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157 Cards in this Set
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scoliosis
1.what type of condition 2. what is it 3. age of onset and what sex 4. manifestations 5. tx 6.is it common |
1.age related
2. a lateral thoracic curvature of the spine ("s" shaped, raised shoulder and hip) 3.adolescence/more females 4.back pain, decreased height, cosmetic deformity, **tell tale sign is uneven rib cage when bending over** 5. nonsurgical clinical management, curves 20-45 degrees=exercise, miwaukee or boston brace, up to 23 hours a day(halo traction), or casting, surgical clinnical management=, spinal fusions, rods:harrington 6.most common spinal deformity |
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osteoporosis
1.what is it? 2.which pathological fractures are most common 3. diagnostics 4. r/f 5. tx 6.what type of condition |
1. decreased mass of bonee
2. hip and wrist 3. Labs, estrogen levels, Ca and Phos will be normal??, bone scan 4. post menopause, caucasion, asian, smoking, alcohol, corticosteroids, cushings, hyperparathyroid, hyperthyroid 5. Etidronate-inhibits osteoclast activity, used for men and women who cant take estrogen, Fosamax, increase calcium in diet, increase weight bearing activity, , stop smoking, calcium supplements 6.age related |
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legg-calve perthes disease
1.what type of condition 2. what is it 3. most common in what sex and age? 4. sx 5. tx |
1.age related, self limiting illness
2. avascular necrosis of femoral head 3. boys, 4-8 4.insidous onset,. limp, ache, sore, stiff 5. rest,non weight bearing, braces |
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osteoarthritis
1.what type of condition 2. what is it 3. sx 4. inflammatory/non-inflammatory 5. what worsens the pain 6. clinical findings 7. diagnosed by? |
1. degenerative
2. degenerative joint disease progressing slowly in articulating joints (especially weight bearing) 3. joint pain, stiffness, decreased ROM 4.non inflammatory 5. progression of activity 6. crepitus, herbedens nodes, (distal phalanges) Bouchards nodes (proximal inter phalangeal joints) phalanges 7. xray sx |
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rheumatoid arthritis
1. what type of condition 2. what is it 3. is it common 4. in who 5. dx 6. mainfestations 7. nsg/med care |
1. degenerative condition
2. chronic systemic autoimmune disease w/ INFLAMMATION of connective tissue in the diarthrodial (synovial) joints 3. most common form of inflammatory arthritis 4. women age 60-70 bbut can occur at any age 5. no single test, rheumatoid factor-autoantibodies against abnormal IgG, ESR, hgb, XRAYS to assess progression of the disease 6. subj pain, stiffness, swelling, limitation in the motion and function of multiple joints, worst in AM, obj firm, nontender, subcutaneous nodules on olecranon bursae or extensor surface of forearm, hx or recent infection of Group AB strep (confirmed with ASO titer) ulnar drift, Boutonniere deformity, swan neck deformity (hands), hallux valgus (feet), multisystem involvement and complications include other autoimmune diseases 7.Initially: r/t sx and prevention of P.C. Meds: NSAIDS primarily salicylates (pain, cortisone, inflammation) disease modifying antirheumatic drugs, mydriatics, liquid gold injections, (given IM monitor for SE______chloroquine |
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juvenile rheumatoid arthritis
1.what type of condition 2. onset is by what age 3. what is it 4. about 1/5 have what 5. who does it affect age/sex 6. associated with what 7. dx |
1. degenerative
2. before 16 3. primarily appears as arthritis, may also affect heart and its lining, lungs and their lining, eyes, and skin 4.enlarged spleen and joint inflammation 5. usually between 2-5 years or 9-12 years, more girls than boys 6. may be associaed with family hx and recent rubella vaccinne or infection 7. based on reviews of clinical signs and sx (persistant arthritis in one or more joints for atleast 6 weeks not attributable to another cause. enlarged liver or spleen, swollen lymph nodes, signs of anemia, heart problems, and shortness of breath) Labs and tx same as in adult RA |
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Sjrogrens Syndrome
1. What type of condition 2. P.C 3. other non specific sx 4. increased risk of what 5. A. scleroderma B.polymalgia Rheumatica C. Temporal Arteritis/Giant cell arteritis |
1. systemic autoimmune disease r/t muscolskeletal
2. salivary and tear glands and joints=dry or itchy eyes, dry mouth, decreased taste, difficulty swallowing, joint pain, and swollen glands 3. chronic fatigue and fever 4. lymphoma 5.A.skin, intestine, less commonly thhe lung B. large muscle groups C. arteries of the head and neck |
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Raynauds Phenomenon
1. what type of condition 2. what does it affect 3. Who gets it alot |
1.localized autoimmine diseases
2. fingers, toes, nose, ears 3.MS* CNS |
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Gullian-Barre Syndrome
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infectious polyneuritis, acute inflammatory polyneuropathy (CNS)
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Systemic Lupus Erhthematosus
1. What is it 2. in who 3. cause 4. may effect what 5.signs/sx 6. dx 7. NSG/MEDICAL treatment |
1. chronic inflammatory autoimmune disorder
2. women 3.production of autoantibodies directed against constituents of cellular dna 4. may affect skin, joints, kidneys, lungs, nervous system, and/or other organs of the body 5. arthritis involving multiple joints**buttefly shaped facial rash on sun exposed skin , fatigue, fever, sores in the nouth or nose for more than a month, alopecia, seizures, strokes, and mental disorders, anemia 6.-ANA increased + anti sm + anti cisto 9WHEN CAUSED BY DRUGS) -ANTI-PHOSPHOLIPID ANTIBODIES + CONFIRM DX AND SHOWS P.C. RISK EX. HIGH RISK FOR MISCARRIAGE, BLOOD CLOTS cva, cvd) -urinalysisshows blood, casts, protein -CBC-decrease in some cell types, including platelets -rheumatoid factor-positive -serum protein electrophoresis-increased gamma globulin proteins -SED rate and c reactive protein-increased -cryoglobulin=positive, cryoglobulins are abnormal proteins in the bloodthat will precipitate when the body temperature drops below normal, causing blockage of the b |
