History ` Pain ` Numbness/Tingling ` Joint Stiffness ` Difficulty with movement Physical Examination ` Skeletal deformity ` Limited ROM ` Inflammation ` Edema ` erythema

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Abduction is movement away from the center, as spreading the toes or fingers apart. Adduction is movement toward the midline of the body, as bringing the fingers and toes together. (Adduction and abduction always refer to movements of the appendicular skeleton). Angular motion is comprised of flexion, extension, adduction, and abduction. Each is based on reference to a certain anatomical position. Circumduction is a special type of angular motion, described as making circular movements as moving the arm in a loop. Dorsiflexion / Plantar flexion refers to movements of the foot. Dorsiflexion is the movement of the ankle while elevating the sole, as if digging in the heel. Plantar flexion is the opposite movement, extending the ankle and elevating the heel, as if standing on tiptoes. Elevation / Depression occurs when a structure moves in a superior or inferior direction, as the mandible is depressed when the mouth is opened and elevated when the mouth is closed. Extension occurs in the same plane as flexion, except that it increases the angle between articulating elements. Extension reverses the movement of flexion. Hyperextension is a continuation of movement past the anatomical position, which can cause injury.

that is. . Opposition is a special movement of the thumb which enables it to grasp and hold an object. Rotation involves turning the body or a limb around the longitudinal axis. as rotating the arm to screw in a lightbulb. flexing the intervertebral joints of the neck. Pronation / Supination refers to the rotation of the distal end of the radius across the anterior surface of the ulna.` ` ` ` ` ` ` Flexion is movement in the anterior-posterior plane that reduces the angle between the articulating elements as in bringing the head toward the chest. Gliding occurs when two opposing surfaces slide past each other as between articulating carpals and tarsals and between the clavicles and sternum. This rotation moves the wrist and hand from palm-facing-front (supination) to palmfacing-back (pronation). Protraction entails moving a part of the body anteriorly in the horizontal plane. Retraction is the reverse movement of protraction as in pulling the jaw back towards the spine. as in jutting the face forward to gain distance at a finish line.

Explain that thismay cause minor discomfort but not painful 3.Electromyography -A test for muscle activity with graphical recording of the muscle at rest and during contraction Interventions: 1. . Administer analgesic as prescribed. Explain that the px muscle will asked to flex and relax muscles during the test 2.

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Arthroscopy -direct visualization of the joint (arthroscope) Intervention: Pre-test 1. Administer analgesic and prophylactic antibiotic as prescribe. Secure informed consent 2. Monitor neurovascular status 3. Post-test 1. Administer analgesic as prescribed . Limit joint use 4. Use of local anesthesia 5. Skin preparation 4. Explain the procedure 3. Apply pressure/compact dressing at site 2.

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Arthrocentesis -needle aspiration of synovial fluid from joint under local anesthesia Intervention Pre-test 1. Secure consent 2. Apply pressure/compact dressing at site 2. Monitor neurovascular status 3. Administer analgesic and prophylactic antibiotic as prescribe. Limit joint use 4. Administer analgesic as prescribed . Explain the procedure 3. Post-test 1.

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2. Pain Pallor Paralysis Paresthesia Pulselessness . 5.1. 4. 3.

. Explain the procedure 2. Advise that radioisotope will be injected 4. 3.Bone Scan -visual imaging of bone metabolism after injection of IV radioisotope Intervention Pre-test 1. Explain that the px will drink several glasses of fluid to enhance excretion of isotope not absorbed by bone tissue. Determine the ability of px to lie down during the scan.

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Inspect site for bleeding 3.Bed rest on semi-fowlers position 2.Myelogram -Fluoroscopic procedure using an injection of radiopaque dye. Monitor neurovascular status . Allows visualization of the subarachnois space. sea food and radiopaque dyes. Note the px allergy to iodine.spinal cord and vertebral bodies. Post-test 1. Explain the procedure 2. Intervention Pre-test 1.

