2024CE_MusculoSkeletalSystem.pdf

2024CE_MusculoskeletalSystem MUSCULOSKELETAL SYSTEM Jeffry T. Sangalang, RN Physical Assessment Spine 1. Kyphosis excessive outward spinal curv...

2024CE_MusculoskeletalSystem MUSCULOSKELETAL SYSTEM Jeffry T. Sangalang, RN Physical Assessment Spine 1. Kyphosis excessive outward spinal curvature ○ Thoracic ○ Sacral Form of kyphosis in children ○ Gibbus Deformity Extremities found in children with tuberculosis / primary 1. Genus Varum complex a.k.a. “bowlegs” 2. Genus Valgum GIBBUS DEFORMITY a.k.a. “knocked knee” Toddler age physiologic in nature 2. Lordosis Excessive inward spinal curvature ○ Lumbar common in pregnant women 3. Scoliosis Side / Lateral spinal curvature Terminologies unknown cause but associated with other conditions Atrophy ○ e.g. ○ Decreased function or tone muscle atrophy Contracture ○ limited movements secondary to Back Brace Fibrosis Crepitation (Crepitus) Milwaukee Brace ○ cracking / grating sound ○ Seen in : osteoarthritis Indication: fracture ○ Scoliosis Festinating gait ○ Back Surgery ○ a.k.a.” shuffling gait” Duration of wearing: ○ rigid, does not stop ○ 18 - 23 hours Muscle Spasticity Layers (Top to bottom): ○ Rigid contractions ○ Pants Myalgia ○ Brace ○ muscle pain / tenderness ○ Undershirt Paresthesia Remove: ○ tingling or numbness ○ bathing Pes plans ○ swimming ○ Flat Foot Avoid: Plantar fasciitis ○ putting anything on top ○ inflammation of soles Problem / Risk : Torticollis ○ Impaired Skin Integrity ○ a.k.a.” wryneck” ○ twisted in abnormal position ○ seen with Tetanus infection eia  2024CE_MusculoskeletalSystem ○ Antinuclear Antibody autoimmune ○ CRP : C-reactive Protein Seen if with: injury infection inflammatio n ○ ESR : Erythrocyte Sedimentation Rate seen with : AIDs Diagnostic Tests Cancer 7. Electromyography 1. Muscle Enzymes Pins and needles used CK MM Painful / Uncomfortable Procedure ○ Creatinine Kinase Most important to diagnose: form of protein that is ○ Carpal Tunnel Syndrome supposed to be inside the cell ○ CK MM = Skeletal Muscles ○ Normals: Males = 55 -170 U/L Females = 30 - 135 U/L LDH ○ Lactate Dehydrogenase ○ Normal: 146 - 280 U/L 2. X-ray 3. Bone Scan With radiation Assistive Devices Px : Supine Indications: 1. Cane ○ specific to : fractures weight on unaffected site ○ osteomyelitis hold cane on unaffected site Not used for bone cancer waist level Post-procedure: supports opposite side ○ increase fluid ○ opposite side = weaker side ○ Avoid contact with pregnant 2. Walker and children protects client from falls based on literature : strongest assistive device AVOID, not DO NOT lift and walk Dye: hip level ○ Radio Nuclei Stairs ○ Duration in body = 72 hours ○ going up = walker at back 4. Arthroscopy ○ going down = walker at front Purpose: 3. Crutches ○ diagnostic Length ○ therapeutic ○ distance of cruch from foot partner with other 3 - 6 inches treatments (such as the taller the arthrocentesis) patient, the broader Visualize joints the stance One of common procedures under Two or three fingerbreadths below the arthroscopy = Arthrocentesis axilla (~ 4cm) 5. Arthrocentesis ○ two avoid injury / nerve Aspirate compression to brachial plexus Nursing Care (PADIS): 30-degree flexion of the arms ○ Pain relief ○ weight should be on the palms ○ Ays Pack Gaits ○ Direct Pressure ○ Four-point Gait standard : up to 6 Opposite crutch of minutes UAL > UAL > Oppostie bleeder : 15 - 20 crutch of AL > AL minutes ○ Three-point Gait ○ Immobilize one leg injured ○ Sterile Procedure crutches with AL > 6. Rheumatoid Test UAL Specific for Rheumatoid