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Medical-Surgical Nursing

MUSCULOSKELETAL

Philippine Nurse Licensure Examination Review

Injuries
STRAINS excessive stretching of muscle or tendon (thick bands that attach muscles to bones) SPRAINS excessive stretching of ligmaents (thick bands that attach bones to bones) Characterized by pain and swelling Management involves cold and heat application, activity limitation, antiinflammatory meds, possible surgery

Fractures
Types: Closed/simple, Open/compound, greenstick, transverse, oblique, spiral, comminuted, complete, incomplete, pathological Reduction, Fixation, Traction, Casts Assessment of Fractures:

Pain or tenderness over area Loss of function Obvious deformity Crepitation Erythema, edema, ecchymosis

Initial Care: Immobilize, cover wound, apply splint

Fractures
COMPLICATIONS Fat embolism emboli from bone marrow usu in long bone fractures

Assessment: restlessness, tachycardia, tachypnea, hypotension, dyspnea,

Compartment Syndrome increased pressure in compartment (fascia) decreased tissue perfusion and anoxia

Assessment: increased pain & swelling, loss of sensation, pulselessness, inability to move joints Assessment: fever & pain, erythema around fracture Assessment: pain, decresased sensation

Osteomyelitis bone tissue infection

Avascular necrosis death of bone d/t loss of blood supply

Pulmonary embolism caused by immobility

Fractures

ARTHRITIS

Osteoarthritis
Degenerative Joint Disease as a result of wear and tear Formation of bony buildup and loss of articular cartilages Affects weight-bearing joints (knees), previously injured joints; DIP (Heberdens nodes) and PIP (Bouchards nodes) Symptoms aggravated by temperature Assymetrical pattern, seldom warm or red

Heberdens nodes

Rheumatoid Arthritis
Chronic inflammation of synovial membrane leading to erosion of cartilage, bone, ligaments and tendons 3x more common in women 30-55 y/o Morning stiffness > 30mins Labs: Rheumatoid Factor (RA), C-reactive protein, Antinuclear Antibody (ANA) Symmetrical, bilateral pattern, often warm, seldom red

Gouty Arthritis
Inflammatory reaction to urate crystals caused by elevated uric acid levels Excruciating pain in involved joints, which is erythematous and hot Usually single joint involvement, with sudden onset Tophi hard deposits in the skin