2Nd Term Nursing Lecture

Front 1

MUSCULOSKELETAL SYSTEM

Back 1

Consists of bones, muscles, joints, tendons, ligaments, cartliage and bursae.

Front 2

206 BONES IN THE HUMAN BODY ARE CLASSIFIED AS:

Back 2

Short bones: such as those in the fingers and toes.
Long Bones: such as the femur and ulna.
Flat Bones: such as the sternum.
Irregular Bones: such as the vertebrae.

Front 3

2 TYPES OF BONE TISSUE:

Back 3

Cancellous Bone: (or spongy bone) which is light and contains many spaces.
Cortical Bone or (compact bone), which is dense and hard.

Front 4

CANCELLOUS BONE:

Back 4

Is found at the rounded, irregular ends, or (epiphyes), of long bones.

Front 5

CORTICAL BONY TISSUE:

Back 5

covers bones and is foung chiefly in the long shafts, or (diaphyes), of bones in arms and legs.

Front 6

BONE IS COMPOSED OF?

Back 6

Cells, protein matrix, and mineral deposits.

Front 7

OSTEROBLAST:

Back 7

Cells that build bones. They secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited.

Front 8

OSTEOCYTES:

Back 8

This proces of Ossification (Ossification is the process of bone formation, in which connective tissues, such as cartilage are turned to bone or bone-like tissue) and Calcification (Calcification (D.C.) is the mineralization of soft tissue without a systemic mineral imbalance) transforms blast cells into mature bones cells, called osteocytes, which are involved in maintaining bone tissue.

Front 9

OSTEOCLASTS:

Back 9

Are the cells involved in destrucion, resorpotion, and remoldeling of bone.

Front 10

RESORPTION:

Back 10

When skeletal growth is complete, the osteoclasts, (part of the mononuclear phagocyte system) blood cells involved in ingestiong particular matter - or recylcling old cells, continue with remodeling of bones by balanceing bone, (Resorption with new bone cell replacement.

Front 11

PERIOSTEUM (A LAYER OF SKIN TISSUE).

Back 11

Covers bones (but not the joints). The inner layer of the periosteum contains Osteoblast, neccessary for bone formation.
The Periostem is rich in blood and lymph vessels and supplies the bone nurishment.

Front 12

2 TYPES OF BONE MARROW INSIDE THE BONE:

Back 12

The Red Bone Marrow, and the yellow Bone Marrow.

Front 13

RED BONE MARROW:

Back 13

Primarily in the sternum, ileum, vertabra and ribs, manufactures blood cells and hemoglobin.

Front 14

YELLOW BONE MARROW:

Back 14

Consisting primarily of fat cells and connective tissue. If blood cell supply is comprised, yellow marrow may take on characterisitcs of red marrow and begin producing blood cells.

Front 15

3 TYPES OF SKELETAL MUSCLES:

Back 15

Voluntary muscles, Involuntary muslces and Smooth (cardiac muscles).

Front 16

VOLUNTARY SKELETAL MUSCLES:

Back 16

Impulses that travel fro efferent nerves of the brain and spinal cord control their function.

Front 17

SKELETAL MUSCLES ARE COMPOSED OF?

Back 17

Muscle fibers that contain serveal myofibers. Sliding filaments called (SARCOMERES) make up myofibers. They are contractile units of the skeletal muscles.

Front 18

IMPULSES FROM CNS (CENTRAL NERVOUS SYSTEM).

Back 18

Cause release of acetylcholine at the motor end plate of the motor neuron that innervates muscle. As a result calcium ions are released, which stimulates actin and myosin in the sarcomeres to slide closer together, resulting in musle contractions. When calcium is depleted, the actin and myosin fibers move apart, causing relaxation of the sarcomeres, and thus the muscle.

Front 19

CARDIAC MUSCLES:

Back 19

Are INVOLUNTARY muscles, their activity is controlled by mechanisms in their tissue of orgin and by neurotransmitters released from the autonomic nervous system. Cardiac muscle is only found in the heart.

Front 20

SMOOTH MUSCLES

Back 20

Are INVOLUNTARY. They are found mainly in the walls of certain organs or cavities of the body, such as the stomach, intestine, blood vessel, and ureters.

Front 21

JOINT:

Back 21

Is the Juntion between two or more bones.

