Board review

Review of Anatomy and Physiology
The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints The primary function of which is to produce skeletal movements

Movement Posture Support Protection of vital organs Storage of minerals Heat production Propulsion of blood Movement of food in GIT and urine in the ureters

Skeletal Muscles Voluntary and striated 2. Cardiac muscles Involuntary and striated 3. Smooth/Visceral muscles Involuntary and NON-striated .Muscles Three types of muscles exist in the body 1.

Perimysium ± separate the muscle tissue into small sections.Structure of the Muscle Epimysium ± outermost layer that surrounds the muscle. Endomysium ± thin covering of a fascicle .

SYNERGISTS ± muscles that contract at the same time as the prime mover. PRIME MOVERS ± muscles whose contractions actually produces the movement. ANTAGONISTS ± muscles that relax while the prime mover is contracting. c.Skeletal Muscles¶ Actions a. helping it produce the movement so the prime mover can produce a more effective movement. . b.

2.shorten muscle length while maintaining muscle tension generating movement. ISOTONIC CONTRACTIONS -.tighten the muscle by increasing muscle tension without shortening the muscle.Different Contractions of the Skeletal Muscles 1. -. .does not usually produce direct movement. ISOMETRIC CONTRACTIONS -.

TWITCH CONTRACTIONS -.Different Contractions of the Skeletal Muscles 3. jerky reactions to a single stimulus. in which individual contraction can¶t be distinguished. continuous contractions.muscle shortens for a fraction of a second.quick. -.serial. . 4. TETANIC CONTRACTIONS -.

series of increasingly stronger twitch contractions occurring in response to repeated stimuli of constant intensity.abnormal contraction visible through the skin as a slight ripple.occurs after neuron destruction . FASCICULATION -. 6.Different Contractions of the Skeletal Muscles 5. -. TROPPE (Staircase Phenomenon) -.

violent rhythmic contractions and relaxations of muscle groups.Different Contractions of the Skeletal Muscles 7. CONVULSIONS -. .abnormal.

TENDONS Bands of fibrous connective tissue that tie bones to muscles .

LIGAMENTS Strong. dense and flexible bands of fibrous tissue connecting bones to another bone .

location and size Functions 1. Blood production 5. Mineral deposition .The SKELETAL SYSTEM Variously classified according to shape. Protection 3. Support and lever 4. Locomotion 2.

and ribs APPENDICULAR ± body appendages with 126 bones -.BONES There are two divisions of the skeleton AXIAL± body upright structure with 80 bones -. vertebral column. hips and legs .consists of the arms.consists of the: skull.

BONES FOUR MAJOR BONE TYPES 1. 3. 4. Long bones ± length exceeds breadth and thickness Short bones ± equal in main dimensions found mainly on hands and feet Flat bones ± primarily made up of cancellous bone tissue Irregular bones ± irregular in shape . 2.

broad. female pelvis± shallow.Difference between Male and Female Skeletons Male skeletons are larger and heavier than female skeleton Male pelvis--deep and funnel shaped with narrow pubic arc. and flaring with wider pubic arc .

JOINTS The part of the Skeleton where two or more bones are connected .

CARTILAGES A dense connective tissue that consists of fibers embedded in a strong gel-like substance .

BURSAE Sac containing fluid that are located around the joints to prevent friction .

body symmetry. gait and muscle and joint function .ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient¶s posture.

Physical Examination Perform a head to toe assessment Nurses need to inspect and palpate The special procedure is the assessment of joint and muscle movement . HISTORY 2.ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM 1.

ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM Gait Posture Muscular palpation Joint palpation Range of motion Muscle strength .

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 1. BONE MARROW ASPIRATION Usually involves aspiration of the marrow to diagnose diseases like leukemia. aplastic anemia Usual site is the sternum and iliac crest Pre-test: Consent Intratest: Needle puncture may be painful Post-test: maintain pressure dressing and watch out for bleeding .

Arthroscopy A direct visualization of the joint cavity Pre-test: consent. incision will be made Post-test: maintain dressing. assist in ambulation as ordered.ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 2. Anesthesia. ice application to relieve discomfort . joint rest for a few days. NPO Intra-test: Sedative. explanation of procedure. mild soreness of joint for 2 days.

pregnancy is contraindicated Intra-test: IV injection. IV radioisotope is used. no special preparation. Supine position for scanning Post-test: Increase fluid intake to flush out radioactive material . BONE SCAN Imaging study with the use of a contrast radioactive material Pre-test: Painless procedure.ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 3. Fluids allowed. Waiting period of 2 hours before X-ray.

no special preparation Advise to remove jewelry .Dual-energy XRAY absorptiometry Assesses bone density to diagnose osteoporosis Uses LOW dose radiation to measure bone density Painless procedure. non-invasive. DXA.ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 4.


