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✓ Protection
FUNDAMENTALS OF MUSCULOSKELETAL o Protection of the vital organs
SYSTEM ✓ Movement and Locomotion
✓ Hematopoiesis
o Blood cell production
SKELETAL SYSTEM
3 types of Bone Cells
Structure of the skeletal system OSTEOBLASTS OSTEOCYTES OSTEOCLASTS
Building of Maintenance of Bone resorbing cells
- Composed of 206 bones in the body immature cells mature bone cells
- 2nd largest system of the body Use: Bond/cement Use: Main cells of Use: Repair of bones
4 categories of bones foundation of bones the bones
1) Long bones
➢ Humerus
MUSCULAR SYSTEM
➢ Femur
2) Short bones
Structure of the muscular system
➢ Phalanges
- Has more than 600 named muscles
➢ Fingers
- Composed of 40 – 60% of body weight
3) Flat bones
- 85% of body heat comes from muscle
➢ Skull
contractions
➢ Scapulae
Facts about the muscles
4) Irregular bones
▪ Biggest: Gluteus Maximus
➢ Vertebrae
▪ Smallest: Tensor Tympani and the Stapedius
Bone anatomy
✓ Inner ear
▪ Epiphysis
▪ Strongest: Masseter
o End part or distal part of the bone
✓ Jaw
▪ Metaphysis ▪ Hardest working: Heart or Cardiac muscle
o Narrowest portion of the bone
o Most common site of osteomyelitis 3 types of muscles
▪ Diaphysis CARDIAC SKELETAL VISCERAL
o Longest Involuntary Voluntary Involuntary
✓ Striated ✓ Smooth
portion
(shaft) Clinical terms used for basic muscle disorder
▪ Periosteum 1. Myopathy
o Thick ➢ Disease
outer 2. Myalgia
surface ➢ Pain
▪ Endosteum 3. Myositis
o Thin ➢ Inflammation
inner 4. Muscle dystrophy
surface ➢ Weakness
▪ Epiphyseal Exercise
line/plate
• Considered as health enhancing activity
o A.k.a.
• Purposeful bodily exertion
Growth
✓ Intentional
plate
o In-charge • Benefits:
of the longitudinal growth ✓ Fitness
o Closes by the age of: ✓ Weight loss
▪ Female: 13 – 15 years ✓ Better lung and heart function
▪ Male: 15 – 17 years old ✓ Muscle strength
✓ Improved mental clarity
Attachments of the Musculoskeletal System ✓ Self-esteem
JOINTS TENDON LIGAMENTS ✓ Mood and emotional stability
Bone to bone Bone to muscle Bone to joint
DIFFERENT TYPES OF MUSCLE CONTRACTIONS
Functions of the skeletal system Isotonic ✓ Same tone
✓ Length changes
✓ Support ✓ Two types:
✓ Mineral storage o Eccentric: Muscle
o 98% of calcium is stored in the bones lengthens
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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o Concentric: Muscle ▪ Steppage gait
shortens
o Neuropathic gait
Isometric Length does not change o High stepping
Spastic Excessive movement o Ex: Multiple Sclerosis/ALS
Flaccid Lacks movement
Atonic Loss of muscle tone
▪ Waddling gait
o Myopathic
Purpose of range of motion exercises o Ex: Pelvic disorders
✓ Increase strength and endurance ▪ Congenital Hip Dysplasia
✓ Delay degenerative changes ▪ Hemiplegic gait
o Paralysis/Hemiplegia
Therapeutic Exercises: RANGE OF MOTION o Ex: Stroke patients
PASSIVE ACTIVE - ACTIVE
ASSISTIVE
Exercise done Exercise done Exercise done 3 Phases of Gait Cycle
completely partially dependent completely STANCE STRIDE SWING
dependent independent Start phase Longest phase End phase

Checking of joint function

ARTICULAR SYSTEM ▪ Abduction
▪ Adduction
Three types of Joints
SYNARTHROSIS AMPHIARTHROSIS DIARTHROSIS
▪ Protraction
Immovable joints Slightly immovable Freely movable o Under bite
joints joints ▪ Retraction
Ex: Skull and Ex: Vertebrae Ex: Knee and
Sutures Shoulder
o Overbite
Connective Tissue: Connective Tissue: Connective Tissue: ▪ Pronation
Cartilaginous Cartilaginous Synovial ▪ Supination
▪ Extension
▪ Flexion
ASSESSMENT ▪ Circumduction
o Diarthrosis joints can do this
Check for: ▪ Rotation
✓ Pain ▪ Inversion
✓ Altered sensations ▪ Eversion
✓ Posture
✓ Gait 3 things to consider for Neurovascular status
✓ Bone integrity 1) Motor function
✓ Joint function ➢ Weakness and paralysis
✓ Muscle strength and size 2) Sensory function
✓ Skin intactness ➢ Paresthesia, numbness, and pain
✓ Neurovascular status 3) Circulation
➢ Color, temperature, and CRT