LE cell preparation test and anti-DNA 2.Check if the female px is not pregnant to avoid fetal damage from radiation exposure. BUN. Monitor venipuncture site Hematologic Studies Key Facts 1. protein. RBC¶s. Hb and HCT 2. Analyzes substances for WBC¶s. .X-ray Key Intervention 1. Blood Chemistry Key Facts 1. Analyzes levels of potassium. Note current drug therapy to anticipate possible interference with test result. calcium.

` ` ` ` Decreased self-esteem Dependence Economic impact Restriction on body movement . occupation and recreational and social. economic.Key Impact on: Development.

Family history . Obesity Non-modifiable 1. Occupations that requires heavy lifting 2. Contact sports 6.Modifiable 1. Vegetarian diet 5. Repetitive motion 4. Use of machinery 3. Menopause 3. Aging 2.

4. 3. Impaired physical mobility Ineffective tissue perfussion: Peripheral Impaired skin integrity Alteration in comfort: Pain . 2.1.

plastic or prosthesis. . Arthroplasty (total joint replacement) ± surgical replacement of a joint with a metal.Arthrodesis ± surgical removal of cartillage from joint surfaces to fuse a joint into a functional position. Synovectomy ± removal of the synovial membrane from a joint using an arthroscope to reduce pain.

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1. 2. 4. Complete preoperative health teaching Complete preoperative checklist Administer preoperative drugs Document assessment data. . 3.

Elevate affected extremity Provide wound care. 2. Encourage turning. Limit joint/area movement of affected limb. coughing.1. 7. 6. 3. Maintain active and passive ROM for unaffected limbs and isometric exercises. 4. . Assess pain level Administer analgesic as prescribed and evaluate response. deep breathing. 5.

Infection Hemmorhage embolus . 3.1. 2.

Fracture immobilization in which transfixing pins are inserted through the bone above and below the fracture site. Pins are attached to a rigid metal frame.

Pre-Operative 1. Apply the GIE 2. Monitor fracture complication 3. Maintain the position of the affected extremity with sandbags and pillows. 4. Maintain traction or splint. Post-operative 1. Assess pain level 2. Administer analgesic as prescribed and evaluate response. 3. Provide wound care 4. Maintain balanced suspension traction.

3.1. Infection Hemorrhage Chronic pain . 2.

Surgical removal of all or part of a limb with two types: closed and open .

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Complete px and family preoperative teaching with spiritual and cultural consideration. Provide emotional support to allay the px and family¶s anxiety to surgery. Prepare the px for the possibility of phantom limb sensation or phantom pain.Pre-operative 1. 3. 2. .

9. 5. 4. Encourage the px to express feelings about changes in body image and phantom sensation and pain. nubain) as prescribed 3. Maintain a rigid dressing for the stump prosthesis. infection and edema. Elevate the affected extremity as directed. 6. Inspect the stump for bleeding. neurovascular assessment and pulse oximetry. . Provide wound care as directed. Assess cardiac and respiratory status 2. Assess pain level and administer pain medication (morphine. Monitor vital signs. laboratory studies. 8. I/O. 7. Provide trapeze.Post-operative 1.

Infection Skin breakdown Depression . 2. 3.1.

Surgical reduction and stabilization of a fracture using orthopedic devices or hardware. .

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Maintain traction or splint.Pre-operative 1. 4. Monitor fracture complication 3. . Apply the GIE 2. Maintain the position of the affected extremity with sandbags and pillows.

Administer anticoagulants as prescribed. Keep px in semi-fowler¶s position: no higher than 30 degrees. I/O. Assess cardiac and respiratory status 2. 4. Use abductor pillow and trochanter rolls.Post-operative 1. Provide wound care as directed. Apply sequential compression or stockings. laboratory studies. 5. 8. nubain) as prescribed 3. 6. Monitor vital signs. 9. 7. neurovascular assessment and pulse oximetry. Administer stool softeners as prescribed. . Assess pain level and administer pain medication (morphine.