Fracture A break in the continuity of the bone and is defined according to its type and extent .

Fracture Severe mechanical Stress to bone bone fracture Direct Blows Crushing forces Sudden twisting motion Extreme muscle contraction Pathologic conditions .

Fracture TYPES OF FRACTURE 1. Complete fracture Involves a break across the entire crosssection 2. Incomplete fracture The break occurs through only a part of the cross-section .

Open or compound fracture The fracture that involves a break in the skin . Close or simple fracture The fracture that does not cause a break in the skin 2.Fracture BROAD CLASSIFICATION OF FRACTURE: 1.

Transverse fracture The break runs across the bone 2.Fracture Classification of Fracture as to Pattern: 1. Oblique fracture The break runs in slanting direction 45 degrees angle .

Longitudinal fracture The break runs parallel to the bone . Spiral fracture The break coils around the bone 4.Fracture 3.


Fracture Classification as to Appearance: Comminuted fracture Bone splintered into fragments Impacted fracture When fractured ends of the bone are pushed into each other .

Fracture Compressed fracture A condition in which a bone. particularly the vertebra collapses Depressed fracture Usually occurs in the skull with the broken bone being driven inward .

Greenstick fracture .

Pain or tenderness over the involved area 2.Fracture ASSESSMENT FINDINGS 1. Crepitus 6. Loss of function 3. Swelling and discoloration . Shortening 5. Deformity 4.

Fracture ASSESSMENT FINDINGS 1. Pain Continuous and increases in severity Muscle spasm accompanies the fracture as a reaction of the body to immobilize the fractured bone .

Fracture ASSESSMENT FINDINGS 2. Loss of function Abnormal movement and pain can result to this manifestation .

Deformity Displacement. angulations or rotation of the fragments causes deformity .Fracture ASSESSMENT FINDINGS 3.

Fracture ASSESSMENT FINDINGS 4. Crepitus A grating sensation produced when the bone fragments rub each other .

Fracture DIAGNOSTIC TEST X-ray .

stick. Suggested temporary splints. rolled sheets 4. Immobilize any suspected fracture 2. Support the extremity above and below when moving the affected part from a vehicle 3.Fracture EMERGENCY MANAGEMENT OF FRACTURE 1. Apply sling if forearm fracture is suspected or the suspected fractured arm may be bandaged to the chest .hard board.

DO NOT attempt to reduce the fracture . Open fracture is managed by covering a clean/sterile gauze to prevent contamination 6.Fracture EMERGENCY MANAGEMENT OF FRACTURE 5.

Emergency First aid splinting .

Principles of fracture treatment Reduction of fracture Maintenance of realignment by immobilization Restoration of function .Fracture MEDICAL MANAGEMENT 1.

Fracture 2. Reduction Closed manipulation using casts or sling Open reduction External fixation Traction 3. . Immobilization the most important phase in obtaining union of fracture fragments.

Teach patient about potential complication of fracture and to report infection. Assist in reduction and immobilization 2. poor alignment and continuous pain .Fracture General Nursing MANAGEMENT For CLOSED FRACTURE 1. Administer pain medication and muscle relaxants 3. teach patient to care for the cast 4.

Prevent wound and bone infection -Administer prescribed antibiotics -Administer tetanus prophylaxis -Assist in serial wound debridement 2.Fracture General Nursing MANAGEMENT For OPEN FRACTURE 1. Administer care of traction and cast . Elevate the extremity to prevent edema formation 3.


fibroblasts and osteoblasts .Fracture Stages of Bone Healing 1. blood extravasates between and around the fragments and the bone marrow. granulation tissue containing blood vessels. Formation of hematoma When a bone is fractured. Cellular proliferation Periostal elevation. 2.

Callus formation Differentiated tissue bridging the fracture 4. Ossification Final laying down of bone State in which the fracture ends have knit together .Fracture 3.

Fracture 5. Remodeling When consolidation is completed. the excess cells are absorbed. Compact bone is being formed .

