary to penetration by infectious organism following trauma or surgery

when after a fx a person has circulatory compromise which results in ischemia and leads to tissue/bone necrosis

person on long term corticosteroids

replace the damaged bone with a bone graft or prosthesis

when a fracture hasn't healed after 6 months of the injury....seen mostly in older adults

Malunion...fx heals incorrectly

Nonunion...fx that never heals

• Blood loss requiring transfusion
• DVT
• PE
• Cardiac complications
• Systemic complications-pneumonia, renal failure, stroke and sepsis
• INFECTION

• Drainage/odor
• Redness
• Positive wound culture
• Increased discomfort at suture line

• FEVER, CHILLS
• INCREASED HR
• DECREASED BP
• Delayed wound healing

• Poor or inadequate nutrition
• Poor blood flow....related to smoking?
• Decreased cardiac output limiting circulation

send to a pain clinic for pain management

abnormal flexion and fixation of a joint caused by muscle atrophy and shortening

Active and Passive ROM exercises and teach pt to avoid long periods of sitting

Above the knee amputee

• Correct V. D deficiency by.....
• diet
• supplements
• sunlight exposure
• wt bearing exercise

• eggs
• meat
• oily fish
• milk
• breakfast cereal Fortified with calcium and V. D

• loss of bone mass
• increased bone fragility
• increased risk for fx

It is an imbalance of processes that influence bone growth and maintenance associated with aging

endocrine and malignancies

• hip
• wrist
• vertebrae

• the diameter of bone increases....
• thinning supportive cortex....
• causing loss of trabeculae and thinning of outer cortex.....

Result-minimal stress leads to fx

• loss of height
• progressive curvature of the spine
• low back pain
• fx of forearm, spine or hip

• dorasal kyphosis
• cervical lordosis
• dowager's hump

• Small framed women
• Age
• Menopausal
• Pregnancy and breast feeding

25-35

• Hyperparathyroidism
• Cushings Syndrome
• DM

• Calcium supplements
• Estrogen replacement
• Stop smoking cigarettes
• Stop drinking alcohol excessively
• EXERCISE

• corticosteroids
• anticonvulsants
• prolonged heparin therapy
• antiretroviral

seen in older persons and women past menopause in which bone loss is accelerated over that predicted for their age and sex

results from a variety of identifiable conditions...drugs, hormones

• Stop or slow down osteoporosis
• Alleviate symptoms
• Prevent complications

reduces bone loss, increases bone density in spine and hip, reducing risk of fractures in postmenopausal women

Recommended for women who have undergone surgical menopause before age 50

Hormone replacement therapy consists of estrogen and progestin and is associated with increased risk for CV disease and BREAST and UTERINE CANCER

Evista

• hot flashes
• leg cramps
• blood clots

Reclast

• Flu symptoms for the first few days following admin.
• Precaution with taking biphosphonates

• Take with a full class of water
• Take 30 minutes before food or other meds
• MUST remain upright for at least 30 min after taking!!!!

• Fosamax
• Boniva

IM, Subq or intranasal

Intranasal....alternate nostrils and watch for dryness

IM and Subq....give at night to decrease side effect of nausea and facial flushing

Men and women at risk for fx

• Subq injection 1/day
• Side effects-leg cramps and dizziness
• If you use for more than 2 years you will have an increase for osteosarcoma

Prevent and educate those under age 35

Prevent complications in those with disease

• 19-50 y/o- 1000mg
• 51-65 y/o-1200mg
• 65+ y/o-1500 mg

• caffeine....limit coffee to 2-3 cups /day
• Diet soda

infection of the bone or bone marrow...acute or chronic

Infection from the blood, local infection like cellulitus or trauma including joint replacement or internal fixation of a fx

• leukocytes engulf the organism and they release enzymes that lyse the bone....
• pus spreads to bones blood vessels impairing blood flow....
• absess is formed....
• body tries to create new bone around area of necrosis....

Constant bone pain, warmth and swelling

Local-pain that is unrelieved by rest and worsens with activity....signs of drainage from the signs tract to the skin and fracture site.

• WBC
• ESR
• X ray
• Bone Scan
• MRI
• Biopsy of soft tissue or bone

• Prolonged antibiotic therapy for 6-8 weeks
• (fluoroquinolones) in a PICC line
• Debridement
• Wound vac
• Amputate?
• Pain Management
• HBO Therapy
• Sterile dressing change

• Prolonged antibiotic treatment for 4-6 weeks in a PICC line
• Immobilize joint, body part
• Prevent/Correct further deformities

• Prevent or reduce muscle spasms
• Immobilization of a joint/body part
• Reduce fracture or dislocation
• Realignment of bone fragments
• Prevent or correct further deformities

• Alignment at the DISTAL fragment to the PROXIMAL fragment
• Remains constant
• Allows for adequate exercise, movement and diversion

• Monitor skin integrity and pin sites for infection...including under bandaids
• Monitor neurovascular....CSM
• Keep in mind hazards of immobility

q2h

when the patient experiences severe pain from  muscle spasms and its unrelieved with meds and/or repositioning.

they have an increased risk for impaired skin integrity due to the loss of elasticity of the skin and decreased sensation.

Especially lower extremities

by blowing cool air from a hair dryer under the cast

• PVD
• Trauma is a major cause of upper extremity amputation

amputation performed through a joint

the removal of a foot with the ankle saved

this is done when an active infection is present.  The wound remains open to drain and the skin flap is closed at a later date

When the wound is closed with the flap of skin sutured in place over the stump to create a weight bearing residual limp or stump

Cuz it requires a lot of energy to use for ambulation

• Preserve length and function of extremity
• Remove all infection, pathologic or ischemic tissue
• Improve possibility of good prosthetic, cosmetic and function satisfaction

it is determined by level at which there is adequate blood flow for healing.

• Angiography
• Dopler laser
• Ultrasonography
• Transcutanous oxygen pressure (TcPO2)
• Ankle Brachial Index

• Mostly done for those that have time...
• Strengthen upper body
• Improve Nutritional status
• Stabilize chronic medical conditions
• Counseling?
• Mt. with Prosthetic Specialist

• Watch for irritation/infections
• D/c use of prosthesis if stumps irritated
• Wash residual limb each night with warm water and bacteriostatic soap. Rinse thoroughly and dry gently.
• Expose stump to air for 20 min.
• No LOTIONS, ALCOHOL, POWDERS
• Wear only residual limb sock and change daily
• Pain Management
• ROM exercises

Elevate on a pillow....lay prone with hip in extension for 30 minutes 3-4 xs daily

osteomalacia is a defect in bone building and osteoporosis is a weakness of existing bones

rickets

estrogen-endometrial cancer

estrogen and progestin-cv disease, breast and uterine cancer

because they haven't had their uterus removed

esophitigis

postmenopausal women with osteoporosis at high risk for fractures

subcutaneous injection every 6 months

they have had an infection in the bone for more than 1 month and it hasn't responded to antibiotic therapy

because they will have pain in the bone that is unrelieved by rest and worsens with activity