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131 Cards in this Set

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define: diaphysis
Shaft of a long bone
define: Epiphysis
Growth area of a long bone
define: metaphysis
the growing part of a long bone between the diaphysis and the epiphysis
define: periosteum
compact and cancellous tissues of bone together; beneath the hard outer shell of the periosteum, there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone; muscles, ligaments, and tendons may attach to the periosteum
what sorts of problems can recieving an injury at the epiphysis cause?
growth problems
the center of bone contains what?
bone marrow (red and yellow)
what minerals is bone made of?
calcium, phosphorus, and other minerals
what is the best indicator of growth?
bone development
how does the pituitary affect growth?
growth hormone
how does the thyroid affect growth of bones?
influences metabolism and growth, increases bone circumfrence
what are the first centers of ossification (think developmentally)
2 month old embryo
how many centers of ossification are there by birth?
400
by 5-6 months, where are the growth centers?
wrist
to accurately determine bone age, what can be done?
x-ray wrist bones and compare to developmental standards
what is the most accurate measure of growth?
x-ray of the degree of bone ossification
why are infant's bones not as brittle as older people's?
they have more organic material.
bones are....% ossified by 8 months of age?
65
at what age does the anterior fontanel close?
16-18 months
why do the fontanels take so long to fuse?
so that the head can expand in circumference
if the head of the femur slips forward w/ pressure from behind, what assessment is it?
ortalani's sign
what are some things a nurse might look for to find dysplasia of the hip (aka, congenital hip dislocation)
ortalani's sign, asymetry of gluteal folds, the affected limb will be shorter
how does one treat hip dysplasia of an infant?
maintain abduction
define abduction:
Moving or pushing an arm or leg away from the body
how is abduction maintained?
by a brace or pavlic harness
when an infant is in a pavlic harness that is not removed, how should the infant be bathed?
sponge bath
what can be done to prevent skin break down in a harness
always put an undershirt under the chest straps and knee socks under foot/leg pieces; check frequently for red areas under straps and clothing, gently massage healthy skin under the straps once/day; avoid lotions and powders;
where should the diaper be placed in relation to the pavlic harness?
under the straps
describe a club foot
foot that is twisted out of shape during uterine develpment or due to genetics
what is the treatment for club foot
series of casts; surgery
what are the main goals of tx for club foot
manual correction of deformity; maintenance of correction w/ casts if necessary; follow up observation to be sure correction is maintained
what are fractures?
a break in the coninuity of bone
why are fractures uncommon in infants
great deal of force is required to break bones because of increased flexibility of baby's bones
what is some of the pathophysiology affecting fractures
break in continuity of bone; torn blood vessel, clot and fibrin strands begin healing process; Ca salts deposited and callus is responsible for stability and new bone formation
define: transverse fracture
crosswise at right angles to the long axis of the bone
define: oblique fracture
slanting but straight between a horizontal and a perpendicular direction
define: spiral fracture:
slanting and circular, twisting around the bone shaft
define: a 'bends' fracture:
the bone straightens slowly when bent, but not completely, to produce some deformity
define: buckel fracture
compression of the porous bone produces a buckle or torus. appears as a raised or bulging projection at the fracture site. occur in porous bone near metaphysis and are more common in young children
define greenstick fracture:
occurs when a bone is angulated beyond the limits of bending. The compressed side bends and the tension side fails, causing an incomplete fracture similar to the break observed when a green stick is broken
define: complete fracture
divides the bone fragments. they often remain attached by a periosteal hinge, which can aid or hinder reduction
what are the types of complete fractures
transverse, spiral, oblique, comminuted, or butterfly
what does a child with uncomplicated fracture and signs of shock need?
immediate further investigation for other injuries
what are some things to assess for fractures?
pain, edema, immobility, crepitus, ecchymosis, muscle spasms, inability to bear weight
what are the 5 p's of ischemia?
pain, pallor, pulselessness, parasthesia, paralysis
what diagnostic studies are done for fractures?
x-ray, blood studies and enzymes (ast, ldh, cbc)
what is the medical treatment for fractures
emergency management and assessment; reduction/ repositioning of bone into normal alignment; retention and application of a device that will maintain alignment while healing; apply cold
name some impromptu types of splints:
immobilize w/ soft splint (towel) or hard splint (magazine)
what is the usual method of closed reduction treatment for fractures
cast
when swelling is involved what type of closed reduction method may be used?
traction
what are some methods of open reduction for the treatment of fractures
surgery w/ hospitalization (infection can be a problem)
what are the retention methods of tx for fractures
casts and splints
why are heating fans or dryers not used to dry casts?
because they cause the cast to dry on the outside and remain wet beneath, thus there is a potential for them to become moldy. They also can cause burns from heat conduction
with what side of your hands should a wet cast be handled?
palms to prevent indenting the cast and creating pressure areas and supported by a pillow covered w/ plastic
what is the chief concern in the first few hours after the cast is applied?
swelling; the cast could act as a tourniquet, shutting off circulation and producing a neurovascular complication
how might the nurse reduce the risk of swelling after a cast is applied?
elevate the body part
once a cast is in place, permanent muscle and tisue damage can occur after how long?
