Bullets MSK

8/3/2019 Bullets MSK

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MUSCULOSKELETAL SYSTEM NURSING BULLETS

I. Anatomy & Physiology:

The CANCELLOUS BONE is soft and spongy, while the COMPACT BONE is hard and

dense.

FLAT BONES are responsible forprotection of organs & Hematopoiesis(Production ofRBCs, WBCs, Platelets).

RED BONE MARROW is abundant in flat bones & is responsible for Hematopoiesis.

Best site for Bone Marrow Aspiration: Iliac Crest & Sternum in ADULTS. Tibia in

CHILDREN.

EPIPHYSEAL PLATE(Growth Plate) is responsible for growth in height. Closes

between 18-25 y.o.

If the epiphyseal plate is damaged in the Fx, it will affect growth of the long

bone.

Vitamin D aids in Calcium absorption in the Jejunum. RDA: 400-800 IU/day.

Calcium & Phosphorus make the bones strong and resistant to fractures

(Compressional Strength).

RDA of Calcium: Premenopausal/Men: 1000-1200 mg/day. Post-menopausal: 1500

mg/day

TENDONS are connective tissues that attach muscles to bone.

LIGAMENTS are connective tissues that attach bones together.

ISOMETRIC CONTRACTION: Muscles contract but theres no change in muscle length.

No joint bending.

ISOTONIC CONTRACTION: Muscles change in length & contract but theres no change

in tension.

Range of Motion exercises improves ability to carry out ADLs.

HYPERTROPHYwill occur if muscle is exercised repeatedly.

ATROPHYwill occur with muscle disuse.

Bone Resorption is the transfer of Calcium from the bone to blood.

Bone Reabsorption is the transfer of Calcium from the blood to bone.

Skeletal Muscles are VOLUNTARY. While Cardiac & Smooth Muscles are

INVOLUNTARY.


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RHABDOMYOLYSIS: the escape ofmyoglobulin from damaged muscles into the

bloodstream.

There are 206 bones in the body.

II. Strain and Sprain

STrain is injury in Tendons or muscles. Also called a muscle tear.

Sprain is injury to the ligament. Management : RICES (Rest, Ice application, Compression, Elevation, Splint)

Cold and Warm applications require a doctors order. Cold application is given in the1st 24H . Intermittent Cold and Warm application on the second day. Remember: Appliedfor 20-30 minutes only.

III. Carpal Tunnel Syndrome and Tarsal Tunnel Syndrome

Cause: Constant Compression of Nerves: Median Nerve (CTS) & Posterior TibialNerve (TTS)

Dx Test: Tinels Test (tapping of wrist), Phalens test (wrist flexed),Electromyography (confirmatory)

Informed consent is needed for EMG (electromyography). Affected fingers and toes: First three digits and half of the 4th digit.

IV. Fracture

Most common fracture in Children : GREENSTICK(one side is broken, the other side isonly bent)

Most common fracture in Adults : COMMINUTED (bone is broken into 2 or more severalpieces)

COLLEs Fx: Fracture of the distal radius associated with falls.

POTTS Fx: Fracture of the distal fibula.

Principles in Fractures : IMMOBILIZE & maintain ALIGNMENT

Most Common Complication of Immobility: Deep Vein Thrombosis (DVT)

Drug to prevent DVT: Heparin & ENOXAPARIN (LOVENOX) SC anticoagulants

Dont massage the leg if there is calf pain upon dorsiflexion (Homans Sign).

Medical Management of Fractures : Reduction, Cast application, Traction

Plaster Cast dries within 24-72 hours. Carry with the PALMS of the hand while wet.Dont place in hard, firm surface because it can cause indentions, thus, pressure ulcers.

Fiberglass cast dries in 20 30 minutes. Does not lose its shape even if it gets wet.

Avoid gas forming foods in clients with Body or Spica Casts because it can lead toCast Syndrome (compression of superior mesenteric artery that leads to ischemia andnecrosis of the bowel).

Windowing: Removal of a portion of a cast to facilitate observation ofHot Spots in theskin.

Petaling: padding the edges of the cast to prevent skin abrasion. Footplate prevents footdrop.

The greater weight capacity ofSKELETAL TRACTION makes it more effective thanSkin Traction.

