the musculoskeletal system frequently use diagnostic testing radiographs or x-rays as they are commonly called help to visualize fractures irregularities spurs changes in joint structure and fluid in the joints multiple x-rays with multiple views are often needed for a full assessment of the structure being examined and serial x-rays may be indicated to determine the status of the healing process so they could be taken over the course of days or weeks to see how well the joint is responding and healing a bone scan is another form of an x-ray it is often used to detect tumors osteomyelitis fractures and aseptic necrosis as well as degenerative disease it uses radioisotopes which are administered iv and then there's a waiting period of two to three hours for this isotope to be absorbed a scan shows areas of greatest concentration and the con the isotope is actually drawn to areas of increased metabolism in the bone so areas with abnormal bone formation will show up as indicated on this image on the right where the red arrow is pointing to this section of the femur you can see that it's darker showing greater absorption than other areas especially when you compare it to the first image this may indicate osteosarcoma metastatic bone disease osteomyelitis or fractures that are not healing as expected nursing interventions for a bone scan would include assessing for allergies assessing for contraindications such as pregnancy or breastfeeding and warning the patient that the isotope may cause flushing and warmth when they receive it but this is temporary encouraging the patient to drink plenty of fluids to distribute the isotope and then afterwards to drink plenty of fluids to help flush it from the system ask the patient to empty their bladder before they have the scan so that it will not interfere with the skin of the pelvic bones and assess for allergies arthrograph is uses a radiopac contrast agent and is injected into the joint capsule to help identify causes of unexplained joint pain pain and progression of joint disease it helps to visualize joint structures such as ligaments tendons cartilage and the joint capsule then the joint is then put through a range of motions to distribute the contrast agent while a series of x-rays are obtained if a tear is present the contrast agent will leak out of the joint and is evident on the x-ray image once again we'll have to assess the patient for allergies before this test is conducted a myelograph uses contrast medium once again the medium is injected via a lumbar puncture into the sub spinal subarachnoid space then as it is dispensed through the cerebral spinal fluid it allows visualization of distortion of the spinal cord or the spinal dural sac caused by tumors cysts herniated vertebral discs or other lesions this testing is less used today due to the availability of better imaging through ct scans and mris nursing interventions will include educating the patient that position changes may be required during the procedure ensuring that the patient lies in bed with the head of the bed elevated at 30 to 45 degrees after the procedure teach the patient to remain in bed in this position for up to three hours or as directed by the provider to avoid spinal headache they should drink plenty of fluids for rehydration and to replace the central cerebral spinal fluid to decrease the incident of post lumbar puncture headache we want to monitor this patient's blood pressure heart rate respiratory rate and temperature and their ability to void we also want to monitor for the risk of a spinal headache and the risk of a bacterial meningitis infection which the signs and symptoms would be headache fever stiff neck photophobia and seizures a ct scan may be performed with or without contrast agents either orally or iv and it shows more detailed cross-section image of the body it may be used to visualize and assess tumors injuries to soft tissue ligaments or tendons and severe trauma to the chest abdomen pelvis head or spinal cord it is also used to identify location and extent of fractures and areas that are difficult to evaluate like the acetabulum acetabulum and are not that are not visible on other x-rays so our nursing interventions for this would include educating the patient on the iv contrast or oral contrast and determining the presence of allergies magnetic resonance imaging also called mri uses magnets and radio waves to create high resolution pictures of bones and soft tissues it can be used to visualize and assess foreign muscles ligaments and cartilage herniated discs and a variety of hip or pelvic conditions the patient does not experience any pain during this procedure the mri scanner is noisy and it may take 30 to 90 minutes to complete the test because an electromagnet is used patients with metal implants such as cochlear implants clips or pacemakers are not candidates for mri and an mri questionnaire will be requested from the patient to ensure that they don't have any implanted devices that are metal that could be influenced by this test an iv contrast agent may be used um sometimes patients experience claustrophobia when they have this because they have to spend 30 to 60 minutes in this tight tubular space the confinement of it can sometimes cause claustrophobia occasionally patients will require sedation to help them deal with having the test done usually getting an order for ativan or some other hypnotic kind of medication that will help them to relax during the test sometimes open mri systems are available but they use a lower intensity magnetic field and they produce lower quality images but sometimes they are better for patient comfort reduce claustrophobic reactions and they're also less noisy one thing to be sure is that you have your patient remove their jewelry hair clips hearing aids their phone their credit cards and any other metal containing objects because they can become either a projectile or they can cause burns as the magnets do their work also remove any transdermal patches that have a thin layer of aluminized backing as they may cause burns on the patient's skin you'll need to discuss this with your providers before removing the patches because they are medications and must have a provider order in order to stop the use of them discography [Music] uses a contrast medium injected into the intervertebral space to visualize the discs in the back you can see in this image the difference between the two discs the dark spaces and the size thickness and