Exam 2 MEdsurg Musculoskeletal disorders

D.
Revilla
E x a m
2
K e y
p o i n t s
C h .
4 4 :
M u s c u l o s k e l e t a l
d i s o r d e r s
.
1 .
S c o l i o s i s :
l a t e r a l
( o r
S )
c u r v a t u r e
o f
t h e
s p i n e
2 .
L o r d o s i s :
a n
i n c r e a s e
i n
t h e
c u r v e
a t
t h e
l u m b a r
s p a c e
r e g i o n
t h a t
t h r o w s
t h e
s h o u l d e r
b a c k
r e s u l t i n g
i n
a
s w a y
b a c k e d
g a i t
3 .
K y p h o s i s
:
j u n c h e d
b a c k ,
f o r w a r d s
h e a d
p o s t u r e .
A
r o u n d i n g
o f
h t e
t h o r a c i c
s p i n e
4 .
H i p
a r t h r o p l a s t y
T o t a l
h i p
a r t h r o p l a s t y
-
i n v o l v e s
t h e
r e p l a c e m e n t
o f
t h e
a c e t a b u l a r
c u p ,
f e m o r a l
h e a d ,
a n d
f e m o r a l
s t e m
H e m i a r t h o p l a s t y -
r e f e r s
t o
h a l f
o f
a
j o i n t
r e p l a c e m e n t .
F r a c t u r e s
o f
t h e
f e m o r a l
n e c k
a r e
t r e a t e d
w i t h
t h e
r e p l a c e m e n t
o f
t h e
f e m o r a l
c o m p o n e n t
-
Bed
rest
with
side
rails
up
after
administering
preoperative
medications
-
Provide
early
ambulation.
Transfer
the
client
out
of
bed
from
his
unaffected
sid
into
a
chair
or
wheelchair
-
M o n i t o r
f o r
n e w
j o i n t
d i s l o c a t i o n :
a
cute
onset
of
pain.
R e p o r t s
h e a r i n g
a
p o p
,
internal
rotation
of
the
affected
extremity,
and
shortened
affected
extremity
“ h e y
i
h e a r d
a
P O P ”
m e a n s
D I S L O C A T I O N
-
Avoid
hip
flexion
greater
than
90
degrees
-
avoid
low
chairs
-
D o
n o t
c r o s s
l e g s
f o r
3
m o n t h s
-
D o
n o t
i n t e r n a l l y
r o t a t e
t h e
t o e s
5 .
O s t e o p e r o s i s / B o n e
s c a n D.
Revilla
O s t e o p e r o s i s
i s
a
d i s o r d e r
t h a t
r e s u l t s
i n
a
l o s s
o f
b o n e
d e n s i t y .
Extended
periods
of
immobility
cause
bone
deterioration
H i g h
r i s k
:
w o m e n
b e t w e e n
5 5 - 6 5 y
( b c
l o s s
o f
e s t r o g e n )
R i s k
f a c t o r s :
o s t e o p o r o s i s :
-
V i t a m i n
D
d e f i c i e n c y
:
Vitamin
D
helps
with
bone
absorption
but
if
you
don’t
have
Vitamin
D,
you
also
don’t
have
calcium
-
u s e
o f
s t e r o i d s
-
a n t o c o n v u l s a n t s
-
i m m u n o s u p p r e s s a n t
t h e r a p i e s
-
h e p a r i n
:
too
much
can
damage
bone
-
d i e t s
l o w
i n
c a l c i u m
-
h i g h
i n
c a f f e i n e
a n d
h i g h
p r o t e i n
(
caffeine
causes
electrolyte
imbalance
-
D u a l
e n e r g y
x - r a y
a b s o r p t i o m e t r y
( D E X A )
d e t e r m i n e
Bone
Mineral
Denisty
( B M D ) .
BMD
measures
how
tightly
bones
are
packed
D i a g n o s t i c
t e s t
f o r
O s t e o p e r o s i s
-
C B C :
(RBC
4.2-6
million.
WBC
5K-10K,
platelet
150K-400K)
-
S e r u m
C a l c i u m
-
P h o s p h o r u s
-
A l k a l i n e
p h o s p h a t a s e
-
B l o o d
U r e a
N i t r o g e n
( B U N )
-
C r e a t n i n e
l e v e l
-
U r i n a l y s i s
-
L i v e r
a n d
t h y r o i d
f u n c t i o n
t e s t s
-
D u r i n g
b o n e
s c a n ,
i f
t h e
c o n t r a s t
u p t a k e s
m o r e ,
t h e r e
i s
b o n e
l o s s
/
a b n o r m a l i t y
O s t e o p o r o s i s
T x
-
C a l c i u m
s u p p l e m e n t s ,
V i t a m i n
D
s u p p l e m e n t s
-
A l c o h o l
i n t a k e
s h o u l d
b e
l i m i t e d
-
W e i g h t
b e a r i n g
e x e r c i s e
p r o g r a m
(
walking,
yoga,
aerobics,
exercises
with
your
own
weight)
-
A l e n d r o n a t e
( F o s a m a x ) ,
z o l e d r o n i c
a c i d
( R e c l a s t )
a n d
i b a n d r o n a t e
( B o n i v a )
t o
i n c r e a s e
b o n e
d e n s i t y
.