Pannus formation 3. Inflammation of synovium 2.Systemic inflammatory disease that affects the synovial lining of joints. . Destruction of cartillage. Basic Pathophysiological process of RA 1. Pannus replacement by fibrotic tissue and calcifies. bone and ligaments. 4.

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swollen joint 2. Idiophatic 2. Symmetrical joint swelling 3.Etiology: 1. Autoimmune disease Top 4 signs and symptoms: 1. Crepitus . Morning stiffness (stiffness from rest to movement) 4. Painful.

Heat andcold therapy 5. Glucocorticoids 4. NSAIDs 3. Latex fixation test: (+) rheumatoid factor 3. Increased ESR Management: 1. Joint replacement . Anti-rheumatic drugs as prescribed 2. ANA test 4. Synovial fluid analysis 5.Diagnostics: 1. Rheumatoid factor: (+) 2.

Assess neuromuscular status 2. Provide heat and cold therapy Complications: 1. Joint replacement . Keep joint extended. Peripheral neuropathy 3. Assess pain level for tolerance 3.Intervention: 1. Keratoconjunctivitis Surgical Intervention: 1. Administer prescribed medication 4. Deppression 2. Synovectomy 2. provide passive ROM 5.

-Affects weight bearing joints -Degenerated cartillage enters synovium which fibroses and limits joint movement. -Primarily affects the knee. . spine and hip joints.-Degeneration of articular cartillage.

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Obesity 3. Congenital abnormalities Tops 3 signs and symptoms 1. Enlarged. Aging 2.Etiology 1. Heberden¶s and Bouchard¶s nodes . Joint trauma 4. Joint stiffness 3. edematous joints 2.

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NSAIDs 2. Analgesic: aspirin 5. Exercise as tolerated 4. Weight reduction .Diagnostics 1. X-ray: joint deformities or bone spur 2. Heat and cold therapy 3. Hematology: increased ESR Management 1.

Synovectomy 2. Provide heat and cold therapy Complications: 1. Assess pain level for tolerance 3. Administer prescribed medication 4. Injury Surgical Management 1. Arthrodesis 3. Assess neuromuscular status 2. Joint replacement . Contractures 2.Intervention: 1.

` Inflammatory joint disease caused by deposits of uric acid crystals Etiology: 1. Redness and swelling 3. Decreased uric acid excretion 3. Tophi or great toe. Chronic renal failure Signs and symptoms: 1. Joint pain 2. Genetics 2. ankle and outer ear .

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Pathophysiology Purine metabolism (uric acid) Abnormal purine metabolism Decreased excretion of urates Increased blood levels of urates Precipitation of urates in areas with slow blood circulation Accumulation in synovium cavity Damage to adjacent tissues .

Signs and symptoms: 1. hematology: increased ESR 2. Joint pain 2. Blood chemistry: increased uric acid 3. Synovial fluid analysis: (+) crystals . Tophi formation Diagnostics: 1. Redness and swelling in joint 3.

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Arthoplasty 3. Uricosuric agents: probenicid 3. Joint replacement 2.Intervention: 1. Evacuation of uric crystals Complication: Renal calculi . Analgesic 5. Patient health education: diet 2. Increase fluid intake for excretion Surgical Intervention: 1. Xanthine-oxidase inhibitor: allopurinol 4.

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causing nonunion Etiology ` Staphylococcus aureus ` Hemolytic streptococcus Risk Factors ` Infection near bone ` Open wound .` ` ` ` Bacterial infection of the bone and soft tissue Infection that causes bone destruction Bone fragments necroses New bone cells form.

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Bone biopsy: (+) . ESR 3. Blood culture: (+) bone organism 2. Hematology: increased WBC. Bone scan: (+) 4.Signs and symptoms ` Bone pain ` Localized edema ` Increased pain with movement Diagnostics: 1.

Assess level of pain 5. Monitor v/s and I/O 2. Specific antibiotic 2. IV therapy 5. Cast or splint Intervention: 1.Management: 1. Analgesic 3. Maintain cast 4. Provide wound care 3. Wound care 4. Administer drugs as prescribed .