Front 22

(DIARTHRODIAL JOINT MOVEMENT)or (FREE MOVING JOINTS):

Back 22

Make up most of the skeletal joints. They allow certain movements. The surfaces are covered with hyaline cartilage, which reduces the friction during joint movement. The spaces between the joint cavity, enclosed by a fibrous capsule lined with synovial membrane. This membrane producess synovial fluid, which acts like a lubricant.

Front 23

TERMS RELATED TO DIARTHRODIAL JOINT MOVEMENT ARE:

Back 23

Adduction: movement toward the midline of the body.
Abduction: movement away from the midline of the body.
Dorisflexion: Movement that flexes hand back toward the body, and foot toward the leg.
Flexion: bending of a joint.
Extension: return movement from flexion.
Hyperextension: extension beyond staight or neutral position.
Supination: rotation of the forearmso that palm of hand is up.
Pronation: rotation of forearm so that palm of hand is down.
Rotation: turning or movement of a part around its axis.
External (outward) rotation: movement away from the center.
Internal (inward) rotation: movement toward the center.

Front 24

LIGAMENTS

Back 24

Consisting of fibrous tissue connect 2 adjecent, freely movable bones.

Front 25

CARTILAGE

Back 25

is a firm, dense type of connective tissue consisting of cells embedded in a substance called the MATRIX.

Front 26

PRIMARY FUNCTIONS OF CARTLIAGE:

Back 26

are to reduce friction friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces.

Front 27

HYLINE OR ARTICULAR CARTLIAGE:

Back 27

Covers the surfaces of movable joints, such as the elbow, and protects the surface of these joints.

Front 28

COASTAL CARTLIAGE:

Back 28

Connects the ribs and sternum.

Front 29

FIBROUS CARTLIAGE:

Back 29

found between verebrae (intervertebral discs).

Front 30

SEMILUNAR CARTLIAGE:

Back 30

ONE OF THE CARTLIAGES OF THE KNEE JOINT.

Front 31

ELASTIC CARTLIAGE:

Back 31

FOUND IN THE LARYNX, EPIGLOTTIS AND OUTER EAR.

Front 32

BURSA:

Back 32

IS A SMALL SAC FILLED WITH SYNOVIAL FLUID. BURSAE REDUCE FRICTION BETWEEN AREAS, SUCH AS TENDONS AND BONE AND TENDON AND LIGAMENT. INFLAMMATION OF THESE SACS ID CALLED BURSITIS.

Front 33

TENDONS:

Back 33

Are cordlike structures that attach muscles to periosteum of the bone.

Front 34

KYPHOSIS: (PHYSICAL EXAMINATION)

Back 34

Exaggerated Conex curvature of the Thoracic spine (humpback).

Front 35

LORDOSIS (PHYSICAL EXAMINATION)

Back 35

Excessive concave curvature of lumbar spine (swayback).

Front 36

SCOLIOSIS: (PHYSICAL EXAMINATION)

Back 36

Lateral curvature of the spine.

Front 37

DIAGNOSTIC TESTS (RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND MAGENIC RESONANCE IMAGING):

Back 37

X-Rays, computed tompgraphy, and magnetic resonance imaging help identify traumatic disorders, such as fractures, and dislocations, and other bone disorders, such as malignant bone lesions, joint deformities, calification, degenerative changes, osteoporosis, and joint disease.

Front 38

ARTHROSCOPY: (DIAGNOSTIC TEST)

Back 38

Is internal inspection of a joint using an instrument called and ARTHROSCOPE. Its most common use is to visualize a knee joint, a common site of injury. After admistering general anesthetic, a physican inserts a large-bore needle into the joint and injects sterile normal saline to distend the joint. After inserting the Arthroscope, the examiner inspects the joint for signs of injury or deterioration.

Front 39

ATHROCENTESIS: (DIAGNOSTIC TEST)

Back 39

Is aspiration of synovial fluid. A large needle is inserted into the joint and removes fluid.

Front 40

ATHROGRAM: (DIAGNOSTIC TEST)

Back 40

Is a radiographic examination of a joint, usually the knee or shoulder. Synovial fluid in the joint is aspirated and sent to the lab for analysis. A contrast medium is then injected, and Xray films are taken.

