Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/135

Click to flip

135 Cards in this Set

  • Front
  • Back
Anatomy of the bone

Bones are make up of what
Cells, protein matrix and mineral deposits. The three basic cell types are osteoblast, osteocytes, and osteoclast
Osteoblasts
Bone forming cell
osteoclast
Bone resorption cell
Break down (destroying) resorbing and remodeling
Osteocyte
Mature cell
Bone maintenance and function
Bone Maintenance
Bone is dynamic tissue, always in a constant state of turnover-resorption and formation.
What are the important regulating factors that determine the balance between formation and resorption?
Vit D, Local stress, Parathyroid hormone, calcitonin and blood supply
Role of:
Vit D
Vit D increases the amount of calcium in the blood by promoting absorbtion of calcium from the GI
Role of:
Local stress (weight bearing)
Weight bearing acts to simulate bone formation and remodeling. Weight bearing bones are thick and strong. Without weight bearing as in bedrest the bones lose calcium, and become weak. Causing bones to easily fx
Role of:
parathyroid hormone
calcitonin
Major hormones for calcium homeostasis. Parathyroid regulates concentration of CA in blood, in part by moving calcium from bone and Calcitonin responds to elevated blood ca levels and increases the deposit of ca into the bone and inhibits bone resorbption.
Role of:
blood supply
Diminished blood supply causes decrease in bone density, and formation. Bone necrosis occurs.
Articular System/Types of joints.

Diarthrosis joints
Freely moveable.
Ball and socket. Examples are: hip, shoulder. Permit full freedom of movement.
Hinge;elbow and knee
Articular System/Types of joints

Synarthrosis joints
inmoveable joints. Example is skull sutures
Articular System/Types of joints

Amphiarthrosis
Allow limited movement. Joined by fiberous cartilage. Example is vertebral joints
What surrounds the articulating bones?
What is it lined with
Joint Capsule.
SYNOVIUM which secretes synovial fluid to lubricate and provide shock resistence.
What binds the articulating joints together?
LIGAMENTS (fibrous connective tissue bands)and
Muscle TENDONS providejoint stability.
How are muscles attached to bone, CT, soft tissue, other muscles or skin?
TENDONS
Types of muscle contractions
Isometric
Length remains constant but the force generated by the muscles is increased.
Types of muscle contractions
Isotonic
Charecterized by the shortening of the muscle with no increase in tension within the muscle.
How do most muscles contract?
Using a combonation of both isotonic and isometric. Example walkin; isotonic contraction results in shorteninf of the leg and isometric contraction causes the stiff lef to push against the floor.
Muscle Tone
State of readiness to respond to a contraction
A muscle that is limp and without tone is described as?
Flacid
A muscle with greater than normal tone is?
Spastic
What is osteoporosis
Significant loss of bone mass and strenght with increased risk for fx
How does exercise influence muscles?
It is needed to maintain function and strength.
Hypertrophy occurs with continues building of muscle/exercise
Atrophy is disuse of muscle which decreases muscle. See with bed rest
How can you decrease the effects of immobility, (which occurs with treatment such as bedrest, cast...)
Isometric exercises(tightening of the muscles esp quad and gluts which help with amb)ROM activities active or passive.
ASSESSMENT

health history
Chief complaint
symptoms
onset/management
functional status(activity)
ie bathing, hygiene, mobility
Any change over the last 6mo to a year
ASSESSMENT
Physical
sensory- numbness, burning,tingling. (could be caused by nerve damage or decreased perfusion)
ASSESSMENT
Pain
Does it increase/decrease with activity
MUSCULAR pain is sore achy, cramppy. Increases with activity
SKELETAL-sharp, piercing and relieved with rest.
INFECTION-throbbing
BONE SECOND TO DISEASE-dull/deep ache. may feel when still.
JOINT-increases with activity

FX pain-accurately point to
Nerve-radiates

What precipittes or relieves
ASSESSMENT
Inspection/palpation
Convex thorax
Concave -lumbar
ABNORMAL
Scoleosis-curvature of spine
Kyphosis
Lordosis-forward curvature of lumbar spine(normal with pregnancy)
Gait, limping shuffling
Bone integrity-deformities of alignment-compare bilaterally.

