ADULT HEALTH musculoskeletal system

Terms in this set (76)

Achilles tendonitis - pain in posterior leg with movement but can progress to pain at rest - results from cumulative stress on tendon
Ankylosis - stiffness and fixation of a joint - results from chronic joint inflammation
Antalgic Gait - shortened stride with little weight bearing on the affected side - may be related to trauma or inflammatory processes
Ataxic Gait - Staggering, uncoordinated gait generally associated with neurological disorders
Atrophy - flabby appearance of muscles leading to decreased function and tone - results from muscle denervation, contracture, prolong disuse
Contracture - resistance of movement of muscles or joint as a result of shortening of muscles or ligaments
Crepitation - audible cracking or grating sound with movement associated with fracture, dislocations, joint dysfunction and osteoarthritis
Dislocation - bone displacement from its normal joint resulting from trauma or disorders of the surrounding soft tissue
Festinating gait - quick, shuffling gait with flexed neck, trunk, knees and rigid body; associated with Parkinson's disease and neurogenic disorders
Ganglion Cyst - small fluid filled bump or mass over a tendon, sheath or joint resulting from inflammation
Lateral epicondylitis - tennis elbow
dull ache along outer aspect of elbow
Myalgia - general muscle tenderness and pain
Parethesias- numbness, tingling
Pes Planus - ( Flat foot) results from heredity, muscle paralysis, and muscular diseases
Plantar Fasciitis - Burning, sharp pain on sold of foot worse in the morning - chronic degenerative/reparative cycle in inflammation
Scoliosis - asymmetric elevation of shoulders, scapulae and iliac crest resulting from congenital anamoly, fracture, dislocation or osteomalacia
Short Leg Gait - limp resulting from leg length discrepancy of 1 inch or more
Kyphosis - Dowager's Hump - forward bending of thoracic spine with exaggerated thoracic curvature - poor posture, TB, inflammatory disorders
Lordosis - Asymmetric scapulae and shoulders with exaggerated lumbar curvature
Subluxation - partial dislocation of joint resulting from trauma, arthritis
Torticollis - (wryneck) neck twisted to one side
Ulnar deviation - ( ulnar drift) fingers drift to ulnar side of forearm often seen with arthritis
-generally takes around 6 weeks for a bone to heal
-kids heals a lot faster than adults, sometime children will get fractures in the growth plate and cause the bone to keep growing, more severe bc the child can have limb length discrepancy
Bone goes through a complex multistage healing process (termed union) that occurs in the following stages:
1) Fracture hematoma. When a fracture occurs, bleeding creates a hematoma, which surrounds the ends of the fragments. The hematoma is extravasated blood that changes from a liquid to a semisolid clot. This occurs in the initial 72 hours after injury.
2) Granulation tissue. active phagocytosis absorbs the products of local necrosis. The hematoma converts to granulation tissue. Granulation tissue (consisting of new blood vessels, fibroblasts, and osteoblasts) produces the basis for new bone substance called osteoid during days 3 to 14 postinjury.
3) Callus formation. As minerals (calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is primarily composed of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified by x-ray.
4) Ossification. Ossification of the callus occurs from 3 weeks to 6 months after the fracture and continues until the fracture has healed. Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed. However, the fracture is still evident on x-ray. During this stage of clinical union, the patient may be allowed limited mobility or the cast may be removed.
5) Consolidation. As callus continues to develop, the distance between bone fragments diminishes and eventually closes. During this stage ossification continues. It can be equated with radiologic union. Radiologic union occurs when there is x-ray evidence of complete bony union. This phase can occur up to a year following injury.
6) Remodeling. Excess bone tissue is reabsorbed in the final stage of bone healing, and union is completed. Gradual return of the injured bone to its preinjury structural strength and shape occurs. Bone remodels in response to physical loading stress or Wolf's law. Initially, stress is provided through exercise. Weight bearing is gradually introduced. New bone is deposited in sites subjected to stress and resorbed at areas where there is little stress.
-generally in place for longer periods than skin traction, is used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia.
-It provides a long-term pull that keeps the injured bones and joints aligned.
-To apply, the physician inserts a pin or wire into the bone, either partially or completely, to align and immobilize the injured body part. have some kind of pin care you have to do, generally cleaned with peroxide
-Weight for skeletal traction ranges from 5 to 45 lbs (2.3 to 20.4 kg).