Front 41

BONE SCAN (DIAGNOSTIC TEST)

Back 41

Uses the intravenous injection of a radionuclide to detect the uptake of radioactive substance by bone. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of imflammatory disorders. The radionuclide is taken up in areas of increased metabolism, which occur in bone cancer, metastatic bone disease, and osteomyelitis (bone infection).

Front 42

CBC (COMPLETE BLOOD COUNT):

Back 42

This includes a red blood cell count, hemoglobin level, white blood cell count, and differential, may be ordered to detect infection, inflammation, or anemia.

Front 43

ELEVATED ALKALINE PHOSPHATASE LEVEL:

Back 43

May indicate bone tumors and healing fractures.

Front 44

ELEVATED ACID PHOSPHATASE LEVEL:

Back 44

May indicate Pagets disease (a disorder characterized by excessive bone disorganized repair) and metastatic cancer.

Front 45

DECREASED SERUM CALCIUM LEVEL:

Back 45

May indicate osteomalacia, osteoporosis, and bone tumors.

Front 46

ELEVATED SERUM URIC ACID LEVEL:

Back 46

May indicate gout. (treated or untreated).

Front 47

INCREASED SERUM PHOSPHORUS LEVEL:

Back 47

May indicate bone tumors and healing fractures.

Front 48

ELEVATED ANTINUCLEAR ANTIBODY LEVEL:

Back 48

May indicate lupus erythematosus, a connective tissue disorder.

Front 49

EXPECTED OUTCOME:

Back 49

Client will maintain tissue perfusion in the injured area as evidenced by normal neurovascular assessment findings.

Front 50

KEEP A SWOLLEN BODY PART ABOVE THE LEVEL OF THE HEART:

Back 50

This position promtes venous circulation and relieves edema.

Front 51

CONSULT WITH THE PHYSICIAN ABOUT APPLYING A COLD PACK IF AN INJURY IS RECENT:

Back 51

Cold reduces circulation to the affected area and may impair neurovascular health.

Front 52

IN CASE OF HEAD INJURY, ELEVATE THE CLIENTS HEAD SLIGHTLY WHILE KEEPING THE NECK NEUTRAL:

Back 52

Such positioning reduces the risk of further injury.

Front 53

REPORT THE ABSENCE OF PERIPHERAL PULSE AND SEVERE PAIN IMMEDIATELY:

Back 53

These findings may indicate ISCHEMIA (In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue).

Front 54

ESTOGEN DEFICIENCY:

Back 54

Which occurs during menopause, is considered the leading factor in osteoporosis (Osteoporosis is a disease of bone leading to an increased risk of fracture) among aging women.

Front 55

ACID PHOSPHATASE:

Back 55

A group of phosphatases (e.g., serum, liver, prostate) with optimal activity below a pH level of 7. Elevated serum levels have been observed in metastatic breast and prostatic cancer; Paget’s, Gaucher’s, and Niemann-Pick diseases and in myelocytic leukemia.

Front 56

SERUM PHOSPHORUS: (The serum phosphorus test measures the amount of phosphate in the blood.)

Back 56

Most of the body's phosphorus is combined with calcium in the bones, but about 15% exists -- as phosphate (PO4) ions -- in the blood and other soft tissues and body fluids. Dietary phosphorus is efficiently absorbed, so a low PO4 level caused by dietary deficiency is unlikely in those on a normal diet unless the person has a malabsorption syndrome (inadequate absorption of nutrients in the intestinal tract).

Front 57

MUSCULOSKELETAL SYSTEM:

Back 57

Consists of structures the body uses for support and movement.

Front 58

STRAIN:

Back 58

Is an injury to a muscle when stretched or pulled beyond capacity.

Front 59

CONTUSION:

Back 59

Is a soft tissue or injury resulting from a blow or blunt trauma.

Front 60

SPRAINS:

Back 60

Are injuries to the ligaments surrounding a joint.

Front 61

A STRAIN RESULTS FROM:

Back 61

excessive stress, overuse, or over-stretching. Small blood vessels in the muscle rupture and muscle fibers sustain tiny tears. The client experiences inflammation, local tenderness, and muscle spasms.