Abnormal angulation
krepitis-grating sound
DIAGNOSTIC TESTS

XRAY
determines bone integrity.Typically done from more than one view. Can reveal some problems with joints(spurs, narrowing)
DIAGNOSTIC TESTS

CT
More than one dimension. Shows slices. Good for soft tissue/bone/ligaments/tendons
sometimes ordered if xray difficult to see fx
may be done w/ or w/o contrast
DIAGNOSTIC TESTS

MRI
Used mostly to rule out cranial and spinal disorders
o radiation. Magnetic field. hear knocks and bangs.
worry about claustriphobia
NO METAL (pacers, inplants, plates)
DIAGNOSTIC TESTS

Arthrography
Checks for continutity of joint capsule. See if tear in cavity. Give contrast and if it leaks out of cavity there is a tear.

RN considerations- rest joint for 12h after, use compression dressing, ice. May have crackling until air/contrast is absorbed.
DIAGNOSTIC TESTS

Bone density
Xray or ultrasound
DIAGNOSTIC TESTS

Arthrocentesis
aspirate fluid to rule out disease, infection, to relieve pain.(may inject anti inflammatory
DIAGNOSTIC TESTS

Arthroscopy
scope to visualize joint structure. Repair of tears. Sterile-infection, bleed in joint, stiffness
DIAGNOSTIC TESTS

Bone Scan
Inject isotope IV 2h before scan. Degree of uptake related to metabolism of bone.
Increase uptake-metastisis, osteomylitis, some fx
Decreased uptake- "cold spots"
RN check for allegies,, preg, after encourage liquid to rid body of isotope. Flush toilets twice, private room
DIAGNOSTIC TESTS

Bone biopsy
marrow used for diagnosis.
watch for bleeding and pain
DIAGNOSTIC TESTS

EMG
Electromyogram, done with nerve studies. Studies muscles and innervation. Helps to distinguish between muscular and nerve problems.
Help support Dx- carpal tunnel ie
DIAGNOSTIC TESTS

LABS
CBC
Coagulation studies
Serum Ca
Thyroid (calcitonin and parathyroid)
What is paresthesias
burning, tingling sensations or numbness
What is a contusion?
A soft tissue injury produced by blunt force causing ecchymosis
What is a STRAIN?
A muscle pull caused by overuse, overstretching or excessive stress. Strains are microscopic, incomplete muscle tears with some bleeding into the tissue.
What might a patient will a strain feel?
soreness, or sudden pain, with local tenderness on muscle use and isometric contraction.
What is a SPRAIN
an Injury to the ligaments surrounding a joint that is caused by a wrenching or twisting motion.
What happens with a sprain?
Blood vessels rupture and edema occurs; the joint is tender and movement of the joint becomes painful
What is an avulsion FX
A bone fragment is pulled away by a ligament or tendon
What is the treatment of contusions, strains and sprains?
R-Rest
I-ice/20 min intervals 24-48h
C-compression
E-elevation

Heat is best used after 24-28h better perfussion and healing.
What is tendinitis?
What is the cause?
What is treatment
Inflammation of the tendon
Overuse
Ice after activity, NSAIDS, splint, stretching before and after
What is bursitis?
Inflammation of a fluid-filled sac. Occurs commonly in the shoulder
What is a dislocation?
A dislocation of a joint is a condition in which the articular surfaces of the bones forming the joint are no longer in anatomic contact.
What is subluxation?
A partial dislocation of the articulating surfaces
S/S of dislocation
Pain
Change in joint contour
shortening of extremity
Always X-ray to make sure no fx
TX for dislocation
Rest to relaz muscle
immovilize
reduce Fx
check CSM
FRACTURES

Definition
Break in the continuity of bone
What is a closed FX
A fx with no break in the skin
What is an open or compound fx
Fx through the skin or MM. High risk for infection.
How are open FX graded
Graded on a scale of 1-3
1- a clean wound less than 1cm long
2-a larger wound without extensive soft tissue damage
3-highly contaminated, has extensive soft tissue damage and is the most severe.
Fracture Patterns:

Greenstick
One side is broken the other side is bent
Fracture Patterns:

Transverse
A fracture that is straight across the bone
Fracture Patterns:

Oblique
A fractue occuring at an angle across the bone (less stable than a transverse fx)
Fracture Patterns:

Spiral
A fx that twists around the shaft of the bone
Fracture Patterns:

Comminuted
A fx in which bone has splintered in several fragments
Fracture Patterns:

Impacted
A fx in which a bone fragment is driven into another bone fragment
Fracture Patterns:

Depressed
A fx in which fragments are driven inward (seen freq. in fx of the skull and facial bones)
Fracture Patterns:

Epiphyseal
A fx through the epiphysis (growth plate)
Fracture Patterns:

Compression
A fx in which bone has been compressed (seen in vertebral fx)
Etiology
A fx occurs when the bone is subjected to stress greater than it can absorb. Fx are caused by direct stress such as a blow, crushing forces, sudden or twisting motion, and extreme muscle contractions. They are also pathological
S/S

Pain
Pain- continuous and increases in severity until the bone fragments are immobilized. The muscle spasm that accompanies fx is a natural type of splinting.
S/S

Loss of function
Abnormal movement (flase movement) may be present.
Loss of function is because the muscle depends on the intefrity of the bones to which they are attached.
S/S
Deformity
Displacement, angulation or rotation of the arm or leg causes a deformity (either visable or palpable) that is detectable when the limb is compared with the uninjured extremity. Deformity is also a result of soft tissue swelling.
S/S

Shortening
In fx of the long bones, there is actual shortening of the extremity because of the contraction of the muscles that are attached above and below the site of the fracture. The fragments often overlap by as much as 1-2in
S/S

Crepitus
When the extremity is examined with the hands, a grating sensation (crepitus) can be felt. It is caused by the rubbing of the bone fragments against each other. TESTING FOR CREPITUS CAN PRODUCE FURTHER TISSUE DAMAGE AND SHOULD BE AVOIDED.
BONE HEALING

Hematoma and inflammation
The bodys response is similar to that after injury elsewhere. There is bleeding into the injured tissue-HEMATOMA. The injured area is invaded by macrophages, inflammation, sweeling and pain are present.
LASTS SEVERAL DAYS
BONE HEALING

Angiogenesis and cartilage formation
Under the influence of signaling molecule, cell proliferation and differentiation occur. Blood vessels and cartilage overlie the fx.
6-10 DAYS
BONE HEALING

Cartilage calcification
Matrix formed

3-10 WEEKS
BONE HEALING

Cartilage removal
cartilage is replaced by woven bone similar to that of the growth plate
3-10 WEEKS
BONE HEALING

Bone formation
Mineral keep being depsitied until the bone is firmly united.
4-6MO
BONE HEALING

Remodeling
Fianl stage. takes MONTHS TO YEARS
Factors that enhance fractue healing
Immobilization of fx fragments
max bone fragment contact
sufficient blood supply
proper nutrition
exercise: weight bearing for long bones
Factors that INHIBIT fx healing
Extensive local trauma
bone loss
Inadequate immobilization
Space or tissue b/w bone fragments
Infection
steroids
age
fx through joint-synovial fluid can lysis hematoma
FRACTURE TREATMENT

Emergency
immobilize asap before pt is moved. Cover open fx with a sterile cloth
ASSESS CSM, DISTAL TO FX
FRACTURE TREATMENT

Reduction
setting the bone, refers to restoration of the fx fragments to anatomic alignment and rotation.
Becomes more difficult to do when bone starts healing
FRACTURE TREATMENT

Open/Closed reduction
Open- requires surgery. internal fixation devices; pins,wires, screws, nails, plates and rods, hold fragments into place until sollid bone healing occures
Closed- done through manipulation and manual traction
FRACTURE TREATMENT

Immobilization
Holds fx in place until union occurs. hold in correct position and alignment
FRACTURE TREATMENT
External/Internal Fixation
External- bandages, casts, splints, continuous trac tion and external fixators
Internal- internal splints, plates and pins
CASTS
define
rigid external immobilizing device that is molded to the ocntours of the body
CASTS
extremity