Average period for firm union of various bones are as follows:
Clavicle Radius-ulna Metacarpals Femur Fibula Phalanges Humerus Lower 3rd radius Tarsals Metatarsals 3-4 weeks 6-13 weeks 4 weeks 12 weeks 12-14 weeks 3 weeks 6 weeks 4 weeks 6-8 weeks 5-6 weeks

FRACTURE COMPLICATIONS Early 1. Shock 2. Fat embolism 3. Compartment syndrome 4. Infection 5. DVT


FRACTURE COMPLICATIONS Late 1. Delayed union 2. Avascular necrosis 3. Delayed reaction to fixation devices 4. Complex regional syndrome 5. Heterotrophic ossification


brain kidneys and other organs Fracture .FRACTURE COMPLICATIONS: Fat Embolism Occurs usually in fractures of the long bones Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure Fat globules occlude the small blood vessels of the lungs.

tachycardia 3. within 24-72 hours ASSESSMENT FINDINGS 1. Crackles. Chest pain 4. Sudden dyspnea and respiratory distress 2.Fracture FRACTURE COMPLICATIONS: Fat Embolism Onset is rapid. wheezes and cough .

FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 1. Support the respiratory function Respiratory failure is the most common cause of death Administer O2 in high concentration Prepare for possible intubation and ventilator support Fracture .

Administer drugs Corticosteroids Dopamine Morphine Fracture .FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 2.

Institute preventive measures Immediate immobilization of fracture Minimal fracture manipulation Adequate support for fractured bone during turning and positioning Maintain adequate hydration and electrolyte balance Fracture .FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 3.

Fracture Early complication: Compartment syndrome A complication that develops when tissue perfusion in the muscles is less than required for tissue viability .

Fracture Early complication: Compartment syndrome ASSESSMENT FINDINGS 1. Pain. throbbing and UNRELIEVED pain by opiods Pain is due to reduction in the size of the muscle compartment by tight cast Pain is due to increased mass in the compartment by edema. swelling or hemorrhage .Deep.

Motor weakness 5. impaired capillary refill time and cyanotic skin . Numbness 4.Fracture Early complication: Compartment syndrome ASSESSMENT FINDINGS 2. Pulselessness. Paresthesia.burning or tingling sensation 3.

Elevate the extremity above the level of the heart 3. Assist in cast removal and FASCIOTOMY . Assess frequently the neurovascular status of the casted extremity 2.Fracture Early complication: Compartment syndrome Medical and Nursing management 1.

Limit joint activity 4. Administer NSAIDs and muscle relaxants .Strains Excessive stretching of a muscle or tendon Nursing management 1. Immobilize affected part 2. Apply cold packs initially. then heat packs 3.

Compression bandage may be applied to relieve edema 4. Immobilize extremity and advise rest 2.Sprains Excessive stretching of the LIGAMENTS Nursing management 1. Assist in cast application 5. Administer NSAIDS . Apply cold packs initially then heat packs 3.

Dislocation Displacement of a bone from its normal joint position to the extent that articulating surface partially lose contact. CAUSES Trauma Disease Congenital condition .

Dislocation SIGNS AND SYMPTOMS Burning pain Deformity Stiffness and loss of joint function Moderate or severe edema around the joint .

Encourage patient to exercise. Assess affected extremity for signs for neurovascular problems. elevate the affected extremity. .Dislocation NURSING MANAGEMENT To lessen swelling. Give pain medications as ordered by the doctor. Provide appropriate care if patient is immobilized.

Common musculoskeletal problems The Nursing Management .

traction. Assess patient¶s perception of pain 2.Nursing Management of common musculoskeletal problems PAIN These can be related to joint inflammation. Instruct patient alternative pain management like meditation. surgical intervention 1. TENS and guided imagery . heat and cold application.

Assess the effectiveness of pain measures .Nursing Management PAIN 3. Administer analgesics as prescribed 4.

either passive or active 2. Turn and change position every 2 hours 4. Provide support in ambulation with assistive devices 3. Instruct patient to perform range of motion exercises. Encourage mobility for a short period and provide positive reinforcements for small accomplishments .Nursing Management IMPAIRED PHYSICAL MOBILITY 1.

Nursing Management SELF-CARE DEFICITS 1. Provide support for feeding problems Place patient in Fowler¶s position Provide assistive device and supervise meal time Offer finger foods that can be handled by patient Keep suction equipment ready . Assess functional levels of the patient 2.

Assist patient with difficulty bathing and hygiene Assist with bath only when patient has difficulty Provide ample time for patient to finish activity .Nursing Management SELF-CARE DEFICITS 3.

