Musculoskeletal System

  1. Arthography
    used to see acute or chronic tears of the joint capsule or ligaments of the knee, shoulder, ankle, or wrist
  2. Arthography procedure
    • radioplaque injected to joint cavity
    • joint put to ROM to distribute agent
    • x-rays are taken

    *note - contrast agent will leak from joint cavity if tear is present for 1-2 days
  3. rnsg interventions
    • normal to hear clicking/cracking in joint for 1-2 days
    • joint rested for 12 hrs
    • compression elastic bandage applied
    • assess for allergies to contrast agent if used
  4. arthrography contraindications
    • pregnancy
    • claustrophobia
    • inability to tolerate position due to age
    • debility or disability
    • metal implants
  5. Bone densitometry
    used to estimate bone mineral density (BMD)
  6. DXA or DEXA
    used to estimate extent of osteoporosis and monitor pt's response to osteoporosis tx
  7. Bone scan
    to detect metastatic & primary bone tumors, osteomyelitis, fractures, & aseptic necrosis

    *radioisotope injected IV - scan done 2-3 hrs after injection
  8. bone scan interventions
    • possible allergies to radioisotope
    • contraindicated to pregnant women
    • drink lots of fluids to distribute & eliminate the isotope
    • empty bladder bec a full bladder interferes w/ accurate scanning of pelvic bones
  9. Arthroscopy
    • direct visualization of a joint (joint structures, synovium, articular surfaces)
    • used to diagnose joint disorders
  10. Arthroscopy can?
    repair/treat tears, defects, and disease process through arthroscope
  11. arthroscopy complications (rare)
    • infection
    • hemarthrosis
    • neurovascular compromise
    • thrombophlebitis
    • stiffness
    • effusion
    • adhesions
    • delayed wound healing
  12. arthroscopy interventions
    • joint wrapped w/ compression dressing to control swelling
    • ice to control edema & promote comfort
    • joint extended/elevated to reduce swelling
    • adm analgesics
  13. arthroscopy s/s of complications
    • swelling
    • numbness
    • cool skin
  14. Arthrocentesis
    joint aspiration to obtain synovial fld for examination or relieve pain d/t effusion
  15. arthrocentesis helpful to diagnose what?
    • (synovial fluid)
    • septic arthritis
    • inflammatory arthopathies
    • bleeding
    • pain from effusion
  16. Synovial fld
    • clear
    • pale
    • straw colored
    • scanty in volume
  17. arthrocentesis rnsg
    • sterile dressing applied
    • risk for infection
  18. Casts
    • used to
    • immobilize reduced fracture
    • correct deformity
    • apply uniform pressure on soft tissue
    • support and stabilize weakend joints
  19. Fiberglass cast
    • let pt know to expect increasing warmth
    • don't put on hard/sharp edges while drying
  20. Plaster cast
    • less costly
    • better mold than fiberglass
    • will also produce heat
    • crystallization process takes 15-20 mins
    • 24-72 hrs to completely dry
  21. Splints and braces
    may be used after cast
  22. Splints
    • do not require rigid immobilization
    • used when swelling is anticipated or require special skin care
  23. Braces
    • used to provide support, control movement, prevent addtl injury
    • for longer use than splints
  24. General nrsg mngt for cast, splint, brace
    • assess neurovascular status
    • consider swelling, bruising, skin abrasions
    • let pt know what to expect with procedure
    • assess pain (character & intensity)
    • most pain can be relieved by elevation, cold packs, analgesics
  25. Potential complications r/t casts, braces, splints
    compartment syndrome: vascular insufficiency & nerve compression d/t unrelieved swelling can result in compartment syndrome. it occurs when there is increased tissue pressure w/in a limited space that compromises circulation and fn of tissue
  26. to relieve pressure compartment syndrome
    • call md
    • bivalve cast while extremity elevated no highter than the heart
    • if pressure not relieved - fasciotomy required
  27. Other complications - pressure ulcers
    • pressure or inappropriate application may cause tissue anoxia or pressure ulcers.
    • lower extremities are more susceptible - heel, malleoli, dorsum of foot, head of fibulla, and anterior surface of patella
  28. S/S of pressure ulcer with cast
    • pain
    • tightness in area

    • a warm area suggests erythema
    • may give foul odor
  29. External fixation device
    • used to manage open fractures w/ soft tissue damage
    • provides stable support for severe comminuted fractures while permitting active tx
    • fracture is reduced, aligned, immobilized by pins in bone (humerus, forearm, femur, tibia & pelvis)
    • facilitates pt comfort, early mobility, active exercise of adjacent uninvolved joints
  30. external fixation implications
    • *disturbed body image and risk for infection
    • neurovascular status q 2-4 hrs
    • assess pin site q 2-4 hrs for redness, drainage, tenderness, pain and loosening of pins
    • clean each pin 1-2x a day w/ cotton w/ chlorhexidine
  31. Traction
    application of pulling force to part of body
  32. traction is used to
    • minimize muscle spasms
    • reduce, align, and immobilize fractures
    • reduce deformity
    • increase space between opposing surfaces

    • may need to use more than one to achieve desired line of pull (vector force)
    • used until external/internal fixation are possible (-> short term)
  33. Principles of effective traction
    • counter-traction must be used
    • must be continuous
    • never interrupted (skeletal)
    • weights not removed unless intermittent
    • good body alignment
    • ropes unobstructed
    • weights freely hanging
  34. Buck's traction
    • is a type of skin traction (non-invasive)
    • controls spasms
    • immobilizes area before sx
  35. skin traction interventions
    • avoid wrinkling, slipping of traction bandage
    • maintain counter traction & positioning (don't turn side2side)
  36. skin breakdown prevention - skin traction
    • remove boot & inspect skin 3x daily
    • palpate area to detect tenderness
    • provide back care q2 hrs
    • use air-filled mattress
  37. Nerve damage prevention - skin traction
    • avoid pressure on peroneal nerve --> foot drop
    • assess toe & foot movement, sensation, pallor, temp, cap refill
  38. circulatory impairment prevention - skin traction
    • assess circulation w/in 15-30 min after traction is first applied then q 1-2 hrs
    • assess peripheral pulses, color, cap refill, temp,
    • **assess for DVT - calf tenderness, warmth, redness, swelling
Card Set
Musculoskeletal System
Exam III