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Gout-Chronic Gouty Arthritis
1. what type of disease 2. what is it 3. Comp. 4.Diagnosis 5.Meds/treatment |
1. autoimmune metabolic disease related to the musculoskeletal system
2. over production of uric acid or a reduced ability of the kidneys to eliminate it. Uric acid is deposited in the joints-cartilage, tendons, and soft tissue-particularly the feet and legs-causing pain 3. chronic kidney failure, more frequent in people with type 2 diabetes , obesity, sickle cell anemia, and kidney disease, or men and postmenopausal women have the highest risk 4. SYNOVIAL FLUID ANALYSIS- to detect crystals derived from uric acid; uric acid-to detect high levels in the blood KIDNEY FUNCTION TEST-to determine if uric acid crystals are accumulating in the kidneys and impairing their function. -X_RAYS of the affected joints may show tophi (uric acid deposits) and damage indicative of gouty arthritis 5. probenecid or sulfinpyrazone, which lowers uric acid, Colchicine-pain relief in 12-24 hours PO meds 4-12 hours IV med. Fluids-intake helps the kidneys flush out uric acid. Diet:alkaline Ash, limit protien (uric acid is |
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Scleroderma
1.What type of disorder 2.What is it 3. more often in who 4. signs/sx 5. dx 6.tx |
1. autoimmune disorder related to musculoskeletal
2. fibrotic inflammatory and degenerative changes, fibrotic increases in connective tissue throughout the body, effects skin, blood vessels, synovial membranes, espohagus, heart , lungs, kidneys, GI tract 3.women 4. articular pain and weakness-hard skin that eventually adheres to underlying structures, telagectasis lips, fingers, tongue, mask like appearance, dysphagia, raynauds 5. +LE prep, gamma globulin levels, antinuclear antibodies present, CREST SYNDROME-a group of symptoms associated with poor prognosis, calcium deep in organs, raynauds, esophageal dysfunction, sceradactyl (digits) telangiectasia 6. NSAIDS, sterois, vasodilators (for raynauds sx) P.T. |
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Carpel Tunnel
1.What type of disorder 2. caused by what |
1. autoimmune related to musculoskeletal
2. caused by inflammation or fibrosis of tendon sheath that results in median nerve compressed by edema |
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Fractures
1. pathological 2. closed 3.open 4. comminuted 5. transverse 6.oblique 7.greenstick 8. spiral 9.impacted 10.compression |
1. results from disease process of bone ie.osteoporosis
2. simple, uncomplicated, does not cause break in the skin 3. compound, complicated, trauma to surrounding tissue and break in the skin 4. produce several breaks in the bone, producing splinters abnd fragments 5.break straight across 6. break at angle 7. breaks one side of bone and bends the other side, occurs in children whose bones are soft and pliable 8. most likely type of fracture in abuse, encircling bone (twisting force 9.loading force applied to the long axis of the bone |
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Fracture
1.signs of 2.emergency care of fracture 3.tx A. physical manipulation B. external fixation device |
1. pain/tenderness on movement, crepitus (grading sound of bone on movement), edema, eccymosis, loss of function of extremity, shortening of extremity, rotation
2. splinting to immobilize and prevent further damage 3. physical manipulation-closed reduction to restore alignment, SURGERY-open reduction with external fixation, insertion of screws, plates, pins, wires, nails, or rods, Casting to immobilize and align B. External Fixation Device-when a fracture accompanies soft tissue Traction: opposing force to reduce/immobilize via weight and pulley system provides proper bone alignment, reduces muscle spasm. ex. bucks in a hip fracture preop prevents muscle spasms to decrease pain and aligns femur Continous-constant pull Intermittent-weights released intermittlently Running-(straight)-a direct pull on the affected part-clients body as counteraction Suspension-(balance)-exerts a pull on the affected part-supports extremity in a splint which is held by balanced weights attached to an overhead |
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Skin Traction
1.holds how much weight 2. what does this mean 3. a.BUCKS b.russel c. bryants |
1.5-10 lb weights
2. applying, belt, boot, or ace wrap directly to skin and attaching weights 3.a.refabricated velcro boot (asses skin along with CMS by looking under the boot) used for TEMP, Immobilize in hip fx observe for foot drop could mean nerve damage b.balnced traction lower part of leg, support in hammack attached to rope and pulleys on balkan frame at foot of bed for Bryants both legs extend straight used for femoral, fx in peds |
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skeletal traction
1.holds how much weight 2. what is done A.Skull tongs B.Halo traction |
1. 15-30 lb weights
2. insertin surgically pins (steinman), wires(kirschner), head tongs (crutchfield or gardner Wells) or screws directly in the bone 3. Crutchfield or gardner wells-running traction with weights attached, spine is immobilized to allow vertebrae to slip back B. fits around head by 4 skull pins inserted through threaded holes in the ring . can be connected to a plaster body cast or plastic halo vest |
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What are the potential complications of fractures ?