-The use of too much weight can result in delayed union or nonunion.
-The major disadvantages of skeletal traction are infection in the area of the bone where the skeletal pin is inserted and the consequences of prolonged immobility.
-For extremity traction to be effective, forces must be pulling in the opposite direction (countertraction).
-Fracture alignment depends on the correct positioning and alignment of the patient while the traction forces remain constant.
-Countertraction is commonly supplied by the patient's body weight or by weights pulling in the opposite direction and may be augmented by elevating the end of the bed.
-It is imperative to maintain traction continuously and keep the weights off the floor and moving freely through the pulleys.
-Keep weights off the floor.
*When traction is used to treat fractures, the forces are usually exerted on the distal fragment to obtain alignment with the proximal fragment.
One of the more common types of skeletal traction is balanced suspension traction*
- Temporary, commonly used after a closed reduction
- Allows patient to perform many normal activities of daily living while providing sufficient immobilization to ensure stability.
- Made of various materials
- Typically incorporates joints above and below fracture, allows stabilization and give healing time to occur
-Immobilization above and below a joint restricts tendon and ligament movement, therefore assisting with joint stabilization while the fracture heals.
- Affected part covered with stockinette that is cut longer than the extremity.
-Padding is then placed over the stockinette with the bony prominences given extra padding.
- Plaster of paris material immersed in warm water, wrapped and molded around the affected part.
- Set in 15 minutes, after it is dry check neurovascular status to make sure they can move things, have feeling and not a lot a swelling, not too tight. Assess circulation and nerve function cast can be too tight
-it is not strong enough for weight bearing until about 24 to 72 hours after application. (The decision about weight bearing is determined by the physician.)
-A fresh plaster cast should never be covered because air cannot circulate, heat builds up in the cast that may cause a burn, and drying is delayed.
-Avoid direct pressure on the cast during the drying period.
-Handle the cast gently with an open palm to avoid denting the cast.
-Once the cast is thoroughly dry, the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of paris debris from falling into the cast and causing irritation or pressure necrosis.
-Several strips (petals) of tape are placed by the health care provider over the rough areas to ensure a smooth cast edge.
-elevate above the heart for the first 24-48 hr prevent edema, drainage should be noted and monitored for changes
-Casts made of synthetic materials are being used more than plaster because they are lightweight, stronger, relatively waterproof, and provide for early weight bearing.
-The synthetic casting materials (thermolabile plastic, thermoplastic resins, polyurethane, and fiberglass) are activated by submersion in cool or tepid water. Then they are molded to fit the torso or extremity.
long term process, great risk for infection, used when trying to salvage an extremity that otherwise might be amputated
-An external fixator is a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals.
-It can be used to apply traction or to compress fracture fragments and to immobilize reduced fragments when the use of a cast or other traction is not appropriate.
-The external device holds fracture fragments in place similar to a surgically implanted internal device.
Patient teaching and nursing actions
-Assess for pin loosening and infection. and notify the Dr.
-Pin site care every 8 to 12 hours, monitor for drainage, color, odor, redness
-elevate extremity, monitor neurovascular status and skin integrity
-observe for signs of a fat or pulmonary embolism
-provide TED hose and SEC devices
-if activity is reduced teach the pt to perform deep breathing and leg exercises and other techniques to prevent immobilization complications
-often used in an attempt to salvage extremities that otherwise might require amputation.
-Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical.
-Infection signaled by exudate, erythema, tenderness, and pain may require removal of the device.
-Instruct the patient and caregiver about meticulous pin care.
-Although each physician has a protocol for pin care cleaning, half-strength hydrogen peroxide with normal saline is often used.
-a condition in which there is swelling and an increase in pressure within a limited space (a compartment) that presses on and compromises blood vessels, nerves, and/or tendons that run through that compartment.
-Prolonged pressure may result when someone is trapped under a heavy object or a person's limb is trapped beneath the body because of an obtunded state such as drug or alcohol overdose
-may occur initially from the physiologic response of the body to the injury, or it may be delayed for several days after the original insult or injury.
-Decreases viability and function of tissue within the space
-Causes capillary perfusion to be reduced below a level necessary for tissue viability.
-Tissue damage can occur within 30 minutes, can lose limb without treatment
- greater than 4 hours irreversible damage
-Usually involve the leg but can also occur in the arm, shoulder, and buttock.