kind of fullness of them compared to the one on the bottom which is kind of highlighted in red that disc is obviously damaged and this will help to determine to assess the internal structures of a disc in order to determine the sources for back pain so once again we would have to assess the patient for allergies to the contrast medium and because this is going an injection straight into the spinal spaces once again this patient would have to be monitored for a spinal headache and taught to drink plenty of fluids to flush out the contrast electromyography is done through measuring the electrical stimulation sent to the muscle through a nerve so there are many reasons why a nerve may not be sending an effective electrical signal this can be due to a physical blockage nerve damage illness or injury regardless of the reason for limited nerve signal reception an electromyogram will allow a doctor to objectively see how the patient is doing providers and provide information about the electrical potential of the muscles and the nerves the test is performed to evaluate muscle weakness pain and disability and it will help to determine the any abnormal functions and to differentiate between whether it is a muscle or a nerve that's causing the problem can be used to identify the extent of damage if nerve function does not return within four months of an injury needle electrodes are inserted into the selected muscles and responses to electrical stimuli are recorded on an oscilloscope you will afterwards apply warm compresses to relieve the residual discomfort after this study nursing interventions include assessing if the patient is taking an anticoagulant because this would increase the risk of bleeding with these punctures being done we're going to assess the skin for infection so that we do not risk introducing infection by piercing the skin and inserting this needle into a muscle and then we want to teach the patient not to use lotions and creams on their skin prior to the test biopsies may be performed to determine the structure and composition of bone marrow the bone itself muscle or the synovium for diagnosis of some diseases involves excising a sample of tissue to be analyzed microscopically for cell morphology and tissue abnormalities nursing interventions include educating the patient about the procedure providing analgesic agents monitoring the site afterwards for edema bleeding pain hematoma formation and infection applying ice to control bleeding and edema administering antibiotics and analgesics if they are prescribed teaching the patient to report signs of infection which include redness bleeding pain exudate fever or chills arthrocentesis synthesis means to puncture and withdraw fluid puncture to withdraw fluid so this is a puncturing to withdraw fluid in the joint okay so it will obtain synovial fluid for examination or to relieve pain due to effusion this often happens when there is what they call water on the knee or excessive swelling in the knee joint and so they will aspirate the contents it may also help to diagnose septic arthritis or other inflammatory arthro arthroplasties may reveal hemiarthrosis which would be bleeding into the joint cavity so when they aspirate this fluid um it could be that the fluid that comes out would be blood and then they would be able to reveal that there was hemiarthrosis going on the provider will aseptically insert a needle into the joint and aspirate the fluids sometimes anti-inflammatory medications may be injected into the joint after this a sterile dressing will be applied remember that there is a risk for infection because we are piercing the skin so we need to teach the patient about the procedure and its indications shave hair from the site if it's provider ordered we want to provide prescribed analgesics as needed and we want to educate the patient to use ice for the first 24 to 48 hours post procedure and remember that's not continual that's 20 minutes on 20 minutes off like we discussed in class educate the patient that they may end up taking antibiotics after this for a course of treatment teach them also to monitor for the signs and symptoms of infection and for bleeding and the need to notify the provider promptly if these occur our arthroscopy this allows direct visual visualization of the joint via a fiber optic endoscope it aids in diagnosing joint disorders some procedures can be performed through arthroscopy like getting a biopsy or treatments of tears or some other defects it is performed in the operating room under sterile conditions with either general anesthetic and sometimes local a large board needle is inserted and the joint is distended through the installation of saline that will allow more movement within the joint and better visualization of the structures a scope is introduced and then the structures are visualized possible complications include infection hemiarthrosis neurovascular compromise thrombophlebitis stiffness effusion adhesions and delayed wound healing your nursing interventions will include maintaining a compression dressing post procedure applying ice for edema and comfort keeping the joint extended and elevated to reduce swelling monitoring for neurovascular status providing analgesic agents as ordered and as needed teaching the patient to avoid strenuous activity of the joint until they are released by the provider and discussing their exercise routine with their provider teach the patient to monitor for signs and symptoms of infection bleeding neurovascular compromise and divorce or concerns to their provider then the next couple slides contain a couple of and test questions for you to think about the nurse is teaching a patient about arthrocentesis of the left knee the nurse explains this procedure and which are the following ways and we'll let you read those and think about that we will discuss and then the next question is the nurse knows to assess the patient for allergies prior to which of the following diagnostic procedures select all that apply all right and that's the last of the slides and we will be able to discuss any questions you have you are free to email me if any of this is unclear and you want clarification i apologize for my cockatiel and all of his chattiness during the beginning of this sometimes when i start talking he starts talking back to me so hopefully that's not too distracting to y'all please let me know if you need to discuss any of this with me if you have questions or concerns thank you