There are 206 divided into four permit full freedom of Physical Assessment patella, meniscus, and Tell

patella, meniscus, and Tell the patient not to drink 21. Uric acid Diagnose and
categories: movement.  Posture: synovial and extra synovial fluids containing caffeine or monitor the treatment of
 Long bones (eg, femur) • Hinge joints permit bending in 1- kyphosis, an increased membranes. to smoke for 3 hours before gout.
 Short bones (eg, one direction only forward curvature of the assess for bleeding and the test, and not to take 22. Human leukocyte antigen
metacarpals) • Saddle joints allow movement thoracic spine; swelling, apply ice to the medications such as muscle Diagnose diseases such as
in two planes at right
 Flat bones (eg, sternum) 2- lordosis, or swayback, an area if prescribed, and relaxants, anticholinergics, juvenile RA or ankylosing
angles to each other. The joint
 Irregular bones (eg, at the base of the
exaggerated curvature of instruct patient to avoid or cholinergics. spondylitis
vertebrae) the lumbar spine; excessive use of the joint 13. (MRI) Used in diagnosis and 23. Creatine kinase (CK)
thumb is a saddle, biaxial joint.
shaped like rods or shafts • Pivot joints are characterized 3- and scoliosis, a lateral for 2 to 3 days. evaluation of avascular Diagnose muscle trauma or
known as the diaphysis, is by the articulation between curving deviation of the 8. Bone density (BD) necrosis, osteomyelitis, disease. Ieased in muscular
primarily cortical bone. The the radius and the ulna. They spine (evaluate degree of tumors, disk abnormalities, dystrophy and traumatic
ends epiphyses, are primarily permit rotation 1. Gait is assessed by having osteoporosis.) and tears in ligament or injuries
cancellous bone. for such activities as turning a the patient walk away from 1. Dual energy x-ray cartilage. Subjective Health
doorknob. the examiner for a short absorptiometry (DEXA) 14. Skeletal x-ray Identify and Assessment
The cells are of three basic • Gliding joints allow for limited distance. The examiner 2. Quantitative ultrasound evaluate bone density and 24. Demographics Age, gender,
types movement in all directions observes the patient’s gait (QUS) structure. socioeconomic status,
Osteoblasts: function in bone and are represented by the for smoothness and 3. Bone mineral density (BMD) 15. Somatosensory evoked Occupation
formation by secreting bone joints of the carpal rhythm. 4. Bone absorptiometry potential (SSEP) Measures 25. Previous Health History
matrix. The matrix, which bones in the wrist.
2. Bone Integrity 9. Bone scan nerve conduction along Allergies, Activities patient
consists of collagen and ground Ligaments (fibrous connective
3. Joint Function deformity, 1. Uptake is increased in pathways to evaluate participates, Diet history,
substances provides a tissue bands) bind the
stability, and nodular osteomyelitis, osteoporosis, evoked potential of muscle Family history
framework in which inorganic articulating bones together.
formation cancers of the bone, and in contractions. Used to 26. History of Injury or Present
mineral salts are deposited. provide joint stability.
4. AXIAL PORTION some fractures. identify dysfunction of Concern History of the
Osteocytes are mature bone Bursa is a sac filled with
a. Cranium 2. Uptake is decreased in lower motor neurons as injury, Pain
cells involved in bone- synovial fluid that cushions the
b. Vertebrae avascular necrosis well as muscle disease. 27. Psychosocial Assessment
maintenance functions movement of tendons,
c. Ribs 10. Gallium/Thallium Scans 16. Bone or Muscle Biopsy Determine if deformities,
Osteoclasts, multinuclear cells ligaments, and bones at a point
5. APPENDICULAR PORTION 1. Gallium concentrates in Blood Test changes in body image, self-
involved in destroying, of friction. (elbow, shoulder,
a. Limbs areas of tumors, 17. Alkaline phosphatase (ALP) concept, socialization, or
resorbing, and remolding bone knee, and some other joints)
b. Shoulders inflammation, and Identify bone diseases. employment are present.
Bone Maintenance Types of Muscle Contractions
c. Hips infections. Increased in bone cancer, Determine coping skills.
