MUSCULOSKELETAL STUDY GUIDE
1. What is the TX OF MGMT of sprain (ligament)/strain (muscle)?
- TX- RICE: rest, ice, compression, elevation
2. What is a traction, know the names for skeletal & skin traction and your nursing
management for each.
a. BUCK’S (skin) TRACTION- force applied to splint; help w/ muscle spasm.
b. SKELETAL TRACTION- pin through bone to hold weight.
i. Force in opposite direction
ii. Realign & immobilize fracture.
iii. Traction weights: hang freely, do NOT remove w/o order, support weight
when moving patient.
iv. MONITOR FOR COMPLICATIONS: fat embolism; compartment syndrome
3. Review Basic A&P
4. Musculoskeletal System: bones, muscle, & joints
5. OSTEOPOROSIS disease which bone mass & density decreases over time resulting in a
weakening of the bones → fracture & deformities (mostly affects older
women/decrease in estrogen)
a. CAUSES/RISKS: immobilization, steroids, heparin, caffeine, genetics, smallframed, post-menopausal, white females who smoke.
b. ASSESSMENT: backache, height loss; lordosis, kyphosis, scoliosis
c. DX: serum Ca+, phosphorous, alkaline phosphatase, BUN, Cr level.
d. Bone densitometry (DEXA)
e. INTERVENTIONS: Ca+ w/ Vit. D; weight-bearing exercises; hormonal replacement
(estrogen); bone resorption inhibitor drugs; milk products.
6. Osteoarthritis concept map vs Rheumatoid arthritis concept map vs Gout concept map
7. Diagnostic testing – invasive vs non-invasive, expected vs complication.
a. MYELOGRAM (fluoroscopy)
i. Injection of radiopaque dye into the subarachnoid space
ii. Ask for IODINE allergy.
iii. WATER-SOL DYE → semi fowler position for 8hrs after
iv. OIL-BASED DYE → rest in a flat position for 12 hrs
v. Assess kidney function; Encourage fluids to excrete contrast.
b. CT SCAN (NPO)
i. 3D picture w/ radiation exposure
ii. Consent form signed; ask for IODINE allergy.
iii. PREOP: Remove jewelry; lie still; may feel warm & nauseated.
iv. Observe delayed allergic reactions.
c. ARTHROCENTESIS/SYNOVIAL FLUID ASPIRATION (invasive)
i. Diagnosis of gout, osteoarthritis, and RA
d. ELECTROMYOGRAM (invasive)
i. Insertion of needle electrodes into muscle to assess electrical activity.
e. MRI (sedate)
i. Use of magnetism & radio waves to make the images of cross sections.
ii. More detailed pictures of fluid-filled soft tissue & blood vessels
iii. Remove any metal→ jewelry, glasses, etc.
iv. CONTRAINDICATED in patients w/ heart valves, orthopedic screws, or
pacemakers.
v. Narrow tunnel machine; ASSESS FOR CLAUSTROPHOBIA
vi. Required to lie still; sedatives used.
f. BONE SCAN (nuclear imaging test)
i. Detects metastatic & inflammatory bone disease.
g. ARTHROSCOPY (invasive)
i. Examines the joint using endoscope that is inserted into the joint through
a small incision.
h. ENDOSCOPIC SPINAL SURGERY (invasive)
i. Small incisions for herniated disc & scoliosis
8. CRUTCH WALKING & SAFETY
a. Weight on hands, not axillae.
b. 2in width between the axillary fold & armpiece on the crutches.
c. Elbow slightly flexed.
d. Crutch tip 6in away from side of feet.
e. Requires adequate muscle strength in upper extremities.
f. COAL- Cane Opposite Affected Leg
g. WWAL- Walker With Affected Leg
h. Crutches going upstairs- good leg, bad leg, crutches
i. Crutches going downstairs- bad leg, crutches, good leg
9. Crutch gait techniques
10. COMPARTMENT SYNDROME
a. Extensive pressure, compromises tissue (6Ps) ischemia→ cell death
b. Notify MD. Early recognition is KEY!
c. DO NOT ELEVATE or apply ice.
d. Remove cast.
11. FAT EMBOLISM
a. Fat globules from fracture (long bones) enter circulation.
b. Contributory factor in many deaths associated w/ fracture.
c. Respiratory distress, petechiae, anxiety/confusion (neuro changes)
d. DX: fat cells in blood, urine, or sputum; PaCO2 <60mmHg, low platelet;
prolonged PTT; CHEST X-RAY whiteout.
e. PREVENTION IS KEY! IMMOBILIZATION OF FRACTURE.
