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110 Cards in this Set
- Front
- Back
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what type of inspection should be done of an injury initially?
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apparent asymmetry, sitting and standing posture, gait, build of the body, clients limitations, skin assessment
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What should be asked of a patient who has musculoskeletal pain?
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duration, pain/discomfort, unilateral/bilateral, what treatments they have tried, what they think it is (perception)
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What are the 5 Ps?
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pain
pulses parathesia pallor paralysis |
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when palpating a severe injury what is expected
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elevated skin temp, local tenderness, swelling, crepitation
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noisy joints - creaking scraping grinding
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crepitation
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what type of muscle strength is there?
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flaccidity
hypotonicity hypertonicity- spasming? |
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what must be checked in a neurovascular assessment (5 p stuff)
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PP- distally and proximally to the injury
color (normal?), edema (how much?), temp (white, blanchy, cold- tissue perfusion), pain, cap refill, sensory motor function |
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what level increases with the distruction of bone?
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alk pos
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what two common lab values have an inverse relationship?
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calcium and phosphate
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what is used to determine bone density- (used for osteoporosis)?
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DEXA bone scan
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used to show bone fractures, stress, degeneration
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x-rays
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used for osteomylitis to determine bone condition. Used with contrast dye (NOT METFORMIN)
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bone scan
CT scan uses dye too |
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used for muniscous tears and soft tissue tears. Can clean out the joint or dye the joint. Can be used for Dx or Tx
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arthroscopy
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used to remove excess fluid from joints
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joint aspirations
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used to determine disc health in spine - used especially for spinal stenosis. Done in radiology
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diskography
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test placed in spinal tap position, insert dye into the spine. The patient will not feel pain but pressure. Encourage fluids to replace spinal fluids
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myelogram
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two types of fracture presentations
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compound/ open- bone exposed through skin
simple / closed- bone not visable |
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What are the different positioning of bone fractures?
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Closed- bone together
Open- bone separated Comminuted- bone in fragments Displaced- bone side by side Oblique- lengthwise fracture Spiral- bone was twisted Impacted-bone inside itself Greenstick- a partial crack usually seen in children |
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a weakness in the bone that gets very sore from frequent pressure
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stress fracture
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what will happen to the muscle in the case of a really back fracture
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the muscle may spasm
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what is the process of fracture healing?
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hematoma formation, hematoma to granulation, Vascular and cellular proliferation, A callus forms and is gradually resorbed and transformed into bone, then Consolidation and remodeling of bone
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why does it take so long for bones to heal?
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because bones have the least amount of blood supply. Infection can keep them from healing, and micromotion
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a bone that heals but not in place
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malunion
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bone that has never healed- after 6 months of not healing
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nonunion
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when no blood supply is provided to an area so that the area dies
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avascular necrosis
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condition where more bone forms than what should form and it may cause pain. Can be chisseled off
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heterotrophic bone formation
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complication affiliated with long bone fractures
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fat emboli
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too much fluid in an area causes pressure and swelling
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compartment syndrome
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what are the expected outcomes of bone healing
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reduction- restore normal alignment
immobilization- maintain position for bone union rehabilitation- restore normal function, coping with disability |
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what are the two types of fixation?
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Open reduction-
internal fixation- plates rods screws external fixation- external fixator holding bone in place |
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what are the two types of bone grafting?
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autogenous (usually taken from iliac crest) self
allograft (cadaver bone bank) - not a large risk of disease transmission due to limited blood supply |
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a method of holding a fractured bone in place in bed, keeping it secure with straps and weights
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traction- must have correct weight, proper function, skin inspection, and correct position
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what are the nursing management measures for fractures?
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VS, 5Ps (pain, PP, paresthesia, pallor, paralysis), limit movement, proper positioning, assess bleeding, draw line around drainage on dressing
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cast types- fiberglass, resins, plastic, plaster; short leg, long leg, body cast
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Hip Spica cast- used for femoral fractures in infants- can cause shortness of breath and bowel obstruction
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how long does it take a cast to dry?
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24-72 hours, never cover a fresh cast with a blanket, handle with palms not fingers, 5 Ps
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when should preop antibiotics be administered?
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right before going into surgery
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what are some complications of a total body cast or hip spica cast?
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skin breakdown, pneumonia or resp dysfunction, constipation, joint contractures, obstruction
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partial or complete intestinal obstruction ; compression of the duodeum against the superior mesenteric artery
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cast syndrome
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what are some complications of casts?
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infeciton, circulation impairment, peripheral nerve damage, skin breakdown
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long term skeletal traction, aligns bones and joints
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external fixator
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what are the different degrees of weight bearing ambulation?