Musculoskeletal Modalities Traction Cast .

bone alignment and relief of muscle spasm .Nursing Management Traction A method of fracture immobilization by applying equipments to align bone fragments Used for immobilization.

Traction means that a pulling force is applied to a body part or extremity while a counter traction pulls in the opposite direction.Nursing Management TRACTION It is the act of pulling or drawing which is associated with counter traction. .

Nursing Management TRACTION Purposes of Traction 1.Traction is often used in the treatment of fractured extremities To lessen muscle spasm To reduce fracture To provide immobilization To maintain alignment .

Prior to total hip surgery. lessen or prevent deformities as in the case of arthritis patients with flexion contraction. 3. Traction is also used to correct. surgeons may apply skeletal traction in an attempt to stretch muscles to obtain more working space.Nursing Management TRACTION 2. 4. Lessens muscle spasm in back pain .

patient¶s position must be supine 2. avoid friction 3. line of pull must be in line with deformity . there should be an adequate counter traction 6. apply traction continuously 5. allow the weights to hang freely 4.Nursing Management Traction: General principles 1.

Observe for DVT. Signs of infection Provide pin care 4. Impaired circulation in the extremities 2.Nursing Management Traction: What to watch out for? 1. Deformity like foot drop Provide foot board . skin irritation and breakdown 3.

Traction Skin traction Application of a pulling force to the skin from where it is transmitted to the muscles and then to the bones Uses adhesive and non-adhesive type of materials .

Steinman¶s pin.Traction Skeletal traction The pulling force is applied directly to the bone using pins and wires such as Kirshner¶s wire. Vinki¶s skull retractor and crutch field tongs. Manual traction Pulling force is applied by hands of the operator .

Application of skeletal traction« .

Traction Equipments for Balanced Skeletal Traction Thomas splint Pearson¶s attachment Rest splint 5 slings (different sizes) 5 safety pins Cord pulleys .

Traction Equipments cont¶n Weight traction and suspension weight bag Steiman¶s pin holder Kirshner¶s wire holder Overhead trapeze Foot board Balkan frame .


Pott¶s disease . cervical strains.Traction Different Kinds of Traction 1. mild cervical trauma. Head-halter traction   Skin Several cervical sprains. Halo ± femoral traction   Skin Severe scoliosis 2.

Traction Different Types of Traction 3. Dunlop traction   Skin Supracondylar fracture of the humerus 4. Buck¶s traction   Skin (adhesive tape) Injuries to the hip and femur bone .

Halo-pelvic traction   Skin Scoliosis 6.Traction Different Types of Traction 5. Pelvic traction   Skin (non-adhesive) Low back pain .

Cotrel   Skin (combination of head halter and pelvic traction) Scoliosis 8. lumbar affection . Pelvic traction   Skin (non-adhesive) Low back pain.Traction Different Types of Traction 7.

Traction Different Types of Traction 9. post poliomyelitis with residual paralysis . congenital hip dislocation in infants less than 6 years old 10. Boot cast traction   Skin Hip and femur fracture. Bryant¶s traction   Skin (adhesive tape) Femur fracture.

90-90 lower extremity traction Skin or skeletal  Displaced femoral fracture  12. Stove-in Chest Skin  Severe chest injury with multiple fracture  .Traction Different Types of Traction 11.

Traction Different Types of Traction 12. Balance skeletal traction   Skeletal Femoral affectation 13. Side arm traction (90-90 upper extremity traction)   Skeletal or skin Supracondylar fracture of the humerus .

Crutchfield Tong and halo traction Skeletal  Cervical fracture or subluxation  14.Traction 14. Russel traction Skin (adhesive)  fracture of femur  .

Head-halter traction .


Skull traction

Dunlop traction

Pelvic traction

Acetabular traction .

Buck¶s Traction And Russel¶sTraction .


BRACES Banjo Splint Peripheral nerve injury Bilateral Long Leg Brace Polio Chair Back Brace Lumbo-sacral affectation .

BRACES Cock-up Splint Wrist drop Dennis Brown Splint Congenital clubfoot or talipes Finger Splint Fractured digits .

BRACES Forester Brace Cervico-thoraco-lumbar spine affectation Jewette Brace Lower thoracic and upper lumbar affectation Milwaukee Brace Scoliosis T9 and above .

BRACES L-S Corset Thoraco-lumbar affectation .