Front 62

IN CONTUSIONS:

Back 62

Injury is confined to soft tissue and does not affect the musculoskeletal structure. Many small blood vessels rupture, causing bruising (ECCHYMOSIS), or a hematoma (COLLECTION OF BLOOD).Applying cold packs alleviates local pain, swelling, and bruising. A contusion usually resolves withing 2 weeks.

Front 63

ACRONYM (RICE):

Back 63

R - Rest
I - Ice
C - Compression
E - Elevation
Method used to remember treatment for strains, contusions, and sprains.

Front 64

NAIDS (NONSTEROIDAL ANTI INFLAMMATORY DRUGS)

Back 64

Ease the comfort for sprains, strains and contusions.

Front 65

DISLOCATIONS:

Back 65

Occur when the articular surfaces of a joint are no longer in contact. The shoulder, hip and knee are commonly affected.

Front 66

SUBLUXATION:

Back 66

This is a partical dislocation.

Front 67

CAUSES OF DISLOCATIONS:

Back 67

Trauma in adults usually cause dislocations. Disease of the joint may result in dislocation when ligaments supporting a joint are torn, stretched, or relaxed.
The injury may disrupt local blood supply to structures such as the joint cartliage, causing degeneration, chonic pain, and restricted movement.

Front 68

DEPARTMENT SYNDROME: (a condition in which a structure such as a tendon or nerve is constricted in a confined space)also may develop.

Back 68

The syndrome affects the nerve innervation, leading to subsequent PALSY (decreased sensation and movement).

Front 69

VOLKMANN'S CONTRACTURE: (If compartment syndrome occurs in an upper extremity.)

Back 69

A clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend his or her fingers and complains of unrelenting pain, particulary if attempting to strectch the hand.

Front 70

FRACTURE:

Back 70

Is a break in the contunuity of a bone. Fractures may affect tissues or organs near the bones as well. Fractures are classified according to type and extent.

Front 71

CAUSES OF FRACTURES:

Back 71

Force applied to a bone exceeds maximum resistance, the bone breaks.
Sudden direct force from a fall caused most fractures, however, some result from indirect force, such as during a seizure.
Few fractures result from bone infections and bone tumors. For 10 to 40 mins. after a bone breaks, muscle surrounding the bone are flaccid (is a term used in medicine to refer to an object that is soft, or not tense).

Front 72

CALLUS: (THE HEALING MASS):

Back 72

It holds the ends of the bone together but cannot endure strain. Bone repair is a local process. About 1 year of healing must pass before bone regains its former structural strength, becomes well consolidated and remodeled (reformed), and possesses fat and marrow cells.

Front 73

AVASCULAR NECROSIS:

Back 73

Death of bone from an insuffcient blood supply.
Clients who are inactive during convalescence are prone to pneumonia, thrombophlebitis, pressure sores, urinary tract infection, renal calcui, constipation, muscle atrophy, weight gain and depression.

Front 74

AVULSION (TYPE OF FRACTURE):

Back 74

A pulling away of a fragment of bone by a ligament or tendon and its attatched.

Front 75

COMMINUTED (TYPE OF FRACTURE):

Back 75

A fracture in which bone has splintered into several fragments.

Front 76

COMPOUND (TYPE OF FRACTURE):

Back 76

A fracture in which damage also involves the skin or mucous membranes.

Front 77

COMPRESSION (TYPE OF FRACTURE):

Back 77

A fracture in which bone has been compressed (seen in vertebral fractures).

Front 78

DEPRESSED (TYPE OF FRACTURE):

Back 78

A fracture in which fragments are driven inward (seen frequently in fractures of the skull and facial bones).

Front 79

EPIPHYSEAL (TYPE OF FRACTURE):

Back 79

A fracture through the epephysis.

Front 80

GREENSTICK (TYPE OF FRACTURE):

Back 80

A fracture in which one side of a bone is broken and the other side is bent.

Front 81

IMPACTED (TYPE OF FRACTURE):

Back 81

A fracture in which a bone fragment is driven into another bone fragement.

Front 82

OBLIQUE (TYPE OF FRACTURE):

Back 82

A fracture occurring at an angle across the bone (less stable than transverse.

Front 83

PATHOLOGIC (TYPE OF FRACTURE):

Back 83

A fracture that occurs through an area of diseased bone(cysts, pagets disease, bony metastasis tumor) call all occur without trauma or a fall.

Front 84

SIMPLE (TYPE OF FRACTURE):

Back 84

A fracture that remain contained; does not break the skin.