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non-weight, partial, and full
canes support 40% of pts weight |
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what are the different type of hip fractures?
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displaced- not aligned
impacted- wedged together comminuted- shattered |
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if patient is having muscle spasms with fractured hip, what is a way to calm the muscle before surgery?
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traction
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a cheaper and faster recovery for this hip surgery than for others- safer and uses pins and nails or screws and a lateral plate. Wt bear 6-8 wks
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ORIF extracapsular
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what are some complications of hip ORIF?
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difficult for elderly to comply, infection, decreased ROM, nail penetrating femoral head (may need repaired)
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reconstruction or replacement of a hip joint, imrpoves or maintains ROM.
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intracapsular arthroplasty
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what is the mainstay treatment for degenerative osteoarthritis
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arthroplasty
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how is replacement connected to bone
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either through cement (faster rehab) or have the bone intermesh with the bone (lasts longer)
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what is covered in pre-op teaching?
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PCA (24h), walking next day, 3-4h surgery, leg exercises, walker training, respiratory routine
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Post operative care includes the following (5 things)
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maintain position, 5Ps, progressive ambulation, prevent infection, monitor for complications
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what is essential that patients have at home for hip replacement?
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raised toilet seat
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what is the OOB process for a spine surgery patient/
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log roll, Have patient roll as you turn legs out of bed. Do not yank patient
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a brace sometimes used for managing back surgery patient
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rigid orthosis
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nurse management of spine surgery- void within 6-8 hours, loss of sphincter tone or bladder tone may indicate nerve damage.
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Don't forget to check donor grafting site
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spinal fusion
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vertebrae in spine are fused and become inflexible
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#1 cause of infection leading to death from a post op surgery
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pneumonia
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runners post op are at higher risk of getting...
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DVTs
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what may a spinal dressing indicate if the fluid is clear with a yellow ring around it?
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spinal fluid is leaking out of incision
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a post op spine surgery patient that gets severe headaches when sitting and standing may have
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spinal headaches
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process where a balloon is placed between compressed vertabrae, it is inflated, and then cement is filled into the area
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kyphoplasty
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Condition associated with fractures or extensive soft tissue damage/ crush injury
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Compartment syndrome
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What is the process of compartment syndrome?
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Edema increases in are, eschemia to the muscle ( loss of o2) , nerve cells can be destroyed, necrosis can result
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What causes th two types of compartment syndrome?
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Internal- extravasation, edema, extreme muscular activity ;
External- burns, tight dressing, cast, pneumatic splint |
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What are the 5 Ps of neuromas ulnar assessment?
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Progressive pain, pallor, poor capillary refill, parathesias, pulselessness
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Treatment for compartment syndrome that is usually healed by secondary intention or a skin a skin graft
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Fasciotomy
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What type of nursing measures are there for care of compartment syndrome?
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Raise extremity to heart level but not above the heart level,
Do not ice!! Remove or loosen bandage, cast, traction |
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Complication that occurs in <2% of fracture patients and usually involves the long bones.
Deadly |
Fat embolism- fat globulins from e bone enters the circulation and form emboli in the pulmonary capillaries
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What is a distinguishing factor of a fat embolism?
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Petechiae usually seen over the chest
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What are the s&s of fat embolism?
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Hypoxemia (pox <60), tachypnea, cyanosis, dyspnea, poor o2 exchange, pulmonary edema, diffuse crackles
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What are the neuro and cardiac s&s of fat embolism?
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Apprehension, changes in mental status, restlessness confusion/
Increased VS, chest pain, tachycardia >110 |
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With a fat embolism, where else may fat sometimes appear?
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The urine and sputum
Pt can go from pallor to cyanosis very fast |
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What ways are fat embolisms diagnosed in a patient?
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Snowstorm X-ray, perfusion test. Pox <60
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What is the best nursing. Are for a fat embolism?
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Prevention (traction) monitor, o2, iv fluids, TCDB
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Muscle damage that causes fibers to breakdown releasing their contents (myoglobulin) into the blood stream. Kidneys filter out myoglobulins but by products trigger renal failure
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Rhabdomyolysis - seen mostly in ortho and may be caused by compartment syndrome
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What process occurs with rhabdomyolysis?
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Fluid and calcium move into damaged muscle causing intravascular volume depletion resulting in dehydration, shock, and acute renal failure
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What are the causes of rhabdomyolysis?
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Trauma, extreme muscular activity, OD on drugs (toxic effects), metabolic abnormalities, medication side effects
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What are some s&s of rhabdomyolysis?
