musculo 2 complete 2007
TRANSCRIPT
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PERCEPTIONPERCEPTION
&&
COORDINATIONCOORDINATION
Musculoskeletal Disorders
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Support
ProtectionMovement
Storage ofMinerals
H ematopoiesis
FUNCTIONSFUNCTIONS
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See what happensSee what happenswhen YOU havewhen YOU have
NO MUSCLES.NO MUSCLES.
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Muscle TissueMuscle Tissue
A specialized tissue thathas the ability to shortenor contract.
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PropertiesProperties1.Contractility
2.Excitability/Irritability3.Elasticity
4.Extensibility
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FunctionsFunctionsMMovementovementPPostureosture
JJoint Stabilityoint StabilityHHeat Productioneat Production
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Strong , fibrous connective tissues
that bind bones
Provide joint stability and allowrestricted joint movement
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Strong, fibrous, non-elastic
connective tissue extending from
muscle sheath Bind muscles to bones
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Nonvascular, supporting connective tissue
composed of various cells and fibers.
Absorption of weight, shock, stress and
strain
Protection of bones, joint, and joint tissue
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Elicit a description of
the present illness and
chief complaint
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Moderate to severe pain
Inability to move body parts
Localized edema
Altered sensation to affected
area
Contourdeformity and
asymmetry
Contusions
CardinalCardinal
Signs and Symptoms
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1. Medical conditions / Medications
2. Unsafe Environment
3. Decreased Dietary intake4. Infrequent Exercise/Sedentary lifestyle
5. Family history
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Inspection
Body alignment
Bone discrepancies
Mobility
Gait
Joint alignment
Muscle discrepancies
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PalpationPalpation Muscle mass
Muscle strength
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X-ray detect structure,
texture and densityproblem
evaluate the diseaseprogression and
treatment efficacy
Bone Scan detect skeletal
trauma and disease
Pt. must voidimmediately before
procedure
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Arthrography identify acute or
chronic tears of thejoint capsule( injection of
radiopaque)
Arthrocentesis allows analysis of
synovial fluid, blood
or pus aspirated from
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(+) RA if...Synovial fluid is cloudy, milky, dark yellow
and contains numerous inflammatory cells. Increased ESR (N: less than 15 mm/hr)
. Decreased RBC
..Decreased C4 Complement (N: 140-510mg/L)
(+) C-reactive protein (CRP) & Antinuclearantibody (ANA)
X-ray: (+) bony erosion and narrowed jointspaces
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Myelography detect herniation,
tumor congenital/degenerativecondition
Keep pt. flat on bed@ least 12hrs posttest
Electromyography(EMG) measures muscle
electrical impulses
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Biopsy studies bone,
synovium,muscle tissue
CT Scan
show soft tissue,bone and thespinal cord inthree-
dimensional,
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MRI allows study of
soft tissue inmultiple planes
of the body
CBCAnalysis identifies
anemias,
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Alkaline phosphatase identify increases in osteoblastic
activity of the inflammatory condition. CPK-MB
elevation may identify skeletal musclenecrosis, atrophy or trauma.
LDH identify skeletal muscle damage.
Serum Calcium bone loss density
C-reactive protein test severity and course of inflammatory
process
Rheumatoid factor measure the presence of
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Relief of pain
Maintenance of adequatetissue perfusion
Improved physical mobility
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Neurovascular Assessment
(6 Ps)ain
ulses
allor
aresthesia
aralysisolar
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Pain signals the beginning of muscle ischemia
Pulses pulselessness indicates disruption of
arterial blood flow.
Pallor indicates disruption of arterial blood flow.
Paresthesia nerve function may be disrupted bynerve compression.
Paralysis increasing edema causes nervecompression
Polar indicates disrupted arterial blood flow
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Sprain
complete or incomplete tearin the
supporting ligaments surrounding joints.
Strain
overstretching injury to a muscle or
tendon.
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Sprain
commonly result from wrenching or
twisting motion
Strain
typically result from excessivelyvigorous movement in understretchedand overstretched muscles and tendons
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Sprain
Pain and discomfort
Edema
Decreased joint
motion and function
Feeling of joint
looseness
Strain
Pain
Edema
Ecchymoses
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1. Administer prescribed medication
2. Provide nursing care for the client who
sustain sprain.
3. Provide nursing care for a client who
suffer muscle or tendon strain.
4. Provide additional teaching
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Displacement of a bone from its
normal articulation with a joint
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May be congenital
May result from trauma or disease
of surrounding joint tissue
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Pain
Visible disruption of joint contour
Edema
Ecchymoses
Impaired joint mobility
Change in extremity length and in axis
of dislocated bones
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1. Administer prescribed medication
2. Prevent from further injury
3. Assist physician in reducing displaced
parts as necessary
4. Provide teaching
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Remember
Rest
Ice Compress
Elevate
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Disruption in the continuity of bone as a
result of trauma or various disease process
Highest incidence in males 15-24 years and
in elderly persons, women aged 65 yearsand older
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Direct blowCrushing force
Sudden twistingmotionExtreme muscle
contraction
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Fractures
Complete fracture-involves a break
across the entire cross
section of the bone
and is frequentlydisplaced from normal
position
Incomplete fracture break occurs through
the only part of the
cross section of the
bone.