 Bone is a dynamic tissue in isometric contraction, the
Function of bones: 2. Thallium detects Paget’s disease, healing 28. Physical Examination
a constant state of length of the muscles remains
 Protects Organs osteosarcoma. fractures, rheumatoid Inspect, palpate, and
turnover—resorption and constant but the force
 Storage 11. CT of the spine can identify arthritis, osteoporosis. observe range of motion
formation. generated by the muscles is
 Hematopoiesis tumors, cysts, vascular 18. Calcium (Ca) Decreased (ROM) of affected areas
 The important regulating increased
 Remodeling malformations, and with lack of calcium and Assess color, warmth,
factors Isotonic contraction, on the
 Reformation herniated intervertebral vitamin D intake, and circulation, and movement
Bone Healing other hand, is characterized by
 Movable Joints disk. malabsorption from the of affected areas
Fracture healing occurs in four shortening of the muscle with
Diagnostic test 1. assess for allergy to iodine, gastrointestinal tract. Palpate all pulses below
areas no increase in tension within
6. Arthrocentesis: Obtain seafood, or x-ray dye. Increased in bone cancer involved area.
1- Hematoma and the muscle;
synovial fluid from a joint 2. Assess medications: oral and multiple fractures.
inflammation Assessment
for diagnosis or to remove hypoglycemic agents are 19. Phosphorus (P), phosphate
2- Angiogenesis and 1- Pain:
excess fluid. contraindicated for use with (PO4). Increased with bone
cartilage formation 2- ALTERED SENSATIONS:
Apply a compression iodinated contrast. tumors and healing
3- Cartilage calcification The patient may
dressing and tell the patient 12. Electromyogram (EMG): fractures. Muscle Grading Scale
4- Cartilage removal describe paresthesias,
to report any bleeding and Measures the electrical 20. Rheumatoid factor (RF) 0 (No visible) contraction;
5- Remodeling which are burning,
leakage of fluid. activity of skeletal muscles increased in lupus paralysis
types of diarthrosis joints tingling sensations or
7. Arthroscopy: surgery and at rest and during erythematosus and
• Ball-and-socket joints numbness.
diagnose diseases of the contraction. scleroderma.
 1 Can feel contraction of 1. Reduction • Monitor for the presence of  Acute/Chronic pain R/T • Delayed union or nonunion  Perform active foot
muscle but there is no • Closed manipulation a foul odor, which may musculoskeletal disorder of fracture exercises and leg exercises
movement of limb • Traction (skin or skeletal) indicate infection  Impaired physical mobility Intervention every hour
2 Passive ROM • Open reduction and • Monitor drainage and circle R/T musculoskeletal  Relieving pain  Elastic hose, pneumatic
3 Full ROM against gravity internal fixation (ORIF), the area of drainage on the disorder, cast, traction, etc.  Muscle-setting exercises compression hose, or
4 Full ROM against some (insertion of prosthesis, cast  Risk for infection R/T  Patient teaching anticoagulant therapy may
resistance screw, plate, nail or wire • Monitor for warmth on the surgical procedure  Healing skin wounds and be prescribed
5 Full ROM against full 2. INTERNAL FIXATION cast. Monitor for wet spots,  Anxiety R/T health status maintaining skin integrity  Trapeze to help with
resistance • Follows open reduction • Instruct the client not to and traction device  Maintaining adequate movement for patients in
Neurovascular Assessment • Involves the application of stick objects inside the cast  Impaired skin integrity R/T neurovascular status skeletal traction
Color: Pallor, cyanosis, screws, plates, pins, or nails Casts Care laceration or abrasions External Fixation Device  Pin care
redness, or discoloration to hold the fragments in • Educate  Risk for ineffective Traction:  Exercises to maintain
Temperature: Unusual alignment • Apply Ice therapeutic regimen  Reduce muscle spasms muscle tone and strength
coolness or warmth Pain • May involve the removal of • Instruct management R/T  Reduce, align, and Joint Replacements
Pain: that is worse on damaged bone and • Prevent skin irritation insufficient knowledge or immobilize fractures Used to treat severe joint pain
passive motion; pain that replacement with a • Attend to complain of pain lack of available support  Reduce deformity and disability and for repair and
no longer responds to prosthesis SKELETAL TRACTION and resources.  Types: Skin traction management of joint fractures
analgesics 3. EXTERNAL FIXATION • Mechanically applied to the  Risk for situational low self- Buck’s extension traction or joint necrosis.
