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46 Cards in this Set
- Front
- Back
Musculoskeletal Vocabulary
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Contusion: a bruise
Strain: muscle stretching beyond the limits Sprain: damage to ligament and usually tendons Fracture: break of bone(s) |
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RICE:
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Rest
Ice (20 minutes on 20 minutes) off with a barrier Compression Elevation (i.e.leg up on the seat next to you ottoman against the chair with a pillow no gap it will cause damage or pain) |
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Contusion, Strain, Sprain
Medications |
no narcotics, anti inflammatory NSAID’s for pain, Analgesics – mild
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Contusion, Strain, Sprain Nursing diagnoses
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Impaired physical mobility, Pain knowledge deficit (if new injury)
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Joint Dislocation Assessment
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Visual ROM posture change length of arm on upper ↑ extremity=longer on lower ↓ extremity shorter from strong ligaments are very strong muscles on iliac crest if femur is fractured or dislocated pulls ↑
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Joint Dislocation Diagnosis
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Visual
X ray CT or MRI only if head of humorous is trapping nerve fibers |
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Joint Dislocation who will put it back in place
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Skilled Orthopedic person to put the dislocation back in may need anesthesia
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Fractures
Classifications |
1. Simple: closed / open (Compound) risk for infection due to break in skin
2. Fracture line: oblique may have a sling, spiral may be linked to abuse (twisting arm), avulses, comminuted (fragmented) needs surgery cage around fracture and get bones from Pt own iliac crest or cadavers, compresses, impacted motor vehicle or motorcycle significant fall use arm to break, depressed 3. Complete / incomplete 4. Stable (non-displaced) / Unstable (displaced) realign stabilize 5. Description by point of reference |
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Healing phases of fractures
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1. Inflammatory phase happens Immediately 1st 12-24 hours p. 2340
Send in RBC WBC vasoconstriction 2. Reparative phase Granulation – Callus formation a. Granulation shifts and become new tissue up to 3 weeks between Inflammatory and granulation bone will need to be put back in place so surgery can wait a few days up to 72 hours before surgery unless a lot of blood vessels have occurred 1st action before surgery will be blood work to make sure they are as healthy as can be before surgery i.e. nutrient blood transfusions b. Callus formation confirmed by Xray approximately 6 weeks after injury person can not due any weight bearing until true callius has formed Tylenol no more than 8 in 24 hours Dr may reduce or take off a cast up to 6 weeks 3. Remodeling phase Osteoblastic (pt unaware of the rest of the healing steps), Bone remodeling, bone healing complete |
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Emergency care of fractures
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1. Immobilization of fracture in the position it is found EMT’s
2. Tissue perfusions assessing the pulse unaffected side to effected side and maybe sensation |
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fractures Medications
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Analgesics
Narcotic Non-narcotic |
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External Fixation fracture
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is aligned put pins through bones above and below the fracture and stabilized the entire bone locked in to reestablish alignment person will go home circulation sensation and motion is maintained person is sent home on crutches, once Callus is formed weight being Diagnoses risk for infection pin care sight important primarily focused on soap and water teach Pt the signs of infection light pink to red increase of drainage call us. Pain gets more and more call us. If infection enter in pi sites inflection will go into the bone. Removal of pins sedations whole I bone will granulate in person can shower in it how to keep toes warm during Winter sweatpants package of tube socks cut to keep toes warm
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Internal Fixation fracture
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Intramedulary rod make sure it is aligned rod pushed though bone into the bone marrow takes over and the hyper produces stays in permentally titanium not picked up in airport screening allows bone to heal but rod stays in
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Traction
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used years ago think what would need to occur to get humorous out of alignment back in alignment used weights to pull against major muscle groups around the fracture site contracting
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Skin traction
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leg on fractured hip is shorter and needs to by time this is called Buck’s foam or shoe shaped devise hooked to a piece or cord to Bulkin frame through a pulley and puts a sand bag may be 15-20 pounds literally pulling fractured hip back down to maintain alignment and not hinder nerve function or blood flow ******NEVER remove the sandbag –if you the upper femur will sift back cause pain and may interfere with nerve root function will be in for 24-48 hours check pulse check for color wiggle toes fixate might see in pediatrics or someone with general hip dysplasia
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Skeletal traction
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Dr will put a pin in below and u shaped bridge close line pulley and weights on the side of the bed ADL issues do to several close lines not used much today replaced by the external
