The Musculoskeletal System

Functions of the Musculoskeletal System

1. Provide _____________ for vital organs. 2. ______________ body structures by providing a strong and sturdy framework. 3. Locomotion/movements. 4. ____________ storage. 5. Hematopoiesis. 6. Heat production.

I. ANATOMY OF THE SKELETAL SYSTEM
a. Axial Skeleton There are ____ axial skeletons. b. Appendicular Skeleton There are _____ appendicular skeletons. • TYPES OF BONES

1. LONG BONES

2. SHORT BONES

3. FLAT BONES

4. IRREGULAR BONES

HISTOLOGY OF BONE TISSUES

a. Osteoblast -Bone-_____________ cells b. Osteocytes -________________ osteoblasts c. Osteoclast -Bone-_____________ 1

BONE MAINTENANCE:

1. STRESS & EXERCISE 2. VITAMIN D 3. HORMONAL CONTROL 4. BLOOD SUPPLY
5. VITAMIN C 6. CALCIUM and PHOSPHORUS

Characteristics: 1. Joints allow the __________ between bones. 2. Joint surfaces are covered with ___________. 3. Joints are enclosed in a capsule. 4. Joints contain a cavity filled with synovial fluid. 5. LIGAMENTS 6. TENDONS
Classifications: 1. SYNARTHROSIS –

• JOINTS

2. AMPHIARTHROSIS –
3. DIARTHROSIS –

TYPES OF DIARTHROSIS JOINTS a. Ball and Socket joints b. Hinge joints c. Pivot joints d. Gliding joints -

II. ANATOMY OF THE MUSCULAR SYSTEM
• MUSCLE TYPES 1. Cardiac – 2. Smooth – 3. Skeletal –

2

• III. SPRAIN • Cause:  Sudden TWISTING or ________________ motion S/Sx • GOAL: a. RICES Nursing Management for Strain and Sprain: b. The ___________ moves the patient’s body part without any assistance from the patient. ACTIVE – RESISTIVE RANGE OF MOTION EXERCISES Description The patient moves own body part or limbs. The patient moves a weak body part as far as possible using his stronger arm or leg. Muscle Relaxants   Ibuprofen (Motrin) Naproxen (Anaprox. ACTIVE b. There is no ____________ movement. ACTIVE – ASSISTIVE d. TRAUMATIC INJURIES 1. 2. ISOTONIC CONTRACTION -Involves change in muscle length and no change in tension. NSAID’s        c. Contraction of muscle against an opposing force. ISOMETRIC CONTRACTION -Muscles contract but does not shorten. STRAIN • Cause:  Overuse  Overstretching  2. Type a. PASSIVE c. Naprosyn) Diclofenac (Voltaren) Diflunisal (Dolobid) Indomethacin (Indocin) Ketorolac (Toradol) Piroxicam (Feldene) Methocarbamol (Robaxin) Cyclobenzaprine (Flexeril) 3 .• TYPES OF MUSCLE CONTRACTION 1.

I • Cause   •      • S/Sx Shoulder Pain Muscle weakness Inability to sleep on the involved side • diagnostic procedure.non-invasive diagnostic scanning technique that uses magnetic waves to obtain a three dimensional view of a body part. S 3.  Instruct to remain still during the procedure. Educate regarding the importance of _____________ exercises prior to strenuous activities. Preparation:  Assess for implanted _____________ in the body.  Contrast medium may be used. Contraindications: • Pts with metallic implants • Pts with pacemakers • ARTHROGRAM -a series of X-rays of a joint after injection of a contrast medium. T 2.  Informed consent  NPO for 8 H 4 . Carisoprodol (Soma)  Baclofen (Lioresal)  Metaxalone (Skelaxin) d.  Remove _____________ accessories. Diagnostic Test X-Ray -most widely used non-invasive musculoskeletal • Computed Tomography Scan -multiple X-rays create a three-dimensional view of a cross-section of a body. 3.  Instruct the Px that the machine produces loud thumping and humming noises. • MRI .  Assess for ________________. Surgical repair for SEVERE STRAIN: ____________________ e. S 4. ROTATOR CUFF INJURIES 1.  Sedation may be done.