Closed fracture doesnot produce a break in
the skin.
Open fracture
presence of break in
the skin.
Greenstick bone
bends w/out fracturingacross completely,
cortex on the covade
side remain intact
h f
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Other fractures Transverse fracture
that is straight acrossthe bone, caused by a
force applied to the
site.
Spiral/ oblique fracture twisting
around the shaft of the
bone, caused by
violence forced
through the limb.
Impacted- fracture
where the fragment are
Crush occurs incancellous bone asresult of acompression force.
Burst occurs in ashort bone resultingfrom strong direct
pressure.
Compression
fracture which thebone has beencompressed
Pathologic fracture
through an area ofdiseased bone.
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Other fractures
Avulsion pullingaway of a fragmet of
bone by a ligament or
tendon & itsattachment.
Epiphyseal fracture
through the epiphysis
Compound fracturewith a surface or
open wound. Include
more than one breakin the bone.
Comminuted
fracture with more
than one fragments
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Pain
Lossof function/sensation
Deformity
Shortening/lenghtening
Crepitus (grating sensation)
Swelling
Discoloration
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Excessive motion on site
Soft tissue edema
Warmth over injured area
Paralysis distal to injury resulting from
nerve entrapment
Signs of shock related to severe tissue
injury
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Fracture care
splinting of fracture
preservation of body alignment
elevation of body part to limit edema
application of cold packs
observe for changes in color, sensation,
or temperature of injured part
observe for signs of shock
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FatFat embolismembolism
Compartment syndrome
Nonunion
Arterial damage
Infection Hemorrhage/ Shock
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Fat emboli
- serious, potentially life-threateningcomplication
S/Sx:
Restlessness
mental status changes
tachycardia
tachypnea
hypotensionDyspnea
Petechial rash over the upper chest and neck.
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Compartment syndrome
- increased pressure within a limited anatomic
space compromising circulation, viability, andfunction of tissues within that space.
S/Sx: increased pain and swelling
pain with passive motion
inability to move joints loss of sensation
pulselessness
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Infection and osteomyelitis
- caused by the interruption of the
integrity of the skin; the infection invadesbone tissue.
S/Sx: fever
pain
erythema in the affected area
tachycardia
elevated WBC count
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Avascular necrosis- interruption in the bloodsupply to the bony tissue, which results in thedeath of the bone.
S/Sx: pain decreased sensation
Pulmonary Emboli- caused by immobilityprecipitated by a fracture
S/Sx: restlessness and apprehension
Dyspnea Diaphoresis
ABG changes
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Treatment
Splinting- immobilization of the
affected part to prevent soft tissue from
being damaged by bony parts
Casting- provides rigid immobilization
of affected body part for support andstability
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Treatment
Internal fixation- use of metal screws,
plates, nails and pins to stabilize
reduced fractures Traction
Reduction- restoration of the fracture
fragments into anatomic alignment androtation.
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Nursing care plan/implementation for
clients with FracturePromote healing and prevent complications
diet: high protein, iron, vitamins (tissue
repair), moderate carbohydrates(prevent weight gain)
increase fluid intake
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Nursing care plan/implementation for
clients with Fracture
assess for complications of immobility
(pneumonia, constipation, decubitus
ulcers, osteoporosis) assess casted extremityfor presence of
foul odor, drainage, paleness or
blueness, change in temperature,pulselessness, tingling, numbness
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Nursing care plan/implementation for
clients with Fracture
Prevent injury or trauma
avoidance of high-risk activities (sky
diving, high impact sports, rollerblading)
avoidance of safety hazards (throw rugs,
untreated vision problems)
regular exercise
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Nursing care plan/implementation for
clients with Fracture
Provide care related to ambulation with
crutches
Provide safety measures related to
possible complications following fracture
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Nursing Management
Administer prescribed medication
Provide care during transfer of the patient
- immobilized the fractured extremity
- support the affected side.
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Provide client and family teaching
- explain prescribed activity restriction
- Teach the proper use of assistive
devices.
- Provide additional teaching
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Stages of Bone Healing
HEMATOMA AND INFLAMMATION
ANGIOGENESIS AND CARTILAGE
FORMATION
CARTILAGE CALCIFICATION
CARTILAGE REMOVAL
BONE FORMATION
REMODELING
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Callus formation: 3 to 4 weeks
Ossification begins within 2 to 3 weekup to 3 to 4
months
Progress should be monitored by serial x-rays reveals
complete bone union
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Types of CASTS
Plaster Casts ( POP)
mold very smoothly to the
body contour.