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Casting Materials
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Fiberglass (more common) colors has to realignment & stabilization
Plaster of paris |
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Assesment of casted limb
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i. Pulses (pulselessness) very concerned extremities cold dusky call Dr( Capillary refill) expect brisk if delay monitor if getting progressively longer
ii. Pain leaves/lessens once bones are stabilized pain should diminish iii. Pallor circulation iv. Paresthesia/paralysis (numbness tingles to paralysis v. Odor fiber glass no order plaster of paris damp order in order increase call Dr vi. Drainage (with drain in= expected) might be expected if drain put in outline drainage in sharpie if circle increases check to see if drain check OR report if drain then this is okay |
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Education od Pt in caste
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Itchy each to scratch on the opposite side no knitting needles or anything down the catse
Wet cast handle the palms of hand so you don’t have pressure sight cast dryer onb Cool not hot= pressure areas Showering wrap cast up in plastic bag |
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Crutch walking
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4 point gait 2 points foot crutch foot crutch only used when person has weight bearing position
3 point 2 crutch point and 1 effective site non weight bearing demonstrating before leaving hospital faster than 4 point can use with walker 2 point gait is swing through= spinal cord trauma is partial weight bearing. less support than 4 point |
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going up and down stairs on Crutches
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(up with the good down with the bad)
Wilkinson Volume 2 p 719 Up= lead with unaffected leg Down lead with affected leg |
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Sizing Axillary Crutches
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Wilinson Volume 2 p 718
1. Have Pt lie down wearing shoes they will use to walk. Measure distance between heel and the anterior fold of the axilla, then add 1 inch (2.5 cm) Select crutch that adjusts to this height Have Pt stand, and posito the cruch tip 4-6 inches(10-15 cm) to the side of the heel. Adjust the axillary pad 3 fingerbredths below the axilla. Adjust the handgrips so Pt can confortably grasp the bar while the elbow is slightly flexed. |
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Nursing Care CSM
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Circulation Sensation Motion
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Test Tip
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Physical needs priority to psychosocial Maslow Hierarchy of needs
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Complications related to fractures
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Compartment syndrome
Fat Embolism Syndrome Avascular Necrosis Osteomyelitis D.V.T |
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Compartment syndrome Pathophysiology
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Progressive degeneration of muscles that results from a severe interruption of blood flow to an area, secondary to edema within the fascia
Increased pressure in compartments = occlusion of arterial blood supply Decreased venous return from compartment = edema, which then increases the arterial problem because the fluids are accumulating in a closed space…like a tourniquet, resulting in muscle ischemia |
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Compartment Syndrome Assessment and Treatment
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Pain – greater than injury would lead you to expect
Pressure within the extremity Paresthesia with passive stretching of affected muscle (do a CSM assessment) Decreased pulses (arterial flow, remember) – is a LATE sign Intervention Surgery to release fascia that is acting like a tourniquet (fasciaectomy) open wound more secondary attention healing then primary |
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Fat Embolism Syndrome
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Fat globules are released from bone marrow and/or damaged tissue
Recognize concept of embolism same thing happens with fat globules releases and causes trauma lodges usually in pulmonary tree usually people More common with: Multiple fractures Pt will be on anti coagulation therapy Long bone fractures Crushing injuries (femur, pelvis, tibia, ribs, also seen in THR, TKR) |
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Fat Embolism Assessment and Treatment
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Changes in cognition or L.O.C. (confusion, apprehension, restlessness, lethargy)
Respiratory: tachypnea, dyspnea, wheeze, rales ABG’s: increase in pH, decrease in O2 Tachycardia Fever Intervention = critical care unit O2 to use of ventilator Rapid anticoagulation (Heparin) |
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Avascular Necrosis
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literally without bloodflow= tissue death
mostly associated orthopedic event Can occur with any bone / most common with fracture head and neck of femur Can occur when trauma causes decrease in circulation May occur slowly after hospital stay in rehab etc i.e. Pt still using walker at 6 weeks taking 4 grams of Tylenol per 24 hours SX: intermittent to constant pain on weight bearing and limited full R.O.M. RX: Total Hip Replacement |
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Osteomyelitis
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Infection involving cortex and/or marrow of bone
Infection from external or internal source can move into a state of dormant for a year or 2 then pop up later like cellulitis Assessment: Low grade T., pain, local tenderness, warmth, purulent drainage Skull Glasgow Coma Scale, pupils Facial bones Airway, nutrition Spine neurological paralysis mobility Intervention high dose of Antibiotics (routine today to prevent this complication) Adequate debriedment of wounds |
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D.V.T.
