Unit 4 - Brunner - Orthopedics

Front 1

results from trauma to a muscle body or to attachment of a tendon from overstretching, overextension or misuse

Back 1

strain

Front 2

arises from twisting/wrenching movements

Back 2

strain

Front 3

s/s of strain

Back 3

muscle spasm
discomfort/pain
ecchymosis
edema

Front 4

care of strain injuries

Back 4

first 24 hrs: elevate and ice
heat after 72 hrs
4-6 weeks = rest injured part

Front 5

is a ligamentous injury from overstress that damages the ligament fibers or their attachment to bone

Back 5

sprain

Front 6

most frequent injury during sports

Back 6

ankle sprain

Front 7

caused when foot is forced inwards and stretches ligaments that hold join in place

Back 7

ankle sprain

Front 8

types of sprain

Back 8

first degree (mild) - no loss of function, no weakining of the ligament

2nd degree (moderate) = partially torn ligament; some loss of function

3rd degree (severe) a ligament is completely torn

Front 9

Tx of sprain (mild)

Back 9

RICE=

Rest
Ice
Compression
Elevation

Front 10

Tx of sprain (moderate)

Back 10

immobilization for 1-2 wks
crutches (no weight bearing)

Front 11

tx of severe sprain (3rd deg)

Back 11

surgical repair
cast or brace 4-6 weeks

Front 12

sprains can lead to ________

Back 12

avulsion fractures

Front 13

is an injury to the bone in a place where a tendon or ligament attaches to the bone. When this occurs, the tendon or ligament pulls off a piece of the bone.

Back 13

avulsion fracture

Front 14

client education for sprains

Back 14

explain all phases of recovery
teach crutch walking
measure correct size of crutch
adequate taping for next 6 months

Front 15

proper crutch walking

Back 15

no weight bearing on the axilla
Pt stands straight, elbows at 30 degrees, wrists extended
3 point gait sequence

Front 16

what is 3 point gait sequence

Back 16

movement of weaker leg with both crutches simultaneously

Front 17

results from mechanicl overload of the bone when more stress is placed on bone than it can absorb

Back 17

Fracture

Front 18

an example of fracture without much force

Back 18

osteoporosis

Front 19

risk factors for fractures

Back 19

osteopenia
neoplasm
post menopausal estrogen loss
protein malnutrition
high risk recreation activities
victims of domestic abuse

Front 20

caused by steroid use or cushing's syndrome

Back 20

osteopenia

Front 21

clinical manifestations of Fractures

Back 21

deformity
swelling
bruising
pain
loss of function
abnormal mobility and crepitus
neurovascular
shock

Front 22

common types of fractures

Back 22

closed/open
complete/incomplete
comminuted
nondisplaced
compression

Front 23

fx that is a break across entire cross section of bone

Back 23

complete

Front 24

more than one fracture line; more than two fragments

Back 24

comminuted

Front 25

fragments aligned at fx site

Back 25

nondisplaced

Front 26

bone buckles and cracks

Back 26

compression

Front 27

common fx during car accidents

Back 27

compression

Front 28

medical management of fx

Back 28

ABC
splinting
neuro checks of the affected extremity
cover with sterile dressings
NPO
freq. Vs
ice, elevation

Front 29

frequency of Neuro checks on Fx?

Back 29

q. 15 mins

Front 30

common ages for fx

Back 30

ages 6-16
elderly

Front 31

the application of a pulling force to an injured body part

Back 31

traction

Front 32

achieved thru use of hands or application of weights

Back 32

traction

Front 33

refers to restoration of the fx fragments into anatomic alignment

Back 33

Reduction (bone setting)

Front 34

surgical restoration of the fx fragments into anatomic alignment

Back 34

closed reduction

Front 35

surgeon makes incision and realigns the fx fragments under direct visualization

Back 35

open reduction internal fixation

Front 36

the use of devices to maintain position for unstable fx's and weakened muscle; used for non-union fx

Back 36

external fixation

Front 37

new type of nail used for fx surgery

Back 37

Innu nail

Front 38

complications of fx (short term)

Back 38

arterial damage
blood loss
DVT and PE
FES
Compartment syndrome

Front 39

the release of fat from the bone marrow resulting in ARDS

Back 39

Fat Embolism Syndrome (FES)

Front 40

s/s of FES

Back 40

hypoxia
apprehensive
anxiety
agitation
acute confusion
fever > 103
tachypnea
tachycardia
petechiae on chest, flank (50-60% of patients)

Front 41

is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation) within a confined space (fascial compartment) in the body impairs blood supply.

