Unit 12: Alterations In Mobility

Front 1

A severe infection of the bone, bone marrow, and surrounding soft tissue; most common microorganism is Staphylococcus aurens; gram-negative bacteria alone or mixed with gram-positive organisms; microorganisms can invade by indirect or direct entry:

Back 1

-Osteomyelitis

Front 2

-The type of entry for microorganisms that causes osteomyelitis is associated with incidence of blunt injury, vascular insufficiency disorders (DM), and genitourinary and respiratory infections:

Back 2

-Indirect Entry

Front 3

This type of entry for microorganisms that cause osteomyelitis from an open wound and presence of a foreign body:

Back 3

-Direct Entry: the microorganisms than lodge in the area of bone in which circulation slows, usually the metaphysis; they grow resulting in an increase in pressure because of the nonexpanding nature of most bone which eventually leads to ischemia and vascular compromise of the periosteum; eventually the infection passes through the bone cortex and marrow cavity, ultimately resulting in cortical devascularization and necrosis (sequestra and involucrum)

Front 4

The area of devitalized (dead) bone that eventually separates from the surrounding bone; surround by pus; may enlarge and serve as a site for microorganisms that spread to other sites, including the lungs and brain; can move out of the bone and into the soft tissue; can be surgically removed through debridement of the necrotic bone:

Back 4

-Sequestra

Front 5

The part of the periosteum that continues to have a blood supply forms new bone called this:

Back 5

-Involucrum

Front 6

Refers to the initial infection or an infection of less than 1 month in duration; systemic manifestations include fever, night sweats, chills, restlessness, nausea, and malaise; local manifestations include constant bone pain that is unrelieved by rest and worsens with activity, swelling, tenderness, and warmth at the infection site, and restricted movement of the affected part:

Back 6

-Acute osteomyelitis

Front 7

Refers to a bone infection that persists for longer than 1 month or an infection that has failed to respond to the initial course of antibiotic therapy; systemic signs may be diminished, with local signs of infection more common: constant bone pain and swelling, tenderness, and warmth at the infection site:

Back 7

-Chronic osteomyelitis

Front 8

Describe treatment for a patient with osteomyelitis:

Back 8

-Vigorous and prolonged IV antibiotic therapy
-Delivered via a central line or PICC line
-Hyperbaric oxygen therapy with 100% O2 may be administered to stimulate circulation and healing in the infected tissue
-Orthopedic prosthetic must be removed (if cause), bone grafts, and amputation (last resort)

Front 9

Describe nursing actions for a patient experiencing osteomyelitis:

Back 9

-Limb should be handled carefully
-Assess the pt's pain
-Admin NSAIDs, opioids, and muscle relaxants
-Apply and change dressings
-Good body alignment and frequent position changes prevent complications
-Instructed to avoid any activities such as exercise or heat application
-Uninvolved joints and muscles should continue to be exercised

Front 10

A primary bone tumor that is extremely aggressive and rapidly metastasizes to distant sites; usually occurs in the metaphyseal region of the long bones of the extremities, particularly in the regions of the distal femur, proximal tibia, and proximal humerus, as well as the pelvis; most common malignant tumor affecting children and young adults; the highest incidence is in males in the 10-25 year old age; secondary osteosarcoma is known to occur in adults over age 60 and is most commonly associate with Paget's dz:

Back 10

-Osteogenic Sarcoma

Front 11

-Gradual onset of pain and swelling, especially around the knee; restrict joint motion
-Confirmed from biopsied tissue specimens; elevation of serum alk phos and Ca levels, and findings on x-ray, CT or PET scans, and MRI
-Metastasis is present in 10-20% of individuals on diagnosis, with their lung being the most frequent site
-Treatment includes chemo, amputation, and quality-of-life considerations

