Nursing for MS 2

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Prittyrick
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306786
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Nursing for MS 2
Updated:
2015-08-24 20:45:47
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musculoskeletal
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muscles and bones
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  1. Osteoarthritis degenerative joint disease (DJD)
    • Chronic joint disease characterized by progressive degenerative changes of articular cartilage in synovial joints
    • most common joint disease
    • wear and tear arthritis
    • usually occurs on weight bearing joints
    • classifled:
    • - primary (Idiopathic)
    • - secondary
    • risk factor: incr in age, wear and tear, gender, obesity, previous joint disease, repetivities use, genetics
    • once started can't stop. it is what u can do to help it
  2. Patho of OA
    • result of many factors with damage to cartilage
    • balance is disturbed: cartilage breaks down faster than it is regenerated
    • result bone to bone contact
    • Brunner p1651 figure 54-3
  3. OA v RA
    • OA- most common, breakdown of jt cartilage with age
    • RA- most crippling or disabling, autoimmune dx, chronic inflammatory type of arthritis
  4. OA S&S
    • Pain
    • stiffiness after awakening/morning
    • functional impairment, dec mobility
    • bony nodules
    • others: s/s crepitus (bone to bone contact), tenderness, joint enlargement
  5. Diag OA
    • physical findings
    • lab test- ESR (inflammation maker), cbc w/diff to look WBC to check for inflammation) normal WBC 5-10
    • x-ray- will tell you more
  6. Management of DJD OA
    • 1. prevention/nursing care/education
    • 2. balance of activity and rest
    • 3. heat/cold application
    • 4. orthotic devices, PT, OT, rehab
    • 5. complementary/alternative therapies- like yoga, swimming
  7. Management DJD OA
    medication, surgery
    • Medication
    • - NSAIDS
    • - Actemiophen
    • - Cox 2 inhibitors
    • - topical analgesic agent

    • Surgery
    • - Intra-articular corticosteriods
    • - Arthroscopy, osteotomy resurfacing (rd brunner, 2036-2037

    emotional support
  8. management of pt with Disc disorders
    • herniated/ruptured disc
    • disc surgery
  9. herniated disc
    • a herniated disk refers to a problem with one of the rubbery cushions b/w the individual bones (vertebra) that stack up to make the spine
    • bone to bone
    • compression of nerve- can affect communication- no impulses--person may experiences inconteniences bc no msg going to the brain letting it know you have to pee
    • neurovascular assessment
  10. Herniatio of a Lumbar disc Patho
    • Intervertebral disc: cartilaginous plate between the vertebral bodies
    • - in a capsule
    • - center of the disc is nucleus pulposus
    • Herniation of disc: the nucleus protrudes into the fiberous rings around of the disc
    • - nerve compression
  11. Risk Factors
    • age/degenerative changes
    • weight
    • occupation/repeated stress
    • trauma ** mostly bc of this
  12. Herniated disc S&S
    • low back pain with muscle spasms
    • arm and leg pain
    • radiation of pain into one hip and leg (sciatica)
    • radiculopathy
    • muscle weakness
    • sensory loss
    • - dec DTR
  13. Complication of herniated disc
    • worsening pain/numbness/weakness
    • Cauda equina- sciatica leg pain/severe back pain, altered sensation over saddle area (genitals, uretha, anus, inner thighs), urine retention of incontinence- EMERGENCY
  14. Diag Herniated disc
    • h/p
    • MRI/CY scan ** will tell u how much damage
    • myelogram
    • EMG
  15. Management of HD
    • Conservative care:
    • Bedrest, immobilizatio
    • ice at time of injury
    • moist heat/massage
    • meds: NSAIDS, muscle relaxants (muscle spasm), neurotin (nerve pain), (celebrex) cox2 inhibitors (blocks prostagladins), narcotics, amitriptyline (used for depression but helps with chronic pain. it confuses the brain), cortisone injection
    • PT strengthening excerise/transcutaneous electrical nerve stimulation (TENS)
    • pt teaching/prevention
    • coping and support
    • prostagladins- starts of inflammation
  16. Surgical management
    • Discectomy: removal of the protruding nucleus pulposus, microdiskectomy
    • Laminectomy:removal of part of the laminae (posterior arch of the vertebrae) to gain access to the protruding disc
    • Spinal fusion: spine is stabilized by fusing of contiguous vertebrae with a bone graft- to stabilize the disc

