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

TYPES OF MUSCLE CONTRACTION

1. ISOMETRIC CONTRACTION -Muscles contract but does not shorten. There is no ____________ movement. 2. ISOTONIC CONTRACTION -Involves change in muscle length and no change in tension. Type a. ACTIVE b. PASSIVE c. ACTIVE ASSISTIVE d. ACTIVE RESISTIVE RANGE OF MOTION EXERCISES Description The patient moves own body part or limbs. The ___________ moves the patients body part without any assistance from the patient. The patient moves a weak body part as far as possible using his stronger arm or leg. Contraction of muscle against an opposing force.

III. TRAUMATIC INJURIES

1. STRAIN Cause: Overuse Overstretching 2. SPRAIN Cause: Sudden TWISTING or ________________ motion

S/Sx

GOAL: a. RICES

Nursing Management for Strain and Sprain:

b. NSAIDs c. Muscle Relaxants Ibuprofen (Motrin) Naproxen (Anaprox, Naprosyn) Diclofenac (Voltaren) Diflunisal (Dolobid) Indomethacin (Indocin) Ketorolac (Toradol) Piroxicam (Feldene) Methocarbamol (Robaxin) Cyclobenzaprine (Flexeril) 3

 Carisoprodol (Soma) Baclofen (Lioresal) Metaxalone (Skelaxin) d. Surgical repair for SEVERE STRAIN: ____________________ e. Educate regarding the importance of _____________ exercises prior to strenuous activities.

3. ROTATOR CUFF INJURIES

1. T 2. S 3. S 4. I

Cause S/Sx Shoulder Pain Muscle weakness Inability to sleep on the involved side

diagnostic procedure.

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. MRI - non-invasive diagnostic scanning technique that uses magnetic waves to obtain a three dimensional view of a body part. Preparation: Assess for implanted _____________ in the body. Remove _____________ accessories. Assess for ________________. Instruct to remain still during the procedure. Instruct the Px that the machine produces loud thumping and humming noises. Sedation may be done. 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. Informed consent NPO for 8 H 4

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. Intra-Articular Corticosteroids: Cortisone (Cortone) Hydrocortisone (Cortef, 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) NSAIDs as ordered Betamethasone (Celestone Soluspan) Cortisone Injection thru arthroscopy Surgical Management Open Acromioplasty a. immobilize shoulder b. duration: several days to ___ weeks c. PT/ shoulder exercises started after ____ weeks d. full recovery takes _____ months

Post-op:

4. CARPAL TUNNEL SYNDROME

Definition: _______ nerve compression at wrist joint. Cause S/Sx 1. (+) 2. (+) 3. EMG -measures electrical potential associated with skeletal muscle contractions. a. Informed consent b. Instruct the client that needle insertion is uncomfortable. c. Instruct the client not to take any stimulants or sedatives for ____ hours before the procedure. d. Inform the client that slight ________ may occur at the needle insertion sites. NURSING MANAGEMENT GOAL no. 1: __________________________________ 1. REST HANDS. 2. Avoid excessive use of involved hand. 3. Instruct patient not to sleep over the involved hand. 5 Paresthesia Muscle weakness Clumsiness when using the hand PAIN Diagnostic tests Repetitive & constant flexion of the wrist.

4. Administer medications as ordered. GOAL no. 2: To prevent injury. 1. Instruct pt to wear gloves. MEDICAL MANAGEMENT 1. Analgesics 2. Corticosteroids ASA (acetylsalicylic acid/Aspirin) NSAIDs SURGICAL MANAGEMENT 1. Carpal Tunnel Release -cutting and releasing of the _____________ ligament.

5. DUPUYTRENS CONTRACTURE
-contracture of the palmar fascia resulting in flexion of the 4th and 5th digit of the hand. Cause: General Information: a. Tends to occur in elderly men b. Familial c. The _____ digit is _________ affected Management: Fasciectomy Collagenase Nursing Management: 1. REST HANDS. 2. Avoid excessive use of involved hand. 3. Splinting

6. FRACTURE
Types of Fracture
a. Complete b. Incomplete c. Transverse d. Linear e. Oblique f. Spiral g. Greenstick h. Comminuted i. Impacted j. Closed or Simple 6

k. Open or Compound l. Colles m. Potts

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. Assess 2. Immobilize 3. Control Bleeding 4. Cover wound 5. NVS Nursing Interventions 1. Maintain ________________ & ________________ of the affected extremity. 2. Elevate the Fx site above the ________________ level. 3. NVS assessment. 4. Consume appropriate diet for bone healing. 5. ________________ to prevent constipation, renal calculi, & UTI. 7

6. Give analgesics as prescribed. 7. Report ________________ pain. 8. Observe for S/Sx of ________________. 9. Teach about cast care, traction, and crutch walking if needed. 10. Give tetanus prophylaxis as ordered for open fractures.