Back 41

compartment syndrome

Front 42

s/s of compartment syndrome

Back 42

increased pain
paresthesia
slow cap refill
muscle damage irreversible after 4 to 6 hours of ischemia
nerve damage irreversible after 12-24 hours

Front 43

what to do when pt develops compartment syndrome?

Back 43

call MD
MD might cut or bivalve the cast

Front 44

means to cut it on both sides from top of the cast to the toes so it can "open up" and allow for swelling. After cut, the cast is usually held together with an Ace bandage to keep it in place

Back 44

to "Bivalve a cast"

Front 45

long term complication of fractures

Back 45

post traumatic arthritis
avscular necrosis
nonfunctional union
malunion

Front 46

is a disease resulting from the temporary or permanent loss of the blood supply to an area of bone.[1] Without blood, the bone tissue dies and the bone collapses

Back 46

avascular necrosis

Front 47

care of client with a cast

Back 47

skin preparation
web rolling and stockinette
1/2 cast applied to allow for swelling
allow for drying
windowing or bivalving a cast
neurovascular assessment
6 ps

Front 48

neurovascular assessment : fx

Back 48

color
warmth
distal pulses
cap refill
movement of toes and fingers

Front 49

affects the area between the lower rib cage and gluteal muscles and radiates into thighs

Back 49

Low Back Pain

Front 50

aka sciatica, pain in the distribution of a lumbar nerve root, w/ muscle weakness

Back 50

low back pain

Front 51

possible causes of low back pain

Back 51

disc prolapse
tumors
bursitis
degenerative joint disease
bony fx
herniated nucleus puposus in discs L3-S1

Front 52

risk factors for low back pain

Back 52

occupations requiring lifting
bending and twisting positions
osteoporosis
spinal stenosis

Front 53

aka compressed vertebrae

Back 53

spinal stenosis

Front 54

is a narrowing of the spinal canal, which may place pressure on the spinal cord or nerves

Back 54

spinal stenosis

Front 55

symptoms include pain in the lower back radiating down posterior surface of one or both legs, paresthesia in the leg or foot; motor weakness, decreased or absent ankle reflex, pain along the nerve during coughing and sneezing

Back 55

herniated disc

Front 56

can also occur in cervical area

Back 56

herniated disc

Front 57

Tx of herniated disc

Back 57

HnP
EMG
CT
MRI
Myelographic procedures
nerve conduction studies

Front 58

A test which measures muscle response to nerve stimulation. Used to evaluate muscle weakness and to determine if the weakness is related to the muscles themselves or a problem with the nerves that supply the muscles.

Back 58

EMG

Front 59

facts about CT and MRI on herniated discs

Back 59

CT is usually done first before MRI; however MRI is better

Front 60

medical approaches to herniated disc

Back 60

NSAIDs
muscle relaxers
no bedrest necessary
spinal injections (cortisone, marcaine)

Front 61

surgical approach to herniated disc

Back 61

diskectomy - done when there's evidence of severe compression

Front 62

s/s of severe disk compression

Back 62

weakness
decrease deep tendon reflexes
loss of bladder/bowel reflexes

Front 63

post op care: disk surgery

Back 63

check voiding / pt prone to urinary retention

Front 64

<surgery> Excision, in part or whole, of an intervertebral disk. The most common indication is disk displacement or herniation.

Back 64

diskectomy

Front 65

3 functions of the bones

Back 65

protect internal organs
metabolism and mineral homeostasis
primary site for hemopoiesis

Front 66

chronic JOINT disorder that has degenerative changes

Back 66

osteoarthritis

Front 67

a process of cartilage breakdown and body's attempts at repair

Back 67

osteoarthritis

Front 68

erosion and cracking appear at the top layer of cartilage and collagen fibers RUPTURE

Back 68

osteoarthritis

Front 69

2 types of osteoarthritis

Back 69

primary (idiopathic)
secondary (aka traumatic arthritis)

Front 70

more common in women
not a normal part of aging
not considered genetic

Back 70

primary osteoarthritis

Front 71

more common in men
results from trauma, other inflamm.disease , avascular necrosis
repetitive injury R/t occupation