Inform the client that slight ________ may occur at the needle insertion sites.  Assess for allergies to Iodine Minimize the use of the joint for 12 H post-procedure • DROP ARM TEST -_____________ to maintain abduction of the arm at the level of the shoulder & the inability to perform _____________ motions or activities. PT/ shoulder exercises started after ____ weeks d. . 3. duration: several days to ___ weeks c. (+) 3. Instruct patient not to sleep over the involved hand. (+) 2.  NURSING MANAGEMENT GOAL no. 2. CARPAL TUNNEL SYNDROME Definition: _______ nerve compression at wrist joint. EMG -measures electrical potential associated with skeletal muscle contractions. c. d. Solu-Cortef) Nursing Management Prednisolone tebutate (Hydeltra) Triamcinolone (Aristocort. Aristospan. Rest of the extremity Kenalog) Intermittent Ice and Heat Compress Methylprednisolone (Depo-Medrol) Dexamethasone (Decadron) NSAID’s as ordered Betamethasone (Celestone Soluspan) Cortisone Injection thru arthroscopy Surgical Management Open Acromioplasty a.  Cause •  S/Sx • • • •  1. Informed consent b. REST HANDS. Avoid excessive use of involved hand. immobilize shoulder b. Instruct the client that needle insertion is uncomfortable. a. 1: __________________________________ 1. full recovery takes _____ months •      •  Post-op: 4. Intra-Articular Corticosteroids: Cortisone (Cortone) Hydrocortisone (Cortef. Instruct the client not to take any stimulants or sedatives for ____ hours before the procedure. 5 Paresthesia Muscle weakness “Clumsiness” when using the hand PAIN Diagnostic tests Repetitive & constant flexion of the wrist.

Tends to occur in elderly men b. Linear e. Corticosteroids ASA (acetylsalicylic acid/Aspirin) NSAIDs  SURGICAL MANAGEMENT 1. Transverse d. Analgesics 2. 2. 2: To prevent injury. Avoid excessive use of involved hand. Cause: General Information: a. 3.4. Impacted j. FRACTURE Types of Fracture a. Administer medications as ordered. Complete b. Familial c. Oblique f. DUPUYTREN’S CONTRACTURE -contracture of the palmar fascia resulting in flexion of the 4th and 5th digit of the hand. Splinting 6. Greenstick h. Comminuted i. GOAL no. Closed or Simple 6 . Instruct pt to wear gloves. REST HANDS. Incomplete c. 5.  MEDICAL MANAGEMENT 1. The _____ digit is _________ affected Management:  Fasciectomy  Collagenase Nursing Management: 1. Carpal Tunnel Release -cutting and releasing of the _____________ ligament. Spiral g. 1.

NVS • Nursing Interventions 1. 2. Colle’s m. Pott’s • Cause  Stress  Pathologic  Traumatic • S/Sx         Pain Tenderness Loss of motion Edema Ecchymosis Shortening of the limb Obvious deformity • Diagnostic test  X-Ray  CT SCAN  Magnetic Resonance Imaging • Emergency Management: GOAL: __________________________ 1. & UTI.k. Immobilize 3. Control Bleeding 4. Open or Compound l. renal calculi. Cover wound 5. 3. 5. NVS assessment. Assess 2. Elevate the Fx site above the ________________ level. ________________ to prevent constipation. Consume appropriate diet for bone healing. Maintain ________________ & ________________ of the affected extremity. 4. 7 .

7. Wound debridement. *X-ray after procedure Open reduction –– __________ approach to reduce fracture fragments with fixation. Prevent crust formation.Rigid external immobilizing device that is molded to the contours of the body. tenderness. Notify the physician for signs of infection. *Complications of External Fixation:  OSTEOMYELITIS -Most _________ form of bone infection. REDUCTION • • Closed reduction –– through ________ manipulation and _______________ traction followed by application of cast. CA:  Signs & Symptoms: • Body malaise • Swelling at the site • Fever • Chills • Pain  Management: 1. bone marrow. Give tetanus prophylaxis as ordered for open fractures. -Infection of the bone. CAST . pain.  • • • Nursing Management Assess for redness. 10. b. swelling and loosening of pins. Immobilize affected part of the patient. Report ________________ pain. Antibiotics 2. Observe for S/Sx of ________________. • Medical Management a. and surrounding soft tissues. and crutch walking if needed. Give analgesics as prescribed. 3. 9. Plaster Cast -aka _____________________ -initially emits heat -cools in ____ minutes -dries in ___________ hours DRY APPERANCE PERCUSSION ODOR TEXTURE 8 WET . Teach about cast care. traction. 8.6.