Philadelphia brace .

L-S Corset .

8 Figure Brace .

Velpeau Brace .

Nursing Management CAST Immobilizing tool made of plaster of Paris or fiberglass Provides immobilization of the fracture .

Nursing Management CAST: types 1. Spica . Short arm 3. Long arm 2.

WHITE. hard and resistant Fiberglass Lightweight and dries in 20-30 minutes Water resistant . it is SHINY.Casting Materials Plaster of Paris Drying takes 1-3 days If dry.

Turn the extremity for equal drying.Nursing Management CAST: General Nursing Care 1. Keep the casted extremity ELEVATED using a pillow 4. DO NOT USE DRYER for plaster cast . Handle a wet cast with the PALMS not the fingertips 3. Allow the cast to dry (usually 24-72 hours) 2.

Nursing Management CAST: General Nursing Care 5. Petal the edges of the cast to prevent crumbling of the edges 6. Examine the skin for pressure areas and Regularly check the pulses and skin .

swelling. coolness.Nursing Management CAST: General Nursing Care 7. Instruct the patient not to place sticks or small objects inside the cast 8. tingling or lack of sensation and diminished pulses . Monitor for the following: pain. discoloration.

Different Kinds of Cast .

Common Musculoskeletal conditions Nursing management .

METABOLIC BONE DISORDERS Osteoporosis A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure .

METABOLIC BONE DISORDERS Osteoporosis: Pathophysiology Normal homeostatic bone turnover is altered rate of bone RESORPTION is greater than bone FORMATION reduction in total bone mass reduction in bone mineral density prone to FRACTURE .

Renal failure . Secondary osteoporosis.advanced age.Steroid overuse. post-menopausal 2.METABOLIC BONE DISORDERS Osteoporosis: TYPES 1. Primary Osteoporosis.

low Ca and Vit D 4. Post-menopausal 5. Diet.caucasian and asian 6. alcohol. Genetics.caffeine. Immobility .METABOLIC BONE DISORDERS RISK factors for the development of Osteoporosis 1. Sedentary lifestyle 2. Age 3.

Fracture Femur 3. Low stature 2.METABOLIC DISORDER ASSESSMENT FINDINGS 1. Bone pain .

METABOLIC DISORDER LABORATORY FINDINGS 1. X-ray studies . DEXA-scan Provides information about bone mineral density T-score is at least 2.5 SD below the young adult mean value 2.

risedronate produce increased bone mass by inhibiting the OSTEOCLAST 4. Moderate weight bearing exercises 5. Hormone replacement therapy 3. Diet therapy with calcium and Vitamin D 2.Alendronate. Biphosphonates. Management of fractures .METABOLIC DISORDER Medical management of Osteoporosis 1.

Promote understanding of osteoporosis and the treatment regimen Provide adequate dietary supplement of calcium and vitamin D Instruct to employ a regular program of moderate exercises and physical activity Manage the constipating side-effect of calcium supplements .METABOLIC DISORDER Osteoporosis Nursing Interventions 1.

METABOLIC DISORDER Osteoporosis Nursing Interventions Take calcium supplements with meals Take alendronate with an EMPTY stomach with water Instruct on intake of Hormonal replacement .

METABOLIC DISORDER Osteoporosis Nursing Interventions 2. Relieve the pain Instruct the patient to rest on a firm mattress Suggest that knee flexion will cause relaxation of back muscles Heat application may provide comfort Encourage good posture and body mechanics Instruct to avoid twisting and heavy lifting .

METABOLIC DISORDER Osteoporosis Nursing Interventions 3. Improve bowel elimination Constipation is a problem of calcium supplements and immobility Advise intake of HIGH fiber diet and increased fluids .

Osteoporosis Nursing Interventions 4. Prevent injury Instruct to use isometric exercise to strengthen the trunk muscles AVOID sudden jarring, bending and strenuous lifting Provide a safe environment

OSTEOARTHRITIS The most common form of degenerative joint disorder

OSTEOARTHRITIS: Pathophysiology Injury, genetic, Previous joint damage, Obesity, Advanced age Stimulate the chondrocytes to release chemicals chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening

Repetitive use of joints with previous joint damage 4.DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Risk factors 1. Increased age 2. Anatomical deformity 5. genetic susceptibility . Obesity 3.

Functional joint impairment The joint involvement is ASYMMETRICAL This is not systemic. Joint stiffness 3.DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 1. Joint pain 2. there is no FEVER Usual joint are the WEIGHT bearing joints .