6-8 hrs
if "hot spots"--places that are wet or foul smelling--are noticed, what should the nurse do?
report it, it may be infection
what is often done to a cast on an extremity that has sustained an open fracture?
a window is left over the wound area to allow for observation and for dressing the wound
the parent should be told to see the health care professional if what happens after cast placement?
it becomes too loose
what are the types of traction?
manual, skin, skeletal
describe manual traction:
applied w/ hand distal to fractures
describe skin traction:
exerts force on skin; non invansive, well tolerated, skin breakdown can occur
describe skeletal traction
pin inserted in bone and traction applied to bone when significant pull is needed. infection can be a problem
when is the likelyhood of using external and internal fixation devices the greatest?
when damage to bone is great
what should the nurse check for those w/ traction?
circulation, 5 p's, line pull, weights, body alignment, cleanliness of pin sites
how should weights be hanging for a pt in traction?
freely, not leaning against bed or floor
what should the nurse do about releasing traction?
the nurse should not release traction
how often should pin sites be assesed and cleaned?
every 4 hours
when would the nurse remove pins?
never
what are some complications of traction and fractures?
circulatory impairment, nerve damage, compartment syndrom, kidney stones, pulmoary embolism
what is compartment syndrome?
increased pressure w/in closed space rises and compromises circulation to the muscle and nerves w/in the space.
what are s/s of compartment syndrome?
motor weakness, pain out of proportion to injury requiring opioids for pain control. May occur as early as 30 min. after ischemia develops. tenseness on palpation
what is the tx for compartment syndrome
relief of pressure, sometimes requiring a fasciotomy
why are kidney stones a problem for bone injuries?
urinary stasis, immobilzation, hypercalcemia
what complication might the nurse watch for w/ multiple fractures?
pulmonary embolism
describe scoliosis
complex spinal deformity involving 3 dimensions
what are the dimensions of scoliosis?
lateral curvature, spinal rotation, rib cage deformity
for whom is scoliosis the most common?
girls 10 years old and adolesant girls
what are the manifestations of scoliosis?
visible curvature, rib hump when bending forward, asymmetrical rib cage, uneven shoulders, pelvis higher on one side, reduced vital capacity
what is the tx for scoliosis?
bracing, milwakee brace, boston brace, surgery
how long must braces usually be worn?
16-23 hours per day
what stands out about the milwakee brace?
it can't be hidden
where is the boston brace found?
underarms
where is the bone graft taken for fusion in surgery for scoliosis?
iliac crest
identify three nursing dx's for immediate postoperative time and home care of scolosis
risk for injury r/t surgery, acute pain r/t surgical procedure, impaired urinary elimination r/t surg; imp. physical mobility r/t spinal surgery; risk for interrupted family process
what are some interventions for post op scoliosis surgery
assess extremities for circulation/warmth/color, cap refill, sensation, motion, pedal pulses; keep flat; HOB can be elevated 2nd day; log roll after 12 hours; pt for exercises on calves, walking w/ assistance by 6th day
how must a log roll be done?
with another person
what are some interventions for home care of post op scoliosis surgery?
wound care; nutritious diet, avoid twisting/bending at waist, activity restriction 6-9 months, resource person for Q's, follow up visits
what activities should a post op scoliosis client avoid for 6-9 months?
active play like biking, rollerblading, skiing
describe osteomylitis
a severe infection of the bone, bone marrow, and surrounding soft tissue
what organisms often cause osteomylitis?
E. coli, salmonella, Neisseria gonorrhea, staph epideridis, and pseudomonas aeruginosa
indirect entry of microorganisms in osteomyelitis most frequently affects whom? p 1692 lewis
boys less than 12
direct entry osteomylitis can occur when? p 1692 lewis
at any age when there is an open wound
what are the clinical manifestations of acute osteomylitis? p 1693 lewis
fever, night sweats, chills, restlessness, nausea, malaise, constant bone pain, swelling, tenderness, warmth in infection site
what are late signs of osteomylitis? p 1693 lewis
drainage from sinus tracts to skin and/or fracture site
what are local signs of chronic osteomylitis? p 1693 lewis
constant bone pain, swelling, tenderness, warmth at infection site
what is the definitive way to determine the causitive microorganism of a case of osteomylitis? p 1693 lewis
bone/soft tissue biopsy is the difinitive way to determine causitive microorganism.