Medical Management

a. REDUCTION
Closed reduction through ________ manipulation and _______________ traction followed by application of cast. *X-ray after procedure Open reduction __________ approach to reduce fracture fragments with fixation. Nursing Management Assess for redness, tenderness, pain, swelling and loosening of pins. Prevent crust formation. Notify the physician for signs of infection.

*Complications of External Fixation: OSTEOMYELITIS -Most _________ form of bone infection. -Infection of the bone, bone marrow, and surrounding soft tissues. CA: Signs & Symptoms: Body malaise Swelling at the site Fever Chills Pain Management: 1. Antibiotics 2. Immobilize affected part of the patient. 3. Wound debridement.

b. CAST
- Rigid external immobilizing device that is molded to the contours of the body. Plaster Cast -aka _____________________ -initially emits heat -cools in ____ minutes -dries in ___________ hours DRY APPERANCE PERCUSSION ODOR TEXTURE 8 WET

Fiberglass -aka __________________________ -it has small pores -water resistant -dries ___________ minutes Purpose 1. Immobilize a reduced fracture. 2. To maintain body alignment. Types of Cast 1. Short Arm Cast extends from the ________ down to the ____________. 2. Long Arm Cast extends from the ________ down to the palmar crease. 3. Short Leg Cast extends from the _______ down to the base of the _______. 4. Long Leg Cast extends from the ________ down to the base of the toes. 5. Walking Cast either a long leg or short leg cast reinforced for strength. 6. Body Cast encircles the _________. 7. Spica Cast - either a shoulder or hip spica cast.

Care of Clients with Cast 1. Carry with the !!!___________ of the hand when WET. 2. Elevate with pillow. 3. Expose to dry environment. 4. Observe HOT SPOTS and musty odor. 5. Maintain skin integrity by _____________ the edges. 6. Perform NVS 7. Do not scratch the skin under the cast by inserting objects inside the cast. 8. Keep clean and dry.

c. TRACTION
- pulling force associated with a counterpull. Purpose 1. Muscle spasm control 3. Pain relief Types 2. Immobilize Fxs 4. Correct deformities

1. Skin Traction -pulling force is applied directly to the skin and indirectly to the bones to
maintain alignment. -Generally _________ lbs of weight is used for the pulling force. *Pelvic Traction = ________________ *Cervical Traction = ______________ a. BUCKS EXTENSION TRACTION Indication: - Simplest form of traction - Counter Traction: 9

- COMMON site of PU: b. RUSSELS TRACTION Indication: - Knee is suspended in a KNEE SLING attached on a rope and pulley on a Balkan frame - COMMON site of PU: - Hip is flexed to ___ from the mattress. c. BRYANTS TRACTION Indication: -N/R: Buttocks should not touch the mattress. -assess neurovascular status d. CERVICAL TRACTION Indication: - make use of a Cervical halter, Cervical sling or Halo vest. - Counter Traction: - COMMON site of PU: e. PELVIC TRACTION Indication: - make use of a pelvic halter. -POSITION:

2. Skeletal Traction -Weights are attached ________________________.

-Make use of pins, screws, wires or tongs -Weight limit: a. Balanced Suspension Traction - Make use of Thomas Splint with Pearson Attachment. -Hips are flexed _______ from 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 Dont ___________ painful calf Increase FI and fiber in diet Teach client to perform DBCE COMPLICATIONS OF FRACTURE

a. Fat Embolism Syndrome

Signs & Symptoms Respiratory: S/Sx:

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Cerebral Disturbances: r/t cerebral occlusion S/Sx: Systemic: S/Sx: Nursing Interventions: 1. Immediate ______________ of fractures 2. Minimal Fracture manipulation 3. Adequate support of fractured bones during positioning and turning 4. Support respiratory function

b. 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. DIRECT COMPLICATIONS
a. Delayed Union -Bone heals for more than ____ mos. b. Non-union -Fractured bone ______________. c. Malunion or Angulation -bone heals at a ___________ angle.

