Med Surg: Class 5

 

Class 5 MSK

 

MSK assessment

  • History
  • Physical assessment
    • inspection, Palpation, motion, strength opposition, gait
  • PTH, Ca levels, Phosphorus PO4, Vit D, Creatinine Kinase (CK)
  • X-ray, and bone density scan

 

Broad issues

  • Pain, Neurovascular compromise (edema, mm spasm, loss of peripheral pulses, cap refill, and neurologic sensitivity), Immobility

 

Osteoporosis

  • loss of bone density over time.
  • diagnosis when 25%-40% of bone calcium lost.
  • x-ray or bone density scan
  • manifests as: pathological fractures, may not present with s/s, bone pain,
  • Drugs: fosamax (alledramate), keep the Ca in the bone and prevent absorption
    • Omeprazole may (PPI’s) may decrease Ca absorption.  
  • Lifestyle changes: Weight bearing exercise, Ca and Vit D supplementation,
  • avoid: alcohol smoking, and carbonated beverages
  • Risk Factors: small thin women, inactive lifestyle, white/asian, ETOH, Chronic Steroid use, Postmenopausal (lower estrogen levels)

 

Fractures

  • reduction – realigning the bone
  • closed reduction is “pulling traction” and the bone is realigned without
  • ORIF -open reduction internal fixation (surgical procedure)
  • Healing: hematoma, granulation tissue, callus formation, ossification, consolidation, remodeling.
  • complications: NEUROVASCULAR IMPAIRMENT, Pain, DVT, Fat embolism, Osteomyelitis, Myoglobinuria (leads to acute renal failure because it is a protein that is hard on the kidneys)

 

Fat embolism – comes from the bone marrow often in long bone fractures.

    • includes the micro vasculature, can go into ARDS (acute resp. distress syndrome), petechiae, neuro issues (change in LOC).
    • the issues arise from the emboli getting stuck in the lungs, brain, or other microvasculature.
    • Cannot really treat this once it is lodged.

 

Compartment syndrome

  • from MM trauma, the muscle swells and pressure increases
  • 6 Ps: pain, paresthesia, pallor, pulseless, pressure, paralysis.
  • treat with a fasciotomy to relieve the pressure

 

Traction

  • pulling the bone to allow for realignment to occur correctly.
  • types
    • Manual, Skin or Bucks, and skeletal(drill into bone)
  • complications
    • sheer, urine retention (from pain meds and positioning), DVT, constipation, psychological issues, and fat emboli.
    • AWFUL: Atelectasis, Wasting bone, Functional MM loss, Urine retention, Lastly constipation

Internal fixation

  • adding screws or plates, to help the bone heal correctly
  • stay in permanently

 

External fixation:

  • drill into the bone to anchor, then a system outside the body holds those anchors until it is healed then they are taken out,
  • Clean the Pins consistently, about TID

 

Rheumatoid arthritis

  • There are many many types and can affect the whole body not just the joints.

 

Gout

  • buildup of uric acid in blood, then the crystals collect (especially in the big toe)
  • Med: NSAID’s, colchicine, ibuprofen

 

THA – total hip arthroplasty (Replacement)

TKA – total knee arthroplasty (replacement)

 

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