Back 11

-Osteogenic Sarcoma

Front 12

-Second only to headache as the most common pain complaint
-Risk factors: lack of muscle tone, excess body weight, poor posture, cigarette smoking, stress, repetitive heavy lifting, prolonged heavy lifting of sitting
-Most often due to a musculoskeletal problem
-Causes: acute lumbosacral strain, instability of the lumbosacral bony mechanism, osetoarthritis of the lumbosacral vertebrae, degenerative disk disease, herniation of an intervertegral disk:

Back 12

-Low Back Pain

Front 13

Lower back pain that lasts 4 weeks or less; usually associated with some type of the lower back; do not appear at the time of injury but develop later because of a gradual increase in paravertebral muscle spasms:

Back 13

-Acute Lower Back Pain

Front 14

Describe treatment for lower back pain:

Back 14

-Analgesics, muscle relaxants, massage and back manipulation, and alternating use of heat and cold compresses

Front 15

Describe nursing actions for a patient experiencing acute lower back pain:

Back 15

-Nurse should use proper body mechanics at all times
-Assess the pt's use of body mechanics and offer advice when activities that could produce back strain are used
-Maintain appropriate body weight
-Flat shoes and/or with low heels and shock-absorbing shoe
-Sleeping position
-Cease smoking
-Assist the pt to maintain activity limitations, promote comfort, and educate the pt about the health problem and appropriate exercises
-Thermotherapy (ice and heat)
-Muscle stretching and strengthening exercise

Front 16

Low back pain that lasts more than 3 months or is a repeated incapacitating episode; causes include degenerative disk disease, lack of physical exercise, prior injury, obesity, structural and postural abnormalities, and systemic disease:

Back 16

-Chronic Lower Back Pain

Front 17

A narrowing of the vertebral canal or nerve root canal caused by encroachment of bone on the space; may be congenital or, more typically, it is acquired through degenerative or traumatic changes to the spine; compression of the nerve roots can result, with subsequent disk herniation; starts in the low back and then radiates to the buttock and leg; worsens with walking and, in particular, standing without walking; treatment includes a reduction of the pain, formal back pain program, and ongoing medical care, weight reduction, sufficient rest periods, local hear or cold application, and exercise and activity:

Back 17

-Spinal Stenosis

Front 18

Porous bone or fragile bone disease, is a chronic, progressive metabolic bone dz characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility; known as the "silent thief;" women age 65 and older should be routinely screened for osteoporosis:

Back 18

-Osteoporosis

Front 19

Why are women 8 times more likely to develop osteoporosis than men?

Back 19

1.) Women tend to have lower calcium calcium intake than men throughout their lives
2.) Women have less bone mass because of their generally smaller frame
3.) Bone resorption begins at an earlier age in women and is accelerated at menopause
4.) Pregnancy and breastfeeding deplete a woman's skeletal reserve unless Ca intake is adequate
5.) Longevity increases the likelihood of osteoporosis

Front 20

Risk factors for this include female, increasing age, family hx, white or Asian, small stature, early menopause, hx of anorexia or oophorectomy, sedentary lifestyle, and insufficient dietary Ca; bone resorption exceeds bone deposition; occurs most commonly in the bones of the spine, hips, and wrists:

Back 20

-Osteoporosis

Front 21

Bone is continually being deposited by osteoblasts and resorbed by osteoclasts, a process called:

Back 21

-Remodeling

Front 22

Wedging and fractures of the vertebrae produce gradual loss of height and a humped back known as:

Back 22

-"dowager's hump" or "kyphosis"

Front 23

Describe nursing actions for a patient experiencing osteoporosis:

Back 23

-Proper nutrition, Ca supplementation, exercise, prevention of fractures, and meds
-Prevention and treatment of osteoporosis focuses on adequate Ca intake (1000 mg/day)
-Whole and skin milk, yogurt, turnip greens, cottage cheese, ice cream, sardines, and spinach
-Vit D
-Quit smoking and cut down on alcohol intake
-Fosamax or Evista