Types of Posture Terminologies for abnormalities in musculoskeletal

KYPHOSIS LORDOSIS SCOLIOSIS system
Forward bending of Backward bending of Lateral bending of
spine spine spine 1. Ankylosis
➢ Scarring within a joint
Abnormal gaits 2. Atrophy
▪ Shuffling gait ➢ Muscle wasting
o Festinating gait 3. Hypertrophy
▪ Fast gait ➢ Increase in size of muscle
▪ A.k.a. Parkinsonian Gait 4. Contractures
o Ex: Parkinson’s Disease ➢ Resistance to movement of muscle or
▪ Antalgic gait joint
o Against pain 5. Crepitations
o Due to foot/ankle/toe injuries ➢ Crackling sound or grating sensations
▪ Ataxic gait
o Intoxication
▪ Scissor-like gait
o Ex: Cerebral Palsy
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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DIAGNOSTIC EVALUATION Risk factors for subluxation and dislocation

▪ Repeated injury
1. X-ray studies ▪ Contact sports
➢ Most common o Such as repetitive overhead arm
➢ Non-invasive motion
➢ Confirmatory for fractures ▪ Throwing
2. CT scan ▪ Swimming
3. MRI ▪ Volleyball
➢ Remove all metallic objects prior the ▪ Congenital looseness
procedure Management for subluxation and dislocation
4. Arthrogram ▪ Joint manipulation
➢ X-ray of joints o Must be well-trained to do this
5. Bone densitometry o Best action
➢ For patients at risk for osteoporosis ▪ Joint immobilization
➢ Invasive o First action
6. Bone scan or scintigraphy ▪ Physical therapy
7. Electromyography ▪ Pain relief
➢ Electrical activity of the muscles
TEST TAKING STRATEGY
TEST TAKING STRATEGY Initial/First Action Best Action
Confirmatory Tests Screening Tests Independent interventions Highly Dependent interventions
Always Conclusive Simply suggestive Simply for alleviating the Ultimately solves the problem
✓ Gold Standard symptom

FRACTURES
MUSCULOSKELETAL TRAUMA
Types of fractures
Types 1) Complete
1. Strain 2) Incomplete
➢ For muscle 3) Close/Simple
2. Sprain 4) Open/compound
➢ For ligament 5) Transverse
3. Subluxation 6) Linear
4. Dislocation 7) Oblique
5. Fractures 8) Spiral
9) Comminuted
STRAIN vs. SPRAIN
10) Impacted
STRAIN SPRAIN 11) Greenstick
Pull or tear of a muscle Overextension or twisting of 12) Stress
ligament 13) Pathologic
Management for strain and sprain How fractures are categorized
▪ Pain relievers ✓ Skin involvement
▪ Cold compress for first 12 hours o Ex: Open/Compound
▪ Warm compress after cold compress ✓ Breaks
▪ Elevation o Ex: Complete/incomplete
o Rationale: To relieve edema ✓ Lines
o Ex: Transverse
Arm and leg
- Are attached to a socket COMPLETE INCOMPLETE
Separation of bone into 2 Bone does not separate
SUBLUXATION vs. DISLOCATION
CLOSE/SIMPLE OPEN/COMPOUND
SUBLUXATION DISLOCATION Skin is intact Penetrates the skin
Incomplete dislocation where Adjoining of bones to completely Nursing Diagnosis: Altered Nursing Diagnosis: Risk for
joint surfaces still touch not touch together Tissue Perfusion Infection

