Medsurg 2 Exam 3 Summary
Chapter 39: Assessment of the Musculoskeletal System Functions of Musculoskeletal System Protect vital organs, mobility & movement, facilitate return of blood to heart, production of
blood cells (hematopoiesis), reservoir for immature blood cells & vital minerals Assessment Include data r/t function & ability of ADLs & IADLs
Health Hx: Family, health maintenance, nutrition, occupation, socioeconomic factors, medications, pain, altered sensations Remember the 6 P’s: Pain, pulselessness, poikilothermia, pallor, paralysis, paresthesia Indicators of peripheral neurovascular dysfunction: circulation, motion, and sensation
Physical Ax: Posture, Gait, bone integrity, joint function, muscle strength & size, skin, neuro status Diagnostic Evaluation
Biopsy & Lab studies X-ray Studies: Will show bone density, texture, erosion, changes in bone relationships with each other, irregularity, and can show how healing is going on
MRI: Picture of soft tissue damage, visualize & assess torn muscle, ligament/cartilage problems Arthrography: Identify cause of joint pain and progression of joint disease
Arthroscopy: Direct visualization of joint via endoscope done under a sterile procedure (first will inject saline to visualize and sometimes might take out fluid/tissues or anything that is there)
Complications: infection, thrombocytopenia/thrombophlebitis, stiffness, bleeding, delay healing, swelling at site Nursing Intervention: if swelling at site ice it, elevate legs (to prevent edema) preform neuro assessment because it can cause a delay in the healing process Post procedure: wrap the joint, apply ice, extension/elevation of joint, assess neuro (6 P’s), pain mx, activity limitations, monitor for complications (fever, excessive bleeding, numbness, swelling) Bone scan: Detect metastatic or primary bone tumor (will first inject isotope to IV site, will then look at pictures to see if there is an uptake of the isotopes), will also show fractures that do not heal or inflammation
Uptake of isotope in the body – will show there is a problem such as inflammation or anything going on in the area
Nursing Interventions: Assess for allergies to radioisotope, contraindications (pregnancy/breast feeding), have patient on an
empty bladder, drink plenty of fluids to flush kidneys Pre-procedure teaching/ Post procedure : indications, possible discomfort from isotope
Arthrocentesis: Removal of fluid from affected joint (synovial fluid is pulled from the joint and this can diagnose septic arthritis or
other inflammatory issues)
Normal removed fluid color straw colored Nursing Interventions: prepare pt, hair removal from site, pre procedure teaching, use of analgesics due to the big bore
needle (need to pre medicate) Post procedure: apply ice, possible antibiotic use due to removal of the fluids under a sterile procedure (prevents
osteomyelitis), neuro assessment, monitor for complications (fever, excessive bleeding, swelling, numbness)
Biopsy: determine the structure and composition of bone marrow, bone, muscle, or synovium
Electromyography: evaluate muscle weakness Bone densitometry: Will show if there is a risk fracture (Older patient will be more at risk for fractures)
Nursing Interventions: assess for allergies, contraindications (pregnancy, claustrophobia, debility, metal implants), pain mx,
activity restrictions, joint mobility Laboratory Studies
Alkaline phosphatase (Paget’s Disease) Coagulation studies PT/INR, PTT
Serum Calcium: calcium helps with bone formation- Normal: 8.5-10.5 Increased C+ may show cancer (13-15)
Decreased C+ we want to replace it Thyroid Studies: Musculoskeletal issues come from hyperthyroidism and hypothyroidism
Calcitonin PTH: Hypothyroidism related Vitamin D level & Specific Urine Osteoporosis Degenerative disease, loss of bone density. Will lose minerals and bones will fracture easily
Risk Factors: Age >60, small lean body, Caucasian/Asian, Older women (with decreased estrogen), decreased calcium intake,
vitamin D deficiency, malabsorption, immobility, hypo/hyperthyroidism, prolong steroid use, decreased bone mass, smoking/alcohol Diagnostic Findings: Back pain (worse at the end of the day), Kyphosis (Patient bent over a little), Decrease in height, frequent
fractures Diagnostic Test: X-ray FIRST, & Bone density test → based on % demineralization
Medical Mx: Calcium supp. (caltrate, citracal), vitamin D, yogurt, bisphosphonates (alendronate), hormone therapy (estrogen) Complications: fractures of wrist, hip, spine
Nursing Mx: Focus on Safety & Nutrition Diagnosis: risk for injury (pt are frail w/ decreased body mass), fall prevention, risk for constipation (due to immobility) Interventions: relieve pain with meds, fall prevention***, nutritional support (vitamins, calcium, proteins- optimal
nutrition), promote mobility (weight bearing exercises w/ gait if needed)
Education: rails, clean spaces, no clutter, no loose matts, nightlights oIncrease calcium & vitamin D in diet GET SUN for vitamin D absorption eat yogurt oAvoid excess phosphorous (phosphorous & calcium have seesaw effect and decreases calcium) (SODA)
Prevention increased calcium intake and exercise Osteoarthritis degenerative joint disease OA is a noninflammatory degenerative disorder of the joints . It is a progressive condition that effects the joint that has NO
REMISSION. occurs in WEIGHT BEARING JOINTS (unsymmetrical) The cartilage degenerates, new bone formation, joint cases close, less synovial fluids causing rubbing of the bones together. Joint
closes and not a lot of synovial fluid is present, and the joints will start rubbing together → joint spaces close without the fluid present
Etiology/Risk Factors: Poor posture, trauma to bones, stress of joints (obesity/smoking), increases with age due to bone/joint
changes, sedentary lifestyle, females, repetitive use of joints, certain occupations (construction workers, basketball players, carpet
installers, farmers) Diagnostic Finding: PAIN, STIFFNESS, FUCNTIONAL IMPAIRMENT Pain with activity, relieved by rest** Unsymmetrical Pain in the joints → synovial fluids decrease therefore joint will rub together and cause pain (the spaces get smaller) ... pain
is worse at the end of the day
Limitation of any kind motion → joint pain is aggravated by movement or exercise and relieved by rest
Tenderness on joint site & crepitus
Stiff joints→ morning stiffness that is brief lasting less than 30 minutes, worst stiffness pain @ the end of the day Impaired ADL performance, Deformity because of the joint
Heberden’s nodes on fingers/hands → located on distal interphalangeal
Bouchard’s nodes on fingers/hands → located on proximal interphalangeal
Patient is obese and sometimes can be debilitated and in a lot of pain
Diagnostic Tests: XRAY is FIRST (will see decreased joint space, bone spurs), MIR (will see spaces narrowing between joints),
LABS: ESR and CRP (inflammation) Pharm Mx: NSAIDS, Opioids, analgesics (acetaminophen/tylenol) if nothing working: total bone arthroplasty (replace the joint) Nursing Interventions: MAIN FOCUS reduce pain/discomfort Diagnosis: Acute/chronic pain, impaired mobility, self-care deficit, ineffective role performance
Balance rest w/ activity, heat/cold application, ROM exercises (low impact program) ****(to maintain mobility),
encourage ADLs, adequate nutrition, obese pt to be on diets, glucosamine given to increase fluids within joints, PT***, self-
care strategies, pain mx Refer clients to PT (physical therapy), encourage use of walker Chapter 41 & 42: Musculoskeletal Disorders
Contusions, Strains, Sprains Contusions: soft tissue injury, hematoma, bruising Strain: injury to muscle or tendon from overuse
