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Five basic functionsof the skeletal system
support,, mvt, protection, mineral storage. Hemopoesis.
no movement where bones meet, skull
slight movement, pelvis, spine
free movement-wrists, knee, ankle, also called sonovial joints because of the fluid
how many muscles
more than 600
muscles make ____of bones and joints possible. muscle is ____ of body weight and 85% of ___ ___. when muscles contract it causes___. muscles also help provide__, and help with___ and ___blood.
movent, 40-50%, body temp, heat, posture, breathing and pumps.
moving away, hip surgery position
moving into body
twisting or circulat mvts
on stomach palms down
foot towards nose
foot towards ground
can show fracture, fluid levels, irregular growth on bone, shape of bone and joint.
inject air or dye into spinal column, looking for tumors, herniated disc, problems in spine
Rheumatoid Spondylitis - AKS
Chronic, progressive disorder- bones and joints of the spine and hip, pelvis.
Rheumatoid Spondylitis - AKS
can also effect
Attacks everything around the joint, muscles, tendens, ligaments.
Can also affect other tissues, CV sys, inflammatory bowel disease, vision problems.
people less than 30
- Over time you get fibrosis- less pliable, thick
- fibrous, then calcified, then get a fusion of the joins-from surrounding tissues hardening
fixation of a joint
AKS data collection
tenderness in spine and hips, limited chest expansion, decreased ROM, hunched forward, may be in abnormal position, start with low back pain, goes away with activity, weight loss, vision problems, ABD distension. kyphosis(hunch back)
Tx of AKS
analgesics for pain. NSAID, may have surgery for fused joints, ongoing endoscopic surgery- cut away calcifications. Hip replacement,
NSG of AKS
want to work with them to maintain the alignment of the spine, may have to wear a brace, when laying in bed try to lay flat, fused on side, incentive spirometry, deep breathing, skin will become issue, assist to reposition Q2h, want to be exercising,
EDU of AKS
active exercise. Heat=circulation and malleable. Try to maintain correct posture, resp exercises.
Osteoarthritis is a form of
Degenerative Joint Disease – DJD
- Progressive. Causes deteration of the joint cartilage. (1380) heberdens nodules-lump of cartilage.
- Occur on the distal joints. Bouchards nodes- on knuckles. Most common of DJD.
- Primarily related to age. More common in women.
no idea what caused it
underlying condition—trauma, obesity.
More common in weight bearing joints. Sports injuries, Constant pressure makes bone grind and get bone spurs.
OA data collection
gradual onset. Joint hurts worse with exercise, want to use for short periods of time and rest periods. Joint swelling, limited mvt in a joint, stiff in the morning, grating of the joint, wet cold weather makes worse, might see a little limp if on leg
- analgesics- Tylenol, ultram, NSAIDS-motrin( can
- interfere with other meds like BP meds) steroids(in joint, kenalog)glucosamine(shark cartilage)-shock absorber allergies.
athroplasty-fake joint. Arthroscopic sutgery- trim and clean damaged tissue.
Osteotomy- change alignment of the joint and bone.
- May need P/T, maintain activity level, ROM, good flat shoes.
- If in hands- deep paraffin treatment.
- Spine- firm mattress.
- Hip- mobility aids. Elevated toilet seats and grab bars, shower chair, lifter chairs. May wear splint.=5 P’s. remove once a shift to check skin area.
complications of OA
decreased ability to walk and move, adl's
EDU for OA
make sure to use joint but not to overuse
Unicompartmental Knee Arthroplasty
only part of knee is ruined, clean it out and put fake part of knee in. fix for 5-15 yrs.
Knee Arthroplasty (total knee)
fake everything. Create meeting place for joint.
NSG knee replacements
- Elevate on pillows first 24 hours only-edema
- Do not flex knee-risk ruining
- Turn side to back to side
- CPM- continuous positive motion. Increase circulation, prevents stiffening of joint. More ROM long term with use of machine, even at home.
- Trapeze bar available.
- Wound care, skin breakdown, dressings. Check for bleeding, may be underneath machine, see pallor, decr bp, hr go up. Dressings can hide blood.
- Pain-PCA pump, ice pack around knee.
- Heel pumps. Partial wt bearing=walker up to the day after.
NSG hip replacement
- Isometric exercise- heel pumps, ROM,
- Specific orders for turning- back and unaffected side.