TRANSVERSE LINEAR
Across the bone Along the bone
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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o Slow drying
OBLIQUE SPIRAL ▪ Provides later weight
Slanted on the bone Around the bone
✓ One-sided only
bearing
o Water-susceptible
COMMINUTED IMPACTED Purpose of cast
3 or more fragments Two bones jammed together ✓ Immobilization
✓ Maintain body alignment
Greenstick fractures ✓ To correct any deformity
- Most common pediatric fracture ✓ To apply uniform pressure to underlying soft
- Bends and breaks tissue
Stress fractures ✓ To support and stabilize weakened joints
- Hairline fractures
- Very minute Cast care
Pathologic fractures 1. Neurovascular checks
- Break due to an underlying disease 2. Windowing
- Ex: Osteoporosis ➢ Putting a hole on pressure areas
➢ 4 pressure areas:
Clinical manifestations o Elbow
• Pain o Wrist
o Most common o Knee
• Loss of motion o Ankle
• Edema after 24 hours 3. Bivalving
• Crepitus ➢ Splitting cast into two
o Joint popping 4. Carry newly casted part with palm
• Ecchymosis 5. Elevate extremity
• Shortening of limb ➢ Rationale: To prevent edema
• Obvious deformity 6. Expose to air to dry
7. Observe for hotspots
Management of fractures 8. Petaling
▪ Cast application ➢ Applying waterproof tape or
▪ Bone reduction adhesives around the cast
▪ Immobilization ➢ Apply on edges to prevent cuts
▪ Traction lacerations or injuries
▪ Analgesia
Compartment syndrome
MUSCULOSKELETAL CARE MODALITIES - Pain, Warm itchiness on pressure areas
Short-arm cast Wrist and distal Nursing diagnosis of fractures
Long-arm cast Elbow and upper arm
Short-leg cast Foot and ankle ❖ Acute pain
Long-leg cast Knee thigh and skin o Short term priority
Walking cast Can bear weight and can ambulate ❖ Impaired physical mobility
Shoulder Spica cast Dislocation and humeral fractures
Short leg hip Spica cast For pediatric patients
o Long term priority
Hip Spica cast For adult patients ❖ Self care deficit
❖ Risk for peripheral neurovascular dysfunction
Casting materials o Potential
1. Non-plaster cast *Tip: Actual nursing diagnosis first before potential
➢ A.k.a. Fiberglass nursing diagnosis*
➢ More common
o Lighter Management for Closed Fractures
o Stronger or sturdier ▪ Control of pain and edema
o Fast drying o Edema occurs after 24 hours
▪ Provides earlier ▪ Use assistive device properly
weight bearing ▪ Modify environment to provide safety
o Waterproof o Remove carpets
2. Plaster cast ▪ Self-care
➢ Less common
o Heavier Management for Open Fractures
o Not as strong or sturdy ▪ WOF: Osteomyelitis, tetanus, and gangrene
o Tetanus – give toxoid vaccine
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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▪ IV antibiotics TRACTION COUNTER-TRACTION
Weights and Sandbags Patient’s weight
o Rationale: Patient at risk for infection
▪ Monitor for delayed primary wound healing
▪ Control of pain and edema What is the main purpose of traction?
▪ Neuromuscular assessment ✓ Guides the body part back into place and holds
it steady
Complications of fractures ✓ Regain normal length and alignment of
1. Hypovolemic shock involved bone
➢ Open and compound fracture ✓ Decrease painful muscle spasms that
➢ Narrowing of pulse pressure accompany fractures
2. Fat embolism
➢ Long bone fractures Types of tractions
3. Compartment syndrome 1. Skin
4. Nerve palsy 2. Skeletal
5. Avascular necrosis 3. Bryants traction
SKIN TRACTION SKELETAL BRYANT’S
6. Delayed union/malunion TRACTION TRACTION
7. Regional pain syndrome Primary purpose: Purposes: Combination of Skin
Immobilization ✓ Immobilization and Skeletal Traction
✓ Bone repair
Used less than 8 Used more than 9 Appropriate
COMPARTMENT SYNDROME weeks weeks positioning:
✓ Buttocks are
- Excessive pressure builds up inside an slightly
elevated and
enclosed muscle space clear off the bed
INTERNAL PRESSURE EXTERNAL PRESSURE ✓ Should not be
Due to bleeding and edema Due to tight cast touched or
Management: Management: resting on the
✓ Fasciotomy ✓ Windowing bed
o First intervention Short term Long term -
✓ Replacement Uses splints, Uses splints and -
o Best intervention bandages, adhesives, weights + tongs, pins,
✓ Bivalving and weights screws
Non-invasive Invasive -
Signs and symptoms >> Irreversible! >> report ASAP! Nursing Diagnosis: Nursing Diagnosis: -
Altered Tissue Risk for infection
✓ Pain unrelieved by analgesic Perfusion
✓ Paresthesia
✓ Pallor Maintaining effective traction
✓ Pulseless ✓ Maintain positioning
✓ Paralysis ✓ Prevent skin breakdown
✓ Cyanosis o Rationale: Can give moisturizers if
✓ Cool to touch on affected extremity dry skin
✓ Monitor neurovascular status
TRACTIONS
For every traction, there should always be a counter-traction
✓ Pin site care
o For skeletal tractions only
Principles of effective traction ✓ Promoting exercise
1) Temperature check ✓ Never remove weights from any traction
2) Ropes should hang freely unless a life-threatening situation occurs
➢ Must be freely hanging o Authorized person to do this:
➢ No knots! Physician
3) Alignment o Needs doctor’s orders
4) Circulation check
5) Type and location Complications of tractions
6) Increase hydration 1. Pressure ulcers
➢ Rationale: At risk for constipation ➢ Ttt: Provide Egg-crate mattress
7) Overhead trapeze 2. Pneumonia
8) No weights on the floor ➢ For thoracic injuries
➢ Weights should be freely hanging 3. Constipation and anorexia
o Rationale: For it to be 4. Infection
effective 5. Venous thromboembolism