7. HIP FRACTURE
-Most common cause of __________________ among elderly. Risk Factors: a. Age b. Chronic medical condition c. Sex d. Heredity e. Medications Types of Hip Fractures 1. INTRACAPSULAR Most common type: -Treated as _______________ 2. EXTRACAPSULAR Most common type: S/Sx 11

1. Affected leg is a_ducted, __ternally rotated and the limb is ______________. 2. Complaints of pain in the GROIN or in the HIP. 3. Inability to move affected leg. 4. Stiffness, bruising and swelling in and around your hip area. Diagnostic Tests X RAY CT SCAN, MRI Surgical Management

1. ORIF

2. HIP REPLACEMENT Total Hip Replacement Partial Hip Replacement NURSING MANAGEMENT

I. GOAL of NSG Measure: Positioning: -Maintain hip abduction - NO HIP FLEXION beyond ____ - Elevate HOB 30 Turning: - Turn patient to his/her _________________________ SIDE. Guidelines: a) Keep the knees ______________ at all times. b) Put a _____________ between the legs. c) Keep extended and a_ducted. d) Never cross the leg when seated. e) Avoid bending forward. f) Use a raised toilet seat. g) Do not flex the hip to put on clothing. h) Flat on bed except on eating. i) Advise patient to report POPPING sensation in the hip. j) Firm chair with foot flat on the floors surface. k) ________________ rolls to prevent external rotation. l) Avoid prolonged sitting and standing position. m) Monitor the wound for infection & hemorrhage. n) Monitor circulation & sensation of the affected side. o) Maintain the use of anti-embolism stockings. p) Maintain the Hemovac or Jackson-Pratt drain if in place. Monitor & record output of drainage.

8. AMPUTATION
Indications: 1. Inadequate tissue perfusion 2. Severe Trauma 3. Malignant Tumors 4. Infection Types of Amputation 1. Open (G__________) -one in which the entire cross-section is left open (flapless) for dressing. 12

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

ASSISTIVE DEVICES FOR WALKING

A. CRUTCHES 13

IMPORTANT MUSCLES a. Shoulder Depressor/ latissimus dorsi -needed to _____ and _____ the body forward. b. Elbow extensors/ triceps -needed to prevent ________ of the elbow joint. c. Finger flexors -needed to ______ the hand grip. CRUTCH GAITS: CRUTCH WALKING GAITS
GAIT 4 POINT

DESCRIPTION Slowest; ________________ A. Left crutch B. Right foot C. Right crutch D. Left foot A. Advance LC & RF B. 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. Advance weak leg & both crutches together B. Advance good leg Fast gait but requires more ________ TO: A. Advance both crutches B. Lift body weight by the arms and swing to the crutches

Note:

THROUGH: A. Advance both crutches B. Lift body weight by the arms and swing through the crutches To go up stairs: Advance ________ leg first; followed by crutches and _________ leg. To go down stairs: Advance crutches with affected leg first, followed by good leg.

GUIDELINES FOR THE USE OF CRUTCHES: 1. Look forward. 2. Weight must be on the hand grip. 3. ______________________ between the axilla and the axillary bar. 4. Elbows are slightly flexed __________________ degrees. 5. Teach patient how to assume a tripod gait by advancing the crutches ___________________ in front and then laterally. 6. Tips should be fitted with rubber soles. 7. Stop ambulation if there is numbness and tingling of the hands or arms. B. CANE Straight and quad cane. Stand at __________________ side of client when ambulating. Flex elbow _____________ degrees angle. Tip of cane should be __________________ lateral to the base of the fifth toe. Hold cane in _____________________ side. Handles should be at the level of clients greater trochanter. Lean on cane when moving good leg. 14

Instruct the client to inspect the rubber tips regularly.

SEQUENCE: 3-STEP a. Advance the cane. b. Advance the affected leg c. Advance UNAFFECTED leg. 2-STEP a. Advance the cane TOGETHER with the affected leg b. Followed by unaffected leg. C. WALKER 1. Elbows flexed _____________ degrees angle. 2. Lift and move walker forward ____________ inches. 3. Step forward with affected leg, supporting self on arms and follow with good leg. 4. Stand _______________ patient when ambulating. 5. Sit down by grasping arm nest on affected side; shift weight to good leg and hand, lower self into chair.