Maintain skin integrity by _____________ the edges.pulling force associated with a counterpull. -Generally _________ lbs of weight is used for the pulling force. To maintain body alignment.either a shoulder or hip spica cast. Immobilize a reduced fracture. Body Cast – encircles the _________. Immobilize Fx’s 4. Types of Cast 1. *Pelvic Traction = ________________ *Cervical Traction = ______________ a. Expose to dry environment. 2. Carry with the !!!___________ of the hand when WET.Simplest form of traction .Counter Traction: 9 . Do not scratch the skin under the cast by inserting objects inside the cast. Keep clean and dry. 4. BUCK’S EXTENSION TRACTION Indication: . Perform NVS 7. Skin Traction -pulling force is applied directly to the skin and indirectly to the bones to maintain alignment. Short Leg Cast – extends from the _______ down to the base of the _______. Correct deformities 1. Walking Cast – either a long leg or short leg cast reinforced for strength. Muscle spasm control 3. c. 5. Purpose 1. 2. 3. 5. 2. Long Leg Cast – extends from the ________ down to the base of the toes.Fiberglass -aka __________________________ -it has small pores -water resistant -dries ___________ minutes Purpose 1. Elevate with pillow. Care of Clients with Cast 1. 6. 8. Observe HOT SPOTS and musty odor. Short Arm Cast – extends from the ________ down to the ____________. 3. 7. Pain relief Types 2. Spica Cast . 6. Long Arm Cast – extends from the ________ down to the palmar crease. TRACTION . 4.

Knee is suspended in a KNEE SLING attached on a rope and pulley on a Balkan frame ..COMMON site of PU: b. -POSITION: 2.Counter Traction: .Hip is flexed to ___° from the mattress.make use of a pelvic halter. Cervical sling or Halo vest.COMMON site of PU: . -assess neurovascular status d.Make use of Thomas Splint with Pearson Attachment. c. Balanced Suspension Traction . wires or tongs -Weight limit: a. PELVIC TRACTION Indication: . CERVICAL TRACTION Indication: .make use of a Cervical halter. RUSSEL’S TRACTION Indication: . -Make use of pins. BRYANT’S TRACTION Indication: -N/R: Buttocks should not touch the mattress. -SITE of PIN: Pearson Attachment: -Thomas Splint: Main Advantage: Princples of Effective Traction: • Continuous to be effective • Never _____________________ • Weights are NOT removed • Weights must hang ________________ • Knots should not touch the pulley • Never tighten any loose screws or pins • Don’t ___________ painful calf • Increase FI and fiber in diet • Teach client to perform DBCE COMPLICATIONS OF FRACTURE a. Skeletal Traction -Weights are attached ________________________. screws. Fat Embolism Syndrome Signs & Symptoms • Respiratory: S/Sx: 10 .COMMON site of PU: e. -Hips are flexed _______° from the mattress. .

Sex d. c. Malunion or Angulation -bone heals at a ___________ angle. b. Adequate support of fractured bones during positioning and turning 4. Chronic medical condition c. Non-union -Fractured bone ______________. HIP FRACTURE -Most common cause of __________________ among elderly. Compartment Syndrome Signs and Symptoms  Pain  Cyanotic nail beds  !!!___________________________  Cold fingers/ toes  Prolonged capillary refill time  Motor weakness or paralysis Nursing Interventions: • Elevation of the extremity • Release constrictive devices • Notify the physician immediately c. Immediate ______________ of fractures 2. Minimal Fracture manipulation 3.• Cerebral Disturbances: r/t cerebral occlusion S/Sx: Systemic: S/Sx: Nursing Interventions: 1. DIRECT COMPLICATIONS a. Support respiratory function • b. EXTRACAPSULAR Most common type: • S/Sx 11 . Risk Factors: a. 7. Medications • Types of Hip Fractures 1. INTRACAPSULAR Most common type: -Treated as _______________ 2. Delayed Union -Bone heals for more than ____ mos. Age b. Heredity e.