Front 85

SPIRAL (TYPE OF FRACTURE):

Back 85

A fracture twisting around the shaft of the bone.

Front 86

TRANSVERSE (TYPE OF FRACTURE):

Back 86

A fracture that is straight across the bone.

Front 87

PROCESS OF BONE HEALING:

Back 87

1)immediately after a bone fractures, blood seeps into the area, and the hematoma (blood clot) forms.
2)After 1 week, osteoblast forms as the clot retracts.
3)After about 3 weeks, a procallus forms and stabilizes the fracture.
4)In 3 to 4 months, osteoblasts begin to remodel the fracture site.
5)If the fractured bone has been accurately aligned during healing, remodeling will be complete in about 12 months.

Front 88

MYOGENIC

Back 88

A myogenic muscle can naturally contract and relax.
e.g. cardiac muscle.

Front 89

TYPES OF JOINTS (SYNATHRODIAL JOINTS):

Back 89

CHARACTERISTIC: Immovable
EXAMPLE: at the suture line of the skull between the temporal and occipital bones.

Front 90

TYPES OF JOINTS (AMPHIARTHRODIAL JOINTS):

Back 90

CHARACTERISTIC: Slightly movable.
EXAMPLE: Between the vertebrae.

Front 91

TYPES OF JOINTS (DIARTHRODIAL JOINTS, ALSO CALLED SYNOVIAL JOINTS):

Back 91

CHARACTERISTIC: Freely moveable.
EXAMPLES: Glinding Joint - Elbow.
Pivot Joint: ends of the radius and ulna.
Condyloid Joint: Between the wrist and the forearm.
Saddle Joint: Between the wrist and metacarpal bone of the thumb, Ball and Socket Joint: hip.

Front 92

COMPLICATIONS OF FRACTURES (SHOCK):

Back 92

DESCRIPTION:Hypovolmeic shock related to blood less and loss of extracelluar fluid from damaged tissue if untreated, the clients condition will deteriorate.
NURSING IMPLICATIONS: Administer blood and fluid volume replacements as prescribed by to prevent futher losses.

Front 93

COMPLICATIONS OF FRACURES (FAT EMBOLISM):

Back 93

DESCRIPTION: Fat globules released after fractures of pelvis or long bones, or after multiple injuries or crushing injuries. Globules combine with platellets to from emboli. Onset is rapid, with client experiancing respiatory distress and cerbral disturbances.
NURSING IMPLICATIONS: Monitor client for symptoms which usually occur 48 to 72 hours. To prevent Fatty emboli, provide early respiratory support, ensure rapid immobilization of fracture, and observe client closley for signs of respiratory and nervous system problems.

Front 94

COMPLICATION OF FRACTURES (PULMONARY EMBOLISM):

Back 94

DESCRIPTION: Thromboembolism may occur after fracture or surgery to repair fractures. These lead to pulmonary emboli in some clients and can be fatal.
NURSING IMPLICATIONS: Promote circulation and prevent venous stasis to avoid pulmonary embolism. Admister low dose heparin subcutaneously as prescribed to prevent clot formation.

Front 95

COMPLICATIONS OF FRACTURES (COMPARTMENT SYNDROME):

Back 95

DESCRIPTION: Tissue perfusion in the muscle compartment (muscle covered by inelastic fascia) is compromised secondary to tissue swelling, hemorrage, or a cast that is too tight. If circulation is not restored, ischemia and tissue anoxia lead to permanent nerve damage, muscle atrophy, and contracture.
NURSING IMPLICATIONS: Monitor client for signs and sympoms of compartment syndrome asuch as unrelenting pain, unreleived by analgesics. Elavate the extremity, apply ice, and perform neurovascular checks to help prevent this complication. As indicated, relieve pressure by loosening cast or preparing the client for a fasciotomy (surgical incision of fasia and seperation of muscles).

Front 96

COMPLICATIONS OF FRACTURES (DELAYED BONE HEALING):

Back 96

DESCRIPTION: Bone falls to heal at the expected rate. Delayed healing may result from nonunion, characterized by the ends fo the fractured bone failing to characterized by the ends fo the fractured bone healing in a deformed position.
NURSING IMPLICATIONS: Delayed union may require surgical intervention to promote bone growth, and correct the incorrect union. If necessary, prepare the client for the use of electrical stimulation measure that promote bone growth, or for a bone graft.