- Abduction pillow to turn-
- Specific mobility restrictions-
- Raised toilet seats, walker for several months. p/t
- 3-4 times a week. Don’t want them to cross legs
Gout – Gouty Arthritis
- disease resulting in an acute inflammation of synovial tissue. Uric acid.
- People overproduce uric acid. If to much will form a crystal, can settle in any
- joint, land in feet or legs. Most common is around the big toe.
- Collection- pain, what dietary- nitrates, pruine. Organ and red meat, yeast,
- sea food, inspect joints. Vitals=increased from pain and inflammatory response
- . Sharp and hard, grinding everything at joint. Causing
- inflammation, major swelling, red shiny and hot. Skin integrity is an issue.
- Kidney failure can have increased incidence of gout.
meds or another disease
- . Can show up in ear cartilage and kidneys. Can go away and have flair
- ups. Occurs at night out of no where with swelling, redness and excruciating
- pain, may be short duration up to 10 days. Happens more often in men.
Urinary output, x-ray may show, lab work= uric acid
gouty arthritis TX
- specific to gout. Also stimulate smooth muscle= diarrhea. Q12h. Steroids-antiinflammatory.
- Preventative- zyloprin=reduces blood levels of uric acid. Uloric=lowers uric
- acid levels. Can do incision. I&D=incision and drainage. Pus.
NSG gouty arthritis
- encourage fluids, elevate and rest if in flair. Monitor labs. Hot and
- cold packs, lose weight, monitor for s/s of kidney stones, bed cradle=blankets
- off the feet.
Juvenile Rheumatoid Arthritis (JRA)
- destroys synovial membrane and fluid. 6mo and up, starts with a rash, flair up
- and go away, damage to joint, mobility issues. Treat c corticosteroids
infection in a joint. Antibiotic.
- Systemic skeletal disease characterized by low bone
- mass and deterioration of bone tissue. Air pockets, at risk for fracture.
- Fracture risk doubles the more bone mass you lose(10%). Wrist most common.
- Femur ball snaps off. Common metabolic bone disorder. Happen with women more
- than men. Estrogen helps protect bones.
- age, decreased activity, estrogen
- deficiency, lack of vit d, cancer of a bone. Can also cause humpback. Can cause
- backache, deformity and height changes, disease caused pathological fracture.
- density test. Special x-rays that tells us how much minerals and calcium in
- bones. Calcium, phosphorus.
- girls. Dairy, activity, green leafy
- vegis, orange juice, calcium supplements, be out side or vit d supplement.
- Fosamax-slows down breakdown of bone. Actenel. Bonevia=injection or oral.
- Estrogen supplement, exercise. Forteo- daily subQ for 2 yrs. Kyphoplasty-
- fusion of spinal bones.
good body mechanics, safety, non skid mats in bathroom, side rales.
Localized of generalized infection of bone and bone marrow
- infection of the
- bone marrow. Bacteria. Trauma, fracture, blood. Weakens bone tissue.
Osteomyelitis Data collection
- hx. Recent fracture, trauma, blood infection. CO pain, look for wounds or scars
- where it hurts, vitals may have fever, swelling,
- up, cal, phos, rbc down. Possible anemia. X-ray, nuclear bone scan, needle
- biopsy. TX antibiotics, home IV therapy because hard to get into bone to remove
- infection may have PIC line. May have to have surgery to get rid of dead tissue
- in bone. Getting wound cat bites- big cause. Check wounds for odor, high
- protein high cal diet. TX pain with narcotics, dec LOC. Avoid trauma to
- area=fracture easily.
- Musculoskeletal chronic pain syndrome- unknown cause. 20-50 yo. Hurts to
- touch them. No perminant damage. Starts in neck and lower back and often flairs
- up at night. Also asst with restless leg syndrome. May feel like bugs are
- crawling in skin
Fibromyalgia data collection
agitated by cold weather, stress, humidity
rule everything else out
- because of neuro component. Flexeril, clonopin-antiseizure( no birthcontrol, pregos)
avoid caffeine, sleep rputine
cause often unknown, occur in areas of rapid growth
benign, bone grows in a weong direction
- fast growing and aggressive cancer. Anemia=marrow not making enough. Only
- remove if interfering with things.
tends to hit shafts of long bones, common in teenagers.
bone tumors- data collection
see growth, tenderness and edema at the site, may break bones easily
bone tumors diagnostics
MRI, bone scan, bone biopsy, xray
bone tumors TX
try surgery, amputate, chemo, radiation
bone tumors- NSG
provide emotional support, preop and postop care
amputation- data collection
- accident. Car accident, farming accident. Industrial or work related. Put part
- in plastic and in ice water. Stop blood loss, clean it, calm down person, pain
- control, maintain urinary output, clean up edges for prosthetics.