Arthritis BEST WITH INJURY RACE (Immune Response; what is ○ Two-point Gait tested) opposite crutch and ○ aRF - Anti Rheumatoid Factor leg move together autoimmune UAL first eia  2024CE_MusculoskeletalSystem ○ Swing-to almost to crutch level ○ Swing-through fastest gait past crutch level Stairs ○ UAL > crutches an ○ Good does to heaven, bad goes to hell = Three-point gait Osteomyelitis inflammation / infection of the bone low incidence rate once it’s developed, difficult to treat S/SX: ○ Localized inflammation + Fever ○ Consistent, localized, pain MGT: ○ Pain ○ Dressing change daily / PRN ○ Surgical I&D remove pus Grafting bone grafting Sequestrectomy Sequestrum = dead bone ○ TREATMENT OF CHOICE: ID-ABX ciprofloxacin / vancomycin OSTEO ○ On long-term antibiotic IV Antibiotic 4-6 weeks ○ Staphylococcus Aureus Pathophysiology ○ Tenderness on site with Fever ○ ESR = High Trauma ○ Ooperahan 1. Twisting Motion Osteoporosis Sprain ○ Ligament metabolic disease Strain ○ bone demineralization ○ Tendons and Muscles Ca 2. Disarticulation ○ bone becomes porous Subluxation Sites: ○ Partial ○ Focus of BoN : Dislocation Hips ○ Toal Spine 3. Fractures Proximal Humerus Break in the continuity of the bone Femur “valley” Pathologic Fractures ○ Fractures due to underlying condition Management Risk Factors RICES ○ Female: ○ Rest Post-menopausal ○ Ice Surgically Menopausal ○ Compression Osteopenia = T-score ○ Elevation GOLD STANDARD : DUAL-ENERGY X-RAY ○ Splint ABSORPTIOMETRY (DEXA) Medications ○ NSAIDs eia  2024CE_MusculoskeletalSystem b = build ○ Increased osteoclasts MiPAGET ○ Mithracin cytotoxic antibiotic ○ Pathologic Fractures ○ Analgesia ○ Gait problems ○ Eye and EarProblems Tinnitus / Hearing Loss Diplopia / Blindness ○ Tone Calcium Herniated Nucleolus Pulposus S/Sx: a.k.a. “Slip Disc” ○ Dowager’s Hump Pulposus = Rupture outward curvature of thoracic ○ Characteristics vertebrae Protrusion ○ Decreasing Height Compression ○ Pathologic Fracture Cause: Nursing Interventions: ○ lifting weights ○ Safety common site : L4-L5 Side Rails up ○ dermatomal involvement : extremities Lower down the bed S/Sx: Semi-Fowler’s position ○ back pain ○ Diet ○ radicular pain / sciatica Vitamin D3 + Ca To extremities Dairy Products ○ numbness / tingling Meat ○ muscle weakness ○ Activity lower extremity Weight-bearing ○ bowel or bladder dysfunction WALKING Medical Emergency : Talk test : after an AUTONOMIC DYSREFLEXIA activity, check Medical MGT: gasping of air ○ Medications Medications: NSAID ○ Hormonal Replacement Therapy Opioids usually estrogen ○ Injection Check for: Epidural Steroid Injection Breast CA /Ovarian CA Decreased CVD Inflammation ○ Thrombophl Decreased pain ebitis / DVT ○ Bed rest. Firm mattress Stroke ○ Physical Therapy ○ Bisphosphonates Surgical MGT: may cause erosive gastritis ○ Discectomy position upright removal of affected disc 1 whole glass of water ○ Microdiscectomy e.g. removal of affected disc but Fosamax smaller incision (Alendronate Na) ○ Laminectomy ○ Selective Estrogen Receptor Modulators Lamina / plate removal to (SERM) relieve pressure e.g. portion of bone Evista (Raloxifene) ○ Spinal Fusion Nolvadex (Tamoxifen permanently join together two Citrate) or more bones in the spine so ○ Vit. D3 + Ca there is no movement 400 IU + 1200 mg between them increased OFI lifetime limited movement prevent formation of LAMINECTOMY stones ○ Logroll move patient as whole or single unit Paget’s Disease 3 nurses if no stryker frame head, body, Autoimmune extremities Progressive Stryker Frame Increased bone resorption ○ Alignment ○ Osteoclast cervical collar c = crush two pillows ○ Osteoblast one pillow at each eia  2024CE_MusculoskeletalSystem side of head emboli ○ Monitor for sensory and motor infection especially the feet Pelvic Injury / Abdominal Injury wiggle toes ○ poor prognosis due to: ○ Infection clots ○ Nutritional Support infection ○ HEmorrhage ○ CSF Leak [ Top of the world; see picture below] spinal headache ○ Tubol ○ Output urine ○ Mag swimming post-op ○ Year recovery Spinal Surgery Notes Two types of Fusion ○ Lower fusion Lumbar Complications of Fracture flat for 12 hours HOB 20 - 30 degrees Early Onset 1 - 2 days post op = can seat Complication not related to bone union ○ Cervical Fusion within 72 hours HOB slightly elevated / Low-fowler’s position PERCIS Activities 1. Pulmonary Embolism (TABA) ○ Riding a vehicle : 30 minutes Thrombus ○ ”Saddle” - huge thrombus Fractures ○ SPECIFIC FOR FRACTURE ○ Preventive Measures: 1. Greenstick Vena Cava Filters one side of bone broken; other side if you have bent high chance seen in toddlers of clotting 2. Transverse Air Embolism break occurs straight across the bone ○ Kozier : 50cc shaft ○ Spine : 20cc 3. Oblique ○ Heart : 10 cc break occurs at an angle across the Baboy / Fat Embolism bone Amniotic Fluid Embolism 4. Comminuted 2. Embolism (Fat) break has more than three fragments either goes into the brain or into the 5. Spiral lung break twists around the bone SPECIFIC FOR FRACTURE suspect abuse Causes: ○ Long bone fractures Hip Fracture Femur Humerus SADDEr Bergman Triad / Fat Embolism ○ Short Syndrome ○ Adducted ○ Dyspnea ○ Externally Rotated ○ neurological impairment MGT [ Top of the world; see picture below]: ○ petechial rash ○ elevate 2-3 pillows 3. Rhabdomyolysis triangular pillow in between Associated with trauma thighs Monitor: for the ball to go back to ○ Kidney socket 4. Compartment Syndrome ○ Ice Causes: ○ Trapeze ○ Fracture ○ Look for a seat that you will recline Fasciotomy higher waist ○ Cast ○ Heparin Bivalving IV / SC ○ Burns prone to clotting Fasciotomy ○ ABX Pressure causing obstruction of blood ○ DO NOT FLEX HIP vessels / Nerves ○ 3 point gait To relieve pressure : Fasciotomy ○ Check for : 6 hours max. time to intervene wound S/Sx (6 Ps): eia  2024CE_MusculoskeletalSystem ○ Pain Monkey Wrench ○ Paresthesia ○ attached for emergencies ○ Pallor may sit up ○ Poikilothermia 2. Thomas Pearson Splint ○ Paralysis Balance suspension ○ Pulselessness Thomas (Person) = Counter traction 5. Infection If with trapeze : patient may change Not immediate onset position Onset : After 72 hours 3. Crutchfield Traction Tongs 6. Shock Supine Hypovolemic Shock for cervical fracture ○ 1L / 20 % blood loss turn patient as a unit Late Onset related to union after 72 hours; no specific time frame 1. Malunion abnormal union 2. Avascular Necrosis Loss of blood supply > necrosis progressive may require surgery Seen in long bones 3. Non union No union occurred 4. Delayed Union Skin Traction takes too long to unite Bone stimulator 1. Buck’s Traction 5. Osteomyelitis Indication: ○ Femur Cast Care ○ Hip Counter traction: 1. Synthetic ○ Shock Blocks Dries in 10-30 minutes Patient may turn on unaffected side Comes in color 2. Bryant traction Expensive < 2 years old 2. Plaster < 30 lbs. Dries 48 - 72 hours 90-degree Air Dry 1-2 fingerbreadths buttocks elevated ○ Board Exam (Partially Correct from bed Answer) : Blow Dry in low 3. Russell Traction setting Knee is suspended During Drying Balkan Frame ○ complaints of heat = NORMAL ○ palms are utilized Buck’s Traction ○ Dependent position