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(covered in vascular content) PREVENT with Venodyne boots [SCD’s] / TEDS
Assessment warmth of calf some may have pain when dorsoflex Intervention Bedrest and call Dr Heparinization Coumadin |
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skull fracture
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neurological issues
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Clavicle (shoulder) fracture
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shoulder ROM no surgical intervention no casting sling to limit mobility
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Humerous Fracture
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ADL's impacted, may need rod axcilla to risk impaired circulation
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Elbow Fracture
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ADL's impacted may need total elbow replacement
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Radius Ulna Fracture
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cast no stay in hospital unless other issues CHF Diabetics ADL’s
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Rib fracture
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Oxygenation issues
puncture lung risk can break uneven shape and go in Incentive spiromiter may cause pneumonia Issues sleeping to pain no longer do constrictive wraps- caused pneumonia |
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Pelvis fracture
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Mobility pain issues transferring bed to Commode
If it impacts ADL’s high priority |
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Osteoarthritis
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pain when active, more active = more pain get spikes from mobility Pt chooses to be less active or reaching or NSAID midday
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Rheumatoid Arthritis
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when you are getting ready for action standing up immobility calms but gets better with activity weight bearing joints (hips knees ankles) hurt
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Hip Fractures / Osteoarthritis
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Classifications:
Intracapsular within joint capsule i.e. head and neck of femur Extracapsular ouside the joint capsule Treatment 1. O.R.I.F. (Open Reduction Internal Fixation)made an incision ran plate and drilled screws into the femur become very stable 24 hours after surgery no changes to the bone 2. Total / Partial hip replacement Fracture hip from a fall selling total hip replacement for stability in the future uses manmade Manmade ball for acitabulium put surgical cement person will be non weight bearing while cement finishes to harden Head of femur and ascitabluim will be solid titanium |
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Care after hip replacement
Considerations: |
Wound care
Keeping incision clean and dry Home management of incision Recognition of signs of infection Mobility Use of assistive devices Changing position frequently Limitations on hip flexion and adduction (must avoid acute flexion and crossing legs / adduction so don't pop out asitablium out of the femur head ) Avoid low-seated chairs Sleeping with pillows between legs to prevent adduction |
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after hip replacement ADL's and Potential problems
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A.D.L’s
Use of raised toilet seat Use of reachers to aid in dressing Acceptance of assistance Potential problems Dislocation of prosthesis Increased pain / shortening of leg Inability to move leg, popping sensation in leg D.V.T. Wound infection – swelling, purulent drainage, pain, fever Pulmonary Emboli – sudden dyspnea, tachypnea, pleuritic chest pain |
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Priority after hip replacement
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Priority Pain management on PCA some with basal rate transiting within 48 hours to oral narcotic rehab with Tylenol works well with orthopedic trauma
Think about pain management with physical therapist appointment should be at peak of pain medicine |
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Muscle-Setting Exercises
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Quadriceps-Setting Exercise: person stretch out on bed back of knee to push into mattress while lifting ankles off mattress
Gluteal-Setting Exercise squeezing and releasing buns |