Non Plaster/ Synthetic
Casts fiberglass casts that
are commonly used today
CASTS & MOLDS
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CASTS & MOLDS
Short arm circular cast wrist and finger
Short arm posterior mold-wrist and finger withcompound affection
Long arm circular cast-radius/ ulna
Fuensters or munsterscast- radius/ ulna with
callus formation.Long arm posterior mold-fx of radius & ulna w/compound affection
CASTS & MOLDS
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CASTS & MOLDS
Hanging cast shaft of
humerusFunctional arm cast
humerus (allows
abduction & adduction)Shoulder spica
humerus and shoulder
jointAirplane humerus and
shoulder compound
affection
CASTS & MOLDS
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Rizzers jacket scoliosis
Minerva upper dorsal
cervical spine1 & hip spica hip & femur
Body cast lower dorso-
lumbar spine
Double hip spica hip &femur
Long leg cast- tibia, fibula
Long leg posterior mold- fx of
the tibia & fibula w/compound affection
Basket severe leg trauma w/
open wound or inflammation
CASTS & MOLDS
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C S S & O S Cylindrical leg cast- patella
Quadrilateral/ ischial weightbearing cast shaft of femur w/CF
Cast brace fx of the femurdistal 3rd
Short leg circular cast ankle &
foot PTB- tibia/ fibula w/ CF
Delbit cast- Tibia & fibula
Short leg posterior mold ankle
& foot w/ compound affection Boot leg cast for traction hip
& femoral fx
Internal rotator splint post hipoperation
CASTS & MOLDS
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Collar cast cervical
affection
Pantalon cast pelvic bonefracture
Frog cast congenital hip
dislocationSingle hip spica hip & 1
femur
1 & spica mold hip &
femur w/ compound
affection
Double hip spica- pelvic
affection w/ CF +2 femur
CASTS & MOLDS
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CASTS & MOLDS
Single hip spica
mold- pelvic bone
fx w/ CF
Night splint post
polio
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immobilized a body part
Exert uniform compression
Provide for early mobilization
Correct or prevent deformities
Stabilize and support unstable joints
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Prepare the client
Assist during application of casts PRN
After cast application, provide cast care
Initiatepain relief measures as indicated
Observe forsigns of cast syndrome
especially with client who are
immobilized in large cast.
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Provide nursing care for compartment
syndrome, if indicated Notify the physician immediately if signs
of otherneurovascular complicationsoccur
Notify the physician ifhot-spots occur
Provide client teaching
Ensure proper technique and procedure incast removal.
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Support fresh cast with the palm of the hand toprevent indentations from tips of the fingers
Expose the cast to warm, circulating, dry air.
Plaster cast - 5-15 minutes up to 48 hours
Synthetic cast 30 minutes
Dry cast : white, odorless, close to room temperature
and resonant to percussion.
Wet Cast: gray, cool, musty smelling and dull topercussion.
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Potential Pressure
Areas/ Points
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Checkneurovascularstatus
Alternate ambulation with periods of elevation to
the cast when seated
Perform active ROM hourly when awake by
wiggling fingers/ toes.
AVOID getting plaster cast wet, especially the
padding under the cast DO NOT cover cast with plastic or rubber boots.
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NO weight bearing exercises for 24 hours after
cast application
Cleanplaster cast using slightly damp cloth, by
rubbing soiled areas with scouring powder and by
wiping off residual moisture
AVOID walking on wet floors or sidewalks to
prevent falls DO NOT place objects under the cast to pressure
and skin injury.
Cast Care
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Neurovascular problems
(Compartment Syndrome)
Pressure Ulcers/ Sores severe initial painover bony prominences, foul odor, purulent
drainage & presence ofhot spots
Immobility/ Disuse Syndrome results tomulti-system problems
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6 Ps Pain aggravated by moving or elevating affected
extremity; usually not relieved by analgesics
Pallor
Pulselessness
Paresthesia occur early in the syndrome whichprogresses to.
Paralysis late sign Puffiness late sign
Signs & Symptoms of
COMPARTMENT SYNDROME
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An orthopedic treatment that involves
placing tension on a limb, bone or muscle
group using variety ofweight and pulley
systems
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1. Decreased muscle spasm
2. Reduce, align, and immobilize
fractures
3. Correct or prevent deformity
4. Increase space between jointsurfaces.
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Straight or Running traction
involve straight pulling force
in one plane.
Balanced suspension traction
involves exertion of a pull
while the limb is supported by
hammock or splint
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Skin traction
involves weight applied and held to the
skin with a Velcro splint.
Skeletal traction
involves weight applied and attached to
metal/pin inserted into bone
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Bucks Extension
Traction femur & hipfracture
Overhead fracture of
humerus
Head halter cervical
spine affection
Pelvic girdle lumbo-sacral affection,
herniated nucleus
pulposus
Dunlops Traction fractured elbow and
h
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humerus
Halo pelvic scoliosis
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Halo femoral severe scoliosis
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Bryants traction
femoral fracture,
Hip injuries amongkids below 3 years
old
Buttocks are slightlyelevated and clear off the
bed.
Boot leg hip and
femoral affection
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Ninety degrees
fracture of the
femur
Stove- in chest severe chest
injury with
multiple ribfracture
Hammock suspension pelvic affection
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Hammock suspension pelvic affection
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Skin Traction
To control muscle spasm
To immobilize an area before surgery
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Uses wires, pins, ortongs placed through
the bones MOST frequentlyused in treatingfractures of femur,
humerus, tibia &cervical spine.
Skeletal Traction
Principles of Effective Traction
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Countertractionmust be maintained for effective
traction Patient is on firm mattress and in good body
alignment in the center of the bed.