Movement Alterations in • An external frame is utilized bone using pins, wires, or esteem R/T impact of Cervical head halter Needs of Patients with Hip or
movement with multiple pins applied tongs musculoskeletal disorder. Pelvic traction Knee Replacement Surgery
Sensation Alterations in through the bone • Monitor color, motion, and  Imbalanced nutrition R/T Skeletal traction  Mobility and ambulation
feeling; tingling or • Provides more freedom of sensation (CMS) of the obesity. Nursing Care  Drain use postoperatively
paresthesias movement than with affected extremity  Risk for ineffective  Monitor for complications  Prevention of infection
Pulses Diminished or absent traction • Monitor the insertion sites peripheral tissue perfusion of skin breakdown, nerve  Prevention of DVT
distal pulses 4. Casts for redness, swelling, or R/T swelling. pressure, and circulatory  Patient teaching and
Capillary refill Nail bed that • Keep the cast and extremity drainage Casts impairment rehabilitation
does not blanch in 3–5 elevated • Provide insertion site care Teaching Needs of the Patient  Inspect skin at least three Hip Prosthesis
seconds • Allow a wet cast 24 to 48 as prescribed with a Cast or Splint times a day  Positioning of the leg in
FRACTURE OF AN hours to dry SKIN TRACTION
 Exercises  Assess sensation and abduction to prevent
EXTREMITY • Handle a wet cast with the Traction applied by the use of
 Do not scratch or stick movement dislocation of the
ASSESSMENT palms of the hand until dry elastic bandages or adhesive
anything under cast  Assess pulses, color, prostheses
29. Pain or tenderness over the • Turn the extremity unless TYPES OF SKIN TRACTION
 Cushion rough edges capillary refill, and  Do not flex hip more than
involved area contraindicated, so that all Cervical traction
 Signs and symptoms to temperature of fingers or 90°
30. Loss of function sides of the wet cast will dry Buck’s traction A boot appliance
report: persistent pain or toes  Avoid internal rotation
31. Obvious deformity • Heat can be used to dry the Bryant’s traction
swelling, changes in  Assess for indicators of DVT  Protective positioning
32. Crepitation cast. Pelvic traction
sensation, movement, skin  Assess for indicators of  Hip precautions
33. Erythema, edema, • Monitor the extremity for Russell’s traction
color or temperature, signs infection  Avoid bending forward
ecchymosis circulatory impairment such BALANCED SUSPENSION:
of infection or pressure Intervention: when seated in a chair.
34. Muscle spasm and impaired as pain, swelling, approximate fractures of the
areas  Promptly report any And pick up an object on
sensation discoloration, tingling, femur, tibia, or fibula
 Required follow-up care alteration in sensation or the floor.
INITIAL CARE numbness, coolness, or DUNLOP’S SKIN TRACTION:
 Cast removal circulation  Use a high-seated chair and
35. Immobilize affected diminished pulse align fractures of the humerus;
 Frequent back care and skin a raised toilet seat.
extremity • cast clean and dry vertical traction maintains the
care
36. If a compound fracture • Notify the physician forearm Recognize dislocation of the
exists, splint the extremity immediately if circulatory Nursing Diagnoses
Complications  Regular shifting of position
prosthesis
• Compartment syndrome  Special mattresses or other
and cover the wound with a compromise occurs  Deficient knowledge R/T  Increased pain at the
• Pressure ulcer pressure reduction devices
sterile dressing • Monitor the client’s treatment regimen surgical site, swelling, and
• Disuse syndrome
Intervention temperature immobilization
 Acute groin pain in the  Risk for ineffective  Encourage the patient to radiculopathy or sciatica  assesses the spinal to support some of the body
affected hip or increased therapeutic regimen set realistic goals and and which suggests nerve curve, any leg length weight; use a footstool to
discomfort management perform self-care care root involvement. discrepancy, and pelvic position
 Shortening of the leg  Impaired physical mobility within limits of the  The patient’s gait, spinal crest and shoulder knees higher than hips if
 Abnormal external or  Risk for situational low self- therapeutic regimen mobility, reflexes, leg symmetry. necessary.
internal rotation esteem and/or disturbed  Preventing atelectasis and length, leg motor strength,  palpates the paraspinal Lying
 Restricted ability or inability body image pneumonia and sensory perception muscles and notes • Rest at intervals; fatigue
to move the leg Complications—Postoperative  Encourage coughing and may be altered spasm and tenderness contributes to spasm of the
 Reported “popping”  Hypovolemic shock deep breathing exercises  Physical examination may  evaluates nerve back muscles.
sensation in the hip  Atelectasis  Use of incentive spirometry disclose paravertebral involvement by • Place a firm bed board under
Knee Prostheses  Pneumonia  Constipation muscle spasm with a loss of assessing deep tendon the mattress.