IV. MSK DISORDERS

A. OSTEOPOROSIS
- Occurs when there is imbalance between bone absorption & bone resorption. - There is an increase rate of bone resorption, thus decreasing bone mass. PRIMARY OSTEOPOROSIS SECONDARY OSTEOPOROSIS -secondary to medications or other conditions & diseases that affect bone metabolism. RISK FACTORS 1. Genetics

5. Aging 6. Medications: Corticosteroids Loop Diuretics Anticonvulsants 7. Other Conditions - Hypothyroidism - Hyperparathyroidism

2. Nutrition 3. Physical Activity 4. Lifestyle Choices SIGNS AND SYMPTOM

a. Usually Asymptomatic b. Sudden onset of severe __________________ c. Skeletal Deformity 15

d. Loss of height e. Bone pain and Tenderness f. Fractures of the _____________, _________, _________ e. May show S/Sx of Pulmonary Insufficiency DIAGNOSTIC TESTS 1. Dual X ray Absorptiometry (DXA) NOTE: If you are taking calcium supplements, stop taking them for 24-48 hours before your test. MANAGEMENT 1. Provide adequate, balanced diet. 2. Regular weight bearing exercises. 3. Prevent Fractures. (Rails or grab bars in the CR, Adequate lighting, Remove rugs) 4. Keep BED AS LOW AS POSSIBLE.

5. Hormone Replacement Therapy a. Calcitonin *Increases bone formation *taken by shot or nasal spray b. Raloxifene *Increases collagen formation & bone thickness *only given to women c. Teriparatide *Increases Osteoblastic action *daily SC injection 6. Administer Drugs as ordered: Biphosphonates Risedronate (Actonel) Ibandronate (Boniva) !!!____________________________ = potent inhibitors of bone _____________ = taken in the morning at least ____ minutes before any food, beverage, or other medicines = take with a ____ glass of fluid = remain upright for at least ____ minutes after taking the drug

B. OSTEOMALACIA
Cause: S/Sx: a. b. c. d. e. Vitamin D deficiency Malabsorption Syndrome Drugs: Anticonvulsants, Barbiturates, Fluoride Renal Failure and Liver Disease

Muscle weakness Waddling and unsteady gait Bone pain Bone tenderness Fractures

Diagnostic tests: X-ray a. Loosers Lines or Zones 16

b. Symmetrical minute fractures of the femoral neck and ribs Nursing Management: 1. Encourage clients to have sun exposure. 2. Recommend that clients exercise 3 times a week for 20-30 minutes. 3. Instruct the client to take Vitamin D-rich foods: Milk, Yogurt & Dairy products Soy, Tofu, Vitamin D fortified Cereals Eggs, Tuna, Salmon, Chicken, Liver

C. PAGETS DISEASE -metabolic disorder of bone remodelling in which increased

resorption results in bone deposits that are weak, enlarged and disorganized. Phases: a. Active Phase -characterized by an increase in multinuclear Osteoclasts that cause massive bone destruction. b. Mixed Phase -osteoblasts react to compensate in forming new bone that is structurally weak and deformed. c. Inactive Phase -there is decline in osteoclasts and the newly formed bone becomes very hard. 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, thick and enlarged Deafness and vertigo Impairment in vision, swallowing, and speech Pathologic Fractures Bone and Joint pain Flushed and warm skin Diagnostic tests: a. Serum Alkaline Phosphatase (ALP) Levels of ALP increases in bone damage. b. Urinary Hydroxyproline levels a 24-hour urine collection that reflects bone collagen turnover and indicates the degree of disease severity. c. X-ray, CT scan, MRI Medical Management: Goal: a. ASA b. NSAIDs

c. Calcitonin

d. Biphosphonates

D. RHEUMATOID ARTHRITIS
Inflammatory Arthritis Characterized by periods of __________________________________ Etiology: RISK FACTORS 17

a. b. c. d. a. b. c. d. e.

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 - Boutonniere Deformity

f. Systemic Manifestations: *Sjogrens Syndrome *Feltys Syndrome g. Presence of Subcutaneous nodules DIAGNOSTIC TESTS 1. X ray 2. Laboratory: Rheumatoid Factor - determines presence of autoantibodies of the IgG and IgM type. Antinuclear Antibody -measures the presence of Ab that destroy the nucleus of cells. Erythrocyte Sedimentation Rate NURSING MANAGEMENT 1. Apply Cold or Heat compress to the affected part. 2. Minimize muscle spasms and joint stiffness. 3. Avoid prolonged sitting or standing. 4. Encourage ROM exercises after taking pain meds. 5. Adequate rest: = Provide rest periods between activities = Bed rest during acute exacerbations 6. During acute exacerbations: = provide firm mattress = keep joints in extension, not in flexion 7. Diet: MEDICAL MANAGEMENT 1. Administer Medications *ASA *NSAIDS *DMARDS: >etanercept >infliximab >leflunomide >adalimumab (Humira) >anakinra (Kineret) *Immunosuppressant: -Methotrexate 18

o o

< 25mg/wk SE: Myelosuppression, N/V, Stomatitis

*Gold therapy: -Sodium Thiomalate (Myochrysine) -Auranofin (Ridaura)