What diagnostic studes would be done for osteomylitis?
wbc, erythrocyte sedementaion rate (ESR), radiologic, MRI, radionuclide bone scans, CT
describe septic arthritis: p 1735, lewis
infections or bacterial arthritis; invasion of joint cavity w/ microorganisms
what is the etiology for septic arthritis? p 1735
bacteria travel via blood to site of infection resulting in hematogenous seeding of joint
what organisms are likely to cause septic arthritis? p 1735 lewis
staph. aureus is most common, strep hemolyticus is also seen; neisseria gonorrhoea is most common in sexually active adults
what is the comparisson between the incidence of septic arthrits compared with osteomylitis? 1735 lewis
septic arthritis occurs twice as often
what factors increase the risk of infection w/ septic arthritis? 17335lewis
leukemia, diabetes mellitus, tx w/ corticosteroids, debilitating chronic diseases
what is a common location for septic arthritis? 1735 lewis
large joints such as knee or hip
what are the clinical manifestations of septic arthritis? pp slide # 23
severe pain, loss of motion, red / swollen joint, fever, chills
what diagnostic procedures are used to dx septic arthritis? slide # 23
blood cultures, joint fluid cultures, films +/-
what is the tx for septic arthritis? slide # 24
IV antibiotics: 2-8 weeks of therapy; Surgery: incision/ drainage, leaving wound open; pain control, gentle ROM when swelling subsides, aseptic tech., diversional activity
what type of fluid usually lubricates many joints? slide 26
synovial
what is the most common form of joint disease?
osteoarthritis
what type of arthritis involves the formation of new joint tissue in response to trauma/damage? slide 27
osteoarthritis
what type of inflammatory process does osteo arthritis have? slide 27
it doesn't have one. It is non inflammatory
what are the risk factors for osteoarthritis? slide 28
males age 45+, female age 55+, trauma, obesity
what are the types of osteoarthritis? slide 29
ideopathic: no known cause; secondary: direct damage to cartilage and injury resulting in joint instability
what diagnostic procedures are used to diagnose osteoarthritis? slide 30
bone scan, ct, mri, plain films, synovial studies
what are the clinical manifestations of osteoarthrits? slide 31
pain worsens as the joint is used during the day, changes in barometric pressure, increase pain,stiffness occurs as the disease progresses crepitation (in more than 90% of patients)
asymmetrical deformity Heberden’s nodes - DIP
Bouchard’s nodes - PIP
which joints are often involved w/ osteoarthritis? slide 33
hips, knees, carpals, proximal and distal interphalangeal, cerv and lumbar vert
describe rheumatoid arthritis:
slide 34
Chronic, systemic disease
inflammation of connective tissue exacerbations and remissions, multi-system manifestations
what are some demographics for rheumatoid arthritis? slide 34
most common among women, native americans, but happens in all cultural groups
what are thought to be some etiologies of rheumatoid arthritis? slide 35
autoimmune, Igg produced resulting ultimately in breakdown of articular cartilage
what sorts of diagnostic procedures might be used for someone who may have rhuematoid arthritis? slide 37
Erythrocyte Sedementation Rate; rheumatoid factor; antinuclear antibodies; c-reactive protein, synovial fluid analysis
what are the clinical manifestations of rheumatoid arthritis? slide 38
Remission/exacerbation; High wbc; Elevated esr; Ulnar drift; Mostly small joints; A lot of stiffness; O golly; Insidious onset; Disease is systemic
what are the most common clinical manifestations of rheumatoid arthritis? slide 39
subcutaneous, small, firm, nontender over extensor surfaces of small joints spine, back of head, sclera, lungs
what is Sjorgren syndrome (associated w/ rheumatoid arthritis--slide 39)
diminished lacrimal and salivary secretions
what is Felty syndrome? (associated w/ rheumatoid arthritis--slide 39)
inflammatory eye problems
describe stage I rheumatoid arthritis: (slide 42)
no destructive changes on x-ray; +/- osteoporosis
describe stage II rheumatoid arthritis: (slide 42)
osteoporosis present; + / - bone destruction; nodules and stiffness
describe stage III rheumatoid arthritis: slide 42
bone destruction; osteoporosis; deformity of joints; nodules
describe stage IV rheumatoid arthritis: slide 42
terminal, fibrous or bony ankylosis
what are the complications of rheumatoid arthritis w/o treatment? slide 43
joint destruction begins within one year of onset
what are some other complications of rheumatoid arthritis? slide 43
scleral nodules:cataracts/ loss of vision; superficial nodules:breakdown – infected; vocal cord nodules: hoarseness
vertebral body: severe pain - immobility
what are some tx options for rheumatoid arthritis? slide 44-487
aspirins, NSAIDS, non opioid analgesics, opioids, corticosteroids, intra articular injections, immunosuppressant, DMARDs, apheresis, nutrition