Line of pull must be continuous; never interrupted
and in line with the long axis of the bone
Weights must hangfreely; should NOT be removed
when repositioning unless prescribed intermittently
Ropes must be unobstructed and alignedwith
pulleys
Knots must not touch the pulley or foot of the bed
and secured tightly
Principles of Effective Traction
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NURSING FOCUSNURSING FOCUS
Weights must hang freely.Line of pull is from the first
pulley back to the point onthe extremity.
Tie all knots securely.
Skin traction is usuallyintermittent and skeletaltraction is usually
continuous.]
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1. Prevent complications of immobility
2. Promote skin integrity
3. Inspect for signs of skin breakdown,irritation or infection
4. Provide client teaching
5. Promote self-care within traction
limitation
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Care of Client with Skeletal Traction
Maintain principles of effective traction
Watch for signs ofinfection especially
around the pin site
Check neurovascularstatus regularly
especially immediately after application of
traction.
Assess sensorimotorfunction. Observe for
pressure at traction
Avoiding infection
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Avoiding infection
at PIN SITE
The pin should be immobile in the bone and skinwound should be dry
Small amount of serous discharge oozing from pinsite may occur
If infection is suspected, percuss gently over thetibia (+) pain if infection is developing
Assess for other signs of infection: heat, redness,
fever. Clean pin tract with sterile applicators and
prescribed solutions to prevent plugging at the pinsite.
Bucks extension
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simplest form and provides for straightpull on the affected extremity
relieve muscle spasm
immobilize a limb temporarily
Heel is supported offbed to preventpressure on heel, weight hangs free ofthe bed, and foot is well away fromfootboard of bed, and parallel to the
bed.
Russel traction
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Russel traction
- permits the patient to move freely in the
bed - permits flexion of the knee joint.
used in the treatment of intertrochanteric
fracture of the femur when surgery is
contraindicated
Hip is slightly flexed. Pillows may be
used under lower leg to provide supportand keep the heel free of the bed.
Russells Traction
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N i I t ti f P ti t
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Nursing Intervention of Patients
with Traction
Monitor color, motion, and sensation ofthe affected extremity
Monitor the insertion sites for redness,swelling, or drainage
Patient education
Maintaining the traction
Skin care
Assist in toileting
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A. Open reduction involves reduction
and alignment of fractures through surgical
opening
B. Internal Fixation involves
stabilization of reduced fracture withscrews, or pins
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C. Bone graft involves placement of bone
tissue for healing, stabilization, or
replacement
D. Arthroplasty involves joint repair
through small arthroscope
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E. Arthrodesis involves immobilization
of joint through fusion.
F. Joint replacement involve
replacement of joint surface with metal or
plastic materials
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Types of Joint Replacement
1. Total hip replacement involves
replacement of the ball and socket of a
severely damaged hip joint
2. Total knee replacement involves
replacement to tibial, femoral, and patellarjoints.
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G. Tendon transfer involves movement
of tendon insertion
H. Tenotomy involves cutting tendons
I. Fasciotomy involves removal ofmuscle fascia, relieving constriction
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J. Osteotomy involves alignment of bone
by removal of a wedge
Purpose of Orthopedic Surgery:
Reconstruct diseased or injured
musculoskeletal structure
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ASSESSMENT
1. Preoperative assessment
Elicit the clients medical history
Identify current medication and condition
Assess nutritional and hydration status
Assess skin integrity
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2. Postoperative Assessment
Assess the cardiovascular,respiratory , fluid and electrolyte.Nutritional status
Assess neurovascular status
Assess for joint dislocation
Assess for infection
Assess for thromboembolism
Assess and maintain safety andeffectiveness of orthopedic apparatus
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Total Hip Replacement
a plastic surgery that involves removal ofthe head of the femur followed by
placement of a prosthetic implant
Signs and symptoms necessitating
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Signs and symptoms necessitating
Surgery
Severe chronic pain
Loss of joint mobility
Excessive joint destruction
Infection in the joint
Contractures
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Nursing Management
Teach client how to use crutches
Teach client mechanics of transferring.
Discuss importance of turning andpositioning post-op.
Place affected leg in an abducted position
and straight alignment following surgery Prevent hip flexion of more than 90
degrees.
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Nursing Management
Apply support stockings
Advise client to avoid external/internal rotationof affected extremity for 6 months to 1 year
after surgery Instruct client to avoid excessive bending,
heavy lifting, jogging, jumping
Encourage intake of foods rich in Vitamin C,protein, and iron.
Administer prescribed medications.
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Complications
Infection
Hemorrhage
Thrombophlebitis
Pulmonary embolism
Prosthesis dislocation
Prosthesis loosening
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An implantprocedure in whichtibial, femoral andpatellar jointsurfaces are
replaced.
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Assess the neurovascular status of the leg
Immobilize knee in extension with a firmcompression dressing and an adjustable splint
or long leg cast Elevate on pillows
Apply ice to control edema and bleeding
Encourage active flexion of the foot every hourwhen patient is awake
Drainage: 1st 8 hrs. = 200 ml
After 48 hrs = less than 25 ml
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Types:Below the knee (BKA)
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Amputation of a Lower Extremity
surgical removal of a lower limb or part of the
limb.