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1.thromboembolism-sx:pain on dorsiflexion of affected leg, 2.Hemorrhage infection-open fractures, must unpleasant odor and drainage "hot Spot" felt on cast increase temp window may be cut for observation
3.Shock-hypovolemic 4.fat embolism syndrome-fat globules released from yellow bone marrow migrate to pulmonary area 5.Compartment syndrome-cause by bleeding or edema into a compartment that consists of muscle, bone, nerves, and blood vessels wrapped by a fibrous membrane Sx: apin not relieved by analgesics, pulselessness, low cap refill, pallor, blanching, cyanosis, motor paralysis, numbness, tingling Tx. Fasciotomy |
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Nursing Care for fractures
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1.the 5 P's, warmth, color, motion, sensitivity, pain control, adm. meds around the clock assess for signs of GAS Gangrene can develop 2-5 days after deep wound injury, crepitus, pallor, bronzed or blackened wound, tissue necrosis
observe for signs of embolism (fat or blood)chest pain, pallor, diaphoresis, dyspnea prevent p.c. ofg immobility, skin, positioning, nutritous diet (protein, vit c) petal casts, etc. INfection-assess site, TCDB, inspirometer, LS VS circle date and discharge found on cast or odor from cast, temp, etc Constipation- increase fluids, stool softener, laxatives per order, stones increase fluids, cast care on pillow keep uncovered, pt bed rest until cast is dried Traction care wights hang freely, released only on MD order, trapeze for mobility, fracture pan, positioning, alignment, check skin for irritation, avoid sheering force Teach isomnetric exercises to pprevent atrophy, teach crutch walking, walker use, transfers, proper positioning ex.less flexion for post op hip repair, abdu |
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Joint Replacement
1.What is it 2. results are 3. nsg care |
1. surgical removal of damaged bone or joint tissue, which is replaced with metal ceramic or plastic parts
2. excellent, especially for knees and hips, other joints such as shoulders, eelbows and nuckles may also be replaced 3. mobility, decrease pain, increase self esteem, increase perfusion |
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Slipped Femoral Epiphysis
1.What is it? 2. r/t what 3. sx 4. population 5. dx 6. tx 7.comp. 8.clinical man. |
1. displacement of epiphysis over the femoral neck. Acetabulum slips off in a backward direction associated with growth spurt, renal osteodystrophy, rickets/malnutrition (young children and neonates), trauma *overweight, and endocrine factors (hypothyroidism)
3. pain radiating down anteromedial thigh to knee, of 2-3. weeks duration. extend rotate leg 4. *most often in boys 10-17, tends to be bilateral 5. history, physical exam, observation of the gait/walking pattern and xrays and or sonogram 6. fixing the femoral head with pins or screws 7. avascular necrosis Chondrolysis (more commonly in females) within a year of slippage. remodeling deformities, degenerative osteoarthritis 8. impaired motor function-immobility, muscular weakness altered neuromuscular function-diminished pulse or sensation at the distal end of a casted extremity alterations in comfort-acute and chronic pain |
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What is comorbidities?
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history or presence of other conditions. ie. diabetes, obesity, alcoholism
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analgesics
s.e. |
respiratory depression, constipation
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NSAIDS
s.e. |
GI irritation, bleeding, (w asa)
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Agents that treat osteoporosis
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Fosamax--remain upright x30 minutes
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antimicrobials do what
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fight infection
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problems with steroids
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risk for infection, immune response,masks sx of infection
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antimetabolites
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k
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isometric
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Same length; Muscle contraction without noticeable change in length of muscle (velocity = 0); No physical work done, but tension and force output production are high; Contraction must be held for at least 6 seconds to develop peak tension
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Patient monitoring
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integumentary system, vital signs, neurovascular assesment
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general preop care
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1.stop taking ASA 2 weeks prior
2. monitor V.S and labs for infection, anemia, etc., teaching, procedure, postop care,consent signed |
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General post op
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1. monitor for p.c. airway, t.c.d.b., inspirometer, lung sounds, sats, V.S., (hemorrhage, infection) CMS peripheral vascular assessment (blood clot) fluid and electrolyte balance (I and O) pain control and measures specific to the procedure
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Orif
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1. repair of hip fracture or dislocation
2. sx--extension rotation shortening of affected extremity, pain 3.assess 5 p's 4.may have Bucks traction 5. Preop: prevents pain, muscle spasms and aligns femur) 6P.C.: thrombus, embolism, infection 7. NSG:pillow b/t legs, trochanter roll to prevent extension rotation avoid flexing of the hip, weight bearing depends on type of device used, teds, ankle pumps, encourage quadraceps exercises, check drainage, pain control admin prior to pt monitor labs, Ptt for heparin for 20-30 sec, assess neurovascular function, 5 p's |
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WHat are the 5 p's
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pain, pulselessness, pallor, paresthesia, paralysis
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Amputation
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1.Preop: copin support, neurovascular assessment,
2.Post: muscle strengthening for crutch, and walking, residual limb (stump) on pillow to reduce edema 1st 12-24 hours after that you can remove pillow to prevent contractures and promote functional alignment, raise foot of bed LE amputee prone, position 2x/day to prevent hi contractures and to stretch flexor muscles 3. tx: for phantom pain , monitor dressing for bleeding, pressure dressing in place |
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Total knee replacement
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CPM adv per MD orders, monitor CMS, pain, infection, risk, dressing, ace drain
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When is a rod insertion used for?
