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Musculoskeletal System

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... usually non-fasting blood draw Uric Acid-Blood ... detects calcium metabolism ... and hard surface Bone Mineral Density/BMD BMD Measures bone mass ... – PowerPoint PPT presentation

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Title: Musculoskeletal System


1
Musculoskeletal System
2
Common Diagnostic Tests
  • ANA, antinuclear antibodies
  • Detects SLE, a collagen disease
  • Arthritis can result from SLE
  • Normal negative
  • Client prep

3
  • CRP, C-reactive protein
  • inflammation and auto-immune disorders show
    abnormal protein
  • Normal female 1-20, male 1-13mm/h
  • Can get false negative
  • Client Prep, usually non-fasting blood draw

4
  • Uric Acid-Blood
  • Elevated with Gout and arthritis
  • Normal male 2.1-8.5, female 2.0-6.6 mg/dl
  • Client prep usually non-fasting blood draw

5
  • Uric Acid-Urine (24 hour collection)
  • Normal 250-750 ml/24hr
  • Client prep

6
CBC
  • Hemoglobin
  • Increase can mean CHF
  • Decrease can mean SLE or sarcoidosis
  • Normal male 14-18, female 12-16 g/dl
  • Client prep

7
CBC
  • WBC
  • elevated with infection/inflammation
  • Normal 5,000 10,000/mm3
  • Client prep

8
  • ESR, Erythrocyte Sedimentation Rate
  • RBC descent in saline in 1 hour
  • Increases with inflammation, infection, necrosis,
    or cancer
  • Normal male up to 15, female up to 20 mm/hr
  • Client prep

9
  • RF, Rheumatoid Factor (IgM)
  • Elevated with autoimmune disease such as
    Rheumatoid arthritis and SLE
  • Normal lt 60 U/ml or negative
  • Client prep

10
  • Serum Calcium, detects calcium metabolism
  • Increase may indicate metastatic bone tumor,
    Pagets disease, acromegaly
  • Decrease may indicate rickets, osteomalacia,
    vitamin D deficiency
  • Normal 9.0 10.5 mg/dl
  • lt 6mg/dl may lead to tetany (cramps, convulsions,
    twitching)
  • gt 14mg/dl may lead to coma
  • Client prep

11
Radiologic Studies
  • Arthrogram/Arthrography-Xray with contrast dye
    into joint to visualize soft tissue of joints
    (meniscus, ligaments, cartilage)

12
Arthrogram
  • Client prep

13
  • Arthrogram Procedure
  • Cleanse anesthetize area
  • Insert needle into joint space
  • Aspirate fluid to minimize dilution of dye
  • Leave needle in, replace syringe with dye syringe
  • Inject contrast and remove needle
  • ROM to distribute dye
  • X-rays will be taken
  • Takes about 30 minutes
  • May experience some discomfort, pressure, tingling

14
  • Following Arthrogram
  • Assess for swelling
  • Apply ice, if needed
  • Mild analgesic
  • May hear crepitus after test. This is normal and
    will disappear in 1-2 days.
  • Instruct pt to call MD if pain or swelling occurs

15
  • CT Scan
  • X-ray (body scanner) with contrast dye
  • Three-dimensional cross-sectional view of tissues
    at various angles
  • Can identify small differences Detects edema,
    hemorrhage, blood flow, infarcts, tumors,
    infections, aneurysms, demyelinating disease,
    muscular disease, skeletal abnormalities, disk
    problems, causes of spinal cord compression
  • Takes about an hour
  • Findings as with arthrogram, but 3-D view

16
CT Scan
  • Client prep

17
Following CT Scan
  • Increase fluid intake to flush dye
  • Evaluate patient for delayed reaction to dye
    (usually occurs within 2-6 hours)
  • Treat with antihistamine and/or steroids, if
    indicated

18
CT Scan Procedure
  • Patient must lie still
  • Show picture of CT machine and discuss
    claustrophobia, may need antianxiety med
  • Performed by a radiologist
  • Takes 30-45 minutes
  • Discomfort includes lying still on a hard
    surface, peripheral venipuncture, mild nausea,
    salty taste, flushing, and warmth from dye

19
MRI
  • MRI/Magnetic Resonance Imaging
  • Magnetic field and radio waves, noninvasive
  • Can evaluate soft hard tissue, blood vessels
  • Unique d/t no exposure to ionizing radiation
  • Advantages over CT
  • Disadvantages

20
MRI
  • Contraindications
  • gt 300 lbs
  • Claustrophobia
  • Metal implants, clips, pacemaker, infusion pumps
  • Pregnancy (long-term effects not known)
  • If on continuous life support

21
  • Client prep
  • Obtain consent
  • Can drive afterwards without assistance
  • Assess for contraindications
  • Show picture of machine, discuss claustrophobia
  • Remove all metal objects from body (create
    artifacts, can go flying, damages credit cards)
  • Must remain motionless in supine position
  • Will hear thumping sound, ear plugs available
  • Empty bladder prior to test for comfort
  • No food or fluid restrictions prior to test
  • Explain procedure

22
MRI Procedure
  • Lie flat on hard table that slide into a tube
  • Must lie still
  • Can talk to or listen to staff
  • Magnevist (contrast agent) may be used via IV
  • Performed by radiologist
  • Takes 30 to 90 minutes
  • Discomfort from lying on hard surface, possible
    venipuncture, possible tingling in teeth (metal
    fillings)
  • No postprocedural care needed