Front 24

Slipped disk; can be the result of natural degeneration with age or repeated stress and trauma to the spine; nucleus pulposus may first bulge and then it can herniate, placing pressure on nearby nerves; most common sites include L4-5 and L5-S1:

Back 24

-Herniated Intervertebral Disk

Front 25

Describe s & s of herniated intervertebral disk:

Back 25

-Low back pain; radiates down the buttock and below the knee, along the distribution of the sciatic nerve, generally indicates disk herniation; reflexes may be depressed or absent; paresthesia or muscle weakness

Front 26

Describe nursing care for a patient with herniated intervertebral disk:

Back 26

-Limitation of extremes of spinal movement, local heat or ice, ultrasound and massage, traction, and transcutaneous electrical nerve stimulation (TENS)
-NSAIDs, short-term opioids, and muscle relaxants, epidural corticosteroid injections

Front 27

A traditional and most common surgical procedure for lumbar disk disease; the surgical excision of part of the posterior arch of the vertebra (referred to as the lamina) to gain access to part of or the entire protruding disk to remove it:

Back 27

-Laminectomy

Front 28

May be performed if an unstable bony mechanism is present; spine is stabilized by creating an ankylosis (fusion) of contigous vertebrae with a bone graft from the pt's fibula or iliac crest or from a donated cadaver bone; rods, plates, or screws may be implanted at the time spinal sx to provide more stability and decrease vertebral motion:

Back 28

-Spinal Fusion

Front 29

The most common form of joint (articular) disease in North America, is a slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints; known to involve the formation of new joint tissue in response to cartilage destruction:

Back 29

-Osteoarthritis

Front 30

Before the age of 50, men are more affected than women, after 50 more women than men; may occur as idiopathic or secondary (aging, genetic factors, obesity); results from cartilage damage that triggers a metabolic response at the level of the chondrocytes; causes the normally smooth, white, translucent articular cartilage to become dull, yellow, and granular which results in softer, less, elastic, and less able to resist wear with heavy use; erosion of the articular surfaces:

Back 30

-Osteoarthritis

Front 31

Describe s & s of osteoarthritis:

Back 31

-Fatigue, fever, and organ involvement are NOT present in OA, this is present in RA
-Range from mild discomfort to significant disability
-In the early stage, joint pain is relieved by rest; In advanced dz, the pt may complain of pain with rest or experience sleep disruptions caused by increasing joint discomfort; worse when barometric pressure falls
-Joint stiffness occurs after periods of rest or static position
-Stiffness occurs in the early am but resolves within 30 minutes
-Affects joints of the fingers, joint of the thumb, weight-bearing joints, and the cervical and lower lumbar vertebrae

Front 32

Describe treatment for a patient with osteoarthritis:

Back 32

-Rest: affected joint should be rested during any periods of acute inflammation and maintained in the functional position with splints or braces if necessary
-Applications of heat and cold may hep reduce complaints of pain and stiffness
-Weight-reduction program, acupuncture, yoga, massage, guided imagery, therapeutic touch, nutritional supplements
-Drug therapy: hyaluronic acid (relief up to 1 year)

Front 33

Describe nursing actions for a patient with osteoarthritis:

Back 33

-Administer drugs, massage, the application of heat or cold, relaxation, and guided imagery
-Tai Chi as a low-impact form of exercise
-Teaching should include info about the nature and treatment of dz, pain management, correct posture and body mechanics, correct use of assistive devices such as a cane or walker, principles of joint protection, and energy conservation, nutritional choices, weight and stress management, and therapeutic exercise program
-OA is a localized dz and that severe deforming arthritis is not the usual course

Front 34

A chronic, systemic autoimmune dz characterized by inflammation of connective tissue in the diarthrodial (synovial) joints, typically with periods of remission and exacerbation; affects all ethnic groups at any time of life peaking between 30s and 50s; women 3x more likely:

Back 34

-Rheumatoid arthritis

Front 35

Cause is unknown; and thought to be autoimmune and genetic
-Autoimmune: begins when a susceptible host experiences an initial immune response to an antigen; autobodies combine with IgG to form immune complexes that initially deposit on synovial membranes or superficial articular cartilage in the joints causing cartilage to fad and bone to bone contact occurring; joint changes from chronic inflammation begin when the hypertrophied synovial membrane invades the surrounding cartilage, ligaments, tendons, and joint capsule
-Genetic Factors: increased occurrence of human leukocyte antigen (HLA):

Back 35

-RA

Front 36

Describe s & s of RA:

Back 36

-Onset is typically insidious
-Pain, stiffness, limitation of motion, and signs of inflammation
-Experiences joint stiffness after periods of inactivity, may last from 60 min to several hours or more
-Joints are typically swollen, tender, painful, and warm to the touch
-Deformities (ulnar drift, swan neck, boutonniere)
-Extraarticular: rheumatoid nodules, sjogren's syndrome, and felty syndrome

Front 37

Describe nursing actions for a patient with RA:

Back 37

-Reduction of inflammation, management of pain, maintenance of joint function, and prevention or correction of joint deformity
-A comprehensive program of drug therapy (DMARDs, methotrexate, enbrel, humira, orencia, steriods), rest, joint protection, heat and cold applications, exercise, and pt and family teaching
-Discuss the action and side effects of each prescribed drug and the importance of necessary lab monitoring
-Morning care and procedures should be planned around pt's am stiffness
-Alternating scheduled rest periods with activity throughout the day helps fatigue and pain
-Help the pt to identify ways to modify tasks to put less stress on joints during routine activities
-Heat and cold can be used as often as desired; however, the heat application should not exceed 20 min at one time, and the cold application should not exceed 10-15 min at one time

Front 38

A chronic inflammatory disease that primarily affects the axial skeleton, including the sacroiliac joints, intervertebral disk spaces, and costovertebral articulations; usual onset is 15 to 35 years, highest incidence is 25 to 34 years; men 3-5x more likely:

Back 38

-Ankylosing Spondylitis

Front 39

Cause is unknown; genetic predisposition; aseptic synovial inflammation in joints and adjacent tissues causes the formation of granulation tissue (pannus) and the development of dense fibrous scars that lead to fusion of articular tissues; extraarticular inflammation can affect the eyes, lungs, heart, kidneys, and peripheral nervous system:

Back 39

-Ankylosing Spondylitis

Front 40

Describe s & s of ankylosing spondylitis:

Back 40

-Characterized by symmetric sacroiliitis and progressive inflammatory arthritis of the axial skeleton
-Spine pain, low back pain, stiffness, and limitation of motion that is worse during the night and in the am but improves with mild activity
-Women feel stiffness in the neck
-Severe postural abnormalities and deformity can lead to significant disability

Front 41

Describe nursing actions for a patient experiencing ankylosing spondylitis:

Back 41

-Educate about the disease and principles of therapy
-Regular exercise and attention to posture, local moist heat applications, and knowledgeable use of drugs
-Smoking cessation, ongoing physical therapy
-Proper positioning at rest is essential: mattress should be firm, and the pt should sleep on the back with a flat pillow, avoiding positions that encourage flexion deformity
-Avoiding spinal flexion, heavy lifting, prolonged walking, standing, or sitting
-Sports that facilitate natural stretching, swimming, racquet games
-Family counseling
-Heat applications
-NSAIDs and salicylates, local corticosteroid injections
-Hydrotherapy and surgery

Front 42

Caused by an increase in uric acid production, underexcretion of uric acid by the kidneys, or increased intake of foods containing purines, which are metabolized to uric acid in the body; deposits of Na urate crystals occur in the articular, periarticular, and sub-q tissues:

Back 42

-Gout

Front 43

In this form of gout, a hereditary error of purine metabolism leads to the overproduction or retention of uric acid; accounts for 90% of cases, occurs predominately in middle-aged men, with almost no incidence in premenopausal women:

Back 43

-Primary gout

Front 44

This form of gout may be related to another acquired disorder or may be the result of drugs known to inhibit uric acid excretion; also caused by drugs that increase the rate of cell death, such as chemo:

Back 44

-Secondary gout

Front 45

Describe risk factors for the development of gout:

Back 45

-Obesity in men
-HTN, diuretic use, and excessive alcohol consumption
-A diet high in purine-rich foods (shellfish, lentils, asparagus, spinach, beef, chicken, pork)

Front 46

Describe s & s for acute gout:

Back 46

-gouty arthritis in one or more joints (no more than 4); joints appear dusky or cyanotic and are extremely tender
-Inflammation of the great toe is the most common initial problem
-Usually precipitated by trigger events such as trauma, surgery, alcohol ingestion, or systemic infection
-Onset typically occurs at night with sudden swelling and excruciating pain peaking within several hours, often accompanied by low-grade fever
-Resolve within 2-10 days

Front 47

Describe s & s for chronic gout:

Back 47

-Characterized by multiple joint involvement and visible deposit of Na urate crystals called tophi
-Typically noted in the synovium, subchondral bone, olecranon bursae, and vertebrae; along tendons; and in the skin and cartilage

Front 48

Describe nursing actions for a patient with gout:

Back 48

-Bed rest may be appropriate with affected joints properly immobilized
-Help the patient and the family to understand the hyperuricemia and gouty arthritis are chronic problems that can be controlled with careful adherence to a treatment program
-Admin drugs: NSAIDs, colchicine, allopurinol, adrenocorticotropic hormone (ACTH), aspirin, should be avoided

Front 49

A severe injury of the ligamentous structures that surround a joint; results in the complete displacement or separation of the articular surfaces of the joint; result from forces transmitted to the joint that cause a disruption of the soft tissue support structures surrounding the joint; joints more frequently affects: thumb, elbow, shoulder, hip, patella:

Back 49

-Dislocation

Front 50

Describe s & s of dislocation:

Back 50

-Deformity, local pain, tenderness, loss of function of the injured part, and swelling of the soft tissues in the region of the joint

Front 51

Describe nursing actions for a patient with a dislocation:

Back 51

-Requires prompt attention and is considered an orthopedic emergency
-Longer the joint remains unreduced, the greater the possibility of avascular necrosis
-Nursing management is directed toward relief of pain and support and protection of the injured joint; motion is usually restricted
-Gentle ROM may be started if the joint is stable and well supported

Front 52

Describe key points for a patient undergoing a limb amputation:

Back 52

-Middle and older age-groups have the highest incidence of amputation because of the effect of peripheral vascular dz, atherosclerosis, and vascular changes related to DM
-Amputation in the young is usually secondary to trauma
-Common indications for amputation include circulatory impairment resulting from a peripheral vascular disorder, traumatic and thermal injuries, malignant tumors, uncontrolled or widespread infection of the extremity, and congenital disorders and may manifest as loss of sensation, inadequate circulation, pallor, and local or systemic manifestations of sepsis

Front 53

A ______ amputation is performed to create a weight-bearing residual limb (or stump).