    * neurovascular assessment is very important
  17. Post op management HD
    • accurate assessments***
    • - assess for bleeding (look at VS), shock
    • - assess neurovascular/CSM/muscle strength- notify MS (have pt close eyes to if they can feel you touching them)
    • Activity, specific instructions
    • - log roll with pillow in between the legs, bed rest
    • - slight knee flexion
    • - avoid sitting for long periods of time
    • - OOB early
    • pain assessment and management
    • - heat: muscle spasms
    • - PCA
    • - pre medicate for pain (pay attention for respiration bc it puts the lungs to sleep pt is not breathing out CO and it will put them into acidiosis)
  18. Post op management HD more
    • assess dressing for bleeding/drainage (use COCA)
    • assess bowel and bladder function
    • assess for risk of DVT
    • - teds, venodynes, lovenox, ROM
    • PT
    • patient teaching/support/rehab
  19. Sprain and strain
    a sprain is abnormal stretching and tearing of a ligaments that supports a joint

    a strain is abnormal stretching and tearing of the muscles or tendon
  20. Soft tissue injuries
    • sprains and strains usually assoc with abnormal twisting/stretching movements
    • ┬átend to occur around joints
    • - strain: excessive stretching of the muscle ad its fascial sheath- can involved tendons
    • sprain- injury to tendoligamentous structure surrounding the joint - classified by degrees (usually hear a pop sound)
  21. signs and symptoms sprains and strains depend on severity
    • Sprain:
    • - pain swelling bruising limited ability to move affected joint, may hear or feel a pop during the time of the injury

    • Strain:
    • - pain, swelling, muscle spasm, limited ability to move affected muscle
  22. Dx sprain/strain
    • h&p
    • x-ray
    • MRI: soft tissue injury
  23. sprain and sprain management
    • usually self limiting and resolve within 4-6 wks
    • immediate treatment:
    • - limited movement
    • - RICE
    • - after 48 hours apply heat
    • - pain management (mild analgesics)
    • - gradually inc activity, weight bearing
    • - assess neurovascular *
    • - prevention teaching
    • braces, splint or surgery if rupture of tendon
  24. PRICE protocol **
    • Protection of the area
    • rest
    • ice
    • compression
    • elevations
    • keep area iced for 15-20 mins, break for 15-20 mins and keep repeating for a few days
  25. Subluxation
    • Subluxation: partial/incomplete displacement of the joint surface
    • - fewer s/s and deformities
    • - not too much of a problem
    • - heals quickly
    • pain inc with movement
    • may feel joint out of place
    • tx: pain control and supportive measures
  26. dislocation
    • dislocation: complete displacement/separation of the articular surfaces of the joint
    • - bones that form the joint are no longer in anatomic alignment
    • - out of the joint
    • traumatic medical emergencies, increased risk of AVN (avascular necrosis)
    • Causes: trauma, congential
  27. risk factors Subluxation and dislocation
    • falls
    • hereditary
    • sports
    • mva
  28. s/s dislocation
    • deformity, shortening of the extremity
    • immovable
    • asymmetry of the extremities
    • intensity local pain and tenderness
    • loss function
    • swelling of the joint neurovascular symptoms
  29. Dx of dislocation
    • H/P - wont tell u much
    • x-ray
    • MRI
  30. management of dislocation
    • immediate treatment
    • - realignment by closed reduction or open reduction
    • assess neurovascular **
    • Post care:
    • assess VS
    • neurovascular- pulses, cap refills, sensation, motor function
    • immobilize extremity by braces, splints
    • pain management- opiods, muscle relaxants
    • PT: gentle mobilization
    • pt teaching: prevention of injury, complications
  31. Meniscal injuries
    • menisci: two semi lunar cartilages located on the sides of the knees
    • function: shock absorbers (lost of this is the injury)
  32. causes of meniscal injury
    f
    • forceful twist or rotation of the knee
    • - deep squatting
    • - heavy lifting
    • - degenerative changes
  33. s/s of meniscal injury
    • pt complains of knee giving away or knee locks complains of knee unstable
    • feel/hear click or pop when walking
    • reduced movement
    • pain
    • tenderness
    • swelling or stiffiness
  34. Complication of Meniscal injury
    • knee instabilty
    • chronic knee pain
    • osteoarthritis
  35. dx menical injury
    • U/S
    • MRI
    • Arthroscopy

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