- supine c legs up, watch bp and pulse, rapid shallow resp. hypotension,
- tachycardia. Low urine production 500ml
- urine in 24 h = oliguria.
term complication of amputation of hip=
gangrene=PAD, tissues die(diabetes). Cancer.
- Pvd- pp decreased or none, ulcer. Septic
- wounds=edema and fever. Sudden confusion= wound became septic.
CMP, CBC, urinalysis
antibiotics to prevent osteomyelitis
phantom pain of amputation
normal nerve tracts in amputated area still firing/working
- watch for infection, incentive spirometry. High protein and fiber diet. Ace
- wrap to keep form, cap refill,
release of the nuleus posus that cushions the vertebrae
TX of herniated disc
- steroids, epidural= lidicane or steroid, no activity that causes aggravation, decreased
- ROM, changes in gait, impaired breathing patterns if toward top,
conservative TX herniated disc
- rest, pain control, P/T, skin traction, chiropractor,
remove boney arches on side of spine
take bone from hip and remove bad parts, replace with prosthesis and cover with hip bone
removal of disc
endoscopic spinal microsurgery
clean up areas that are swollen or disk removal, local anesthssia
chymopapain eats away at protruding problems
NSG- herniated disk
- control, ice or heat, if moving=log roll, reposition Q2h, watch how sitting,
- walking, no lifting
- soft tissue bleeding
- injury from a blow or blunt force
- wernching pr hyperextension of a joint
- possible hemarthrosis- bleeding into a joint
ankle sprain assessment
- right away, swelling, and ecchymosis, hurts if touching or moving.
ankle sprain TX
- • RICE and
- 5P’s. ice
- first 48hrs.
Heat rules- not directly on skin, 15m on 15m off.
- MVA- most common, may show up later.
- • Hyperextension
- which results in compression of anatomical structures.
- CO headache, numbness in arms neck fingers, blurred vision,
- weak hand grasp.
- Give Ultram for pain, flexeril,
- Intv- restrict activity, cervical collar, heat, P/T.
- • microscopic
- muscle tear, the result of over
- stretching muscles and tendons. Any muscle
- of the body. Acute-suddenly. Chronic-repeated overuse. Hurt to touch, swelling,
- Find through physical exam, use x-ray. Use RICE. Common area
- is in the back.
- • displacement
- of the bones of a joint. Damages things around joint. Not bone.
- Hip, knee,
- shoulder, fingers, toes
- or partial dislocation.
– Data Collection-
- happened, describe pain, paresthesia, redness, swelling, tenderness, deformity
- of joint,
- Closed Reduction-pop back into place, Versed and pain meds.
Sling, ace wraps, RICE, analgesics. Avoid future trauma.
Carpal Tunnel Syndrome
- Compression on the median nerve of the wrist
- bone came out of skin. Pain, infection, swelling. Need antibiotics, need
result of disease or illness
straight across, easiest to fix
- not all the way broken through. Common in kids.
common ankle fracture, twisting either side.
- a slant, hit hard in one direction
broke into many pieces
- - break and have piece of bone break
- twisting motion most common in child
2 pieces come together
in wrist, catching when falling.
no longer touching
• Polar temperature
• Puffiness from edema
Tx of fractures
- • emergency
- treatment- wait for swelling to go down before casting, will immobilize= air
- splints. Ice and elevate and maintain splint for 48-72h.then will cast. Watch
- for shock= dec bp, inc hr, short resp. on back with feet up.
fx external fixation
pins hold bone where we want
fx internal fixation
nuts and bolts
skin traction= hip fracture to line up.
- Skin traction= make sure to check for skin breakdown, only
- take off for code.
- fiberglass, splint, air cast, short or bodycast. Stabilize and realign
- stolkingette over skin and over the cast. Plaster casts 24-48 hours to dry.