Back 53

-Closed

Front 54

An ______ amputation leaves a surface on the residual limb that is not covered with skin; generally indicated for control of actual or potential infection and usually closed later by a second surgical procedure or closed by skin traction surrounding residual limb:

Back 54

-Open

Front 55

Describe nursing actions for a patient experiencing amputation:

Back 55

-Control of causative illnesses such as peripheral vascular dz, DM, chronic osteomyelitis, and pressure ulcers can eliminate or delay the need for amputation
-Allowing the pt to go through the grieving process and recognizing it as a normal consequence
-Nurse must know the level of amputation, the type of postsurgical dressings to be applied, and the type of prosthesis to be utilized
-Warn about phantom limb sensation
-Prevention and detection of complications
-Careful monitoring of the pt's VS and dressings
-Careful attention to sterile technique
-Compression bandage is initially worn at all time except PT and bathing; bandage is taken off and reapplied several times daily, and care is taken so that it is applied snugly but not so tight as the interfere with circulation
-Nurse must have a clear understanding of the exercise regimen to reinforce it and ensure that the exercises are performed correctly

Front 56

A disruption or break in the continuity of the structure of the bone:

Back 56

-Fracture

Front 57

Occurs when a piece of the periosteum is intact across the fracture and either external or internal fixation has rendered the fragments stationary; are usually transverse, spiral, or greenstick:

Back 57

-Stable fracture

Front 58

Grossly displaced during injury and is a site of poor fixation; usually comminuted or oblique:

Back 58

-Unstable fracture

Front 59

Formerly called compound fracture; involves communication of the fracture throughout the skin with the external environment:

Back 59

-Open fracture

Front 60

Involves the fracture within the skin and no external contact:

Back 60

-Closed fracture

Front 61

Fracture of bone resulting from the strong pulling effect of tendons or ligaments at the bone attachment:

Back 61

-Avulsion

Front 62

A fracture with more than 2 fragments; smaller appear to be floating:

Back 62

-Comminuted fracture

Front 63

Involves a displaced fracture fragment that is overriding the other bone fragment; periosteum is disrupted on both sides:

Back 63

-Displaced fracture

Front 64

An incomplete fracture with one side splintered and the other side bent:

Back 64

-Greenstick fracture

Front 65

A comminuted fracture in which more than 2 fragments are driven into each other:

Back 65

-Impacted fracture

Front 66

A fracture extending to the articular joint surface of the bone:

Back 66

-Interarticular fracture

Front 67

An incomplete fracture in which the line of the fracture extends in an oblique direction:

Back 67

-Longitudinal fracture

Front 68

A spontaneous fracture is at the site of a bone disease:

Back 68

-Pathologic fracture

Front 69

A fracture in which the line of the fracture extends in a spiral direction along the shaft of the bone:

Back 69

-Spiral fracture

Front 70

A fracture that occurs in normal or abnormal bone that is subject to repeated stress, such as from jogging or running:

Back 70

-Stress fracture

Front 71

A fracture in which the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis:

Back 71

-Transverse fracture

Front 72

Describe nursing actions for a patient with prosthesis:

Back 72

-The patient is referred to a prosthetist, who initially makes a mold of the residual limb and measures landmarks for the fabrication of the prosthesis
-Molded limb socket allows the residual limb to fit snugly into the prosthesis
-Limb is covered with a residual limb stocking to ensure good fit and prevent skin breakdown
-Prosthetist may also train the amputee to use it
-Patient should be instructed to clean the prosthesis socket daily with mild soap and rinse thoroughly to remove irritants
-Have regular maintenance

Front 73

During this phase of fracture healing; bleeding creates a hematoma, which surrounds the ends of the fragments; is extravasated blood that changes from a liquid to a semisolid clot; occurs in the initial 72 hours after injury:

Back 73

-Fracture hematoma

Front 74

During this phase of fracture healing: active phagocytosis absorbs the products of local necrosis; hematoma converts to granulation tissue; produces the basis for new bone substance called osteoid during 3 to 14 days postinjury:

Back 74

-Granulation Tissue

Front 75

During this phase of fracture healing: minerals (Ca, PO4, and Mg) and new bone matrix are deposited; unorganized network of bone is formed; primarily composed of cartilage, osteoblasts, Ca, and PO4; usually appears by the end of the second week after injury; can be verified by xray:

Back 75

-Callus Formation

Front 76

During this phase of fracture healing: occurs from 3 weeks to 6 months after the fracture and continues until the fracture has healed; sufficient to prevent movement at the fracture site when the bones are gently stressed; the fracture is still evident on x-ray; may be allowed limited mobility or the cast may be removed:

Back 76

-Ossification

Front 77

During this phase of fracture healing: callus continues to develop, the distance between and eventually closes; ossification continues:

Back 77

-Consolidation

Front 78

During this phase of fracture healing: excess bone tissue is reabsorbed in the final stage of bone healing, and union is completed; gradual return of the injured bone to its preinjury structural strength and shape occurs:

Back 78

-Remodeling

Front 79

A nonsurgical, manual realignment of bone fragments to their previous anatomic position; tractions and countertraction are manually applied to the bone fragments to restore position, length, and alignment; usually performed while the patient is under local or general anesthesia:

Back 79

-Closed reduction

Front 80

The correction of bone alignment through a surgical incision; usually includes internal fixation of the fracture with the use of wires, screws, pins, plates, intramedullary rods, or nails:

Back 80

-Open reduction

Front 81

The application of a pulling force to an injured or diseased part of the body or an extremity while counter traction pulls in the opposite direction:

Back 81

-Traction

Front 82

What is the purpose of traction?

Back 82

1.) Prevent or reduce muscle spasm
2.) Immobilize a joint or part of the body
3.) Reduce a fracture or dislocation
4.) Treat a pathologic joint condition

Front 83

Generally used for short-term treatment until skeletal traction or surgery is possible; tape, boots, or splints are applied directly to the skin to maintain alignment, assist in reduction, and help diminish muscle spasms in the injured extremity; weights are usually 5-10 lbs:

Back 83

-Skin traction

Front 84

Generally in place for longer periods; used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia; provides long term pull that keeps the injured bones and joints aligned; physician inserts a pin or wire into the bone, either partially or completely, to align and immobilize the injured body part; weights are usually 5-45 lbs:

Back 84

-Skeletal traction

Front 85

Describe key points for casts:

Back 85

-Common treatment following closed reduction
-Generally incorporates the joints above and below a fracture
-Plaster sets within 15 minutes; it is not strong enough for weight bearing until about 24-72 hours
-Never be covered with a blanket because air cannot circulate and heat builds up in the cast
-Casts made of synthetic materials are being used more than plaster because they are lightweight and relatively waterproof and provide for immediate mobilization
-Extremity should be elevated onto pillows above the heart level for the first 24 hours
-Casted extremity should not be placed in a dependent position because of the possibility of excessive edema
-Nurse should observe for signs of pressure, especially in the regions of the heel, anterior tibial border, fibular head, and malleoli

Front 86

Describe key points for external fixation:

Back 86

-An external fixation is a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals
-Used to apply traction or to compress fracture fragments and to immobilize reduced fragments when the use of a cast or other traction is not appropriate
-Holds fracture fragments in place similar to a surgically implanted internal device
-Attached directly to the bones by percutaneous transfixing pins or wires
-Is indicated in simple fractures (either open or closed), complex fractures with extensive soft tissue damage, correction of bony defects (congenital), pseudoarthrosis and nonunion or malunion and for limb lengthening
-Nurse should monitor for signs of infection at pin sites and instruct pt and family about pin care

Front 87

Describe key points for internal fixation:

Back 87

-Pins, plates, intramedullary rods, and metal and bioabsorbable
-Are surgically inserted at the time of realignment

Front 88

Describe nursing actions for a patient with a fracture:

Back 88

-Assess: color, temp, cap refill, peripheral pulses, edema, sensation, motor function, pain, pink, pale, cyanotic, hot, warm, cool, cold
-Preoperative: the nurse should inform pts of the type of immbolization and assistive devices
-Postoperative: monitoring VS, frequent neurovascular assessments, pain and discomfort, dressing or casts, sterile technique to avoid contamination

