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Musculoskeletal and Connective Tissue Disorder- Nclex

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