decrease edema When dry : ○ complaint of heat = INFECTION Intervention : ○ Petaling filing of edges ○ Windowing Neurovascular checking Blanch Test ○ Bivalving Indications: Healed injury Bryant Traction / Gallow’s Traction Tight cast Itching complaints: ○ blow dryer on a cool setting / low setting ○ scratch the opposite side Tractions continuous pull Skeletal Traction 1. Halo eia  2024CE_MusculoskeletalSystem Balkan Frame Median Nerve Compression Care of Traction ○ nerve supplies sensation to the areas of numbness Causes: ○ RSI Repetitive Strain Injury S/Sx: ○ Pain all throughout the day most prominent at night splint best worn at night ○ Numbness Tests : ○ Tinel’s Test : Tap the median nerve (+) = pins and needles felt ○ Phalen’s Test : Temperature Flex ○ check the distal extremity ○ Carpal Compression mas malayo = better assessment since better TINEL’S TEST perfusion [ Top of the World; see picture below] PHALEN’S TEST Carpal Tunnel Syndrome eia  2024CE_MusculoskeletalSystem Food LATE STAGE Heberden’s Tophi Boutonniere : Node : Deposits at Thumb Distal aforemention Phalanges ed sites Ulnar Deviation : Bouchard’s Metacarpophala Node : ngeal Joints Proximal Phalanges Swan Neck: Specific Fingers Finding Sjogren’s Syndrome: associated with MGT: RA; dry eyes and ○ Splint dry mouth ○ Cortisol Injection near the median nerve Felty’s ○ NSAID Syndrome : ○ Surgery associated with Open Carpal Tunnel Ligament RA ; High neutrophils ; Surgery Splenomegaly **Dupuytrens ○ Fourth and Fifth Finger Treatment Gold Salt Hip Colchicine / MGT Replacement Amputation Methotrexate; Allopurinol antidote = Cortisol PIPPAYS Leucovorin Injection Febuxostat (Hepatotoxic) ○ Phantom Limb Sensation warm bath in warm bath in pain on lost limb MORNING AFTERNOON Administer pain meds pain is real (stump), Pain Relief just misinterpreted Activity ○ I-mark ang bleeding ○ Acute Phase monitoring extent of bleeding none; rest ○ Prosthesis ○ activity only is asked in ○ Prone Position boards: initial position Non-weight avoid flexion contracture Bearing ○ Adducted (24 hours) SWIMMI ○ Yelling is okay (verbalization of feelings) NG ○ Stump position NSAID First 24-72 hours = slightly Corticosteroids for all elevated Opioids decrease edema Char. RHEUMATOID OSTEO- GOUTY ARTHRITIS ARTHRITIS ARTHRITIS Etiology Autoimmune Inflammatory, Altered Degenerative, Purine Wear & Tear Metabolism Prevalence Middle Age 60 y/o and Middle Age (35-50) above (35-50) Female Male = Female Female Localized No Yes Yes (Systemic) Joints Small Joints Large Joints Tophi Affected (Bilateral) (Unilateral) deposits at : Earlobe, Big toes, Tip of the nose Pain Morning Late Attack stiffness Afternoon / Periods Evening triggered by intake of High Uric Acid eia  2024CE_MusculoskeletalSystem Characteristics RHEUMATOID ARTHRITIS OSTEOARTHRITIS GOUTY ARTHRITIS Etiology Autoimmune Inflammatory Altered purine metabolism wear and tear = degenerative Prevalence Middle Age (35-50) 60 and above Middle age (35-50) Female male = female Male Localized None Yes Yes Systemic Joints Affected Small Joints (Bilateral) Large Joints (Unilateral) Ears; Tip of the nose; Big Toe Pain Morning Stiffness Late afternoon / evening Attack Periods Uric Acid - beer - shellfish Specific Finding Late Stage Heberden’s Node = distal Boutonniere - thumb Bouchard’s Node = proximal Swan neck - fingers Ulnar Deviation - metacarpophalangeal joints Treatment / Management Pain Relief Activity ○ Acute Phase none; rest ○ activity only is asked in boards: Non-weight Bearing SWIMMING NSAID Corticosteroids for all Opioids eia