128 musculoskeletal test 2
Terms
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- health history of musculoskeletal assessment includes
- past health, history, social and personal occupation
- a physical assessment would include?
- posture, gait, RoM, muscle strength,inspect and palapte each joint
- How to assess posture?
- spine, front, back , side, lordosis, kyphosis, scoliosis
- check gait for
- smoothness, balance, stride, ataxic, unsteadiness
- when inspecting a joint check for
- deformity, edema, redness, swan neck , unlar drift
- palpate joint for
- temperture, fluid, nodules, synovial cysts, heberden and bouchard nodes, bony enlargements
- what equipment do you use to check range of motion
- goniometer
- how do you check muscle strength?
-
have pt
squeeze fingers
pull and push feet - muscle strength is rated on a scale from?
- 0-5
- how do you assess for neurocirculatory of an involved extermity?
- compare affected limb with unaffected side.
- what are the 5p's of abnormal findings
- pain, pallor, pulselessness, parethesia, paralysis
- signs of a fracture include
-
edema
pain
muscle spasm
deformity
ecchymosis
loss of function
crepitation - discoloration of skin due to extravasation of blood in subcutaneous tissues
- ecchymosis
- disruption of soft tissues or bleeding into the surrounding
- edema or swelling from a fracture
- why do muscle spasms occure with a fracture?
- as a protective response to injury and fracture
- how to heal a fracture?
- IMMOBILZATION
- WHAT IS HEMATOMA FORMATION IN REGARDS TO FRACTURE MANAGEMENT? and how long?
- blood clot provides a structure upon which a fibrin network can build. takes 48-72hr
- what is callus formation? and how long to occur
- loosely woven cartilage and bone matrix. 6-21days
- calcium deposits-bone become rigid and heals in 2-6 weeks
- Ossification
- bone returns to its normal shape and contours 1-several yrs
- Remodeling
- stages of bone healing (6)
-
hematoma formaition
cellular proliferation
callus formation
ossification
remodeling
lenth of time it takds to heal depends on fracture, immobilization, age, general health. - restore bone's normal alignment, position, length
- reduction
- cells at the torn ends multiply and form a soft tissue bridge
- cellular proliferation
- metallic device to compress fractures and to immobilize-attached to the bones by percutaneous pins
- external fixation
- surgical insision with the application of pins nails plates, screws to the bone
- ORIF open reduction with internal fixations
- ways to immobilize
-
cast
traction
internal and external fixation - breaks in the contimuity of the bone
- fractures
- break at point of contact
- direct force
- break distant from point of contact
- shear force
- uneven pull (cause)
- muscle fatigue
- what kind of break is it when skin is intact?
- simple
- what is compound fracture?
- skin broken
- what is imnomplete fracture?
- one side of the bone
- what is complete fracture?
- goes through the bone
- what is it when one part of the bone is driven into the other
- telescoped fracture
- what is it called when fractue sites are seperated>?
- displaced fracture
- injury from bone to a body organ is called what?
- complicated fracture
- thin break line is called what
- hairline fracture
- bone is pulled away from tendon is what
- compression/avulsion
- bone is broke in several little pieces.
- comminuted fracture
- what is a fracture of the distal radius called
- colles
- what is a transverse fracture
- goes around
- types of hip fractures include
- femoral head, intertrochanteric, sub trochanteric
- pre op management for hip fracture is
- bucks traction
- DO NOT'S with hip fractures and replacements (8)
-
hip into more then 90 decree flexioni
force hip into adduction or
into internal rotation
cross legs
put on own shoes or stockings until 8 weels after surgery
sit on chair without arms to aid raising to a standing position - Do's for hip replacements (5)
-
use toliet elevator
chairs inside shower
use pillows between legs
notify surgeon if sever pain
notify dentist of prosthesis before
so he can give antibiotics - signs of fractures include (7)
-
edema
pain
muscle spasm
deformity
ecchymosis
loss of funcion
crepitation - important in fracture healing
- immobilization
- long bone and pelvic fractures release yellow bone marrow into the blood stream
- fat embolism
- when does fat embolism occure?
- in the first 12-72 hours
- who is most at risk for fat embolism
- males 20-40 or older then 80
- these lodge in the lung, causing hemorrhagic intestitial pneumonitis that produces symptoms of acute respiratory distress
- fat embolism
-
major <a href="http://www.ntsearch.com/search.php?q=signs&v=56">signs</a> of ______ are:
respiratory cahnges, sob, tachycardia dec po2, cyanosis, peteciae - fat embolism
- 7 complications of fractures include:
-
fat embolism,
compartment syndrome
avascular necrosis
delayed and nonunion
malunion
osteomyletis
dvt - when bone heals in abnormal position predisposing to degenerative arthritis angularion it is called
- malunion
- signs of osteomyelitis are:
- hig temps, diaphoresis, red, warm swelling
- treatment of acute osteomyelitis
- long term iv antibiotics
- cause of dvt?
- complications of immobility
- treatment of chronic osteomyelitis ?
- surgical debridement, iv or intraosseous antibiotics
- medications used with pain and spasms include:
- nsaid, muscle relaxants, narcotics, pca pumps
- treatment of muscle spasms?
- immobilization, ice, muscle relaxants, heat
- what does rice stand for?
-
rest
ice
compression
elevation - surgical procedures of amputation include
-
open
closed - 6 complications of amputation include
-
hemorrhage
infection
phantom limb
problems with immobility
neuroma
flexion contractures - chronic progressive systemic disease characterized by inflammation and destruction of synovial tissue in joints?
- rheumatoid arthritis
- occurrence in rheumatoid arthritis
- all races 20-40age 3:1 female
- what causes flares in rheumatoid arthritis?
- physical and psychological stress
- diagnosis of rheumatoid arthritis
-
x rays for cartilage, bone destruction
synovial fluid analyisis or biopsy
Lab work- ers, ra, ana - surgeries for rhumatoid arthritis
-
synovectomies
osteotomy
total joint replacements - cause of djd?
- unknown but age genetics and obesity , trauma lack of exdercise lead to it
- diagnose djd with
-
ex reays for erosions , osteophytes, narrowing of joint space
lab tests - surgical procedures of djd include (5)
-
debridement
arthrodesis
arthroplasty
osteotomy
total joint displacement - post op care issues for djd include
-
dislocation
infection
dvt
bleeding
neurovascular
pain managemnt
mobility
self care - morning stiffness lasting more then an hour is a sign of
- rheumatoid arthritis
- anemia, and effusions are common in what disease
- rheumatoid arthritis
- pain increases in evening and are common signs of what disease?
- degenerative joint disease
- heberdens nodes are common with what disorder?
- djd
- chronic multi-system autoimmune disease with remissions and exacerbations is what?
- lupus
- some signs of lupus include
-
red ras
alopecia
polyarthritis
fever
fatigue
anorexia
;pericarditis - inflammatory disorder resulting from deposition of uric acid crystals in the joints usually the great toe
- gout
- a progressive systemic disorder caused by excessive collagen deposition characterixed by inflammation, fibrosis, sclersis of skin and with organs is
- systemic sclerosis (sclerodema)
- chronic musculoskeletql pain disorder of unknown cause
- fibromyalgia