MUSCULOSKELETAL SYSTEM NURSING BULLETS I.

Anatomy & Physiology: The CANCELLOUS BONE is soft and spongy, while the COMPACT BONE is hard and dense. FLAT BONES are responsible for protection of organs & Hematopoiesis (Production of RBCs, WBCs, Platelets). RED BONE MARROW is abundant in flat bones & is responsible for Hematopoiesis. Best site for Bone Marrow Aspiration: Iliac Crest & Sternum in ADULTS. Tibia in CHILDREN. EPIPHYSEAL PLATE (Growth Plate) is responsible for growth in height. Closes between 18-25 y.o. If the epiphyseal plate is damaged in the Fx, it will affect growth of the long bone. Vitamin D aids in Calcium absorption in the Jejunum. RDA: 400-800 IU/day. Calcium & Phosphorus make the bones strong and resistant to fractures (Compressional Strength). RDA of Calcium: Premenopausal/Men: 1000-1200 mg/day. Post-menopausal: 1500 mg/day TENDONS are connective tissues that attach muscles to bone. LIGAMENTS are connective tissues that attach bones together. ISOMETRIC CONTRACTION: Muscles contract but theres no change in muscle length. No joint bending. ISOTONIC CONTRACTION: Muscles change in length & contract but theres no change in tension. Range of Motion exercises improves ability to carry out ADLs. HYPERTROPHY will occur if muscle is exercised repeatedly. ATROPHY will occur with muscle disuse. Bone Resorption is the transfer of Calcium from the bone to blood. Bone Reabsorption is the transfer of Calcium from the blood to bone. Skeletal Muscles are VOLUNTARY. While Cardiac & Smooth Muscles are INVOLUNTARY.

RHABDOMYOLYSIS: the escape of myoglobulin from damaged muscles into the bloodstream. There are 206 bones in the body.

II. Strain and Sprain STrain is injury in Tendons or muscles. Also called a muscle tear. Sprain is injury to the ligament. Management: RICES (Rest, Ice application, Compression, Elevation, Splint) Cold and Warm applications require a doctors order. Cold application is given in the 1st 24H. Intermittent Cold and Warm application on the second day. Remember: Applied for 20-30 minutes only. III. Carpal Tunnel Syndrome and Tarsal Tunnel Syndrome Cause: Constant Compression of Nerves: Median Nerve (CTS) & Posterior Tibial Nerve (TTS) Dx Test: Tinels Test (tapping of wrist), Phalens test (wrist flexed), Electromyography (confirmatory) Informed consent is needed for EMG (electromyography). Affected fingers and toes: First three digits and half of the 4th digit. IV. Fracture Most common fracture in Children: GREENSTICK (one side is broken, the other side is only bent) Most common fracture in Adults: COMMINUTED (bone is broken into 2 or more several pieces) COLLEs Fx: Fracture of the distal radius associated with falls. POTTS Fx: Fracture of the distal fibula. Principles in Fractures: IMMOBILIZE & maintain ALIGNMENT Most Common Complication of Immobility: Deep Vein Thrombosis (DVT) Drug to prevent DVT: Heparin & ENOXAPARIN (LOVENOX) SC anticoagulants Dont massage the leg if there is calf pain upon dorsiflexion (Homans Sign). Medical Management of Fractures: Reduction, Cast application, Traction Plaster Cast dries within 24-72 hours. Carry with the PALMS of the hand while wet. Dont place in hard, firm surface because it can cause indentions, thus, pressure ulcers. Fiberglass cast dries in 20 30 minutes. Does not lose its shape even if it gets wet. Avoid gas forming foods in clients with Body or Spica Casts because it can lead to Cast Syndrome (compression of superior mesenteric artery that leads to ischemia and necrosis of the bowel). Windowing: Removal of a portion of a cast to facilitate observation of Hot Spots in the skin. Petaling: padding the edges of the cast to prevent skin abrasion. Footplate prevents footdrop. The greater weight capacity of SKELETAL TRACTION makes it more effective than Skin Traction. Nurses can only remove weights in traction if there is compromised circulation and tissue perfusion. Earliest sign of FES is a change in the mental status. Risk includes Long Bone, Hip, & Multiple Fractures.

Pathognomonic sign or a distinguishing characteristic of FES is the presence of PETECHIA (esp in CHEST). Earliest sign of Compartment Syndrome is PARESTHESIA (numbness and tingling sensation). Surgical management for Compartment Syndrome: FASCIOTOMY (Incision of the Fascia).