Trunk/body
leg, arm


encirlces the trunk
CASTS

SPICA
Hip/femur full leg cast up one side across hip and down, across to knee on the other side
CASTS

Plaster
Traditional cast
takes LONG time to dry 24-72h
gives off heat as dries
Use palms to move until dry so not to DENT
If get wet use hair dryer on cool setting
CASTS

Non-plaster
Fiberglass
water activated
dries in minutes
lighter/stronger/water resistent
Used for nondisplaced fx with minimal swelling and for long-term wear
If get wet use hair-dryer on cool setting
NURSE ALERT
What should you do if pain is unrelieved?
report immediately MD to avoid possible paralysis and necrosis, impaired tissue perfusion and ulcer formation
NURSE INTERVENTIONS
Pain mgmt
neurovascular
mobility
teaching
PQRST
reposition, elevate to heart level (decreases swelling and increases circulation
each joint a little higher than other
check CSM freq and regularly.
Perform active ROM on uneffected joints.encourage indep. ADL, know WB status, use assistive devise
teach cast care and mobility
CAST SPECIFIC RN INTERVENTIONS
Arm casts
Proper elevation and use of sling
CAST SPECIFIC RN INTERVENTIONS
Leg casts
transferring/ambulating with assist, devices, monitor for peroneal nerve injury (causes foot drop)
CAST SPECIFIC RN INTERVENTIONS
Body/Spica casts
skin care/hygiene
cast syndrome-psychological (claustrophobic reaction) and physiologic (superior mesenteric artery syndrome) slow down of GI, Ileus- all responses to confinment in body cast
Complications of Casts:

Compartment Syndrome
Occurs when ther is increased tissue pressure within a limited space (eg cast, muscle compartment) that compromises the circulation and the function of the tissue within the confined area. To relieve pressure the cast must be BIVALVED (cut in half longitudinally) and the extemity must be elevated no higher than heart.
If not resolved may have to perform a FASCIOTOMY
What are the 5 P's associated with compartment syndrome?
Pain-uncontrolled with passive movement
Pallor- cool, pale, cyonotic
Pulselessness-Decreased CSM
Paresthesia-abnormal sensation
Paralysis
If not recognized can have permanent loss of function in 6h
Complications of Casts:
Pressure Ulcers
bony protrusion at risk
s/s pain, tightness, cast staining or odor, warm feeling (spot) on cast
Complications of Casts:

Disuse Syndrome
Atrophy due to miuse. Teach pt to perform isometic muscle contraction
EARLY COMPLICATIOMS OF FX
Shock
Compartment syndrome
Due to bone being very vascular. results form hemmorage

see other card
EARLY COMPLICATIOMS OF FX
DVT/PE
Occurs days to weeks after injury.
treat with anticoags
EARLY COMPLICATIOMS OF FX

Fat Embolism
Occurs after fx of long bones or pelvis or multiple fx. Most at risk is young athletic males. At time of injury fat globules move into blood because the pressure in the marrow is greater than the capillary pressure. Onset of symptoms is rapid usually within 24-72h
S/S of Fat embolism
hypoxia
tachypnea
tachycardia
pyrexia
dyspnea, crackles, CP
cough with lg. amt sputum
edema, petichia
mental status changes
DELAYED COMPLICATIONS OF FX

Delayed union and nonunion
delayed union Occurs when healing does not occur at a normal rate for the location and type of fx. NOn union results from failure of the ends of fractured bone to unite
cause is excessive space, no stability and no perfusion
TX is internal fixation, bone graft or electric bone stimulation
DELAYED COMPLICATIOMS OF FX

Avascular necrosis
Bone loses its blood supply and dies associated with non-union, prolonged high doses of steroids.causes PAIN
TX bone graft, bone fusion
DELAYED COMPLICATIOMS OF FX
Reaction to internal fixation devices
Pain and decreased function are the prime indications that a problem had developed with fixation devices. may be mechanical, material or corrosion of the device
DELAYED COMPLICATIOMS OF FX
Complex regional pain syndrom
CRPS is a painful sympathectic nervous systen problem. It occurs infreq.
Occurs mostly in woman in the upper extremities after trauma. manifestations include; severe burning pain, local edema,skin changes freq. cool and clammy then warm
It is chronic and symptoms extend to other areas.
ORTHOPEDIC SURGERIES