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scoliosis
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is ROM objective or subjective?
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objective
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Labs
1.ESR 2. Rheumatoid factor 3. C reactive protein 4. MRI 5. CT scan 6.antinuclear antibodies 7.Bone SCAN 8. bone densitometry 9Arthroscopy 10.Myelography |
1.serology in inflammation and infection
2.serology autoantibodies against abnormal IgG found in 80% of pts with rheumatoid arthritis and other connective tissue diseases. (pos in lupus) normal less than 40 3.serology in inflammation and infection evaluating severity and course of an inflammatory process 4. teach pt about procedure, 90 minutes, enclosed in small tube, claustrophobia, relaxation techniques, assess for contrindications ex. pacemaker, metal plates, remove dentures, earing, hair pins, etc., jewelry, metal fasteners, toilet pt prior, provides cross sectional view of bone marrow blood vessels (blood velocity, spinal cord white grey matter of brain, hear, breast tissue, eye structures, etc. 5.check for iodine allergy if being done w/ contrast, npo 4 hour prior, remove wigs, clips, pins, teach pt what to expect-to lie still in tube while x rays are taken, info on tumors,infarcted areas, atrophy, vascular lesions 6. antibodies that go against the cell nucleus, or central controlling part of the |
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assign pt care
1.remove and reapply elastic stockings of a pt with a total hip replacement 2.pincare in a ot with an external fixator following a fracture 3. monitor pts response to the use of continous ROM machine 2. |
1. stna
2. LPN 3.RN |
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provide what type of device for a pt following a hip replacement
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abductor device
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provide safety measures for who?
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a pt in traction
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Continous passive motion machine does what? (knee replacement)
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stimulates regeneration of articular tissue, provides ROM without weight bearing
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maintain what for a pt with a fractured femur
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skeletal traction
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a casted extremity should be what?
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elevated
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monitor what in a child with a hip spica cast?
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skin condition
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monitor what for a pt following surgical correction of scoliosis
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urinary output
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what type of meds should be administered to a pt with arthritis
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antiinflammatory
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teach pt with osteoporosis how to take what kind of med?
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fosamax--empty stomach, stay in upright position x30 minutes after
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at home what should be arranged for a child in a hip spica cast
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at home tutoring, and correct body allignment
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where does an arthroscope go
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into a joint for visualization or surgery
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arthrocentesis
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incision or puncture of joint capsule to obtain samples of synovial fluid from within joint cavity or to remove excess fluid
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refer patient with total hip replacement where?
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home physical therapy
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teach pt with leg calve perthes disease what
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about appliances used
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teach parent of a child with scoliosis the application schedule for the brace
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on 23 hours a day
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where should a child with juvenile rheumatoid arthritis to what org.
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american juvenile rheumatoid arthritis foundation
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What is osteomalacia?
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softening of the bones due to a lack of vitamin D or
a problem with the body's ability to break down and use this vitamin. |
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1.who can report ambulation before fatigued?
2. who can report pts ADL management 3. who can report pain level |
1.STNA
2. home health aide 3.LPN |
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suggested code for functional level classification
1. 0 2. 1 3. 2 4. 3 5. 4 |
1.completely independent
2. requires use of equipment or device 3. requires help from anoother person for assistance, supervision, or teaching 4. requires help from another person, equipment, or device 5.is dependent does not participate in activity--restricted movement affects the ability to perform most ADL's, safet with ambulation is a concern |
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What are potential effecs of immobility
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skin break down
muscle weakness thrombophlebitis constipation pneumonia depression |
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assess for developing thrombophlebitis
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calf pain, homans sign
redness, localized swelling, and rise in temp |
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what nutritional needs relate to immobility
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possible hypocalcemia, negative nitrogen balance, pressure sores develp more quickly in a pt with a nutrition deficit
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feet should be supported in what position?
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dorsiflexed
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point of a bed cradle
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keeps heavy bed linen off feet
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how often should a pt be turned to prone or semiprone and why?
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once daily to drain bronchil tree
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foods high in bulk will do what?
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encourage bowel movement
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joints should be exercised to what point?
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to the point of pain but not beyond
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when should you not apply cold to acute injury or inflammation
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anesthetic skin
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when shoudl u not apply cold to acute or chronic pain?
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cold allergy or cold induced urticaria
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when should u not apply cold to acute/chronic muscle spasm?
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cold induced myocardial ischemia (or other unstable heart or lung disease)
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when should u not apply cold to neuralgia?
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diabetes mellitus (when complicated by vascular disease or sensory loss)
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when should u not apply cold to postsurgical pain and edema?
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peripheral vascular disease
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when should u not apply cold to use prior to rehab exercises?
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raynauds phenomenon
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when should u not apply cold to small superficial first degree burns?
