Musculoskeletal and Connective Tissue Disorder- Nclex

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Care of the Client with Musculoskeletal and Connective Tissue- Muscles, Bones, Joints

Simple or Closed Fracture

no break in skin

Compound or Open Fracture

Skin surface is broken

Comminuted Fracture

Damage to soft tissue nerves and blood vessels

Green Stick Fracture

Only partly broken bone- often in children

Treatment for Fractures

-Splinting Above and Below the affected area, Air splints, - Elevate affected extremity. - Remove Jewelry from extremity. -Cover Open fractures wounds with Strerile dressing. -Give Antibiotics, Antithrombotics, Heprin, Narcotics, muscle relaxers. - Use traction to maintain Bone alignment.

Manual Traction

Maintained by Care givers, The process of applying tension to straighten and realign a fractured limb before splinting. Also called tension.

Skin Traction

nonsurgical method of providing necessary pull for shorter periods. This is frequently used to temporarily immobilize a part or stabilize a fracture. Applied by using elastic bandages or adhesive- Cervical, Buck's (extension), Russell's, Pelvic, Bryants.

Skeletal Traction

surgical insertion of pins or wires thru the bones is continuous and is used most frequently for fractures of the femur, tibia and cervical spine-aid in realignment- Crutchfield tong, Halo vest, 90-90.

Balanced Suspension Traction

uses more than one force of pull to raise and support the injured extremity off bed and support alignment- realigns Fx of femur pully, Thomas ring splint (under thigh), Pearson attachment (from knee down, supports leg),

Nursing Care for Tractions

- Weights must hang free. -Linens shoudl not lie on ropes. -Ropes remain within Pulley. -Assess CMS of extremity. -Maintain proper alignment. - Assess for complications: Pneumonia, DVT, pressure uclers. - Skeletal: assess for infection, Pin care with cleansing.

Cast- Nursing Care

Used to keep specific body part immobile- Nonplaster (Fiberglass)/ Plaster- Tx: Cast dry inside out, handle wet cast with Palms, Place extremity on Plastic-lined pillow, assess for "Hot" spots, relieve itching with cool blow dryer, note drainage, Assess CMS.

Compartment Syndrome- Nursing Care

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue- S/S: Pain, Pallor, Pulselessness, Paresthesia, Polar. Tx; Bivalve (cut each side of CAST) or Fasciotomy.(cut each side of LEG) to relieve pressure.

Osteomyelitis- Nursing Care

infection of bone and bone marrow causing inflammation- Tx: receive antibiotics prior to dental or other invasive procedures, immobilize, diet high in protein/ vit. C, To promote healing: (Bone Grafts: non-wt. bearing, Bone stimulator: Wt. bearing.)

Osteoporosis

abnormal loss of bony tissue resulting in fragile porous bones attributable to a lack of calcium

Osteoarthritis- Nursing Care

chronic breakdown of cartilage in the joints-S/S: Heberden's Nodes, Bouchard's Nodes, Crepitation, deformities, stiff/painful joints.- Tx: Pain relief though heat packs, losing wt, TENS, Massage,

Fibromyalgia

a chronic disorder characterized by widespread aching and stiffness of muscles and soft tissues due to fatigue sleep problems, headaches, depression, and anxiety.- Gets better through out the day and worse at night with weather change.

Ankylosing Spondyitis

chronic, progressive arthritis inflammtion with stiffening of joints between the spinal bones, and the joints between the spine and pelvis.AKA: Marie- Stumpell disease or Rheumatoid spondylitis.

Gout

a painful inflammation of the big toe and foot caused by defects in uric acid metabolism resulting in deposits of the acid and its salts in the blood and joints- develop stones- Tx: diet in Low Purine (breakfast foods- Omelet/OJ), Avoid High Purine (Dinner foods-Fish/Liver), Give Allopurinol.

Rheumatoid Arthritis

A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities from increase thickness of tissue inside joints.

Rheumatoid Arthritis- Nursing Care

S/S: Subcutaneous Nodules, warm joints, weakness, stiffness, Loss of appetite, Wt. Loss, Pleurisy, Pneumonia, Pericarditis, Iritis of eyes, Sjogren's Syndrome (Dry eyes, mouth, vagina)

Arthrocentesis

removal of fluid from a joint by centesis

Systemic Lupus Erythematosus (SLE)

chronic inflammatory autoimmune disease involving joints, skin, kidneys, nervous system (CNS), heart, and lungs- can lead to organ failure.

Discoid Lupus Erythematosus (DLE)

photosensitive, scaling, plaque-like superficial eruption of skin confined to face, scalp, ears, chest, arms, and back, which heals with scarring

Crutches Two-Point Gait

Right Leg and Left Crutch move together, Left Leg and Right Crutch move together- Allows limited weight-bearing bilaterally

Crutches Three-Point Gait

Both crutches and affected legs move at the same time- Non weight bearing on affected leg.

Crutches Four- Point Gait

Left crutch and right foot move, than right crutch and left foot move- Allows weight-bearing on both legs.

Crutches Swing through

Both crutches move forward and both legs swing through between the crutches- No weight-bearing on affected legs.

Crutches on Stairs

Up: Lead with unaffected leg, and crutches and affected leg move together (good leg first). Down: leads with crutches and affected leg (bad leg first)

Walker

Walker, Affected leg, Unaffected leg

Arthralgia

pain in a joint or joints

Contractures

A permanent shortening of the muscles, followed by shortening of the tendons and ligaments - fixing or permanently retaining that joint in one position (leads to loss of joint motion and normal use of the limb)

Crepitation

dry, grating sound or sensation caused by bone ends rubbing together, indicating a fracture or joint destruction

Arthography

radiopaque dye is injected to visualize a joint

Arthoscopy

Visualization of a joint and joint capsule through a lighted instrument

Gallium or Thallium Scan

After a administration of a radionuclide (gallium) a whole body scan is done to test for tumors and abscesses.

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