- 10% of patients experience uncomfortable
sensations- phantom limb pain.
- Phantom limb pain described as a cramp or
uncomfortable sensation
- disappears with time- the pain is a real sensation and should not be
dismissed as illusionary.
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Monitor for bleeding.
Elevate the foot of the bed ifhemorrhage is suspected.
Apply pressure directly over thearea of bleeding.
Notify surgeon ASAP.
Have clamps available at bedside.
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Complications of Amputation
Infection
Wound necrosis
Phantom limb pain
Contractures
Skin breakdown
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Monitor vital signs q 15 min until stable, then q
2 hours for 1st 24 hours, then q 4 hours.
Keep the stump elevatedfor 1st 24 hours toprevent edema
After48 hoursDO NOTelevatewith pillows
BUT rather elevate the foot of the bed.
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To prevent contractures:
Place patient in a prone position for15 minutes, four
times per day. (especially AKA) after 24-48 hrs to
stretch the muscles and prevent flexion contracture of
hip Have patient lie in a supine position with the knee in
extension (especially BKA).
Encourage to do active ROM of extremity to strengthen
muscles and inhibit contractures.
Maintain on low-Fowlers or flat position after AKA
In prone position, place a pillow under the abdomen
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In prone position, place a pillow under the abdomenand stump and keep the legs close together to prevent
abduction
Support stump with pillow for first 24 hours; placerolled bath blanket along outer aspect to prevent
outward rotation.
Encourage exercises to prevent thromboembolism
Encourage patient to ambulate using correct crutch-walking techniques
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Crutch Cane
Walker
37
C t h W lki
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Crutch Walking
Crutches
artificial supports
assist patients aid in walking
Preparation:
strengthen muscles ofthe shoulder girdle andupper extremities
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Measurement:
Lying down: from anterior fold ofaxilla to the sole of the foot, then add2 inches OR subtract 16 inches from
patients height Standing:two-finger-width insertion
between axillary fold and underarmpiece grip with tip of the crutchplaced 6 to 8 inches lateral to thefloor.
Basic stance:
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Basic stance:
TRIPOD POSITION
Crutches rest approx.8 to 10 inches in front
of and to the side ofpatients toes
TALLER = WIDER
NO Weight bearing on
axilla; should be onHANDS
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NURSINGALERT
Three-point gait is used fornon-weight bearing person
with a fracture of the leg orhip.
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NURSINGALERT
Four-point gait is used forpatients affected by polio andcerebral palsy.
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NURSING
ALERTSwing-through gait is used bythe paraplegic with leg braces.
Stair Climbing
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g
Using Crutches
Going up stairs: proceed with unaffected
(good) leg first, then advance crutches andaffected (bad) leg.
Going down stair: proceed with both
crutches and affected (bad) leg first, thenadvance unaffected (good) leg.
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NURSING ALERT
Remember: the GOOD GO TO HEAVEN(move good leg first when going up); THEBAD GO TO HELL (move crutches andbad leg first when going down).
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Using a Cane Hold the cane on unaffected (good) side. Move
the cane and the affected (bad) leg at the same
time first (simultaneously), then advance the
good leg; or advance the cane first, then affected
leg, then unaffected leg. The cane handle should be held, with the elbow
flexed at 30 degrees, it should be at the level of
the femur.
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Using a Walker
The top of the walker should be at thesame level as the cane (head at femur
level) with elbow flexed at 30 degrees. When using a walker, advance it 6
inches and then move into it.
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Caring for Patient with
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A disease characterized by
exaggeratedloss of bone massand changes in microarchitectureof the bone tissue thatcompromise bone quality.
Bones become fragile andprone to fracture.
Characteristics of OsteoporosisCharacteristics of Osteoporosis
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Silent": most patients are
unaware of osteoporosis until
the first bone fracture
occurs.
It is more common in females than
males: in women, hormone secretiondrops drastically during menopause and this
accelerates bone loss.
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These factors increase your risk ofdeveloping osteoporosis:
1. Heredity factors
2. Early menopause in women
3. Drinking too much coffee and strong tea4. Cigarette smoking and alcoholism
5. Low calcium intake
6. Lack of exercise
7. Some diseases, such as rheumatoid arthritis,
hyperthyroidism or some reproductivedisorders.
8. Prolonged use of certain medications, such as
steroids and thyroid hormone
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Loss of BONE MASS
Aging
CALCITONIN ESTROGEN PTH
BONE RESORPTION BONE FORMATION
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Health history includes questions concerning:
Occurrence of osteoporosis
Family history Previous Fractures Dietary consumption of calcium Exercise patterns Onset of menopause Use of corticosteroids Alcohol, smoking & caffeine intake
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IMPAIRED MOBILITY
BACK PAIN
CONSTIPATIONSHORTENED STATURE &
SPINAL DEFORMITY
FRACTURE BREATHING PROBLEMS
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1. Reviewing and evaluating apatient's:
physical condition,
lifestyle & daily living habits
2. Measuring Bone Density
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Balance diet rich in CALCIUM & VITAMIN D Regular weight-bearing EXERCISES Hormone replacement therapy (HRT) with
ESTROGEN & PROGESTERONE Other medications:
Alendronate Calcitonin
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Prevention of osteoporosis begins fromchildhood as it is important that you maximizeyour peak bone mass before the age of 35years.