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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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ASSISTIVE LOCOMOTION Left foot Achilles tendon tear 3-point gait
repair
Right above the knee Swing through gait
Canes amputation
▪ Position: COAL Right ACL repair 3rd day post 3-point gait
o Cane Opposite Affected Leg op
▪ Maneuver: CWS
o Cane, weak leg, strong leg Wheelchair
▪ Wheeled assistive device with back, arms and feet
Walkers support
▪ Correct way to use a walker ▪ Recommended for patients:
o Pick it up o With paralysis of the lower body
o Set it down (forward) o Not allowed to bear weight on both lower
o Walk to it extremities
▪ Correct way to get up from a chair using a walker ▪ Types
o Hold on to the chair o Manual propulsion
o Stand up o Remote controlled
o Grab the walker o Breath and voice operated
Nursing considerations
Crutches 1. Lock wheels if not moving
▪ Correct measurement 2. Transfer patient via the stronger side or the
o 2-3 finger breadths below the axilla body
o Laterally and slightly in front of the foot 3. Always lead with the larger wheels when
o Elbow flexion must be 30 degrees entering elevators
▪ Types of gaits 4. On inclined areas
4-point gait ✓ Slowest ➢ Push when climbing up
✓ Most stable
✓ Right crutch, left foot, left ➢ Back up when going down
crutch, right foot
2-point gait • Military gait Morton’s neuroma
• Right crutch and left foot,
left crutch and right foot - Pain in 3rd and 4th digit of the toes
3-point gait ✓ Classic gait Impingement syndrome
✓ Most common - Tendons of the rotator cuff of the shoulder are
✓ Both crutches and affected
leg, unaffected leg pinched as they pass between the top of the
Swing to gait • Both crutches, both legs upper arm and the tip of the shoulder
level to crutch Dupuytren’s contracture
Swing through gait ✓ Fastest gait
✓ Both crutches, both legs past - Base of fingers
the crutch
CARPAL TUNNEL SYNDROME
▪ Crutch walking gaits
o Going up and down the stairs up with the - Median nerve compression or squeezing
good down with the bad Common affected parts ✓ Wrist
▪ Good leg, bad leg with the crutch ✓ Thumb
✓ Index
✓ Middle finger
Principle in choosing a gait Causes ➢ Repetitive wrist maneuvers
1) Even for even, odd for odd ➢ Common: Typewriting
Hallmark sign Tinel’s sign
2) Even gait ✓ A tingling “pins and
➢ Bilateral condition needles” feeling when the
➢ Acute case: 2-point gait healthcare provider taps the
skin over a nerve
➢ Severe case: 4-point gait Provocative sign Phalen’s sign
3) Odd gait ✓ Reverse prayer maneuver
✓ Expectation: Tingling
➢ Unilateral condition sensation after flexing the
4) Use swing through wrist to 90 degrees after 1
➢ For non weight bearing full minute
Signs and symptoms ➢ Tinel’s sign
➢ For amputees ➢ Phalen’s sign
➢ Poor grip strength
APPROPRIATE TYPE OF GAIT ➢ Clumsiness and dropping
Early-stage Rheumatoid 2-point gait objects unintentionally
Arthritis ➢ Poor ROM of wrist
Bilateral total knee replacement 4-point gait Preventive Management Avoid repetitive flexion of wrist
Advanced stage ALS 4-point gait Surgical Management Surgical release of transverse
carpal ligament
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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a) Traditional
- Open
- More risk for infection SCOLIOSIS
b) Endoscopic
- Close
Other Management ✓ Rest and splint the wrist
- Abnormal lateral curvature of the spine
✓ NSAIDS
✓ Corticosteroids Signs and symptoms ✓ Prominent scapulae and ribs
✓ Carpal Canal Cortisone ✓ Asymmetry of shoulders
Injection ✓ Uneven waistline
- Uneven skirts and bra
straps
Diagnostic tests a. Bend test
- Screening
OSTEOMYELITIS b. X-ray
- CONFIRMATORY
c. Routine assessment
- Bone infection causing swelling that can lead - As early as 10 years
old (females)
to bone damage and loss - Rationale: They are
- Most common infection via the blood stream more at risk compared
to adolescents due to
heavy backpacks
Low-grade fever vs. High-grade fever Complications Respiratory Depression
• Low fever ✓ Compresses the lungs
✓ Localized
✓ Chronic
• High fever Structural
TYPES OF SCOLIOSIS
Functional
✓ Systemic S – shaped C – shaped
✓ Most common
Common affected parts Metaphysis Primary scoliosis Secondary scoliosis
Causes Staphylococcus Aureus bacteria Cause: Unknown Causes:
(Staph infection) ✓ Congenital Hip Dysplasia
Risk factors ✓ Traumatic injury or wound ✓ Posture
✓ Blood infection ✓ Torticollis
✓ Artificial joint (hip - Twisting of the
replacement) sternocleidomastoid
✓ Metal implants muscle
✓ Deep pressure ulcers or
injuries When it deviates:
Signs and symptoms ➢ High fever
➢ Diaphoresis ▪ Dextroscoliosis
➢ Chills o To the right
➢ Limited and painful
movement
▪ Levoscoliosis
➢ Irritability and lethargy o To the left
➢ Purulent drainage Management
- Pus, abscess and
exudates 1) Postural exercise
Diagnostic tests a. Needle biopsy ➢ < 20 degrees
- GOLD STANDARD ➢ Teaching patient how to sit and stand
b. Biomarkers for
inflammation straight
- WBC ➢ Proper posture
- ESR
c. Radioactive bone scan
2) Pelvic traction
d. Imaging tests ➢ >20 degrees
- Least sensitive ➢ Ex: skin traction
- Ex: X-ray
Complication ✓ Recurrent accumulation of 3) Milwaukee/Boston brace
abscess ➢ Used 23 hours daily
✓ Osteonecrosis
✓ Stunted growth
➢ 1 hr: for rest and bathing
Surgical Management Debridement ➢ Worn within 2 – 3 years
✓ Most advisable ➢ Shirt first (cotton), brace after
Other Management ➢ IV antibiotics
➢ Anti-fungals
➢ Do not apply creams, powders, lotion
➢ Needle aspiration when using the brace
➢ Pain relievers o Keep skin dry
4) Spinal fusion with Harrington rod
5) Preferred management
➢ Structural
o Spinal fusion