g) Do not flex the hip to put on clothing. HIP REPLACEMENT • Total Hip Replacement • • Partial Hip Replacement NURSING MANAGEMENT I. __ternally rotated and the limb is ______________. Complaints of pain in the GROIN or in the HIP. n) Monitor circulation & sensation of the affected side. Open (G__________) -one in which the entire cross-section is left open (flapless) for dressing. l) Avoid prolonged sitting and standing position. p) Maintain the Hemovac or Jackson-Pratt drain if in place. Inability to move affected leg. Affected leg is a_ducted. 2. e) Avoid bending forward.NO HIP FLEXION beyond ____ . h) Flat on bed except on eating. o) Maintain the use of anti-embolism stockings. i) Advise patient to report “POPPING” sensation in the hip.Elevate HOB 30° • • Turning: . Malignant Tumors 4. Guidelines: a) Keep the knees ______________ at all times. Infection  Types of Amputation 1. bruising and swelling in and around your hip area. Severe Trauma 3. f) Use a raised toilet seat. k) ________________ rolls to prevent external rotation. 8.1. m) Monitor the wound for infection & hemorrhage. Inadequate tissue perfusion 2. b) Put a _____________ between the legs. GOAL of NSG Measure: • Positioning: -Maintain hip abduction . Stiffness. MRI Surgical Management • 1. 3. d) Never cross the leg when seated. • Diagnostic Tests • X –RAY • CT SCAN. AMPUTATION  Indications: 1. j) Firm chair with foot flat on the floor’s surface.Turn patient to his/her _________________________ SIDE. 12 . Monitor & record output of drainage. 4. c) Keep extended and a_ducted. ORIF 2.

PREPARE STUMP FOR PROSTHESIS . Relieving pain: Pain r/t soft tissue injury  Administer Narcotic Drugs as ORDERED 2. ASSISTIVE DEVICES FOR WALKING A.Massage the stump using Effleurage stroke. . – DO NOT put pillows below the KNEE b.Divert the attention of the patient.  ____________________ N/R: -prepare at bed side a __________________________! -Mark bleeding and drainage on the dressing if it occurs. . Provide stump care — Daily washing — Assess for blisters. Promote wound healing .Remove and rewrap _______ times daily. Above Knee Amputation (Aka) 4. . CRUTCHES 13 . ________________ Amputation  Nursing Management 1.Provide SKIN CARE 4.Pain medications as prescribed 3. the residual limb is elevated. Minimizing Phantom Limb Pain NSG MGT: .Residual limb must be shaped into a _________________________. adhesions — Apply elastic bandage — Do not elevate beyond ____ hours — _______ position — Range of Motion Exercises — Psychological support — ______ the use of irritating substances such as lotions.Perform exercises to the __________ and ____________________. 7. AKA: – NOTE: in the first ____ hours. Below Elbow Amputation (Bea) 3.  Levels of Amputation 1. Monitor and manage potential complications.2. . Above Elbow Amputation (Aea) 2. Below Knee Amputation (Bka) 5.Maintain application of an Ace wrap or elastic stump shrinker. Closed (M_________ / F_____) -one in which flaps are made from skin and subcutaneous tissue and sutured over the bone end of the stump.  CONTRACTURES GOAL: Prevent _______________ contractures of the lower extremities a. powders. -Immediately notify the physician for any signs of bleeding. 5. alcohol. BKA: Prevent KNEE FLEXION CONTRACTURE – DO NOT hang the residual limb over the EDGE of the bed. . 6. Promote physical independence.