Front 97

COMPLICATIONS OF FRACTURES (INFECTION):

Back 97

DESCRIPTION: The potential for infection increases with compound fractures, application of skeletal traction, or surgical procedures.
NURSING IMPLICATIONS: Perform careful assessments and maintain aseptic technique to prevent infections. Monitor for early signs fo infection because early detection promotes early correction of the problem.

Front 98

COMPLICATIONS OF FRACTURES (AVASCULAR NECROSIS):

Back 98

DECRIPTION: This condition occurs from interruption of blood supply to the fracture fragments, after which the bone tissue dies; most common in the femoral head.
NURSING IMPLICATIONS: Be alert for client reports of pain and decreased function of the affected limb. If necessary, prepare the client for surgery, such as bone graft, bone prosthesis, joint replacement, joint fusion, or amputation.

Front 99

OSTEOMYELITIS:

Back 99

Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria. It can be usefully subclassifed on the basis of the causative organism, the route, duration and anatomic location of the infection.

Front 100

EMBOLI

Back 100

In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body.

Front 101

THOMBOEMBOLISM

Back 101

Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. Thromboembolism is a general term describing both thrombosis and its main complication which is embolisation.

Front 102

IF A CLIENT HAS AN OPEN WOUND:

Back 102

Ascertain when the cleint last received a tetanus immunization.

Front 103

URINE TESTS

Back 103

When ordered, collect 24 hour urine samples for analysis to determine levels of uric acid and calcium exceretion.

Front 104

URIC ACID

Back 104

Uric acid (or urate) is an organic compound of carbon, nitrogen, oxygen and hydrogen with the formula C5H4N4O3.

Front 105

A CLIENT WITH MUSCULOSKELETAL INJURY: ASSESSMENT:

Back 105

Assess the injury in terms of its ocation , nature, and effects on mobility. Determine circulatory status to the injured area by checking circulation, sensation adn mobility, if indicated. Assess the clients level of pain. Monitor V/S and closely observe for signs of shock.

Front 106

DIAGNOSIS:

Back 106

Describe diagnostic test or treatments brifely, because the client will find it fifficut to comprehend detail while anxious.
Provide information about how long the test or examination will take, where it will be done, and what preparation (if any) are necessary.
Allow the client an oppurtunity to ask questions, or make comments.

Front 107

MANAGING THE CARE OF THE CLIENT IN TRACTION:

Back 107

Assesss neurovascular staus frequentley. Compare assessment findings in the affected limb with those in the unaffected limb.
Check traction equipment for:
Proper aligment (postion client so that the body is in an opposite straight line to pull of traction).
Correct attactment
Prescribed amount of weight.
Freely hanging weights and freely moving ropes over unobstructed pulleys.
Maintaince of counteraction and continous traction.
Montior client for signs of pressure sore.
Encourage client to be as mobile as possible and to perform exercise as indicated.
If traction is applied to the lower extremity, observe foot position and prevent footdrop.
If skeleton traction is applied, follow procedure for pin care.
Cover tips of any protuding metal pins or rods with corks or other protective material.

Front 108

OSTEOMYELITIS:

Back 108

Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria. It can be usefully subclassifed on the basis of the causative organism, the route, duration and anatomic location of the infection.

Front 109

CAST:

Back 109

Is a rigid mold that immobilizes an injured structure while it heals. Cast ususally are made of fiberglass, polyester, or thermoplastic material. Plaster of Paris may be used, but these cases require several hours for drying, whereas other material dry rapidly.

Front 110

THREE BASIC CASTS: CYLINDER CAST, BODY CAST, SPICA HIP CAST.

Back 110

A Cylinder cast: encircles an arm or leg, leaving finger or toes exposed.
A Body cast: is a larger form of cylinder cast that encircles the trunk from about the nipple line to the iliac crest.
A Spica hip cast: Surrounds one or both legs and the trunk, it may be strengthened by a bar that spans a casted area between the legs. It is trimmed open in the anal and genital area to facilitate elimination.

Front 111

ECCHYMOSIS:

Back 111

A bruise, also called a contusion or ecchymosis, is a kind of injury to biological tissue in which the capillaries are damaged, allowing blood to seep into the surrounding tissue.