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systemic lupus erythematosus
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when should u not apply cold to spasticity accompanying central nervous system disorders
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uncovered open wounds
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Contusions (bruise)
1.DEFINTION 2.FINDINGS 3. MANAGEMENT 4.RESOLUTION |
1. A FALL OR BLOW BREAKS CAPILLARIES BUT NOT SKIN
2. FINDINGS-ECCHYMOSIS (BRUISE) AND PAIN WHEN THE CONTUSION IS PALPATED 3.-FOR FIRST 24-48 HOURS, APPLY ICE FOR 15 MINUTES, THREE TIMES A DAY THEN APPLY HEAT IF NECESSARY -WRAP TO COMPRESS 4.RESOLUTION: SHOULD HEAL WITHIN 7-10 DAYS color changes: from a blackish-bluish to greenish-yellow after 3-5 days |
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Strains
1.definition 2.etiology and patho 3. assessment of acute first-degree strain 4.management of acute 1st degree strain |
1. lesser injury of the muscle attachment to the bone
2. caused by overstretching, overexertion, or misuse of muscle Acute:recent injury to muscle or tendon; classified by degree First degree: mild; gradual onset; feels stiff; sore locally 3. tenderness to palpation, muscle spasm, no loss of range of motion, little or no edema or ecchymosis 4. comfort measures, apply ice, rest-possibly immobilization for short term |
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Assessment of Acute 2nd degree strain
1.what is it 2.management |
1. moderate stretching, sudden onset, with acute pain that eventually leaves area tender
extreme muscle spasm, passive motion increases pain, edema develops early, echymosis later 2. keep limb elevated, apply ice for the first 24-48 hours-then moist heat, limb mobility, muscle relaxants, analgesics, NSAIDS, physical therapy for strength and ROM |
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Assessment of Acute 3rd Degree strain
1.What is it 2. management 3. Chronic Strain |
1. severe stretching with tear, sudden snapping or burning sensation
muscle spasm, jopint tenderness, edema (may be extreme), client cant move muscle voluntarily, delayed ecchymosis 2. keep limb elevated, apply ice for 24-48 hours, then moist heat, either immobilize or limit mobility of limb, meds: muscle relaxants, analgesics, NSAIDS, physical therapy for strength and ROM 3. long term overstretching of muscle/tendon |
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Sprain
1. definition 2.ALSO 3.Management |
1. GREATER THAN STRAIN; INJURY TO LIGAMENT STRUCTURES BY STRETCHING, exertion or trauma
2. minimal tearing of ligament fibers, localized edema or hematoma, no loss of function, no weakining of joint structure-joint integrity remains intact, mild discomfort at location of injury, pain increases with palpation or weight bearing 3. compress with ace bandage to limit swelling, keep limb raised to decrease edema, apply ice 24-48 hrs following injury, analgesics for discomfort, isometric exercises to increase circulation and resolve hematoma |
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Second Degree Sprain
1.definition 2. Also 3.Management |
1. repeated use of muscle beyond physiologic limits
up to 1/2 of ligament fibers are torn, increased edema and possible hematoma, decreased active ROM, increased pain, milk weakining of joint and loss of function 3. protectively dress/splint the joint, immobilize it, elevate the limb to decrease edema, for 24-48 hours, alternate ice and moist heat--ice to produce vsoconstriciton to decrease swelling to reduce transmission of nerve impulses and conductive velocity to decrease pain Moist Heat-to reduce swelling and provide comfoort, analgesics for discomfort, physical therapy to increase circulation and maintain nutrition to the cartilage |
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Third Degree Sprain
1.What is it 2.management |
1.complete rupture of the ligamentous attachment, severe edema with hematoma, usually severe pain, dramatic decrease in active ROM, loss of joint integrity and function
2. casting, srugery, see second degree treatment |
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Fractures
1.Definition 2.fracture dislocation |
1.fracture is any alternation in the coontinuity of a bone
2. a fracture in which the joint iis dislocated in that position, fracture will not heal complete |
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Fracture by completeness
1.complete 2.incomplete |
1. bone broken in 2 or more pieces
2. bone broken but still in 1 piece |
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Fracture by wound
1.closed 2.open |
1. simple, doesnt break skin
2.compound=complex -bone fragments break through skin -injures soft tissue and often infects tissue -subdivided by degree of soft tissue injury |
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Fracture By fracture Line
1.longitudinal 2.oblique 3.spiral 4.transverse |
1. linear fracture
2. produced by a twisting force, and requires traction to heal properly 3. also results from twisting force, may accompany damage to soft tissue, and requires traction or internal fixation 4. caused by angulation, common in patho fractures, and generally stable after reduction |
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Fracture by type
1. avulsion fractures, bone fragments and soft tissue 2. comminuted fractures 3. compression fractures 4. greenstick fractures 5.impacted fractures 6.stress fracture 7.incomplete fracture |
1. pulled away from the bone results from a direct force on the bone
2. produced by high energy forces results in 2 or more bone fragments splinters the fragments injures soft tissue severly 3. often seen in the lumbar spine, may be pathological (a disease weakens the bone) 4. results in an incomplete fracture caused by: compression, angulation, cortex of the bone bends to one side and buckles on the other, cortex stays in tact on the side subject to tension forces and fractures on the opposing side, requires reduction or completion of the fracture line through the cortex 5.(telescoped) direct force breaks bone and telescopes the fragment with the smaller diameter into the fragment with the larger diameter fracture fragments move in unison, rapid union occurs 6.stress fracture 7. results of repetitive trauma to region 2 types -fatigue:from repeated trauma -insufficiency:pathological fracture |
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Classification by location of bone
1. apophyseal growth plate of long bone may effect growth 2. articular 3. condylar 4. cortical 5. diaphyseal 6. epiphyseal 7.extracapsular 8. intraarticular 9.intracapsular 10. metaphyseal 11. periarticular 12. subperiosteal 13. supracondylar |
1.