 Encourage active flexion  Urinary retention  Monitoring of bowel the normal lumbar curve reflexes, sensations • Avoid sleeping in a prone
exercises  Infection function and possible spinal Diagnosis position.
 Use of continuous passive  Thromboembolism—DVT or  Hydration deformity • Acute pain related to Lifting
motion (CPM) device PE  Early mobilization Assessment and Diagnostic musculoskeletal problems • When lifting, keep the back
 Stool softeners  a focused history and • Impaired physical mobility straight and hold the load as
Nursing Process:  Constipation or fecal
physical examination, related to pain, muscle close to the body as possible.
1. Preoperative: impaction  Patient teaching
 Routine preoperative including general spasmsand decreased flexibility • Lift with the large leg muscles,
Relief of Pain ACUTE LOW BACK PAIN
observation of the • Deficient knowledge related not the back muscles.
assessment  Administration of Causes: acute lumbosacral
 Hydration status patient, to back-conserving techniques
medications strain, unstable lumbosacral
 back examination, and of body mechanics
 Medication history  Patient-controlled analgesia ligaments and weak muscles,
neurologic testing • Risk for situational low self-
 Possible infection  Other medications osteoarthritis of the spine,
reflexes, sensory esteem related to impaired
 Knowledge  Medicate before planned spinal stenosis, intervertebral
impairment, straight- mobility, chronic pain, and
 Support and coping activity and ambulation disk problems, and unequal leg
leg raising, muscle altered role performance
2. Postoperative  Use alternative methods of length
strength, and muscle • Imbalanced nutrition: more
 Pain pain relief  As a person ages, the disks
atrophy than body requirements related
 Vital signs, including  Repositioning, distraction, become dense, irregular
Medical Management to obesity
respirations and breath guided imagery. etc. fibrocartilage.
 Most back pain is self- Nursing Interventions
sounds  Specific individualized  Disk degeneration is a
limited and resolves  RELIEVING PAIN
 LOC strategies to control pain common cause of back
within 4 weeks with  IMPROVING PHYSICAL
 Neurovascular status and  Use of ice or cold pain.
analgesics, rest, stress MOBILITY
tissue perfusion  Elevation  The lower lumbar disks, L4–
reduction, and Standing
 Signs and symptoms of  Immobilization L5 and L5–S1
relaxation • Avoid prolonged standing and
bleeding—wound drainage Intervention: Disk protrusion (herniated
 Nonprescription walking.
 Mobility and understanding  Muscle setting, ankle and nucleus pulposus) or facet joint
analgesics • When standing for any length
of mobility restrictions calf-pumping exercises changes can cause pressure on
(acetaminophen, of time, rest one foot on a small
 Bowel sounds and bowel  Measures to ensure nerve roots as they leave the
ibuprofen stool or box to relieve lumbar
elimination adequate nutrition and spinal canal, which results in
 Heat or cold therapy lordosis.
 Urinary output hydration pain that radiates along the
NURSING PROCESS • Avoid forward flexion work
 Signs and symptoms of Note: Large amounts of milk should nerve.
 encourages the patient positions.
complications—DVT or not be given to orthopedic patients Clinical Manifestations:
with low back pain to • Avoid high heels
infection on bed rest  The patient complains of
describe the discomfort Sitting
either acute back pain or
Nursing Process  Skin care measures  Descriptions of how the • Avoid sitting for prolonged
chronic back pain
 Acute pain including frequent turning pain occurred—with a periods.
 The patient may report pain
 Risk for peripheral and positioning specific action • Sit in a straight-back chair
radiating down the leg,
neurovascular dysfunction  Follow physical therapy and  posture, position with back well supported and
which is known as
rehabilitation programs changes, and gait. arm rests