Nurses can only remove weights in traction if there is compromised circulation andtissue perfusion.

Earliest sign ofFES is a change in the mental status. Risk includes Long Bone,Hip, & Multiple Fractures.


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Pathognomonic sign or a distinguishing characteristic ofFES is the presence ofPETECHIA (esp in CHEST).

Earliest sign ofCompartment Syndrome is PARESTHESIA (numbness and tinglingsensation).

Surgical management for Compartment Syndrome: FASCIOTOMY(Incision of theFascia).

V. Hip Fracture Remember: S/Sx: ADDUCTION, EXTERNAL ROTATION, & SHORTENED LIMB

No hip flexion beyond 90 degrees in the first 2 months post-operatively.

Hips must be ABDUCTED using an ABDUCTOR PILLOW (Charnley Pillow).

Total Hip Replacement: replacing both the acetabulum (socket) & femoralcomponents w/ prosthesis.

Dont cross the legs, used a raised toilet seat, and avoid bending forward to avoid hipdisplacement.

VI. Amputation

Most common amputation : BKA

Amputation resulting from trauma: Guillotine amputation Common complication ofAmputation: Hemorrhage and Contracture

Emergency Equipment @ bedside after Amputation: Tourniquet

Believe the clients pain description, pain is a subjective experience.

Phantom Limb Pain (PLP) is due to nerve endings in the stump that haventadjusted to the loss of the limb.

The stump or residual limb must be elevated in the 1st 24H by elevating the foot ofthe bed.

Elastic or Ace wrap must be rewrapped 3-4 times daily.

Place the patient in the prone positiontwice or thrice dailyfor 30 to 60 minutes eachtime.

VII. Assistive Devices for Walking

Principle in going up and down the stairs: UP with the GOOD. DOWN with the BAD.

Crutch Gait that resembles Normal Walking Pattern: 2 Point Crutch Gait

Most Commonly used Crutch Gait : 3 Point Crutch Gait

The weight must be in the HAND GRIP in crutch ambulation with elbows flexed at 30degrees.

The Cane is indicated for clients with Parkinsons Disease.

Hold the Cane in the UNAFFECTED SIDE.

The Walker is the most stable of the assistive devices for walking.

VIII. Osteoporosis

Osteoporosis: Increase in Bone Resorption (Ca loss) and a decrease in BoneReabsorption (Ca Deposit).

Corticosteroids make the bones weak and fragile. Stunting of growth is the effect inchildren.

Confirmatory Diagnostic Test: Dual X-ray Absorptionmetry (DXA/DEXA).

According to the WHO: Osteoporosis is a T-Score of < -2.5

Most falls at home occur in the bedroom, so provide night light.

Main Treatment for Osteoporosis : Hormone Replacement Therapy (HRT)


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Raloxifene (Evista) is a Selective ESTROGEN Receptor Modulator that increasesBone Mass.

Biphosphonates are potent INHIBITORS ofRESORPTION. ALENDRONATE(FOSAMAX): take in the AM 30 minutes before meals, take with a full glass offluid, remain upright for @ least 30 minutes.

IX. RA, OA, GA

RA OA GAInflammatory,

Systemic

Non-Inflammatory, Non-Systemic

Inflammatory, Non-Systemic

Etiology/Theory

Autoimmune Theory Wear and Tear Theory Defective purinemetabolism

Hallmark PANNUS Formation OSTEOPHYTE formation TOPHI formation,PODAGRA

Age 20-40 y.o. 40-50 y.o. 30-40 y.o.Sex Women Women MenAffectation Bilateral Unilateral Random

Joints Small joints Weight-bearing joints Small joints; BIG TOEJoint

Stiffness

>30 mins


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-metabolic disorder of bone remodelling in which increased resorption results inbone deposits that are weak, enlarged and disorganized.

Treatment ofPagets Disease: Biphosphonates and Calcitonin

Osteomalacia: VITAMIN D DEFICIENCY IN ADULTS

Ricketts: VITAMIN DEFICIENCY IN CHILDREN

CLUBFOOT OR TALIPES EQUINOVARUS: Adduction, Plantar Flexion, Inversion of thefoot

Treatment of Clubfoot: CAST APPLICATION Bryants Traction is used for children with Congenital Hip Dysplasia,


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