27 terms

Med. Surg. Musculoskeletal

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Identify risk factors for the development of arthritis.
heredity, aging, female gender, obesity, previous joint injury, and recreational or occupational usage of joints
Assess the patient's and family's sources of stress and coping mechanisms when living with arthritis.
The Arthritis Foundation provides some excellent printed material written with the layperson in mind. Another source of information is the Arthritis Information Clearinghouse at the National Institute of Medicine
Compare and contrast the pathophysiology and clinical manifestations of OA and RA.
Pathophysiology of RA: Chronic inflammation of synovial membranes and formation of chronic granulation tissue (pannus) in the joint; pannus capable of eroding cartilage in joints and spreading to bone, ligaments, and tendons.
OA: Microscopic changes in the cartilage in the joint; eventually there is loss of cartilage, bony enlargement, and malalignment of joints.
Subjective/objective data: RA: Morning stiffness; pain on motion; swelling and tenderness of joints; subcutaneous nodules; typical rheumatoid changes seen on radiograph
OA: Stiffness, relieved by moderate motion; joint malalignment; symptoms increase in cold, wet weather
Apply knowledge of pathophysiology to monitor for and prevent complications of total hip and knee arthroplasty.
DVT is a possible complication of joint replacement. Low-molecular-weight heparin, enoxaparin (Lovenox), dalteparin (Fragmin), or tinzaparin (Innohep) can be administered to prevent this problem. Assess for signs of thrombus formation, checking calf for warmth, swelling, and pain on foot dorsiflexion. Respiratory, encourage pt to use incentive spirometer and circulatory complications, Circulation should be checked after each application of the wedge to be certain that the straps are not too tight. Skin should be assessed every shift on the surface of the legs with particular attention to areas over bony prominences.
Teach patients and their families about the postoperative care required after a total joint arthroplasty.
• For 3 months you should not cross your legs.
• You should put a pillow between your legs when you roll over on your abdomen or lie on your side in bed.
• It is all right to bend your hip, but not beyond a right (90-degree) angle (demonstrate); avoid sitting in low chairs.
• Continue your daily exercise program at home in the same way you did the exercises at the hospital.
Teach the patient and family about home safety when the patient has a metabolic bone problem such as osteoporosis.
Determine whether alterations in pathways in the home need to be made. Scatter rugs should be removed, and furniture may need to be rearranged to offer a path wide enough to allow the patient to move from one area to another to prevent falls.
Apply principles of infection control for patients with osteomyelitis, including contact precautions if needed.
Monitor temperature and WBC count and monitor site for redness, swelling, drainage
Develop a teaching plan about ways to decrease the risk of osteoporosis.
Daily weight-bearing exercise can decrease the chance of developing osteoporosis. Walking down stairs seems to be especially helpful, but walking for 30 minutes three times a week is sufficient.
Educate the patient and family about common drugs used for bone diseases, such as calcium supplements and bisphosphonates.
Bisphosphonates
• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Etidronate (Didronel)
• Pamidronate (Aredia)
Identify key features of Paget's disease of the bone.
bone is weak and prone to fractures.
main problem is pain
The patient should avoid lifting or twisting.
Differentiate acute and chronic osteomyelitis.
This acute infection occurs predominantly in children and is often seeded hematogenously
Chronic infection that develops secondary to an open injury to bone and surrounding soft tissue, mostly happends in adults.
Prioritize care for patients with osteomyelitis
The affected limb is immobilized for complete rest.
Apply principles of infection control when caring for a patient with a compound fracture.
Should be taken to surgery w/in 6 hrs to decrease the chance of infection, Prophylactic antibiotics are usually administered
Identify community resources about amputations for patients and their families.
The Arthritis Foundation has been instrumental in working with the YMCAs
Recognize the importance of teaching the public about ways to prevent fractures and other MS injuries.
Weight training and exercise throughout life is needed to maintain bone mass, increase muscle strength, mass, agility, balance, and coordination, thereby preventing falls and consequent fractures.
Describe how to assess the patient's and family's reaction to changes in body image resulting from amputation.
Assess degree of body image disturbance, noting verbal or nonverbal clues to negative response to changes.
Assist to verbalize feelings about effect of loss on usual roles and lifestyle.
Explain how to assist patients in coping with loss of a body part
Assist patient to identify strengths and abilities and positive coping mechanisms, Demonstrate acceptance of patient and encourage significant others to do the same with touch and affection.
Encourage as much independence as possible; allow to do things for self.
Compare and contrast common types of fractures.
Complete fracture is when a bone breaks into two parts that are completely separated
An incomplete fracture is when a bone breaks into two parts that are not completely separated.
A comminuted fracture is one in which the bone is broken and shattered into more than two fragments.
A closed (simple) fracture is one in which there is no break in the skin.
An open (compound) fracture is one in which there is a break in the skin through which the fragments of broken bone protrude.
A greenstick fracture, common in children, is one in which the bone is partially bent and partially broken.
Describe the usual healing process for bone.
1. Blood oozes from the torn blood vessels in the area of the fracture; the blood clots, and begins to form a hematoma between the two broken ends of bone (1 to 3 days).
2. Other tissue cells enter the clot, and granulation tissue is formed. This tissue is interlaced with capillaries, and it gradually becomes firm and forms a bridge between the two ends of broken bone (3 days to 2 weeks).
3. Young bone cells enter the area and form a tissue called "callus." At this stage, the ends of the broken bone are beginning to "knit" together (2 to 6 weeks).
4. The immature bone cells are gradually replaced by mature bone cells (ossification), and the tissue takes on the characteristics of typical bone structure (3 weeks to 6 months).
5. Bone is resorbed and deposited, depending on the lines of stress. The medullary canal is reconstructed during consolidation and remodeling (6 weeks to 1 year).
Assess patients with MS trauma to prioritize interventions for their care.
Have you ever suffered an injury to a bone?
Have you ever experienced a severe muscle strain or muscle problem?
Is there a history of osteoporosis or arthritis in your family?
Explain the typical clinical manifestations that are seen in patients with fractures.
Pain (SUBJECTIVE),-tenderness, deformity of the bone, ecchymoses (a discoloration of the skin resulting from bleeding underneath, typically caused by bruising), crepitation with any movement, and loss of function.
Delineate nursing care needed to maintain casts, traction and external fixation for patients with fractures
Care includes maintaining good alignment of the affected leg, preventing complications of immobility, and keeping the patient comfortable with pain control measures.
Plan pain management for MS trauma.
Assess pain in systematic, objective manner and track course of pain and effectiveness of pain control.
Instruct in use of various heat and cold treatments to decrease pain.
Administer analgesic, inflammatory, and steroid medications, as ordered, to decrease pain.
Identify the risk for complications from fractures, and take measures to help prevent them.
Continued twisting, shearing, and abnormal stresses prohibit a strong, bony union.
Inadequate levels of serum calcium and phosphorus, vitamin deficiency, and generalized atherosclerosis—which deprives the healing site of adequate blood supply—also can complicate a fracture by delaying healing.
Describe how to perform focused MS and NV assessment for patients with MS trauma.
Musculoskeletal
obtain a history of the causing event so that an assessment can be made of other areas that may have been injured.
Neurovascular:
Assessment should be performed every 2 to 4 hours.
Skin color
Skin temperature
Pulses
Movement
Sensation
Pain
Capillary refill
Identify common causes of amputations.
amputation of a lower limb are related to peripheral vascular disease, often associated with diabetes mellitus, and resultant gangrene.
Plan care for patients with common types of sports-related injuries.
Rest, ice, PT w activity limitation, slings, NSAIDS and steroids
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