E. OSTEOARTHRITIS
Also known as ________________________________ ___________________ and _________________ disease Etiology: _______________

RISK FACTORS a. Greater in __________ b. Age of Onset: c. Obesity d. Joint trauma a. b. c. d. e. SIGNS AND SYMPTOMS No signs of inflammation Pain aggravated by use & relieved by rest Joint discomfort is ____________________ Joint Stiffness Joint Deformity -Bouchards Nodes -Heberdens Nodes f. g. Crepitation/Crepitus Tenderness on palpation and pain on passive motion.

DIAGNOSTIC TESTS 1. No lab Exams 2. X ray MANAGEMENT GOAL: ________________________________________________________________ 1. Implement pain Relief Measures. 2. Provide Periods of Rest 3. Maintenance of Activity with joint protection 4. Plan Activities or exercises when pain is least severe. 5. Encourage weight reduction MEDICAL MANAGEMENT 1. Administer Medications as ordered: -Analgesic DOC: __________________________ -NSAIDs -ASA -COX-2 Inhibitors: Celecoxib (Celebrex) Valdecoxib (Bextra) Meloxicam (Mobic) -Hyaluronate (Hyalgan) -GF 20 (Synvisc) 19

F. GOUTY ARTHRITIS
CLASSIFICATIONS 1. Primary Gouty Arthritis 2. Secondary Gouty Arthritis Due to Acquired Conditions Starvation Alcohol Intoxication Renal Failure RISK FACTORS . Common among ____________ . . . Age of Onset: SIGNS AND SYMPTOMS Inflammation of the joints Pruritus TOPHI Formation Skin Ulceration Intolerance to bed linens Podagra DIAGNOSTIC TESTS 1. Laboratory:

2. X ray 3. Arthrocentesis MANAGEMENT 1. Assess affected joint for pain and appearance. 2. Educate patients in recognition of early symptoms. 3. Increase fluid intake. 4. Encourage gradual weight loss. 5. Bed rest until pain subsides. 6. Report any decrease in urine output. 7. Low purine diet. 8. Administer medications as ordered: ANALGESICS: NSAIDs

ANTIGOUT Medications
Colchicine
-Mechanism of action: -Drug of Choice for: -SE: -Toxic effect:

Allopurinol

-Mechanism of Action: -Drug of Choice for: -SE: 20

 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 ________________ ________________ Lasegues Test - Radiating pain when the legs are raised in a straight position up to 70. ________________ DTR

DIAGNOSTIC TESTS 1. X-Ray 2. Myelogram: PREPARATION: a. Informed consent b. Assess for allergies to seafood or iodine. c. HYDRATION for at least 12 hours before and after the procedure. SITE of ADMINISTRATION:

2 TYPES OF DYES
a. Water-based dye -Amipaque Post-Procedure: b. Oil-based dye -Pantopaque, Hyapaque Post-Procedure: -___________ bed for 6-8 Hours Common complications: 1. Spinal headache N/R: Increase fluid intake 21

2. Seizure N/R: Prepare anticonvulsant medications MEDICAL MANAGEMENT: 1. Give muscle relaxants as ordered: -cyclobenzaprine (Flexeril) -methocarbamol (Robaxin) -metaxalone (Skelaxin) 2. Give NSAIDS or corticosteroids

3. Chemonucleolysis -injection of an enzyme into a bulging spinal disc. ENZYME: GOAL: Consideration: NOTE: Local anesthesia or general anesthesia may be used to control pain during the injection. SURGICAL MANAGEMENT 1. LAMINECTOMY 2. Microdiscectomy 3. Spinal Decompression & Fusion a. Decompression of nerves b. Fusion of vertebrae c. Stabilization of the fusion

NURSING MANAGEMENT: GOAL of CARE: 1. Make use of FIRM MATRESS. 2. Pt may assume: Semi-Fowlers with moderate hip & knee flexion. 3. Make use of ________________ technique when turning the patient with pillow between the leg. 4. AVOID PRONE POSITION. 5. Assist the pt to apply the BRACE. 6. Apply moist heat application/ massage. 7. Do calf exercises. 8. Assess for complications:

Thank You! God Bless Nurse!!!

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