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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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o Steel rods on spine Management for Rheumatoid Arthritis
(Harrington Rods) ▪ Surgeries
➢ Functional a. Osteotomy (Bone cutting)
o Postural exercise ➢ Manages bone erosion
o Pelvic traction b. Synovectomy
o Milwaukee/Boston brace c. Arthroplasty

Common deformities of Osteoarthritis “HB”

OSTEOARTHRITIS vs. RHEUMATOID ▪ Heberden’s nodes
ARTHRITIS o Small bony growths that appear on the
distal phalanges
OSTEOARTHRITIS RHEUMATOID ARTHRITIS ▪ Bouchard’s nodes
Problem: Cartilage loss Problem: Synovial Inflammation
✓ Degenerative ✓ Inflammatory
o Bony bumps on the proximal
Risk Factors: Risk Factors: phalanges
✓ Genetics ✓ Systemic Cause of both Heberden’s and Bouchard’s Nodes
✓ Old age ✓ Autoimmune
✓ Obese ✓ Chronic
✓ Fibrosis due to synovial tissue
✓ Overuse
Unilateral/Asymmetrical Bilateral/Symmetrical GOUTY ARTHRITIS
Big bones Small bones and Joints
✓ Hips and knees ✓ Hands and feet
Harbeden’s and Bouchard’s nodes Presence of nodule - Monoarticular (isolated joint) acute attacks
✓ Extra articular effects caused by elevated serum uric acid levels
Morning stiffness Morning stiffness
✓ <1 hour ✓ >1 hour
Diagnostics: Diagnostics: TYPES OF GOUTY ARTHRITIS
✓ Normal ESR and C-Reactive ✓ Elevated ESR & C-reactive Primary Secondary
protein Genetic Medication and Lifestyle
Management: Management: ✓ Most common type
✓ Occupational therapy ✓ Rest ✓ Ex: Alcoholism and Diet
✓ Viscosupplementation ✓ DMARDS
o Joint lubricants ✓ NSAIDS
o Contains hyaluronic
acid Common sites of Tophi ▪ Big toes
✓ NSAIDS formation ▪ Ears
▪ Fingers
▪ Joints
Common deformities of Rheumatoid Arthritis Causes Uric acid levels
1) Swan neck deformity ✓ Most common
Hallmark signs 1. Tophi formation
➢ Most common - Uric acid crystals
➢ Proximal Interphalangeal (PIP) Joint - Visible palpable soft
tissue masses with
hyperextension. whitish or yellowish
➢ Flexion of Distal Interphalangeal deposits
(DIP) joint - Chalky-white deposits
2. Podagra
2) Ulnar drift - Pain on big toes
➢ Metacarpophalangeal (MCP) joints 3. Renal calculi
become swollen which causes fingers 4. Low-grade fever
Diagnostic tests a. High serum uric acid level
to bend abnormally towards the pinky - > 7mg/dL
finger - CONFIRMATORY
3) Boutonniere deformity b. ESR
- Inflammation
➢ PIP joint flexion - >30mm/hr
➢ DIP hyperextended - Screening test
c. X-ray
4) Hallux Valgus Deformity - Presence of Tophi
➢ A.k.a. Bunions - Screening test
➢ Base of the big toe or d. Synovial fluid aspiration
- Presence of Urate
Metatarsophalangeal (MTP) joint is crystals
affected Management for Acute attacks ▪ Colchicine
➢ Misalignment of MTP joint - First medication to
give
- Maximum of 12 tabs a
Pannus formation in RA causes: day
✓ Bone erosion - WOF: Diarrhea >>
increase hydration
✓ Cartilage destruction ▪ NSAIDS
✓ Ligament damage Management for Prolonged use ✓ Probenecid (Benemed)
✓ Allopurinol (Zyloprim)