Comp[lication: 1. Bone necrosis 2. Amputation 3. Chronic osteomyelitis 4. Pathologic fractures 5. Sepsis Surgical Intervention: 1. I and D of bone abcess 2. Bone graft 3. Bone segment transfer

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Metabolic bone dysfunction; reduced bone mass and density and porosity Illness and medications increases the risk of skeletal fractures

Etiology 1. Calcium deficiency 2. Bone marrow disorders 3. Vitamin D deficiency 4. Cushing¶s syndrome 5. hyperthyrodism

Risk Factors 1. Age 2. Post menopausal 3. Immobility 4. Corticosteroid use Signs and symptoms 1. Dowager¶s hump 2. Thoracic and lumbar pain 3. Decrease in height 4. Joint pain 5. Pathologic fracture

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DEXA scan: decreased bone mineral density 3. Exercise program with weight bearing Intervention 1.Diagnostics: 1. Calcium supplementation 2. Assess musculoskeletal status 2. Prevent fall 4. Administer medication as prescribed Complication ± pathologic fracture . Assist with planning exercises 3. X-ray: porous bone 2. Bones scan: decreased bone mineral density Treatment 1.

Etiology 1. Tenosynovitis 4. Obesity . Fractures of the wrist 3. Streneous and repetitive use of the hand 2.` Chronic compression neuropathy of the median nerve at the wristmedian nerve supplies motor innervention (function) of the wrist and fingers.

Signs and symptoms 1. Burning and tingling of the hand 3. Weakness 4. Phalen¶s test: (+) Diagnostic: ` Motor nerve velocity (MNV) studies: (+) delayed conduction of the nerve at the wrist . Nocturnal pain and paresthesia 2. Tinel¶s sign: (+) 5.

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Complication 1. Hand splint 4. Trophic changes of the hand and fingers .Intervention: 1. NSAID 5. Loss of thumb abduction 3. Chronic hand pain 2. Health teaching: avoid wrist flexion 2. Carpal tunnel release 3. Instruct the patient to avoid manual activity that includes dorsiflexion and volar flexion of the wrist.

L5) Cervical (C5. Back and neck strain 2.C6.` ` ` Rupture of the intervertebral disk Lumbo sacral (L4. Weakness of ligaments 4. Heavy lifting 5. trauma .C7) Etiology 1. Degeneration of the disk 3.

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` Primarily caused by nerve root compression due to herniation. .

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Sensory Impairment r/t Spinal Cord Injury .

Cervical affection: neck pain that radiates down the arm and hand. CT scan: disk displacement 2. 3.Signs and symptoms: 1. Weakness. X-ray: narrowing of disk space . Pain in the back radiating across the buttock and down to the leg 2. MRI: disk protrusion 3. numbness and tingling of the foot and leg. Diagnostics: 1.

Progressive paralysis Surgical Interventions: 1. Assess neuromuscular status 2. Laminectomy 2. Administer pain medication as prescribed 5. Muscle arthropy 4. Spinal fusion 3. Thrombophlebitis 2. Assess level of pain 4. Maintain traction: braces and cervical collar 3. Chronic pain 3. Microdisktectomy .Interventions: 1. Reposition patient every 2 hours using log rolling technique. Complications: 1.

Force on a bone . edema. Results in muscle spasm. hemmorhage. Etiology: 1. Trauma 2.compressed nerve and ecchymosis.` ` ` Break in the continuity of the bone Occurs when the stress in the bone is greater than the bone can withstand.

Loss of motor function 3. Contact sports 4.X-ray: (+) deformity . Increased stress in the bone. 5. Osteoporosis: decreased bone density 3. Signs and symptoms: 1. Pain aggravated by motion 2. Deformity 4. Ecchymosis Diagnosis. Aging: demineralization of the bone 2. Edema 5. History of fracture.Risk Factors: 1.