V. Hip Fracture Remember: S/Sx: ADDUCTION, EXTERNAL ROTATION, & SHORTENED LIMB No hip flexion beyond 90 degrees in the first 2 months post-operatively. Hips must be ABDUCTED using an ABDUCTOR PILLOW (Charnley Pillow). Total Hip Replacement: replacing both the acetabulum (socket) & femoral components w/ prosthesis. Dont cross the legs, used a raised toilet seat, and avoid bending forward to avoid hip displacement. VI. Amputation Most common amputation: BKA Amputation resulting from trauma: Guillotine amputation Common complication of Amputation: Hemorrhage and Contracture Emergency Equipment @ bedside after Amputation: Tourniquet Believe the clients pain description, pain is a subjective experience. Phantom Limb Pain (PLP) is due to nerve endings in the stump that havent adjusted to the loss of the limb. The stump or residual limb must be elevated in the 1st 24H by elevating the foot of the bed. Elastic or Ace wrap must be rewrapped 3-4 times daily. Place the patient in the prone position twice or thrice daily for 30 to 60 minutes each time. VII. Assistive Devices for Walking Principle in going up and down the stairs: UP with the GOOD. DOWN with the BAD. Crutch Gait that resembles Normal Walking Pattern: 2 Point Crutch Gait Most Commonly used Crutch Gait: 3 Point Crutch Gait The weight must be in the HAND GRIP in crutch ambulation with elbows flexed at 30 degrees. The Cane is indicated for clients with Parkinsons Disease. Hold the Cane in the UNAFFECTED SIDE. The Walker is the most stable of the assistive devices for walking. VIII. Osteoporosis Osteoporosis: Increase in Bone Resorption (Ca loss) and a decrease in Bone Reabsorption (Ca Deposit). Corticosteroids make the bones weak and fragile. Stunting of growth is the effect in children. Confirmatory Diagnostic Test: Dual X-ray Absorptionmetry (DXA/DEXA). According to the WHO: Osteoporosis is a T-Score of < -2.5 Most falls at home occur in the bedroom, so provide night light. Main Treatment for Osteoporosis: Hormone Replacement Therapy (HRT)

Raloxifene (Evista) is a Selective ESTROGEN Receptor Modulator that increases Bone Mass. Biphosphonates are potent INHIBITORS of RESORPTION. ALENDRONATE (FOSAMAX): take in the AM 30 minutes before meals, take with a full glass of fluid, remain upright for @ least 30 minutes. RA Inflammatory, Systemic Autoimmune Theory PANNUS Formation 20-40 y.o. Women Bilateral Small joints >30 mins a. Ulnar Drift b. Swan Necks c. Boutonniere Rheumatoid Factor Range of Motion exercises Cold application for joint inflammation; Warm application for stiffness DMARDs OA
Non-Inflammatory, NonSystemic

IX. RA, OA, GA GA

Inflammatory, NonSystemic Defective purine metabolism TOPHI formation, PODAGRA

Etiology/The ory Hallmark Age Sex Affectation Joints Joint Stiffness Joint Deformities Diagnostic Test Activity Managemen t DOC

Wear and Tear Theory OSTEOPHYTE formation 40-50 y.o. Women Unilateral Weight-bearing joints <30 mins a. Bouchards Nodes b. Heberdens Nodes NONE Water exercises, Swimming Warm application for stiffness; Rest relieves pain Acetaminophen

30-40 y.o. Men Random Small joints; BIG TOE NONE a. Podagra Arthrocentesis Bed Rest Bed Rest during exacerbation

Acute GA: Colchicine Chronic GA: Allopurinol Foods rich in Purine: RED MEAT (STEAK), Organ Meat (Gizzard, Intestine, Liver, Heart), Shellfish, Sardines, Beans Aspirin is contraindicated if client is taking ANTIGOUT medications Antigout medications: CAPS: Colchicine, Allopurinol, Probenecid, Sulfinpyrazone. Old name of OA: Degenerative Joint Disease Peak Onset of Juvenile Rheumatoid Arthritis: 2-16 years old

X. Herniated Nucleus Pulposus Common Site: between L4-L5 or L5-S1 Diagnostic Test: Myelogram (-gram: use of dye or contrast medium) Back pain is triggered by: Increase in Intraabdominal and Intrathoracic pressure Surgical Management: Laminectomy, Microdiskectomy, Spinal Decompression and Fusion Medical Management: Muscle Relaxants, NSAIDS, Corticosteroids, CHYMOPAPAIN For Chymopapain, Check for allergy to: Meat tenderizers XI. Other Musculoskeletal Disorders Pagets Disease -otherwise called Osteitis Deformans

-metabolic disorder of bone remodelling in which increased resorption results in bone deposits that are weak, enlarged and disorganized. Treatment of Pagets Disease: Biphosphonates and Calcitonin Osteomalacia: VITAMIN D DEFICIENCY IN ADULTS Ricketts: VITAMIN DEFICIENCY IN CHILDREN CLUBFOOT OR TALIPES EQUINOVARUS: Adduction, Plantar Flexion, Inversion of the foot Treatment of Clubfoot: CAST APPLICATION Bryants Traction is used for children with Congenital Hip Dysplasia, <3 y.o., & < 40 lbs. ORTOLANIS SIGN: audible and palpable CLICK in children with Congenital Hip Dysplasia. GALEAZZI SIGN (shortening of the leg on the affected side) is seen in children with Congenital Hip Dysplasia. Asymmetrical gluteal and thigh folds are findings in Congenital Hip Dysplasia. Treatment of Congenital Hip Dysplasia: Pavlik Harness and Hip Spica Cast Scoliosis: LATERAL CURVATURE of the spine Treatment of Scoliosis: Milwaukee brace (worn for 20-23 Hours) and Boston brace Most common Bone Infection: OSTEOMYELITIS Most common Bone Cancer: OSTEOSARCOMA Most common metastasis site of Osteosarcoma: LUNGS Treatment of Osteosarcoma: AMPUTATION, CHEMOTHERAPY, RADIATION THERAPY DUPUYTRENS CONTRACTURE: 4th and 5th digit is flexed.