Front 112

IF A COMPOUND FRACTURE IS PRESENT:

Back 112

There is an open wound or a protrusion of bone. X-rays show the type of location of the fracture.

Front 113

FRACTURES FEMUR:

Back 113

Usually occurs in a car accident, gunshot, or may occur in falls from high places: ladders.

Front 114

FRACTIRES OF THE FEMUR:

Back 114

Usually are treated initially with som form of traction to prevent deformaties and soft tissue injury.
Skeletal traction or an external fixator aligns the fracture in preparation for future reduction if the fracture occurred in the lower two thirds of the femur.
Once the Femur is aligned, a Spica cast may be used to maintain the correct position.

Front 115

BEFORE CAST APPLICATION:

Back 115

1) inspect the skin that will be covered with the cast.
2) assess the circulation, sensation, and mobility to establish a basline.
3) evaulate the clients pain level.
4) remove clothing that will be difficult to remove after the cast is applied.
5) explain the procedure to the client. Remember to tell the client that the cast will feel warm - even hot - as it is applied, but that it will not burn the skin.

Front 116

AFTER CAST APPLICATION:

Back 116

1) leave the cast uncovered.
2) assess the circulation, sensation, and mobility in exposed fingers and toes every 1 to 2 hours.
3) monitor for signs of complications related to cast application. Report any abnormal findings.
3) handle wet cast with the palms of the hands, NOT the fingers.
4) elevate the cast extremity so that it is higher than the heart.
5) reposition the client frequently while the cast is drying so that cast dries as evenly as possible.
6) apply ice packs to the cast where surgery was performed.
7) circle areas where blood seeped through and write the time on the circle.
8) petal cast edges eith strips of adhesive tape to prevent chipping and to cover any remaining to rough areas.
9) replace windows in the hole from which they were cut to prevent tissue from bulging through the opening.
10) ambulate client as soon as indicated.

Front 117

DICHARGING TEACHING CLIENT WITH A CAST:

Back 117

1) elevate casted extemity for 24 to 48 hours after cast application and as indicated.
2) if the client has a leg cast, show him or her how to ambulate safely.
3) exercise points proximal to distal to the cast as indicated to prevent muscle atrophy, weakness, and loss of joint mobility.
4) keep the cast clean and dry. A damp cloth may be used.
5) Explain that the skn under the cast may feel itchy, and caution client not to insert objects like straws, combs, eating utensils, knitting need, and the like.
6) report the following to the physician or nurse: unusul and sudden pain, painful or decreased movement, or persistent pain, fever, foul odors, or increased wamth of extremity, drainage from under the cast, changes in circulation, mobility, or sensations (burning, numbness, tingling, or cold).

Front 118

MONITOR BOWEL FUNCTION DAILY. PROVIDED INCREASED FLUIDS AND FIBER:

Back 118

Immobilization causes constipation secondary to inactivity and food intake.

Front 119

ENCOURAGE CLIENT TO INCREASE FLUID INTAKE TO 2000ML/DAY UNLESS CONTRAINDICATED:

Back 119

This intake promotes normal bladder funtion and prevents constipation, kidney stones, and other related complications of prolonged bed rest.

Front 120

INSPECT PINS OR WIRE SITES USED IN TRACTION OR EXTERNAL FIXATION DEVICES AND THE SURGICAL INCISION, OR BENEATH THE CAST WINDOW FOR SIGNS OF INFECTION:

Back 120

Regular inspection promotes early detection of and prompt intervention for infection.

Front 121

ADMISTER PRECRIBED ANTIBIOTICS:

Back 121

They reduce microogamsisms and control infection.

Front 122

REPORT PURULENT WOUND DRAINAGE, ELEVATED TEMP., CHILLS, AND INCREASED WHITE BLOOD COUNT:

Back 122

These are signs of infection that require intervention.

Front 123

CONSULT WITH THE PHYSICAL THERAPIST (PT), AND OCCUPATIONAL THERAPIST (OT) ABOUT CLIENTS NEEDS RELATED TO ADLs:

Back 123

PT and OT will determine adaptive equipment needed, as well as clients strengths and abilities to master self care tasks.

Front 124

PROVIDE PAIN MEDS. 45 MINS. BEFORE ACTIVITY:

Back 124

pain relief promotes participation in self care.