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Sufficient intake ofcalcium
Adequate weight-bearing exercises.
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Maintain a healthy lifestyle.
Home safety to prevent falls and fractures.
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To maintain bone mass, postmenopausal women
may need adequate hormone replacement therapy
according to a doctor's advice.
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ETIOLOGY
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ETIOLOGY
Result from trauma or secondary
infection.
Blood-borne (hematogenic)osteomyelitis is common children
Chronic illness
Long term corticosteroid therapy
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Clinical Manifestations
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Clinical Manifestations
Localized bone pain
Tenderness, heat, and edema
Guarding of the affected area Restricted movement
Systemic symptom
Purulent drainage
malaise
Lab/ Dx Findings
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Lab/ Dx Findings
WBC count reveals leukocytosis
ESR is elevated
Blood cultures identifies the causative agent(Staph. Aureus)
Radiograph and bone scan
Nursing Management
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Nursing Management
1. Administer prescribed medication
2. Protect the affected extremity from furtherinjury and pain
3. Promote healing and tissue growth
4. Prepare client for surgical treatment
5. Provide additional teaching
6. May apply warm, wet soaks 20 minseveral times a day
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-a slowly progressive, degenerative joint diseasecharacterized by variable changes in weight-bearingjoint.
-Also known as Degenerative Joint Disease/Hyperthropic Arthritis
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Associated with
Obesity
Aging (>50yr) Trauma
Genetic predisposition
Congenital abnormalities
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Pain and muscle spasm, aggravated by userelieved by rest
Limited motion
Joint grating with movement Flexion contractures Joint tenderness Presence of Heberdens nodes or Bouchards
nodes Weight loss Cold intolerance
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Radiographs may reveal a narrowing of
joint space
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1. Administer prescribed medication
2. Provide nonpharmacologic comfort
measures3. Position the client to prevent flexion
deformity
4.Plan activities that promote optimal functionand independence
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5. Refer to physical and occupational therapy
6. Prepare the client fro surgical treatment as
indicated7. Provide referrals
Medication
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Medication
Aspirin
inhibits cyclooxygenase enzyme, it
diminishes the formation ofprostaglandins
anti-inflammatory, analgesic, antipyretic
action inhibit platelet aggregation in cardiac
disorders
Adverse effects:
GI E i t i di t d
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GI: Epigastric distress, nausea, and
vomiting
Blood: inhibition of platelet aggregation
and a prolonged bleeding time
Respiratory: In toxic doses, can cause
respiratory depression
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Hypersensitivity
Reyes syndrome: Acute encephalopathy
following a viral illness and ischaracterized pathologically by cerebral
edema and fatty changes in the liver
Toxicity: (mild or severe)
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Toxicity: (mild or severe)
Mild salicylism: nausea, vomiting, markedhyperventilation, headache, mental
confusion, dizziness, and tinnitus
Severe salicylism: restlessness, delirium,hallucinations, convulsions, coma,
respiratory and metabolic acidosis and
death from respiratory failure.
Ibuprofen
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p
anti-inflammatory, analgesic,and
antipyretic acitivity
use for chronic treatment of rheumatoidand osteoarthritis
less GI effects than aspirin
reversible inhibitors of thecyclooxygenases and inhibit the synthesis
of prostaglandins
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Adverse effects:
GI: dyspepsia to bleeding
CNS: headache, tinnitus and dizziness
Indomethacin
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anti-inflammatory, analgesic and
antipyretic acitivity
inhibits cyclooxygenase enzyme more potent than aspirin as an anti-
inflammatory agent
Adverse effects:
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*dose-related
GI: nausea, vomiting, anorexia, diarrhea
and abdominal pain
CNS: frontal headache, dizziness,vertigo, light-headedness, and mental
confusion
Hypersensitivity reaction
Nursing Management
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g g
Promote comfort: reduce pain, spasms,
inflammation, swelling
medications as prescribed.
Heat to reduce muscle spasm
Cold to reduce swelling and pain
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Prevent contractures: exercise, bed reston firm mattress, splints to maintainproper alignment
Position: elevate extremity to reduceswelling
Promote independence
Pain
RheumatoidEarly morning stiffness
Osteoarthritis
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Joints
General
Early morning stiffnesswhich gets better as theday progresses. May beexacerbated by exercise.Typical deformity issymmetrical (bilateral)
with swelling.Ulnar deviation
Weight loss, fatigue, andfever.
Stiffness worsensduringthe day.Feels better afterexercise.
May be localized toa single joint ormore, may not beswollen, but may bepainful.Finger joints maybecome affected.