Open reduction
The correction and alignment of the fx after surgical dissection and exposure of the fracture
ORTHOPEDIC SURGERIES
Arthroplasty
The repair of joint problems through the operating arthroscope or through open joint surg
ORTHOPEDIC SURGERIES
Joint replacement
the replacement of joint surfaces within a joint with metal or synthetic material
ORTHOPEDIC SURGERIES
Meniscetomy
The excision of damaged joint fibrocartilage
ORTHOPEDIC SURGERIES
Bone Graft
The placement of bone tissue to promote healing, to stabilize or to replace diseased bone
ORTHOPEDIC SURGERIES
Fasciotomy
The incision and diversion of the muscle fascia to relieve muscle constiction as in compartment syndrome or to reduce fascia ccontracture
ORTHOPEDIC SURGERIES
Arthrodesis
immobilizing fusion of a joint
ORTHOPEDIC SURGERIES
Amputation
The removal of a body part
Pre-op
Assessment
hydration/nutrion needs/iron supplements
meds
current/recent infections ( will not do surg.)
Pain rating
Post-op Care
Mental status changes
I&O risk for hypovolemic shick
neurovascular status-r/o DVT use SCDS/TEDS
Pain control- greatest first 2 days
Resp. mgmt-antibiotics
wound mgmt-aseptic tecq
nutrion-adv. diet as tolerated
mobilization-work with PT and assistive devices
If a temp is present in the first 48 hours what is generally the cause?
atelectisis
TKR
usually elective
have history of OA
can donate own blood
timing is important. want to due before muscles atrophies yet not to early as joints only last 10-15y
TKR Post op
Monitor wound drainage-usually 200-400cc
Compression bandage-left intact first 24h
neurovascular assessment-CSM, dorsi/plantar flextion
cold therapy-cryocuff
CPM 0-90 degree
Mobilize-progressive, WB status, asst device
POST OP complications
hypovolemic shock
N/V
atelectisis
DVT/PE
infection
skin breakdown
urinary retention-epidural!
delayed complications
infection
non union
avascular necrosis
loosening of fixation device
FX hip
Intracapsular
Extracapsular
intra-femoral neck
Extra- trochanteric, subtrochanteric (these fx heal better)
S/S FX hip
shortening
external rotation
pain and decreased mobility
Treatment of hip Fx
bucks extension-mobilize and decrease pain, decrease muscle spasms
plates, screws and nails- open reduction internal rotation
Intermedullary Rods
Arthroplasty-replace head of femur done if cant be nailed
THR Post op
Prevent dislocation-Hip precaustion 4-6mo
wound drainage 200-500cc
assess for DVT/PE-foot ankle exercises and early amb
infection-prophalactic antibiotics
Education
daily exercise, swin/walk
use assistive device walker/cane 3mo
Minimize stair climbing
sex-dependent and supine
no crossing legs
low chair
sit for no more than 45min
keep 90 degress or less
no bending twisting
no bath
AMPUTATIONS
Removal of body part due to PVD, Tumor, gangrene, dongential deformities, chronic osteomyelitis or trauma done to save rest of limb and improve quality of life
Site of Amputation
AKA-above the knee
BKA-below the knee
done at most distal point that will successfully heal. 2 factors are circulations(how far limb perfused) Function (try to perserve joint)
healing residual limb
Goal is for stump to be non tender with healthy skin so able to use prosthesis. Use compression to decrease edema and increase circulation.
STaged Amp
gangrene/infection
first amp insicion left open. give antibiotics
then close in a few days
Complications
infection
hemorrhage-nerves vessels cut
skin breakdown-esp suture line
Phantom limb pain- eventually goes away
poor prosthetiic fit
Prosthesis
Fitting-usually done after stiches and bandage and stump healed.
Encourage pt to do self care, wash 2x a day and check for skin breakdown
Complications of prosthesis
Flexion deformities-no amb
No shrinkage of residual limb
abduction deformity of hip