CRUTCH GAITS: CRUTCH WALKING GAITS GAIT 4 POINT DESCRIPTION Slowest. 7. 6. Stop ambulation if there is numbness and tingling of the hands or arms. 2.IMPORTANT MUSCLES a. followed by crutches and _________ leg. Lift body weight by the arms and swing to the crutches Note: THROUGH: A. Elbows are slightly flexed __________________ degrees. Stand at __________________ side of client when ambulating. 3. Advance RC & LF REQUIREMENTS Used when _____________________________ is allowed for BOTH LEGS Used when _____________________________ is allowed for BOTH LEGS Used when weight bearing is ___________________ LEG 2 POINT 3 POINT SWING TO SWING THROUGH A. Lean on cane when moving good leg. CANE        Straight and quad cane. 5. Right foot C. 4. followed by good leg. b. Finger flexors -needed to ______ the hand grip. c. Teach patient how to assume a tripod gait by advancing the crutches ___________________ in front and then laterally. Tip of cane should be __________________ lateral to the base of the fifth toe. Left foot A. Look forward. Elbow extensors/ triceps -needed to prevent ________ of the elbow joint. Advance LC & RF B. Right crutch D. ______________________ between the axilla and the axillary bar. Advance good leg Fast gait but requires more ________ TO: A. Lift body weight by the arms and swing through the crutches To go up stairs: Advance ________ leg first. Advance both crutches B. Advance weak leg & both crutches together B. 14 . Weight must be on the hand grip. B. Shoulder Depressor/ latissimus dorsi -needed to _____ and _____ the body forward. Left crutch B. Handles should be at the level of client’s greater trochanter. GUIDELINES FOR THE USE OF CRUTCHES: 1. Tips should be fitted with rubber soles. To go down stairs: Advance crutches with affected leg first. Hold cane in _____________________ side. Advance both crutches B. ________________ A. Flex elbow _____________ degrees angle.

Sit down by grasping arm nest on affected side. Elbows flexed _____________ degrees angle. Medications: – Corticosteroids – Loop Diuretics – Anticonvulsants 7. Usually Asymptomatic b. shift weight to good leg and hand. 3. Advance UNAFFECTED leg. 5. Other Conditions . Instruct the client to inspect the rubber tips regularly. supporting self on arms and follow with good leg. 2. Genetics 5. Skeletal Deformity 15 . Advance the cane TOGETHER with the affected leg b. OSTEOPOROSIS . b. Followed by unaffected leg.Hyperparathyroidism 2. SEQUENCE: • 3-STEP a.Hypothyroidism . . Advance the cane. WALKER 1. Physical Activity 4. Advance the affected leg c. • PRIMARY OSTEOPOROSIS • SECONDARY OSTEOPOROSIS -secondary to medications or other conditions & diseases that affect bone metabolism. 4.There is an increase rate of bone resorption. Stand _______________ patient when ambulating. Lifestyle Choices • SIGNS AND SYMPTOM a. • IV. thus decreasing bone mass. Nutrition 3. Step forward with affected leg. Lift and move walker forward ____________ inches. MSK DISORDERS A. 2-STEP a. lower self into chair. Aging 6. C. Sudden onset of severe __________________ c.Occurs when there is imbalance between bone absorption & bone resorption. • RISK FACTORS 1.

_________ e. Regular weight bearing exercises. Teriparatide *Increases Osteoblastic action *daily SC injection 6. c. Dual X –ray Absorptiometry (DXA) NOTE: If you are taking calcium supplements. _________. Remove rugs) 4. Prevent Fractures. Adequate lighting. Fractures of the _____________. 3. or other medicines = take with a ____ glass of fluid = remain upright for at least ____ minutes after taking the drug B. b. e. Bone pain and Tenderness f. beverage. Barbiturates. OSTEOMALACIA Cause:     S/Sx: a.d. balanced diet. d. stop taking them for 24-48 hours before your test. Loss of height e. Vitamin D deficiency Malabsorption Syndrome Drugs: Anticonvulsants. Looser’s Lines or Zones 16 . Hormone Replacement Therapy a. 5. (Rails or grab bars in the CR. Administer Drugs as ordered: Biphosphonates • Risedronate (Actonel) • Ibandronate (Boniva) • !!!____________________________ = potent inhibitors of bone _____________ = taken in the morning at least ____ minutes before any food. Keep BED AS LOW AS POSSIBLE. 2. • MANAGEMENT 1. Calcitonin *Increases bone formation *taken by shot or nasal spray b. May show S/Sx of Pulmonary Insufficiency • DIAGNOSTIC TESTS 1. Fluoride Renal Failure and Liver Disease Muscle weakness Waddling and unsteady gait Bone pain Bone tenderness Fractures Diagnostic tests:  X-ray a. Raloxifene *Increases collagen formation & bone thickness *only given to women c. Provide adequate.