-Fractures of the distal humerus and proximal tibia are the most common fractures
-injury can also occur following knee or leg surgery.
-38 compartments in upper and lower extremities
-Two basic causes of compartment syndrome
-↓ Compartment sizee*, resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia
-↑ Compartment contentss*, related to bleeding, inflammation, edema, or IV infiltration.
-Arterial flow compromised → ischemia → cell death → loss of function
-Edema can create sufficient pressure to obstruct circulation and cause venous occlusion, which further increases edema. -Eventually arterial flow is compromised, resulting in ischemia to the extremity.
-As ischemia continues, muscle and nerve cells are destroyed over time, and fibrotic tissue replaces the healthy tissue. Ischemia can occur within 4 to 8 hours after the onset
-Compromises neurovascular function of tissues within that space
-Contracture, disability, and loss of function can occur.
-Delays in diagnosis and treatment cause irreversible muscle and nerve ischemia, resulting in a functionally useless or severely impaired extremity.
-Most commonly associated with trauma, fractures (especially the long bones), extensive soft tissue damage, and crush injury.
Prompt, accurate diagnosis is critical.
-Perform and document regular neurovascular assessments on all patients with fractures, especially those with an injury of the distal humerus or proximal tibia or soft tissue injuries in these areas.
-Early recognition and effective treatment of compartment syndrome are essential to avoid permanent damage to muscles and nerves.
-Carefully assess the location, quality, and intensity of the pain.
-Evaluate the patient's level of pain on a scale of 0 to 10.
-Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications
-Pulselessness and paralysis (in particular) are later signs.
-Notify the health care provider immediately of a patient's changing condition.
nursing actions
-Because of the possibility of muscle damage, assess urine output.
-Myoglobin released from damaged muscle cells precipitates and causes obstruction in renal tubules.
-This condition results in acute tubular necrosis and acute kidney injury.
-Common signs are dark reddish brown urine and clinical manifestations associated with acute kidney injury.
-Elevation of the extremity may lower venous pressure and slow arterial perfusion. the extremity should not be elevated above heart level.
-Similarly, the application of cold compresses may result in vasoconstriction and exacerbate symptoms, DO NOT DO
- It may also be necessary to remove or loosen the bandage and split (bivalving) the cast in half.
-A reduction in traction weight may decrease external circumferential pressures.
-Surgical decompression (e.g., fasciotomy) of the involved compartment may be necessary.
-The fasciotomy site is left open for several days to ensure adequate soft tissue decompression.
-Infection resulting from delayed wound closure is a potential problem following a fasciotomy.
-In severe caseS, an amputation may be required.
- Early recognition of FES is crucial to prevent a potentially lethal course.
-Most patients usually manifest symptoms within 24 to 48 hours after the injury. Severe forms have occurred within hours of injury.
- after a long bone fracture need to assess them for the first 12 to 72 hours for signs and symptoms; headache, mental status changes, feeling of impending doom, increased pulse and fever, trouble breathing, using accessory muscles
- Fat globules transported to lungs cause a hemorrhagic interstitial pneumonitis.
-The fat emboli in the lungs cause a hemorrhagic interstitial pneumonitis that produces signs and symptoms of acute respiratory distress syndrome (ARDS), such as chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and decreased partial pressure of arterial oxygen (PaO2)
-Bc of poor oxygen exchange. changes in mental status (a result of hypoxemia) are important to recognize. Memory loss, restlessness, confusion, elevated temperature, and headache should prompt further investigation so that central nervous system involvement is not mistaken for alcohol withdrawal or acute head injury.
- Cutaneous Petechiae - neck, chest wall, axilla, buccal membrane, conjunctiva may appear due to intravascular thromboses caused by decreased oxygenation.
- Clinical course of fat embolus may be rapid and acute emergency situation
- Patient frequently expresses a feeling of impending disaster.
- In a short time skin color changes from pallor to cyanosis the patient may become comatose.
No specific lab test but things to aid in diagnosis:
- Fat cells in blood, urine, or sputum
- ↓PaO2 < 60 mm Hg
- ST segment changes
- ↓ platelet count and hematocrit levels
- Prolonged prothrombin time
- Chest x-ray may reveal areas of pulmonary infiltrate or multiple areas of consolidation → white out
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