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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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Both stop uric acid formation and Management
enhances excretion of uric acid
Other Management ▪ Hydration
1) Abduct the affected leg with knees flexed
▪ Diet and lifestyle ➢ Pavlik harness
modification ➢ Hip spica cast
▪ Avoid high PURINE foods
- Organ meat ➢ Frejka splint
- Alcohol ➢ Triple diapers
- Seafood (Shellfish, 2) Avoid sitting on low chair
Sardines, Scallops)
- Anchovies 3) Avoid prolonged sitting

Summary of Management for Arthritis
RHEUMATOID
▪ Naproxen
▪ Sulindac (Clinoril)
▪ Arcoxia
▪ Ibuprofen (Motrik)
▪ Diclofenac
▪ Salicylates
- For its Anti-
inflammatory
function
▪ Tumor necrosis
factor blockers
▪ Etanercept
▪ Methotrexate
(DMARD)
▪ Gold salts
▪ Glucocorticoids
✓ Risk for depression
✓ Decreased libido
✓ High sugar
✓ High salt
OSTEOARTHRITIS
NSAIDS
Herbal supplements:
✓ Glucosamine
✓ Chondroitin
If patient is obese
✓ Total hip replacement
✓ Viscosupplementation
✓ Weight loss
OSTEOPOROSIS
GOUTY - Disorder when bone mineral density and bone
ARTHRITIS mass decreases
Short term
✓ Colchicine - Most common metabolic bone disease
✓ NSAIDS - Females > males
- Affects upper extremities
Risk factors “ACCESS” ▪ Alcohol use
▪ Corticosteroid use
Long term ▪ Calcium is low
✓ Allopurinol ▪ Estrogen is low
✓ Probenecid ▪ Smoking
▪ Sedentary lifestyles
Patient teaching
✓ Diet and Signs and symptoms ✓ Decreasing height (10cm –
hydration 15cm)
✓ Back pain (T5 – L5)
✓ Dowager’s hump
✓ Fracture with minimal
trauma
- Pathologic fractures

Disease Modifying Anti Rheumatic Drugs “MASH” Diagnostic tests 1) X-ray

- Every year
- All immunosuppressants or immune 2) Dual energy x-ray
modulators absorptiometry
- Uses: interferes with inflammatory cascade 3) Bone mass density
- CONFIRMATORY
- Methotrexate 4) Laboratories
o Most used - Serum calcium
- Azathioprine - Serum phosphate
- Serum alkaline
- Sulfasalazine phosphate
- Hydrochloroquine - ESR
Preventive Management ✓ High calcium and Vitamin D
diet
✓ Cessation of smoking
CONGENITAL HIP DYSPLASIA ✓ Decrease in alcohol intake
✓ Regular weight bearing
exercises
- Displacement of femoral head form the - Brisque walking
acetabulum Pharmacologic Management ▪ Selective Estrogen Receptor
Modulators
- Rolaxifene
Signs and symptoms ▪ Bisphosphonates
- Alendronate
▪ Barlow sign (Fosamax)
o (+) Dislocation upon adduction - Resendronate
o Seen in children more than 1 year old (Actonel)
- Ibandronate (Boniva)
▪ Allis/Galeazzi’s Sign
o Unequal knee height
o Shortened affected leg
▪ Limitation of movement
▪ Ortolani’s sign
o (+) Abnormal clicking sound upon
abduction
o Less than 12 months
▪ Trendelenburg’s sign
o Waddling gait
▪ Asymmetrical gluteal fold
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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OSTEOMALACIA FAT EMBOLISM

