Musculoskeletal NUR106

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  1. X-Ray
    Pregnancy risk also first line and cost effective.
  2. CT
    ask about iodine or shellfish allergy
  3. MRI
    No metal objects, ask about implants such as pacemakers
  4. Arthroscopy
    looking into the joint, monitor site of incision
  5. 5 P
    • Pain
    • Pulse
    • Pallor
    • Paresthesia
    • Paralysis
  6. S&S of fractures
    • Obvious deformity
    • swelling
    • pain
    • redness
    • loss of function
    • misalignment
    • hematoma
  7. Bone healing times
    • neonatal 2-3 weeks
    • early child hood 4 weeks
    • later child hood 6-8 weeks
    • adolescence 8-12 weeks 
    • adults 12 weeks
  8. ABCDE
    • Airway
    • breathing
    • circulation-C1-C4. C3,4,5 Keep the phrenic nerve alive.
    • disability
    • exposure
  9. Hemorrhagic shock
    Loss of 20% of blood or more will lead to decompensated shock
  10. H/H Lab
    Hemoglobin and Hematocrit
  11. TDaP
    Adults every 10 years. possible prophylaxis booster at 5 years if needed-break in skin.
  12. Reduction
    Realign bones to restore neurovascular function. Under conscious sedation at times.
  13. Immobilization
    Splints, casts, ORIF-Open reduction internal fixation.
  14. External Fixator
    Crush injuries-shattered bone-
  15. External fixator and pin care risks
    Osteomyelitis-Infection of the bone- Proper cleanliness for pins in order to prevent this.
  16. Tractions
    Of major long bones for pain relief and to help neurovascular.
  17. ESR (erythrocyte sedimentation rate)
    ­Early indicator of widespread inflammatory reaction due to infection or autoimmune disorders­Usually normal in OA
  18. HS-CRP (high sensitivity C-reactive protein)
    ­Non-specific response to acute inflammation­Increase after surgery indicates possible infection­Shows inflammation earlier than ESR
  19. Serum chemistry for bones
    • 99% of calcium stored in bones and teeth
    • 85% of phosphorous stored in bones and teeth
    • Bone disease can lead to an increase in the blood of hypercalcemia and hyperphosephatemia
  20. Lab values for Muscle
    • CK-Creatine Kinase for skeletal and cardiac muscle
    • CPK-MM-Creatine phosphokinase for skeletal muscle
    • LDH- HS-CRP (high sensitivity C-reactive protein)
    • ­AST (liver, kidney, heart, skeletal muscles)
  21. Osteoarthritis treatments
    • Early treatment-Rx for swelling, PT, Waterarobics, RICE for trauma, Injections of corticosteroid.
    • Late treatment-TKA
  22. Osteoarthritis
    OA Nursing care
    • Degeneration of the articular cartilage in the joints caused by prolonged wear & tear of joint surfaces
    • -Care
    • Assess
    • Administer
    • Apply
    • Teach
  23. Multi_Model_Pain_Protocal
    • M2P2
    • designed to prevent narcotic overdoses
  24. DVT post surgery
    • increased calf pain
    • increased tenderness above or below the knee
    • Veins you can see
    • Warmth and redness
  25. Osteoporosis
    • Primary-part of aging 
    • Secondary-Medical conditions, drug therapy-prednisone leads to this condition-prolonged immobility-not weight bearing.
  26. Test for Osteoporosis
    DEXA scan-duel energy x ray measures bones mineral density.
  27. Nursing care for osteoporosis
    Teach importance of wt Bearing exercise
  28. Risks associated with osteoporsis
    • excessive caffeine-calcium loss in  urine
    • lack of vitamin D for calcium uptake
    • high phosphorus intake-low calcium levels
    • protein intake too high or too low
    • excessive alcohol and tobacco use
    • eating disorders and female athletes-triad.
  29. Calcitonin
    stimulates osteoblasts
  30. vertebroplasty
    percutaneous-injection of bone cement into vertebra which reduces pain, increases function, restores strength.
  31. Osteoporosis
    example of a pathologic fracture leading to a fall in a geriatric patient.
  32. rheumatoid arthritis
    • Autoimmune disorder-women more prone
    • debilitating
    • iritis
    • Chronic systemic disease of autoimmune cause with recurrent inflammation involving the synovium or lining of the joints
  33. rheumatoid arthritis labs
    • rheumatoid factor RF
    • antinuclear titer ANA
    • Erythrocyte sedimentation rate ESR
    • High sensitivity C-reactive protein hsCRP
  34. Nursing Care for RA
    • Assess pain and stiffness
    • administer anti-inflammatory medications
    • aspirin, nsaids,corticosteroids
    • implement strategies to protect joints-water aerobics
  35. Vitamin D importance
    • synonym=cholecalciferol=vitamin D3 sunlight
    • VIT D +Parathyroid Hormone+Calcitonin regulate calcium metabolism and osteoblasts.
    • Ergocalciferol=Vitamin D2 absorbed from plants

    deficiency Leads to increase risk of heart attack, fractures, hypertension and autoimmune diseases.
  36. Gout
    • Deposit of urate (uric acid) crystals in & around joints; hereditary error in purine metabolism
    • S&S
    • Tophi (deposits of crystals on skin) present near joints & on outer ear; renal calculi
    • Meds to treat Uric acid build up.
    • ­Colchicine for acute treatment­
    • NSAIDS for inflammation
    • ­Allopurinol for chronic treatment
  37. Gout Lab tests
    • Serum Uric acid Levels
    • 20% of patients develop kidney stones
  38. Pediatric conditions
    • club foot-congenital twisting of the foot
    • developmental dysplasia of the hip DDH- Congenital hip-Spica cast
  39. Legg-Calve-Perthes
    Avascular necrosis of the femoral heads occurs in childhood
  40. Osteomalacia and rickets
    Softening of the bones due to demineralization-due to a deficiency of calcium and vitamin D. chronic renal failure also a risk factor.
  41. Image Upload 1
    Avulsion: tearing away by force-ex. skateboard tricks or a sprined ankle.
  42. Image Upload 2
    Communited: broken into pieces-ex. gunshot wound or crush injury.
  43. Image Upload 3
    Greenstick: One side of bone, not a complete break. ex-bending a live tree branch vs a dead one.
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    Compound: Open wound
  45. Image Upload 5
    Compression: squeezed together leading to Fx.
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    Depressed:Below normal level
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    Displaced: removed from normal
  48. Image Upload 8
    Transverse: crosswise
  49. Image Upload 9
    Impacted: packed together
  50. Image Upload 10
    Oblique: slanting/diagonal
  51. Image Upload 11
    Simple: Closed fracture/ not displaced
  52. Image Upload 12
    Spiral: like a thread of a screw
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Musculoskeletal NUR106
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