- Fiberglass dries right away, but some people are allergic. Can go into the
- water with them. Also have jointed casts. Most important is neurovascular
- checks 5 p’s. if you get a change in them you call the doctor. Compartment
- syndrome, need to call doc. Nsg intv- elevate and ice.
if infection under cast
there will be a hot spot and c heck fot drainage
if cast is rubbing
if itchy with cast
- special saw. Assure that its safe, wear glasses, will apply lotion to area,
- will be sloughing off skin, will have atrophy and weakness,
NSG and EDU on casts and after care
- • Exercise
- --- isometric-contract a muscle but don’t move a joint. Done to improve muscle tone. And
- • Activity-
- 48h no mvt, ice. Then activity as tolerated.
- • Medication
- and treatment- analgesics,
- • Use of
- assistive devices crutch, walker, cane-on good side.
longest time of bones to heal
upper leg 12 weeks
fx of vertabrae INTV
keep spine straight
- Halo- external immobilization devise it’s a form of skeletal
- traction. Pins go into the bone.
allows whole body to move as one mvt.
- Need firm mattress, firm chair, proper lifting, back
- exercises. May tell to sleep on side, don’t sit more than 20-30 min,
hip fx intracapsular
- and ball. Surgery. More damage.
hip fx Extracapsular
- part of the femur. More common. May without surgery, with cast. Heal quicker,
- not as much tissue damage.
data collection hip fx
- Shorter leg and what happened, inability to move the
- affected leg.
- Crepitus- grinding sound when 2 bones grind against
hip fx NSG
- • Post-operative
- care cant bear weight for 6-8wks.
hip fx NSG
- • Activity-
- don’t raise
- knee above hip, elevated toilet seat, don’t lean forward when sitting, don’t cross
- resp. can get without a cast.( cut open skin and let drain.) Extremely bruised
- muscle, helmet ram into someone’s thigh, severe burns,
compartment syndrome data collection
tx compartment syndrome
cut skin open to relieve pressure
NSG compartment syndrome
pain meds, elevate, cold packs, monitor for s/s of infection
EDU compartment syndrome
explain what happened and why
- Blood vessel occluded by an embolus carried in the blood stream from the
- site of formation of the clot
Thromboembolus data collection
- Risk= reduced skeletal muscle mvt, bed rest, on feet all the
- time, thick blood, meds.
- -tingling feeling. Cold, cyanotic, edema, pain and may have
- hot spot.
- Pulmonary- sudden sharp chest pain, dyspnea, coughing,
- hemoptysis-cough up blood.
- Calf- pain tenderness, homans sign=push toes to the nose and
- will have pain in calf. Red warm swollen.
- Neuro checks to see if it has moved. Chest pain SOB. Never
- massage the leg that has a dvt in it.
- Elevate leg scd’s, assess lung sounds, if don’t have use
- plantar flexion and dorsiflexion.
Venography- pic of vein by x ray
d-dimer- if there is fragments of blood clots in body.
- • Heparin
- -breaking up. Have to watch for bleeding and buising. Iv or subq prothrombin
- time, inr
- • Coumadin
- (wayfarin)thins blood, prevention, opposite is vit k
- Embolism of tissue fat, platelets and circulating free fatty acids. most
- ends in death.
- • After
- multiple fractures or fractures of long
bones or the pelvis
fat embolism data collection
- signs. Hypoxia =tissue death. Change in LOC, gets restless, panic like,
- irritable. CO pain in chest, inc resp, dyspnea, crackles and wheezes, develop
fat embolism dx
labs- fat in blood
fat embolism Tx
- to take them out. Monitor resp status. IVfluids, O2, digoxen( toxicity- halo
- sign, they see yellow)
fat embolism EDU
- Immobilization of long bones, careful turning and moving, family on safety.
- Severe infection of the skeletal muscle- diabetes, compromised immune
- sys, vascular disease.
- • Gram
- positive Clostridium bacteria-anerobic(w/o air or o2, leaves air
- behind/swelling) sends toxins that breaks down RBC’s, liver
- cant filter, get jaundice and liver failure, can cause brain damage.
- • Compound
- fractures and lacerated wounds
gas gangrene data collection
• Pain – sudden and severe
- • Skin
- assessment, becomes necrotic and black foul drainage. Wound will be hot and
- have fever, tachycardia.
gas gangrene Tx
- wound larger to let air out, clean and debride, IV antibiotics.
gas gangrene NSG
- • Wound
- care- let heal from inside out. Anything that is reuseable has to be autoclaved.