Closed reduction 7.Management: 1. Casting 6. Skin traction: Buck¶s. Analgesics 3. Bryant¶s and Russel traction 4. External fixation . ORIF 8. Abductor pillow (fractured hip) 2. Skeletal traction 5.

I and O. 4.Intervention: 1. coughing. Provide skin. Monitor and record v/s. pin and cast care. Assess neuromuscular status 2. Provide a trapeze. deep breathing and passive ROM . Encourage turning. 5. Keep legs abducted (hip fracture) 3. 6.

Check all skin surfaces for signs of tolerance or pressure areas This helps uncover signs of pressure that will lead to pressure sores.1. pin site and suspensions. 3. 2. This helps to ensure that traction is functioning properly Check weights and avoid unnecessary movement This ensures that proper amount of weight is suspended and prevent additional pain upon movement 4. freedom of movement This helps to ensure that traction is functioning properly Check traction set up. pulleys. Check ropes. .

Complication: 1. Compartment syndrome 6. DVT 2. Pneumonia 5. Fat embolism 3. Pulmonary embolism 4. Osteomyelitis .

This leads to long-term (chronic) inflammation. . But in patients with an autoimmune disease. the immune system helps protect the body from harmful substances. The result is an overactive immune response that attacks otherwise healthy cells and tissue.` ` ` Chronic inflammatory autoimmune disorder that affects the connective tissue Deposits of antigen/antibody complexes affect the connective tissue cells Normally. the immune system cannot tell the difference between harmful substances and healthy ones.

Some develop arthritis. ` ` ` ` ` ` ` ` ` ` Other common symptoms include: Chest pain when taking a deep breath Fatigue Fever with no other cause General discomfort. Swollen lymph nodes .a "butterfly" rash over the cheeks and bridge of the nose affects about half of people with SLE. hands. wrists. and knees. The rash may also be widespread. uneasiness. or ill feeling (malaise) Hair loss Mouth sores Sensitivity to sunlight Skin rash -. Frequently affected joints are the fingers.Etiology ± Idiopathic Signs and symptoms: Almost all people with SLE have joint pain and swelling. The rash gets worse in sunlight.

fingers that change color when cold (Raynaud's phenomenon) . nausea. tingling.Other symptoms depend on what part of the body is affected: ` Brain and nervous system: Headaches Mild cognitive impairment Numbness. and vomiting Heart: abnormal heart rhythms (arrhythmias) Kidney: blood in the urine Lung: coughing up blood and difficulty breathing Skin: patchy skin color. or pain in the arms or legs Personality change Psychosis Risk of stroke Seizures Vision problems ` ` ` ` ` Digestive tract: abdominal pain.

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8. hemoglobin. LE cell preparation test: (+) 2. 7. or platelets Chest x-ray showing pleuritis or pericarditis Kidney biopsy . ANA test: (+) 3. hematuria 5. Antibody tests. including: Antinuclear antibody (ANA) panel Anti-double strand (ds) DNA Antiphospholipid antibodies Anti-Smith antibodies 6. Rheumatoid factor: (+) 4. Urine chemistry: proteinuria.Diagnostics: 1. CBC to show low white blood cells.

Intervention: 1. . Avoid exposing patient to sunlight 6. and sunscreen when in the sun. Patient should wear protective clothing. Prevent infection 4. Minimize environmental stress 5. sunglasses. Assess musculoskeletal and renal status 2. Provide adequate rest period 3.

` Corticosteroid creams are used to treat skin rashes. deppression . Pleural effusion 2. myocarditis. ` An antimalaria drug (hydroxychloroquine) and lowdose corticosteroids are sometimes used for skin and arthritis symptoms. Coronary atherosclerosis. endocarditis 4.Treatment ` Nonsteroidal anti-inflammatory medications (NSAIDs) are used to treat arthritis and pleurisy. pericarditis. ` Immunosuppressant ` Plasmapharesis Complication: 1. Renal failure 3. Systemic infection 5.

ALARCA .Thank you very much for listening and active participation! Prepared and discussed by: MELVIN NIZEL M.

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