Rheumatoid arthritis
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chronic systemic inflammatory disease
destruction of connective tissue and
synovial membrane within the joints
weakens and leads to dislocation of the
joint and permanent deformity
Ri k F t
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Risk Factors:
exposure to infectious agents
fatigue
stress
Diagnostic tests
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g
Elevated ESR
Mild leukocytosis
Anemia
Positive RF
Signs and Symptoms
inflammation, tenderness, and stiffness of
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the joints
moderate to severe pain and morning
stiffness lasting longer than 30 minutes
joint deformities, muscle atrophy, anddecreased range of motion
spongy, soft feeling in the joints
low grade fever, fatigue and weakness
Signs and Symptoms
i i ht l d i
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anorexia, weight loss, and anemia
elevated ESR, and positive RF
Nonreactive: 0-39 IU/ml (CRP)
Weakly reactive: 40-79 IU/ml (CRP)
Reactive: greater than 80 IU/ml (CRP)
X-ray showing joint deterioration
Rheumatoid Arthritis
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Rheumatoid Arthritis
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Medication
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Salicylates (acetylsalicylic acid )
NSAIDs
Corticosteroids- anti-inflammatory
Gold salts
Gold salts
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slow-acting, anti-inflammatory agents
Gold sodium thiomalate, Aurothioglucose,
Auranofin
- these drugs cannot repair existing damage,rather they can only prevent further injury
- use in the treatment of RA that does notrespond to salicylates or other NSAIDtherapy
Adverse effects: dermatitis of the skin or of the mucous
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membranes
proteinuria and nephrosis
Gold salts should be avoided in patients
suffering from hepatic or renal disease,
pregnancy.
Serious Toxicity: Dimercaprol
Treatment
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Hot and Cold packs to affected joints
Surgical Procedures: synovectomy,
arthrotomy, arthrodesis, arthroplasty
Nursing Management
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Prevent or correct deformities
bed rest
daily ROM exercises
heat and/or pain medication
increase oral fluid intake at least 1500 mLto prevent renal calculi
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A metabolic disease marked by
urate crystal deposits in joints
throughout the body.
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- Linked to a genetic deficitin purine metabolism
- Age (>50yr)
- Higher incidence in men
Signs and Symptoms
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extreme pain
swelling
erythema of the involved joints fever
tophi
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sudden attacks, usually at night
Pain, joint swelling and inflammation
Intolerance to the weight of bed linenover the affected joint
Pruritus or skin ulceration
Signs of renal involvement
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1. Arthrocentesis reveals urate crystal in
synovial fluid
2. Serum uric acid level is increased
3. Radiographs may show joint damage
in advanced disease.
Treatment
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Allopurinol
- a purine analog
- reduces the production of uric acid bycompetitively inhibiting uric acid
biosynthesis which are catalyzed by
xanthine oxidase.
Allopurinol
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- Effective in the treatment of primary
hyperuricemia of gout and
hyperuricemia secondary to other
conditions (malignancies).
Adverse effects: hypersensitivity
reactions, nausea and diarrhea
Colchicine
Eff ti f t tt k f t th iti i
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Effective for acute attacks of gouty arthritis pain
Reduces inflammation in the joint.
Does not prevent the progression of gout but have
a suppressive, prophylactic effect reducing the
frequency of acute attacks and relieves pain.
Anti-inflammatory activity alleviating pain within
12 hours
Colchicine
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Adverse effects: nausea, vomiting,
abdominal pain, diarrhea,
agranulocytosis, aplastic anemia,
alopecia
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1. Administer prescribed medication
2. Promote measures to prevent
exacerbations.
3. Provide measures to promote comfort
and reduce pain
4. Provide client teaching
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Caring forPatient with
What is ?
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Osteomalacia
involves softeningof the bones caused
by a deficiencyof vitamin D orproblems with the
metabolism of thisvitamin.
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In children, thecondition is
called ricketsand is usuallycaused by a
deficiency ofvitamin D .
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In adult, the conditionis usually caused by:
1. Inadequate dietary
intake of vitamin D2. Inadequate exposure
to sunlight (ultravioletradiation)
3. Malabsorption ofvitamin D
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Other conditions: Hereditary or acquired disorders
of vitamin D metabolism
Kidney failure and acidosis ,
PO4 depletion associated withlow dietary intake or kidneydisease
Side effects ofmedications usedto treat seizures .
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Risk factors are related tothe causes. In the elderly, there is an
increased risk for those whotend to remain indoors andwho avoid milk because oflactose intolerance
The incidence is 1 in 1000people.
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diffuse bone pain , especially in the hips
muscle weakness
symptoms associated with low calcium
numbness around the mouth & ofextremities
Carpopedal spasms
Bowing of legs
Waddling or limping GAIT Decrease in height/ Spinal Deformities
(i.e. KYPHOSIS)
In children, symptoms ofricketsinclude:
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delayed sitting, crawling, and walking;pain when walking; and the development
ofbowlegs orknock-knees.
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Bone biopsy: (+) increase in osteoid
Bone X-ray or CT scan of lumbosacral spineshows demineralization.
Studies of the vertebrae: (+) compression fx Low serum vitamin D level
Low serum calcium &phosphate levels
Elevated ALP (Alkaline Phosphatase)
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Adequate dietaryintake of dairyproducts that are
fortified withvitamin D
Adequate exposureof the body to
sunlight
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Oral supplementsof vitamin D ,calcium, and
phosphorus
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Large doses of Vitamin D
with exposure tosunlight may beindicated in people withintestinal malabsorption .