Front 125

HEMIARTHROPLASTY:

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total hip replacement. The head and neck of the femur are removed and replaced with a metal device, such as an Austin Moore, or Thomas Posthesis.

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ARTHRITIS:

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Is a general condition characterized by inflammation and degeneration of a joint.

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RHEUMATIC DISORDERS:

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Include more than 100 different types of recogized inflammatory disorders, making this collective group the most common orthopedic problem.
These disorders involve inflammation and degeneration of connective tissue structures, especially joints.

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RHEUMATOID ARTHRITIS: (RA)

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Is a systemic inflammatory disorder of connective tissue/joints characterized by chronicity, remission, and exacerbations.
Potential for disability with RA is great and related to effects on joints, as well as systemic problems.

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THE CHANGES PRODUCE MORE INFLAMMATION, PERPETUATING THE ENTIRE PROCESS OF (RA)
RHEUMATOID ARTHRITIS:

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1) The inflammation process (synovitis) advances as congestion and edema develop in the synovial membrane and joint capsule.
2) Synovial tissue experiences reactive hyperplasia.
3) Vasodilation and increased blood flow cause warmth and redness.
4) Increases capillary permeability causes swelling.
5) RA synovitis advances, leading to PANNUS (Pannus is a medical term for a hanging flap of tissue) formation (destructive vasular granulation tissue characteric of RA).
6) Pannus (Pannus is a medical term for a hanging flap of tissue) destroys adjaacent cartilage, joint capsule, and bone.
7) Pannus (Pannus is a medical term for a hanging flap of tissue) eventually forms between joint margins reducing joint mobility and leading to potential ANKYLOSIS (joint immobility).
8) Disease progression causes futher inflammation and strucural changes.

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MALAISE:

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Malaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease. Often defined in medicinal research as a "general feeling of being unwell".

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SJOGREM SYNDROME:

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Dry eyes and mucous membranes.

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VASCULITIS:

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a group of diseases featuring inflammation of the wall of blood vessels including veins (phlebitis), arteries (arteritis) and capillaries due to leukocyte migration and resultant damage. While most vasculitides are rare, they generally affect several organ systems and can cause severe disability.

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NEUROPATHY:

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meaning a disease of the peripheral nerve or nerves

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ARTHROPLASTY:

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Or reconstruction of a joint, using an artifical joint that restores previously lost function and relieves pain. Reconstructive joint surgery is discussed more fully with the surgical management of degenerative joint disease.

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(TENS) TRANSCUTANEOUS ELECTICAL NERVE STIMULATION:

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A TENS unit has electodes that are applied to the skin from a portable stimulation unit that the client learns to operate. (Nursing Management).

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(DJD) DEGENERATIVE JOINT DISEASE, ALSO REFERRED TO OSTEOARTHRITIS:

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Is the most common form of arthritis. It also is known as the "wear and tear" disease and typically affects weight bearing joints.
It is characterized by the slow and steady destructive changes in weight bearing joints and those repeatedly used for work.
Unlike (RA), (DJD) has no remission and no systemic symptoms, such as malasise and fever.

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GOUT:

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A painful metabolic disorder involving an inflammation reaction in the joints, usually affects the feet (especially the greater toe), hands, elbows, ankles, and knees.

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HYPERURICEMIA:

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Accumulation of uric acid in blood, caused by alterations in uric acid production, excretion, or both. Hyperuricemia occurs from one or a combination of the following pathologies:
Primary hyperuricemia
Servere dieting or starvation
Excessive ingestion of purines (organ meats, shellfish, or sardines)
Heredity
Secondary Hyperurucemia
Abnormal purine metabolism
Increased rate of protein synthesis with overproduction or underproduction or uric acid.
Increased cellular turnover, as in leukemia, multiple myeloma and other cancers, some anemias and psoriasis
Altered renal tubular function related to use of diurectics and salicylates and excessive alcohol intake, leading to underexcretion of uric acid.

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OSTEOMYELITIS:

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Is an infection of the bone. Limited blood supply, inflammation and pressure on the tissue, and formation of new bone around devitalized bone tissue make ostemyelitis a fiffuclut and challenging condition to treat.
In adult Ostemyelitis my become chronic greatly affectin quality of life.