2.Of or relating to a joint 3.a formen in front of each condyle of the occipital bone 4.Of, relating to, associated with, or depending on the cerebral cortex. 5. Pertaining to or affecting the shaft of a long bone 6. 7.outside the capsular ligament of a joint. 8.situated within, occurring within, or administered by entering a joint 9.situated or occurring within a capsule 10.of or relating to a metaphysis 11.the tissues surrounding a joint 12.situated or occurring beneath the periosteum 13.supracondylar frxs typically remains extra-articular & involves thin bone between coronoid fossa & olecranon fossa of distal humerus |
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Fractures:patho
predisposing factors |
1.biologic
2. bone density 3. clients age |
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Fractures:patho
extrinsic factors |
1.force-direct or indirect
2. rate of loading (how fast the force strikes) |
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Fractures:patho
intrinsic factors-bone capabilities |
1.patho fractures bone is weakened by disease
2. fractures occur in response to minimal or no applied stress |
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Fractures:patho
classification by cause |
1.general disorder: developmental, nutritional, hormonally controlled
2.local: neoplasm, infection, cystic lesion |
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Fractures:patho
Behavioral Factors |
high risk activities (such as football, ballet)
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Fractures:management
closed reduction |
1.purposes: realign bone fragments for healing, minimal deformity, minimal pain
2.pre and post reduction x rays are essential to determine succesful reduction of fracture |
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Fractures:management
Immobilization |
1.relieves pain
2. keep bone fragments from moving 3. methods:cast-synthetic or plaster, traction-skin or skeletal, splints, braces, and external fixation |
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External fixator: Ilizarov Device
1.what is it 2. how does it work 3. how much does it lengthen limb 4. when do you teach client and about what 5. how long can client have device on |
1. specialized type of external fixator used for non union fractures and limb lengthening needed due to congenital deformities
2. tension wires are inserted into the bone and then attached to rings outside the body. These rings are joined by telescoping rods attached to a rigid frame. Daily adjustments of the rods causes the wires to turn, which stimulates bone formation 3.about 1 cm per month 4. before discharge: care for pin, to adjust rod 5.for several months |
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Type of Traction
1.manual 2.skin 3.skeletal 4. open treatment |
1. applied by pulling on extremity-may be used during cast application
2. applied by pulling force through the clients skin-used to relax the muscle spasm 3. applied directly through pins into the clients bone-used to align fracture 4. (see orthopedic surgery that follows) |
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Stages of Bone Healing
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1.hematoma formation
2. fibrocartilage/granulation tissue formation 3. callus formation 4.ossification 5.consolidation/remodeling |
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Evidence of a healed fracture
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1. radiographic
A. presence of external callus or cortical bone across the fracture site B. fracture line may remain long after healing C.clinical 2.peices of bone no onger move at fracture site 3. no tenderness over fracture site 4.weight bearing is pain free |
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Complications of a fracture
1.shock 2.fat embolism 3. compartment syndrome 4. DVT 5. Pulmonary embolism |
1. higher risk with pelvic and femur
2. occurs after initial 24 hours from the injury 3. a nursing emergency 4. DVT 5. a complication of DVT, findings include chest pain (pleuritic), sudden shortness of breath, tachycardia, palpitations, or change in mental status if PE is suspected, do not leave client. Get chage nurse to notify health care provider immediately, DIagnosis confirmed via ventilation/perfusion scan or pulmonary angiography |
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Delayed Complications of a fracture
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1.joint stiffness
2. post traumatic arthritis (osteoarthritis, type II) 3.REFLEX SYMPATHETIC DYSTROPHY 4.painful dysfunction and disuse syndrome characterized by abnormal pain and swelling of the extremity 5. myositis ossificans A. formation of hypertrophic bone near bone and muscles forms in response to traumas B. hypertrophic bone is removed when bone is mature 6.malunion A.fracture healing is not stopped but slowed B. prevention of malunion 1.reduce and immobilize properly 2. be sure clients understand limits on activity and position 7. delayed union A. fracture doesnt heal, more common with multiple fracture fragment B. no evidence of fracture healing 4-6 months after the fracture 8.loss of adequate reduction 9.refracture |
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What are the NSG interventions for a fracture
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1.monitor for peripheral neurovascular deficit
2. elevate limb above heart (except with compartment syndrome) 3. aaply cold to minimize edema 4. asses pain on 1-10 and manage it 5. teach client how fractur will heal while being immobilized, how to bear weight and how much if permitted, how bones heal, how to use assistive devices to walk 6.prevent and monitor for infection, impaired skin integrity, impaired gas exchange 7. mobilize client ASAP 8. turn client atleast every 2 hrs. 9. position client properly with alignment in mind 10. use orthopedic devices to limit skin impairment |
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Factors that affect healing of fractures
What enhances heealing? |
1.fracture is near good supply of blood
2. minimal damage to soft tissue 3. anatomic reduction 4. fragments in good position to heal 5. immobilization 6.weight can be borne on long bones |
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Factors that affect healing of fractures
What hinders healing? |
1.poor blood supply to one or more bone fragments (mid shaft fractures have less blood supply)
2.severe damage to soft tissue 3. seperation of fragments 4. traction pulls fragments apart 5. improper fixation lets bones move or rotate 6. preexisting factors:obesity, diabetes mellitus, use of steroids 7.severe comminution 8.bone loss 9.infection |
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Fractures are classified by what 5 parameters?