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Monitoring of blood levels
ofphosphorus andcalcium may be indicatedwith some underlyingconditions.
Braces or surgery tocorrect deformities
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Protrusion of the nucleus of the disk into the
fibrous ring of the disk with subsequent nerve
compression
May occur in any portion of the vertebral column
Signs & Symptoms
1. Pain
2. Sensory changes
3. Loss of reflex
4. Muscle weakness
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1. Cervical Pain/ Stiffness head, neck & upper extremities Paresthesia, numbness
Weakness
2. Lumbar Low back pain radiating to the buttocks and leg Postural deformity of the spine
(+) Straight-Leg Raise test
Weakness & Asymmetric reflexes
Sensory loss
Nursing Alert:Perform repeated assessments ofsensorimotor
functions/ reflexes to determine progression of condition
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Alleviating pain
Anti-inflammatory drugs, muscle relaxants, and
narcotic analgesics
Use ofbed boards under the mattress
Bed rest supine or low fowlers or side lying
position with slight knee flexion and pillows
between knees.
Moist heat application Relaxation techniques
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Signs & Symptoms: Abnormal lateral deviation of spine
Unleveled shoulder
Asymmetric waistline Prominent scapula
Complications:
Related to respiratory problems dueto decreased lung expansion as aresult of severe curvature of thespine
Nursing Implementation
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1. Monitor progression of the curvature
2. Prepare the child and parents for the use of abrace if prescribed
usually worn from 16 to 23 hours a day inspect the skin for signs of redness or breakdown
keep the skin clean and dry, avoiding lotions andpowders
advise the child to wear soft nonirritating clothingunder the brace
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Nursing Implementation
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Prepare the child and parents for surgery if prescribed.
Postoperative:
maintain proper alignment; avoid twisting movements
logroll the child when turning, to maintain alignment
instruct in activity restrictions
instruct the child to roll from a side-lying position to asitting position, and assist with ambulation
Paget's Disease of Bone
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Localized rapid bone turnover, most commonlyaffecting the skull, femur, tibia, pelvic bonesand vertebrae
Primary bone resorption followed by boneformation
Diseased bone is highly vascularized butstructurally weak
More common in the adult (>50 y/o) Male > female
Clinical Manifestations
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bowing of femur and tibia
enlargement of the skull
cranial nerve compression
respiration distress
pain
high cardiac outputfailure
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Nursing Management
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Prevent pathological fractures
Control pain
Administer drugs as prescribed
Bone Tumors
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Osteosarcoma
Most common primary bone tumor
Occurs between 10-25 years of age, with Paget's
disease and exposure to radiation
Exhibits a moth-eaten pattern of bone destruction.
Most common sites: metaphysis of long bones
especially the distal femur, proximal tibia andproximal humerus
Osteosarcoma
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Clinical Manifestations
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local signs pain ( dull, aching and
intermittent in nature), swelling,
limitation of motion
systemic symptoms: malaise, anorexia,
and weight loss
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Diagnostics
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Biopsy- confirms the diagnosis
X-ray
MRI Bone Scan
Medical Management
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Radiation
Chemotherapy Surgical management
amputation
limb salvage procedures
Nursing Management
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Promote understanding of the disease
process and treatment regimen
Promote pain relief
Prevent pathologic fracture.
Promote coping skills and self esteem
Assess for potential complications(infection, complications of immobility).
Nursing Management
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Provide care for client with amputation
Observe for signs of bleeding
Elevate stump on pillow for 24-40 hrs Turn patient to prone position for short
time first post-op day then 2-3x daily
Nursing Management
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Encourage exercise as soon as possible
(1st or 2nd post-op day)
Dangle and transfer patient to
wheelchair and back within 1st or 2nd
day post-op; crutch walking started as
soon as patient feels sufficiently strong
Apply lanolin to dry skin
Other Musculoskeletal Disorders
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Dysplasia of the Hip
condition in which the head of the femur
is improperly seated in the acetabulum,
or hip socket, of the pelvis.
Congenital or develop after birth
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Assessment
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Neonates: laxity of the ligaments around the hip,
which allows the femoral head to be displaced
from the acetabulum upon manipulation.
Implementation:
Splinting of the hips with Pavlik harness to
maintain flexion and abduction and externalrotation (neonatal period)
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Assessment
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Infants beyond the newborn period:
a. Asymmetry of the gluteal and thigh skinfoldswhen the child is placed prone and the legs areextended against the examining table.
b. Limited range of motion in the affected hip.c. Asymmetric abduction of the affected hipwhen the child is placed supine with the kneesand hips flexed.
d. apparent short femur on the affected side(Galleazzi sign, Allis sign)
Spica Cast
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CARPAL TUNNEL SYNDROME: It occurs when the median nerve at the wrist is
compressed
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ASSESSMENT:
Pain
Numbness
Paresthesia
Thumb, 1st & 2nd fingers affected=Tinel Sign(
tingling sensation when inner wrist is
percussed)
Management:
Wrist splinting
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Avoid repetitive wrist movement
Carpal canal cortisone injection
Surgical release of tendon sheat
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