MEDSURG | Musculoskeletal Problems

🦴 Medical–Surgical Exam Review Guide: Musculoskeletal Problems

1️⃣ Osteomyelitis (Bone Infection)

Pathophysiology: Infection of bone, bone marrow, and soft tissue (usually Staphylococcus aureus). Microbes enter via hematogenous spread (common in children, IV drug users, diabetics) or direct inoculation (open wounds, surgery, prosthetic joints). Inflammation → pus → ↑ intramedullary pressure → ↓ perfusion → ischemia → bone necrosis (sequestrum) surrounded by new bone (involucrum). Antibiotics struggle to reach the necrotic core.

High-Yield Manifestations

PriorityKey FindingsNotes🔴 HighConstant, worsening painNot relieved by rest; hallmark finding.🔴 HighFever, night sweats, restlessnessMay progress to sepsis.🟡 ModerateLocal swelling, warmth, tendernessReduced mobility near site.🟢 ChronicDrainage from sinus tractIndicates chronic infection.

Medications & Management

Drug/ClassKey EffectNursing FocusIV antibiotics (Oxacillin, Nafcillin, Vancomycin, Linezolid, Ciprofloxacin)Bactericidal; 4–6+ weeksUse CVAD, monitor for nephrotoxicity/ototoxicity (esp. Vanco), monitor ESR & CRP.Oral antibiotics (Ciprofloxacin, Levofloxacin)Step-down therapyMonitor for tendon rupture (fluoroquinolones).NSAIDs, opioids, muscle relaxantsPain reliefAdminister ATC; handle limb gently.

Nursing Priorities

• 🚨 Prevent sepsis: Monitor temp, WBC, ESR, drainage.
• 💉 CVAD care: Maintain sterility; teach home IV use.
• 🦵 Immobilize limb: Prevent pathologic fracture.
• 🧼 Wound care: Sterile technique, NPWT if ordered.
• 📚 Education: Complete antibiotic course, report toxicity, ROM for unaffected joints.

Quick Review

• NCLEX Alert: Risk for sepsis & pathologic fracture.
• Hallmark: Constant, unrelieved bone pain.
• Core Therapy: Long-term IV antibiotics.
• Monitor Labs: ESR, CRP trends.

2️⃣ Intervertebral Disc Disease (IDD) / Spinal Surgery

Pathophysiology: Disc degeneration (DDD) or herniation → nucleus pulposus protrudes through annulus fibrosis → compresses spinal nerve root (radiculopathy) or spinal cord (myelopathy).

Red-Flag Manifestations

PriorityClinical FeatureDetails🚨 EMERGENCYCauda Equina Syndrome (CES)Severe low back pain, saddle anesthesia, new bowel/bladder dysfunction → surgical emergency.🔴 HighRadicular pain (sciatica)Radiates down leg, worsens w/ cough or strain.🟡 ModeratePositive straight-leg raisePain reproduced on raising affected leg.

Conservative & Surgical Management

• Drugs: NSAIDs, acetaminophen, muscle relaxants (Cyclobenzaprine, Diazepam), epidural corticosteroid injections.
• Surgery: Laminectomy, discectomy, spinal fusion.

Post-Op Nursing Care

ProblemAssessInterveneEducate🧠 Neuro declineMotor, sensory, circulation Q2–4hReport new weakness or paresthesiaReport any numbness or new weakness.💧 CSF leakClear/yellow drainage, HAKeep flat, notify HCPReport severe HA or drainage.🚽 Bowel/bladderSounds, distention, voidingCath if ordered, stool softenersReport retention or constipation.🛏️ AlignmentPosition, painLogroll, avoid twistingAvoid lifting, bending, long sitting.