Front 89

Describe nursing actions for a patient in traction:

Back 89

-Inspect exposed skin areas regularly
-Skeletal traction pin sites must be observed for signs of infection
-Pin site care varies but usually includes removal of exudate with half-strength H2O2, rinsing pin sites with sterile saline, and drying of the area with sterile gauze
-Incorrect alignment can result in increased pain and nonunion or malunion
-Encourage participation in a simple exercise program

Front 90

This diagnostic procedure invole injecting a radiographic opaque dye into the sac around the nerve roots; CT scan may follow to show how the bone is affecting the nerve roots; very sensitive test for nerve impingement and can pick up even very subtle lesions and injuries:

Back 90

-Myelogram

Front 91

Describe nursing actions for a patient experiencing myelogram:

Back 91

-Main risk is the potential for spinal headache, inform patient that headache should resolve in 1-2 days with rest and fluids, but should be reported to HCP

Front 92

This diagnostic study involves insertion of arthroscope into joint (usually knee) for visualization of structure and contents; it can be used for exploratory surgery (removal of loose bodies and biopsy) and for diagnosis of abnormalities of meniscus, articular cartilage, ligaments, or joint capsule; other structures that can be visualized through the arthroscope include the should, elbow, wrist, jaw, hip, and ankle:

Back 92

-Arthroscopy

Front 93

Describe nursing actions for a patient undergoing arthroscopy:

Back 93

-Inform pt that procedure can be performed in outpatient setting with strict asepsis and that either local or general anesthesia is used; after procedure, cover wound with sterile dressing

Front 94

This diagnostic study involves injection of radioisotope that is taken up by bone; a uniform uptake of the isotope is normal; increased uptake is seen in osteomyelitis, osteoporosis, primary and metastatic malignant lesion of bone, and certain fractures; decreased uptake is seen in areas of avascular necrosis:

Back 94

-Bone scan

Front 95

Describe nursing actions for a patient undergoing a bone scan:

Back 95

-Explain that tech gives a calculated dose of radioisotope 2 hr b4 procedure; ensure that bladder is emptied b4 scan; inform pt that procedure requires 1 hr while pt lies in supine and that no pain or harm will result; explain that no follow-up scans are required; increase fluids after the exam

Front 96

This diagnostic study evaluates electrical potential associated with skeletal muscles contraction; small-gauge needles are inserted into certain muscles; needle probes are attached to leads that feed info to EMG machine; recordings of electrical activity of muscles are traced on audiotransmitter, as well as on oscilloscope and recording paper; study is useful in providing info related to lower motor neuron dysfunction and primary muscle disease:

Back 96

-Electromyogram (EMG)

Front 97

Describe nursing actions for a patient undergoing EMG:

Back 97

-Inform pt that procedure is usually done in EMG lab while patient lies supine on special table; keep pt awake to cooperate with voluntary movement; some needle discomfort; avoid admin of stimulants include caffeine and sedative 24 hr prior

Front 98

Describe actions, use, side effects, and nursing considerations for Salicylates:

Back 98

-Actions: antiinflammatory, analgesics, antipyretic, act by inhibiting synthesis of prostaglandins
-Side effects: GI irritation, prolonged bleeding time, exacerbation of asthma, tinnitus, dizziness with repeated large doses
-Nursing Considerations: admin drug with food, milk, antacids, full glass of water; may use enteric-coating aspirin, report signs of bleeding

Front 99

Describe actions, side effects, and nursing considerations for NSAIDs:

Back 99

-Actions: antiinflammatory, analgesic, antipyretic, act by inhibiting synthesis of prostaglandins
-Side Effects: GI irritation, prolonged bleeding time, headache, tinnitus, rash, acute renal insufficiency, exacerbation of asthma
-Nursing Considerations: admin with food, milk, or antacids, report signs of bleeding, edema, skin rashes, persistent headaches, visual disturbances; monitor BP for elevations