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1. completeness complete/incomplete
2. wound in flesh (closed or open) 3.fracture line in bone (4 lines) 4. type (6 types of impact and damage) 5.location in the bone |
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Radiographs
1.What is it? 2. about it? 3.includes what? |
1.2 dimensional representation of the bone and soft tissue
2. -include joints above and below suspected fracture -clinical evidence of fracture overrides negative x ray analysis It will also offer evidence of..... -bone pathology -bone density (in advanced cases of osteoporosis) 3. Computerized tomogram scan-specialized tomograms Magnetic Resonance Imaging scan-clearer views of soft tissue structures Bone Scan-increased uptake of contrast may indicate A.fracture B.infection C.tumor growth |
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reflex sympathetic dystrophy
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an abnormal response of nerves of the face or an extremity, marked by pain, autonomic dysfunction, vasomotor instability, and tissue swelling. ALthough the precise cause of the syndrome is unknown, it often follows trauma, stroke, neuropathy, or radiculopathy. In about 1/3 of all patients, the onset is insidous. Affected pts often complain of burning pain with any movement of an affected body part, excessive sensitivity to light touch or minor stimulation, temp changes (heat or cold) in the affected limb, localized sweating, localized changes of skin color, or atrophic changes in the skin, nails, or musculature
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Physiologic effects of heat and cold
Heat 1.vasodilation 2.increases cap perm 3. increases cellular metabolism 4. relaxes muscles 5. increases inflammation, increases blood flow to an area 6. decreases pain by relaxing muscles 7. sedative effect 8.reduces joint stiffness by decreasing viscosity of synovial fluids |
Cold
1.vasoconstriciton 2. decreases cap perm 3. decreases cellular metabolism 4. relaxes muscles 5. slows bacterial growth, decreases inflammation 6. decreases pain by numbing the area, slowing the flow of pain impulses, and by increasing the pain threshold 7.local anesthetic affect 8.decreases bleeding |
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What are the 5 stages of bone healing?
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1.hematoma formation
2. granulation tissue formation 3. callus formation 4.ossification 5.consolidation/remodeling |
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Step I: Hematoma formation
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a.1-3 days
b. blood clot forms around the fracture site c.bone necrosis occurs distal to the fracture site do to a loss of blood |
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Step II.:Granulation Tissue Formation
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a. begins 3 days to 2 weeks after fracture
b. osteoclast formation in fibrous matrix of collagen c.fibroblasts 1.from outer layer of periosteum 2.from damaged connective tissue d. osteoblasts 1.from the periosteum and marrow cavity 2.develop collagen E. vascular and mechanical factors affect healing 1.motion 2.distraction of fracture fragments |
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Step III:Callus Formation
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A.2-6 weeks
b. granulation tissue is matured into a callus c. siza and shape of callus in direct response to the amount of dispacement of fracture fragments D. Phagocytosis breaks down and removes the formed hematoma E. delay at this stage delayed union or nonunion of bone |
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Step IV. Ossification
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A.3 weeks to 6 months
B. The gap in the bone is bridged and union occurs |
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Step V. Consolidation/remodeling
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a.6 weeks to one year
b. calus becomes calcified and bends into the bone c.fracture line may still be evidence on radiographs |
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Compartment Syndrome
1.Definition 2.2 types 3.Acute 4.chronic 5.patho |
1.increased pressure in a limited space (muscle compartment) cramps the circulation and function of the tissues within that space
2. acute and chronic (exertional) 3. A. following trauma to the muscle B. External Forces: casting/bracing compresses limb C. Internal FOrces: Compartment content increases; space does not D. Results in necrosis of the tissue 4. when exercise of a limb raises intracompartmental pressure and produces deficits 5. a.schemia edema pathology cycle b.if cycle lasts more than 6 hours, neuromusclar damage is irreversible c.duration of 24 to 48 hours:extremity may be paralyzed d. may develop rapidly for up to 6 days after initial trauma e. a nursing emergency f. compression occurs of the vessels and nerves |
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What are the instructionas for a pt with a cast
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1. keep casted limb elevated above his heart to minimize swelling. Instruct him to elevate a casted leg by lying supine withhis leg on top of pillows and to position a casted arm so that his hand and elbow are higher than his shoulder.
2. advise pt to call healthcare provider if he cant move his fingers or toes; numbness or tingling in affected extremity; or has sx of infection: fever, pain, or fould odor from cast 3. teach pt to maintqain muscle strength by continuing exercises that he performed in the hospital, but not without approval first from the health care provider or bear weight without approval 4. dont get cast wet cuz moisture will weaken or destroy it. dont insert anything like backscratcher or powder to relieve itching. foreign matter can damage skin and cause infection. Alcohol can be used on skin at the casts edges 5. warn pt not to chip, crush, cut or break any area of the cast. if cast needs repair notify dr. 6. if pt needs crutches teach him how to use properly. Also teach to remove th |
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7 different casts
1.short arm cast 2. long arm cast 3. body jacket cast 4. single hip spica cast 5. double hip spica cast 6. long leg cast 7.short leg cast |
1. goes till right before elbow
2. up to shoulder 3.under arm pits to groin area (back, belly, sides, wrapped aound) 4. wrapped around back/belly down one leg to ankle 5. wrapped around body and both legs down to ankle and connected in middleby a casted bar that connects both legs to hold still 6. up to thigh 7.up to knee |
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What is urticaria?
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hives
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sx of complication of lupus?
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fever, edema, decreased urine ouput, chest pain, dyspnea
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What 2 foundations could help a pt with lupus?