- Marked softening of your bones, caused by - Fat moves from bone marrow to bloodstream
severe vitamin D deficiency o From yellow marrow
- Affects lower extremities - Can go into:
- Can be mistaken with Osteoporosis o Lung
o Brain
Pediatric counterpart o Heart
✓ Rickets Disease Common in: Closed, long bone fractures
particularly the femur
Signs and symptoms Triad symptoms ▪ Respiratory changes
▪ Bowed legs - Tachypnea
▪ Bone pain - Hypoxia
▪ Neurological changes
▪ Muscle weakness - Restlessness
▪ Porous bones - Confusion
Management ▪ Petechial rash
- Fat globules affect
1) Vitamin D and calcium supplementation dermal capillaries
2) Adequate sun exposure Hallmark sign Ventilation-perfusion mismatch
3) Assisting in ADLS ✓ Lungs receive O2 without
blood flow or vice versa
➢ Wheelchair Supportive Management ▪ Early immobilization of
REMEMBER ‼️ fracture
OSTEOMALACIA OSTEOPOROSIS ▪ Adequate oxygenation
Cause: Lack in vitamin Cause: Multifactorial ▪ Adequate hydration
Lower extremities Upper extremities ▪ Maintenance of
✓ Legs ✓ Spine hemodynamic stability
Common in Pedia Common in Elderly

OSTEOGENESIS IMPERFECTA NECK / CERVICAL DYSTONIA

- Autosomal dominant genetic disorder due to - Conditions of the head and neck muscle
loss of collagen making bones fragile and hard stiffness
to form o A.k.a. Spasmodic torticollis
- A.k.a. Brittle bone disease - Torti/Tortus: Twisting
- Irreversible and non-curable - Collis: Neck or collar

Signs and symptoms Common affected parts Sternocleidomastoid muscle

Types of Torticollis ▪ Rotated: Torticollis
▪ Brittle bones and teeth ▪ Sideward: Laterocollis
▪ Loose joints ▪ Backward: Retrocollis
▪ Kyphosis ▪ Forward: Anterocollis
Complication Vertebral or Postural Deviation
▪ Blue sclera Preventive Management ✓ Stretching or postural
o Sclera contains collagen deviation
o If lacking collagen, sclera will thin ✓ Firm pillow support
Other Management ▪ Analgesia
and then blue ▪ Warm compress
▪ Triangular-shaped face ▪ Muscle relaxants
o Broad forehead ▪ Botox injection
▪ Small body
CONGENITAL ACQUIRED
o Since epiphyseal plates are also Birth trauma Cold exposure
affected Ocular abnormalities Unbalanced carrying
Management ✓ Most common
Tumor Posture
1) Preventive
➢ Bisphosphonates
20/20 vision
o Slows down the progression of the
- Achieved by the age of 6 years old
disease
20/150 vision
2) Rehabilitative
- At birth vision
➢ Physical and palliative therapy
➢ Intramedullary bonding
o Metal rods
▪ At risk for osteomyelitis
o Casting

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Patricia Marie A. Braulio, BSN - Velez College - SLRC
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BASILAR SKULL FRACTURE DUCHENNE’S MUSCULAR DYSTROPHY

- Head injury that involves a break in at least - Genetic disorder causing muscle weakness
one of the bones of the skull due to loss of a muscle protein, Dystrophin
- Bones are not affected!
Common affected part Temporal bone - Irreversible
Causes ▪ High impact blunt trauma
▪ Motor vehicular accidents
▪ Assault Signs and symptoms
▪ Falls
▪ Suspect abuse in women and ▪ Gower’s sign
children o They cannot stand appropriately
- If no other related o Difficulty standing up
medical hx
- First to suspect o Splinting their hand to stand on the
Incidence Common in males with high-risk floor or knee
activity occupation ▪ Tiptoeing
Hallmark sign Hemotympanum
Signs and symptoms ✓ Bloody otorrhea ▪ Weak muscles over diaphragm and heart
✓ CSF rhinorrhea and otorrhea ▪ Calf hypertrophy (fat and fibrosis
✓ Battle’s sign replacement)
✓ Raccoon eyes
- Develops in 6 – 12 ▪ Lordosis
hours ▪ Waddling gait
✓ Cranial nerve deficits
✓ Decreased auditory acuity
▪ Protruded belly
✓ Tinnitus Management
✓ Dizziness 1) No known cure
✓ Nystagmus
Complications ▪ CSF leak and fistula 2) Glucocorticoid
▪ Cranial nerve injury ➢ Deflazacort (Emflaza)
▪ Cerebrovascular injury 3) Physiotherapy
▪ Meningitis
▪ Hearing loss ➢ For muscle strength
▪ Vertigo 4) Braces and wheelchair
▪ Intracranial hemorrhages ➢ For mobility
- Most fatal 5) WOF
complication ➢ Developmental delays
- Bleeding internally
Diagnostic tests 1. CT scan
▪ Still cannot walk by 3 years
2. X-ray can miss 70% – 80% old
of skull fractures ➢ Risk for injury
- Not recommended for
BSF ➢ Respiratory arrest or cardiac failure
3. Physical examination ▪ Most fatal
4. MRI
Management ▪ No special treatment
▪ Check for: CLUBFOOT
- Signs of bleeding
- Level of consciousness
- Nerve deficits
- A.k.a. Talipes Disorders
▪ Do not insert NGT and - Complex deformity of the ankle and foot
Nasopharyngeal suction - Affects the ligaments
▪ Symptoms will disappear 24
– 72 hours after
- Chronic overextension of the ligament