12. TYPES OF FRACTURES, assessment, nursing management, complications
a. COMPOUND (open infection)
b. SIMPLE
c. GREENSTICK (one-side bent-kids)
d. COMMINUTED (splintered)
e. TRANSVERSE (straight across)
f. IMPACTED
g. SPIRAL
h. COLLE’S (fracture of radius)
i. POTT’S (distal end of fibula)
**INTERVENTIONS: ACE, RICE, analgesics, closed or open reduction (ORIF), cast,
splint, braces; skin/skeletal tractions; trapeze; primary arthroplasty or amputation.
13. CAST CARE – pt teaching
a. CAST CARE DO’S
i. Frequent neurovascular assessments
ii. Apply ice for the 1st 24-hours.
iii. Elevate above heart for 1st 48hrs.
iv. Exercise joints above & below
v. Use hair dryer for on cool setting for itching.
vi. Check w/ health care provider before getting wet.
vii. Report swelling associated w/ pain & discoloration OR movement.
viii. Report burning or tingling under cast.
ix. Report sores or foul odor under cast.
b. CAST CARE DON’Ts
i. Elevate if compartment syndrome.
ii. Get plaster cast wet.
iii. Remove padding.
iv. Insert objects inside the cast.
v. Bear weight for 24-48 hrs.
vi. Cover cast w/ plastic for prolonged period.
14. FRACTURE IMMOBILIZATION- CAST
a. Plaster: immersed in warm water, wrapped, & mottled
b. Long/short leg cast: elevate, observe for signs of compartment syndrome
c. Hip Spica Cast: for femur fractures, more common in peds
i. Instruct client in repositioning, fracture bedpan, monitor abd pain.
15. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) (more common on women)
16. FIBROMYALGIA condition that causes pain all over the body (widespread pain), sleep
problems, fatigue, & often emotional & mental distress (more sensitive to pain)
a. CHRONIC PAIN SYNDROME IN MUSCLES, BONES OR JOINTS→ HEADACHES &
MUSCLE STIFFNESS
b. CAUSES: UNKNOWN; mostly women
c. ASSESSMENT: neck & lower back pain; aggravated by cold weather, fatigue,
stress; pain (11/18 tender points), sleep disturbance.
d. DX: no specific test, labs, sleep study, pain specialist, psych consult.
e. INTERVENTIONS: relaxation techniques; exercise programs; TRICYCLIC
ANTIDEPRESSANTS (amitriptyline/Elavil); ANTICONVULSANTS
(pregabalin/Lyrica)
17. Neurovascular Assessment (6 P’s):
pulselessness, paralysis, pain, pallor, paresthesia, palor temp/poikilothemia
18. Who is at risk for FAT EMBOLISM? Patients w/ orthopedic trauma.
MULTIPLE FRACTURES OF LONG BONES & PELVIS→ embolization of fats w/ platelets
19. COMPARTMENT SYNDROME pressure (fracture, tight cast)→ compression of arteries,
nerve & tendons→ muscle hypoxia→ paralysis & sensory loss→ disability of extremity
w/n 24-48 hours.
a. ASSESSMENT: unrelenting pain unrelieved by analgesic; numbness or tingling;
VOLKMANN’S CONTRACTURE (claw-like deformity)
b. INTERVENTIONS: elevate limb; FASCIOTOMY.
20. Why are the 6 p’s important to do? CLASSIC SIGNS ACUTE COMPARTMENT SYNDROME
21. CARPAL TUNNEL SYNDROME compression on the median nerve→ pain on wrist & hand
a. CAUSE: obese, middle-aged women, pianist & typewriters
b. ASSESSMENT: inability to grasp or hold small objects, burning/tingling pain;
PARESTHESIA of the thumb, index, & middle fingers; relieved w/ vigorous
shaking.
c. DX: Tinel’s Test: gentle tap over the wrist→ numbness & tingling; Phalen’s Test:
hold wrists in palmar flexion→ numbness & tingling; Electromyogram.
d. INTERVENTION: ROM exercises, splinting, cortisone injection, surgery,
decompression of the median nerve.
22. KNEE AMPUTATION – nursing management, concept map
a. PHANTOM PAIN: tx like its real; administer pain medication.
23. HIP FRACTURE intracapsular fractures disrupt blood supply to head of femur→
AVASCULAR NECROSIS
a. ASSESSMENT: severe pain; paralysis; popping sound, crepitus, paralysis, edema,
shock; SHORTENING/EXTERNAL ROTATION of the leg.
b. INTERVENTIONS: abduct the legs; HOB 45degrees; avoid bending hip >90deg,
crossing legs, low toilet seats; antiembolic stockings; limit weight-bearing; skin
traction; arthroplasty; total hip replacement.