23
MRI
  • Detects edema, hemorrhage, blood flow, infarcts,
    tumors, infections, aneurysms, demyelinating
    disease, muscular disease, skeletal
    abnormalities, disk problems, causes of spinal
    cord compression

24
X-ray
  • X-ray, electromagnetic radiation passes photons
    (light particles) through the body onto film
  • Bone (very dense) blocks photons, appears white
  • Air appears black
  • Muscle, fat, and fluid appear as various shades
    of gray
  • Metal and contrast block almost all photons and
    appear bright white

25
X-ray
  • Client prep
  • Nonfasting
  • Position determined by area to be x-rayed
  • Patient should be still, usually hold breath
  • Contraindicated if pregnant
  • May need to remove jewelry don a gown
  • No discomfort except r/t position
  • Detects fractures and some joint abnormalities

26
Myelogram
  • Myelogram
  • X-ray with contrast dye of spinal subarachnoid
    space
  • Detects spinal tumors, herniated discs, bone
    spurs, cervical ankylosing spondylosis, arthritic
    lumbar stenosis
  • Contraindications Multiple sclerosis patients
    (may cause exacerbation), ICP, infection near
    lumbar puncture sight, allergy to shellfish

27
Myelogram
  • Client prep

28
  • Myelogram Procedure
  • Empty bladder
  • A lumbar puncture is performed
  • 15 ml CSF removed
  • 15 ml of radiopaque dye injected
  • Patient will be tilted up and down to spread dye
    (prone position)
  • Lights are off, dye followed with fluoroscopy
  • X-ray films taken
  • Needle remains in place until exam concluded
  • Done by radiologist and takes 45 minutes
  • Discomfort varies from mild to severe

29
Following Myelogram
  • Bed rest for several hours
  • Head position varies per dye used, per MD order
  • Monitor for bleeding, fever, headache,
    photophobia, seizure, VS, ability to void,
    reaction to dye
  • Possible med restrictions
  • Push fluids

30
Bone Scan
  • Bone Scan
  • Radioactive isotope intravenous
  • They use a gamma camera to detect hot spots of
    activity where the isotope collects
  • Can detect tumor, arthritis, fracture, necrosis,
    degenerative changes, osteomyelitis
  • Normal uniform distribution
  • Abnormal area of higher concentration
  • Contraindicated in pregnancy, breastfeeding

31
Bone Scan
  • Advantages
  • Disadvantages

32
Bone Scan
  • Client prep
  • Explain procedure, is non-fasting, no sedation
    required
  • Arrive at Nuclear Medicine department 4 hours
    prior to test
  • Dye given IV, takes 4 hours to travel to bones
  • Push fluid to aid in dye distribution
  • Empty bladder upon return to avoid artifact
  • You may be asked to wear a gown
  • Done in supine, prone, lateral position, takes
    an hour
  • Takes 6-24 hours for dye to leave system (push
    fluids)
  • Discomfort is needle stick for dye infusion, and
    hard surface

33
Bone Mineral Density/BMD
  • BMD
  • Measures bone mass
  • The only test to diagnose osteoporosis
  • Normal is comparative to same age, sex, size.
    Lower density higher risk for fractures
  • -1 to 2, Osteopenia
  • lt -2.5, Osteoporosis
  • Client prep Non-fasting, non-invasive, do Q2 yrs

34
Other Tests
  • Arthrocentesis
  • Obtain synovial fluid from a joint
  • Needle aspiration
  • Sterile procedure
  • Detects infections, synovitis, crystal-induced
    arthritis, tumors, joint degeneration
  • Inject anti-inflammatory medications
  • Normal Clear, straw-colored fluid, no crystals
  • Contraindicated if infection near joint being
    tested

35
  • Arthrocentesis contd
  • Informed consent
  • Explain procedure
  • May or may not be fasting
  • Local anesthetic
  • Aseptic procedure
  • Fluid may be removed, Steroid may be injected
  • Apply pressure dressing following procedure
  • May do venipuncture to compare chemical content
  • Doctor office or bedside, by MD, takes 10 minutes
  • Pain may worsen after test

36
  • Following Arthrocentesis
  • Assess for pain, fever, swelling
  • Apply ice
  • Apply pressure dressing to decrease
    reaccumulation of fluid or hematoma
  • Avoid strenuous use of joint for several days

37
  • Arthroscopy-used most often for knee
  • Small incision, endoscope
  • Examine the inside of a joint
  • Diagnose disease, meniscus problems, torn
    cartilage, remove small bodies, do biopsy
  • Advantage allows direct visualization, can
    perform surgery, can monitor disease progress,
    can attach video camera can examine, biopsy, or
    do surgery
  • ContraindicationsInfection or ankylosis in joint

38
  • Arthroscopy
  • Client prep
  • Obtain consent
  • NPO at midnight
  • Teach crutch use for post procedure use
  • Shave 6 above and below joint
  • May use local or general anesthesia
  • Pressure wrap or tourniquet
  • Knee at 45 degree angle
  • May have 2-3 small incision sights
  • Sutured with dressing applied
  • Done by orthopedic surgeon, takes 15 to 30 minutes

39
  • Arthroscopy Follow-up
  • Asses neurologic status and circulatory status
  • Assess for sxs of infection, for drainage
  • Teach to elevate ice to decrease swelling
  • May walk with crutches if MD order
  • Suture removal in 7-10 days
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