TYPES OF TALIPES
Talipes Varus Inversion
EPIDURAL vs. SUBDURAL HEMORRHAGE Talipes Valgus Eversion
Talipes Equinus ✓ Plantar flexion
Epidural Hemorrhage Subdural Hemorrhage ✓ Toes are lower than the heel
Convex/lens shaped Concave/crescent shaped Talipes Calcaneus ▪ Dorsiflexion
Pear shaped Banana shaped ▪ Toes are higher than the heel
Rapidly expanding with arterial Slowly expanding with venous
blood blood
✓ Emergency
Common in head trauma, injury, Common in shaken baby Management
or fracture syndrome ▪ Ponseti Method
o Serial manipulation and casting
weekly for 3 – 6 months
▪ Change of cast every week
▪ Rationale: To restore the
deformity to its normal place
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Patricia Marie A. Braulio, BSN - Velez College - SLRC
____________________________________ORTHOPEDIC NURSING___________________________________
▪ Achilles Tenotomy SAMPLE QUESTIONS
o Releases tension/tightness in the heel
cord 1. An adult has a fracture left radius, which has
▪ Bracing been casted, while performing an assessment of
o Boot and bar this client, the nurse will correctly identify
which of these findings as emergent?
HEADACHE a. Pain at the fracture site
b. Swelling of fingers of left hand
- Stimulation of pain-sensitive structure of the c. Diminished capillary refill of fingers of
head and neck left hand
Types d. Warm, dry fingers of left hand
1) Primary
a. Chronic 2. Following a motor-vehicle accident, a patient
b. Recurrent arrives in the emergency department with
2) Secondary massive right lower-leg swelling, which action
a. Abrupt or acute will the nurse take first?
➢ Most dangerous a. Elevate the leg on pillows
TYPES OF HEADACHES b. Apply a compression bandage
Primary Secondary c. Place ice packs on the lower leg
Chronic and recurrent Abrupt and acute
✓ Most dangerous d. Check leg pulses and sensation

3. A client with a recently applied plater leg cast

HEADACHE CLASSIFICATION complains of unrelieved pain and paresthesia in
Cluster Tension Migraine the affected extremity. The assessment by the
Least common Most common 2nd most common
Idiopathic Due to: Due to:
nurse reveals diminished pulse, pallor, and
✓ Associated with ✓ Muscle stiffness ✓ Cortical increased pain on passive motion. What must
Trigeminal ✓ Dehydration spreading the nurse do first?
Neuralgia ✓ Lack of sleep depression
Duration: 30 minutes Duration: Variable Duration: 4 – 72 a. Monitor the client for the next hour
– 3 hours hours b. Administer an analgesic for pain
Characteristics: Characteristics: Characteristics: c. Administer an anxiolytic
✓ Stabbing ✓ Both sides ✓ Pulsatile
✓ Sharp ✓ Temporal or ✓ One day onset d. Notify physician immediately
✓ Orbital Frontal ✓ Unilateral
✓ Unilateral ✓ Non-pulsatile ✓ N/v 4. What must you do initially for fat embolism?
✓ Ptosis ✓ Band-like ✓ Disabling
✓ Partial Horner a. Place the patient in high-fowler’s
Syndrome position to maximize lung expansion
Continuous and Waxing and Waining “Worst headache of
Explosive ✓ Like having a
b. Administer 100% oxygen via non-
my life”
rubber band on breather mask
the head c. Make sure the patient has patient IV
Management: Management: Management:
▪ Sumaptriptan ▪ Analgesics ▪ Hydration
line and administer IV fluid
▪ Oxygen (NSAIDS) ▪ Analgesics d. Put the patient in recumbent position
▪ Intranasal ▪ Acetaminophen (NSAIDS) 5. A 63 – year old woman has been taking
Lidocaine ▪ Caffeine ▪ Antiemetics
▪ Sumatriptan prednisone (Deltasone) daily for several years
after a kidney transplant to prevent organ
rejection. What is most important for the nurse
to assess?
a. Staggering gait
b. Ruptured tendon
c. Back or neck pain
d. Tardive Dyskinesia

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Patricia Marie A. Braulio, BSN - Velez College - SLRC