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arthritis foundation and lupus foundation
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What should be applied to stiff sore joints?
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moist heat (hot packs and warm shower)
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sjogren's syndrome
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autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva.
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inflammation in the heart causes what?
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valvular lesions
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pericarditis
1.what is it 2.sx |
1.a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.
2.Ankle, feet and leg swelling (occasionally) Anxiety Breathing difficulty when lying down Chest pain, caused by the inflamed pericardium rubbing against the heart May radiate to the neck, shoulder, back or abdomen Often increases with deep breathing and lying flat, and may increase with coughing and swallowing Pleuritis type: a sharp, stabbing pain Usually relieved by sitting up and leaning forward Dry cough Fatigue Fever Need to bend over or hold the chest while breathing |
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myocarditis
1. what is it 2. sx |
1.inflammation of the heart muscle
2.There may be no symptoms. If symptoms occur, they may include: Abnormal heartbeat Chest pain that may resemble a heart attack Fatigue Fever and other signs of infection including headache, muscle aches, sore throat, diarrhea, or rashes Joint pain or swelling Leg swelling Shortness of breath Other symptoms that may occur with this disease: Fainting, often related to irregular heart rhythms Low urine output |
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amyloidosis
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Amyloidosis is a group of diseases that result from the abnormal deposition of a particular protein, called amyloid, in various tissues of the body.
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tenosynovitis
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inflammation of tendons on the side of the wrist at the base of the thumb
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myositis
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Inflammation of muscle tissue
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rheumatoid vasculitis
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patients with rheumatoid arthritis, a chronic disease with painful inflammation of the joints, who also develop inflammatory disease in small and medium-sized blood vessels.
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edema
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observable swelling from fluid accumulation in body tissues
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keratoconjunctivitis
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Inflammation of the eye involving both the cornea and the conjunctiva, can be due to diverse causes, including infections and autoimmunity
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episcleritis
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Inflammation of the episclera, a thin membrane that covers the sclera (the white of the eye). Episcleritis is typically benign,
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lymphadenopathy
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Abnormally enlarged lymph nodes
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interstitial fibrosis
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is scarring of the lung caused by a variety of inhaled agents including mineral particles, organic dusts, and oxidant gases.
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pleuritis
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is inflammation of the lining of the lungs that causes pain
when you take a breath or cough. The main symptom of pleurisy is pain in the chest. Some people feel the pain in the shoulder. |
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caplans syndrome
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Caplan syndrome is swelling (inflammation) and scarring of the lungs in people with rheumatoid arthritis who have been exposed to mining dust, such as coal, silica, or asbestos.
Causes Caplan syndrome is caused by breathing in mining dust, which causes inflammation and can lead to the development of many small lung bumps (nodules) and mild asthma-like airway disease. |
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rheumotoid nodules
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Rheumatoid lung disease is a group of lung problems related to rheumatoid arthritis. The condition can include fluid in the chest (pleural effusions), scarring (pulmonary fibrosis), lumps (nodules), and high blood pressure in the lungs (pulmonary hypertension).
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carpal tunnel syndrome
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The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually. As they worsen, grasping objects can become difficult.
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peripheral neuropathy
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is a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, and an inability to control muscles.
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discoid erythema
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an inflammation of subcutaneous fat tissue. If the inflammation is pressed it causes quite a lot of pain. It appears to be a painful bruise on both the shins. Other bumps may be seen on the elbows, knees, thighs and forearms. The person affected by Erythema nodosum may feel as if suffering from flu.
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palmar erythema
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reddening of the palms
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mucosal ulcers
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recurrent small ulcers inside his lip, gums & tongue
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pericarditis
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is a condition in which the sac-like covering around the
heart (pericardium) becomes inflamed. |
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pleural effusion
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accumulation of fluid between the layers of
tissue that line the lungs and chest cavity. |
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pneumonitis
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inflammation of the lung caused by bacteria, mold, fungi, and inorganic matter.
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glomerulonephritis
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is a type of kidney disease caused by inflammation
of the internal kidney structures (glomeruli), which help filter waste and fluids from the blood. |
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arthritis
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inflammation of one or more joints, which results in
pain, swelling, stiffness, and limited movement |
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myositis
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inflammation of your skeletal muscles, which are also called the voluntary muscles. T
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synovitis
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term for inflammation of the synovial membrane. This membrane lines joints which possess cavities, known as synovial joints
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where does a CVA, seizures, peripheral neuropathy, psychosis, and organic brain syndrome occur?
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central nervous system
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organic brain syndrome
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Dementia
Confusion Delirium Restlessness Alteration In Consciousness Aggression Memory Loss Grand Mal Seizure Combative Behavior Hard to Awaken Impaired Self-Care Aimless Movement |
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psychosis
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is a loss of contact with reality, usually including false ideas about what is taking place or who one is(delusions) and seeing or hearing things that aren''t there(hallucinations
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peripheral neuropathy
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a problem with the nerves that carry information to and from the brain and spinal cord. This can produce pain, loss of sensation, and an inability to control muscles
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hematopoietic system
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The bodily system of organs and tissues, primarily the bone marrow, spleen, tonsils, and lymph nodes, involved in the production of blood.
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thrombocytopenia
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any disorder in which there are not enough
platelets. Platelets are cells in the blood that help blood to clot |
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butterfly rash
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A red, flat facial rash over the bridge of the nose
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feltys syndrome
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rheumatoid arthritis, an enlarged spleen, an abnormally low white blood count),
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