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Fever, malaise, NV, agitation, delirium, myopathy,swelling, cramping, electrolyte imbalance, brown urine*** blood in urine
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Muscle weakness with pain is called
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Myopathy
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What labs become elevated as a result of rhabdomyolysis?
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BUN, creatinine, WBC, potassium, myoglobulin in urine(what turns the urine brown), creatine kinase (identifies muscle breakdown)
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What are some treatments for rhabdomyolysis?
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Loop diuretics, treat electrolyte abnormalities, administer 12L IV NS 24h, kayexalate, correct metabolic acidosis, dialysis if needed
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What are two ways of getting osteomyelitis?
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Direct- exogenous - result of an open fracture or surgery
Indirect- endogenous- a blood borne infection from a distant site such as teeth, diabetic ulcers, furuncles Contiguous - from open sores in skin |
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What are the common types of bacteria that cause infection?
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Staphylococcus aureus
Psuedomonas aeruginosa |
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Dead bone separates from living bone and pus forms in between the spaces causing bacteria
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Acute osteomyelitis (less than 1 month)
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Infection that persists longer than 4 weeks. Fails to respond to therapy. Pus accumulates, ischemia of bone, bacterial growth antibiotic resistent
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Chronic osteomyelitis ( MRSA is an example of this)
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What are the clinical manifestations of an infection?
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Fever, night sweats, chills, restlessness, pain, nausea, malaise
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What are some diagnostic studies to confirm an infection?
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Wound culture, biopsy (to determine how much tissue is viable), CBC, WBCs, sed rate to determine bone damage, bone scans , mris ct scans
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What are some treatments for infection?
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Debriidement, antibiotic beads, suction, amputation
Sterile dressings, position change, no heat or exercise, avoid foot drop |
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What are the clinical manifestations of someone who may need an amputation
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Loss of sensation, inadequate circulation (antibiotics can't reach it), pallor, sweating, systemic or local infection
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Used to check circulation to an area of the body by injecting dye and watching blood flow
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Arteriogram
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A process where legs are elevated to see the color in the foot. Used to determine arterial supply
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Buergers test
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Mprocess where BP is taken at ankle and also at brachial and if they are >= to 1 it is. Normal.
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ABI index
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What are the types of amputations?
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Closed amputation- usually use a skin flap so incision is not in prosthesis
Disarticulation- amputation performed through a joint Open amputation- (guillotine amputation) leaves a surface uncovered by skin. Temp. W/D for 2days to decide if skin is viable |
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What are post operative management of an amputation?
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VS, dres sings, hemorrhage, elevate extremity to avoid edema it limit elevation to avoid contracture
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Term where hip can't lay leg down anymore
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Contracted hip flexing
Prevent by getting them out of chair and laying them on belly |
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What is e purpose of stump wrapping?
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Mold the limb to decrease edema and help it to fit into a prosthesis
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How do you treat phantom limbs?
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If patient has pain give medication , if not treated in the early stages it can become chronic
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How to you care for a severed limb?
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Wrap in moist cool cloth, seal in plastic bag, bag in ice water.. Do not remove anything that's attached.
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What factors affect the reattachment of a severed limb?
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Type- clean cut or ragged, location- is it viable, time- how long has it been severed, coexisting injuries- diabetic, liver failure, ect; age- circulation issues
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What are some causes of back pain?
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No physical exercise, prior injury, obesity, fractures, >55 age, pulls, muscle strains, bone to bone rubbing
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Chronic condition where discs of vertebrae wear away and bone pinches on the nerves
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Degenerative joint disease
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Back pain at the sacrum
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Claudia equina ( where you sit on a horse)
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Narrowed spinal column
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Spinal stenosis
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What is the progressed process of back pain
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Degeneration causes intervertebral narrowing, disks are poor shock absorbers, small tears form in the annulus fibrosis, glycoproteins protrude from the intervertebral disk, compress on a cervical, lumbar, or sacral spinal nerve root
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What are severe symptoms of pinched nerves
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Severe pain, neurological deficit (can't feel toes), reflexes, sensory loss, abdonminal pain, trauma
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Microsurgical discectomy laminectomy
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Procedure where patient has to kneel over bed and place face in donut pillow. Watch for skin integrity on knees and face
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What are ways patients can improve spinal cord recovery?
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Stop smoking, loose 5% of their body weight, limit alcohol or nicotine
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What are ways to aid in recovery from back surgery?
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Exercise and pt, thermal therapy , ultrasound( phonophoresis)
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Sever pain unrelated to original pain stimulus.
Sometimes hospital is to blame, caused by long term opioid use that create pain generation in the central nervous system |
Opiod-induced hyperalgesia
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Williams position
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Pillos are placed under patients knees
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Williams position
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Pillos are placed under patients knees
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