enlarged and disorganized. Yogurt & Dairy products  Soy. Serum Alkaline Phosphatase (ALP) Levels of ALP increases in bone damage. Biphosphonates D. Urinary Hydroxyproline levels a 24-hour urine collection that reflects bone collagen turnover and indicates the degree of disease severity. Encourage clients to have sun exposure. X-ray. c. Chicken. Symmetrical minute fractures of the femoral neck and ribs Nursing Management: 1. RHEUMATOID ARTHRITIS • • • Inflammatory Arthritis Characterized by periods of __________________________________ Etiology: • RISK FACTORS 17 . Instruct the client to take Vitamin D-rich foods:  Milk. Active Phase -characterized by an increase in multinuclear Osteoclasts that cause massive bone destruction. Vitamin D fortified Cereals  Eggs. c. ASA b. Liver C. Calcitonin d. and speech  Pathologic Fractures  Bone and Joint pain  Flushed and warm skin Diagnostic tests: a. Tofu.b. Cause: Risk Factors:  Familial  Possibly measles  Viral infection  80 years old S/Sx:  Enlargement of the Spine and back pain  Bowing of the Long Bones  Short stature  Skull is soft. Phases: a. MRI Medical Management: Goal: a. Recommend that clients exercise 3 times a week for 20-30 minutes. b. swallowing. CT scan. Inactive Phase -there is decline in osteoclasts and the newly formed bone becomes very hard. Mixed Phase -osteoblasts react to compensate in forming new bone that is structurally weak and deformed. 3. PAGET’S DISEASE -metabolic disorder of bone remodelling in which increased resorption results in bone deposits that are weak. Salmon. NSAID’s c. thick and enlarged  Deafness and vertigo  Impairment in vision. 2. b. Tuna.

Boutonniere Deformity f. Apply Cold or Heat compress to the affected part. 4.  Antinuclear Antibody -measures the presence of Ab that destroy the nucleus of cells.a. Age of Onset: Genetics Common in Women than in Men Exposure to infection • SIGNS AND SYMPTOMS Signs of inflammation especially in ________________ joints __________________ or ________________ joints are affected Joint Stiffness Joint Deformities .Ulnar Drift .Swan – Neck Deformity . 2. Diet: • MEDICAL MANAGEMENT 1. Encourage ROM exercises after taking pain meds. Avoid prolonged sitting or standing. d. b. Laboratory:  Rheumatoid Factor . Systemic Manifestations: *Sjogren’s Syndrome *Felty’s Syndrome g. Administer Medications *ASA *NSAIDS *DMARDS: >etanercept >infliximab >leflunomide >adalimumab (Humira) >anakinra (Kineret) *Immunosuppressant: -Methotrexate 18 . c. X – ray 2. b.determines presence of autoantibodies of the IgG and IgM type. 3.  Erythrocyte Sedimentation Rate • NURSING MANAGEMENT 1. e. a. c. Minimize muscle spasms and joint stiffness. During acute exacerbations: = provide firm mattress = keep joints in extension. Adequate rest: = Provide rest periods between activities = Bed rest during acute exacerbations 6. 5. not in flexion 7. d. Presence of Subcutaneous nodules • DIAGNOSTIC TESTS 1.