Joint pain Caused by Inflamed synovium Stretching of the joint capsule Irritation of nerve endings .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 1.

Stiffness commonly occurs in the morning after awakening Lasts only for less than 30 minutes DECREASES with movement .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 2.

Blood tests will show no evidence of systemic inflammation and are not useful .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Diagnostic findings 1. X-ray Narrowing of joint space Loss of cartilage Osteophytes 2.

Use of splinting devices to support joints 3. Occupational and physical therapy 4. Pharmacologic management Use of NSAIDS Use of Glucosamine and chondroitin Topical analgesics .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Medical management 1. Weight reduction 2.

Provide relief of PAIN Administer prescribed analgesics Application of heat modalities Plan daily activities when pain is less severe Pain meds before exercising .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions 1.

Advise patient to reduce weight Aerobic exercise Walking 3. Administer prescribed medications NSAIDS .DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions 2.

Rheumatoid arthritis A type of chronic systemic inflammatory arthritis affecting more women than men .

Rheumatoid arthritis
Pathophysiology Immune reaction in the synovium attracts neutrophils releases enzymes breakdown of collagen irritates the synovial lining causing synovial inflammation edema and pannus formation and joint erosions

Rheumatoid arthritis
ASSESSMENT FINDINGS 1. PAIN 2. Joint swelling and stiffnessSYMMETRICAL 3. Warmth, erythema and lack of function 4. Fever, weight loss, anemia, fatigue 5. Palpation of join reveals spongy tissue 6. Hesitancy in joint movement

Rheumatoid arthritis
ASSESSMENT FINDINGS Joint involvement is SYMMETRICAL and BILATERAL Characteristically beginning in the hands, wrist and feet Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement

Rheumatoid arthritis ASSESSMENT FINDINGS Joints are swollen and warm Painful when moved Deformities are common in the hands and feet causing misalignment Rheumatoid nodules may be found in the subcutaneous tissues .

milky or dark yellow containing WBC and inflammatory proteins . Arthrocentesis shows synovial fluid that is cloudy. elevated ESR and CRP 3.Rheumatoid arthritis Diagnostic test 1. Blood studies reveal (+) rheumatoid factor. X-ray Shows bony erosion 2.

arthroplasty. Therapeutic dose of NSAIDS and Aspirin 2. antimalarials. gold therapy and steroid 3. synovectomy 4. Nutritional therapy . For advanced cases.Rheumatoid arthritis MEDICAL MANAGEMENT 1. Chemotherapy with methotrexate.

then HEAT application as the inflammation subsides .Rheumatoid arthritis Nursing MANAGEMENT 1. Relieve pain and discomfort USE splints to immobilize the affected extremity during acute stage of the disease and inflammation Administer prescribed medications Suggest application of COLD packs during the acute phase of pain.

Decrease patient fatigue Schedule activity when pain is less severe Provide adequate periods of rests 3. Promote restorative sleep 4.Rheumatoid arthritis Nursing MANAGEMENT 2. Increase patient mobility Advise proper posture and body mechanics Support joint in functional position Advise ACTIVE ROME .

Secondary gout.excessive uric acid in the blood caused by other diseases . Primary gout.Gouty arthritis A systemic disease caused by deposition of uric acid crystals in the joint and body tissues CAUSES: 1.disorder of Purine metabolism 2.



Gouty arthritis ASSESSMENT FINDINGS 1.yellowish-whitish. PODAGRA . TOPHI. initially the big toe 2. Severe pain in the involved joints. Swelling and inflammation of the joint 3. irregular deposits in the skin that break open and reveal a gritty appearance 4.

Body weakness and headache 7. malaise 6. Fever.Gouty arthritis ASSESSMENT FINDINGS 5. Renal stones .

Gouty arthritis DIAGNOSTIC TEST Elevated levels of uric acid in the blood Uric acid stones in the kidney .

Gouty arthritis Medical management 1. Allupurinol 2. Colchicine .

Instruct the patient to avoid alcohol 4. Provide bed rest during early attack of gout . Encourage an increased fluid intake 3. aged and processed foods 2. Provide a diet with LOW purine Avoid Organ meats. Provide alkaline ash diet to increase urinary pH 5.Gouty arthritis Nursing Intervention 1.

Position the affected extremity in mild flexion 7.Gouty arthritis Nursing Intervention 6. Administer anti-gout medication and analgesics .

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