Obesity d. Age of Onset: c. Implement pain Relief Measures. 5. c. Plan Activities or exercises when pain is least severe. No lab Exams 2. b. Stomatitis *Gold therapy: -Sodium Thiomalate (Myochrysine) -Auranofin (Ridaura) E. Maintenance of Activity with joint protection 4. N/V. Greater in __________ b. Provide Periods of Rest 3. • DIAGNOSTIC TESTS 1.o o < 25mg/wk SE: Myelosuppression. OSTEOARTHRITIS • • • Also known as ________________________________ ___________________ and _________________ disease Etiology: _______________ • RISK FACTORS a. g. Joint trauma • a. 2. X – ray • MANAGEMENT GOAL: ________________________________________________________________ 1. Encourage weight reduction • MEDICAL MANAGEMENT 1. Crepitation/Crepitus Tenderness on palpation and pain on passive motion. Administer Medications as ordered: -Analgesic DOC: __________________________ -NSAID’s -ASA -COX-2 Inhibitors:  Celecoxib (Celebrex)  Valdecoxib (Bextra)  Meloxicam (Mobic) -Hyaluronate (Hyalgan) -GF 20 (Synvisc) 19 . d. e. SIGNS AND SYMPTOMS No signs of inflammation Pain aggravated by use & relieved by rest Joint discomfort is ____________________ Joint Stiffness Joint Deformity -Bouchard’s Nodes -Heberden’s Nodes f.

2. Report any decrease in urine output. 4. Encourage gradual weight loss. Administer medications as ordered: ANALGESICS: • NSAID’s ANTIGOUT Medications • Colchicine -Mechanism of action: -Drug of Choice for: -SE: -Toxic effect: • Allopurinol -Mechanism of Action: -Drug of Choice for: -SE: 20 . 5. 3. Assess affected joint for pain and appearance. χ. Common among ____________ β. Increase fluid intake. Laboratory:       • 2. Primary Gouty Arthritis 2. X – ray 3. 8. 6. Age of Onset: SIGNS AND SYMPTOMS Inflammation of the joints Pruritus TOPHI Formation Skin Ulceration Intolerance to bed linens Podagra • DIAGNOSTIC TESTS 1. Bed rest until pain subsides. 7. δ . GOUTY ARTHRITIS • CLASSIFICATIONS 1. Low purine diet. Educate patients in recognition of early symptoms.F. Arthrocentesis • MANAGEMENT 1. Secondary Gouty Arthritis  Due to Acquired Conditions  Starvation  Alcohol Intoxication  Renal Failure • RISK FACTORS α.

Hyapaque • Post-Procedure: -___________ bed for 6-8 Hours Common complications: 1. • SITE of ADMINISTRATION: 2 TYPES OF DYES a.Radiating pain when the legs are raised in a straight position up to 70°. Informed consent b. ________________ DTR  DIAGNOSTIC TESTS 1.• Probenicid • Sulfinpyrazone -Mechanism of action: -Drug of choice to prevent _______________________ -SE: G. HERNIATED NUCLEUS PULPOSUS  CAUSES:  COMMON SITE AFFECTED:  • • • • • • SIGNS & SYMPTOMS Muscle weakness Loss of sensation ________________ ________________ Lasegue’s Test . Water-based dye -Amipaque • Post-Procedure: b. Oil-based dye -Pantopaque. HYDRATION for at least 12 hours before and after the procedure. Myelogram: • PREPARATION: a. c. Assess for allergies to seafood or iodine. X-Ray 2. Spinal headache N/R: Increase fluid intake 21 .

5. Pt may assume: Semi-Fowlers with moderate hip & knee flexion. Do calf exercises. Spinal Decompression & Fusion a. AVOID PRONE POSITION. 2. Chemonucleolysis -injection of an enzyme into a bulging spinal disc. Assist the pt to apply the BRACE. Give muscle relaxants as ordered: -cyclobenzaprine (Flexeril) -methocarbamol (Robaxin) -metaxalone (Skelaxin) 2. Stabilization of the fusion  NURSING MANAGEMENT: GOAL of CARE: 1.2. Fusion of vertebrae c. LAMINECTOMY 2. Assess for complications: Thank You! God Bless Nurse!!! 22 .  SURGICAL MANAGEMENT 1. Make use of FIRM MATRESS. Decompression of nerves b. 6. ENZYME: GOAL: Consideration: NOTE: Local anesthesia or general anesthesia may be used to control pain during the injection. 8. Apply moist heat application/ massage. 7. Give NSAIDS or corticosteroids 3. 4. Make use of ________________ technique when turning the patient with pillow between the leg. 3. Microdiscectomy 3. Seizure N/R: Prepare anticonvulsant medications  MEDICAL MANAGEMENT: 1.

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