Back 71

secondary (traumatic) osteoarthritis

Front 72

stimulates cartilage growth by driving synovial fluid thru the cartilage matrix

Back 72

osteoarthritis

Front 73

is the deterioration and abrasion of joint cartilage, with the formation of new bone at the joint surfaces

Back 73

osteoarthritis

Front 74

what decreases risk of OA

Back 74

exercise (weight bearing)
weight control

Front 75

pathopysiology of OA

Back 75

chondrocytes produce collagen and proteoglycans

Front 76

remodels and maintains integrity of bone ends

Back 76

chondrocyte

Front 77

a systematic AUTOIMMUNE disease that causes chronic inflammation of the connective tissue in the joints

Back 77

Rh. arthritis

Front 78

affects women more, 3-1 ratio

Back 78

Rh. arthritis

Front 79

increased at third decade of life, cause remains obscure

Back 79

Rh. arthritis

Front 80

hypertrophy of synovium produces pain
Protrusion of synovial fluid (hypertrophy)
An autoimmune disorder
More obvious deformities
Systemic effects

Back 80

Rh. arthritis

Front 81

differences between OA and RA

Back 81

OA - affects wt . bearing joints; pain with activity; resting helps decrease pain

RA - affects SMALL joints; pain at rest; more at night

Front 82

PIP

Back 82

proximal interphalangeal joints affected by RA

Front 83

clinical manifestations of RA

Back 83

xray - narrowed joint spaces
stiffness
decreased ROM
joint enlargment
locked joints or gives away
Heberden's nodes

Front 84

on OA, these hard nodules or enlargements of tubercles of last phalanges of fingers --

Back 84

Heberden's nodes

Front 85

Medical Management of OA /RA

Back 85

Pain relief w/ mobility exercises
maintain functional independence
lose weight
low impact aerobics
rest joint when painful
warmth or heat/cold therapy

Front 86

meds for OA/RA

Back 86

Capsaicin
NSAIDs - not 1st line of choice
Tylenol - 1st drug of choice
COX 2 selective agents
Vioxx
Glucosamine and chondroitin

Front 87

Surgical Management of OA/RA

Back 87

Total hip replacement (arthroplasty)

cemented or noncemented

Front 88

performed by replacing arthritic bone with metal components; done when pain management not working

Back 88

THR

Front 89

why is cemented THR not done on young/heavier persons

Back 89

because cement will loosen

Front 90

allows fixation, bone grows into the porous surface - limited weight bearing for several weeks

Back 90

noncemented THR

Front 91

allows for immediate intra-op fixation of femoral and acetabular components; done on elderly

Back 91

cemented THR

Front 92

complications of THR

Back 92

venous thromboembolism
infection
bladder infections R/t FoleyCath
joint instability
revision surgery

Front 93

osteomyelitis infection requires what antibiotic?

Back 93

vancomycin

Front 94

ways to prevent venous thromboembolism

Back 94

early ambulation
TED stockings
arterial pumps

Front 95

nursing management THR

Back 95

HnP, xrays and pre-op teaching
post op: respiratory and vs function
Hip precautions
Turning
position in external fixation and abduction with foam wedge
Foley cath
freq circ/neurovasc checks
check dressing
maintain skin integrity
JP drains and Hemovac
no more than 200ml/8hours
Pain control
Prevent constipation
Check for dizziness
bed exercises start post op day

Front 96

what are hip precautions?

Back 96

adduction or internal rotation

Front 97

what should you know about turning done post op

Back 97

stay off the affected side
maintain side lying position
return to supine position q. 2hours

Front 98

what should you know about dressing changes? post op THR

Back 98

MD changes first dressing
RN can reinforce if necessary
change dressing after shower

Front 99

what to know about epidurals? THR post op

Back 99

apnea monitor
pulse saturations watch for ARDS

Front 100

what to know about pain control? THR post op

Back 100

PCA drugs: mS, Dilaudid, Demerol - continuous or intermittent

switch to PO meds after 48-72 hours

check BM (risk of constipation)

Front 101

what to know about physical mobility? THR post op

Back 101

goal is to ambulate 150 feet before going come

cemented prothesis - WBAT or FWB (full weight bearing)$

when standing first time, 2 people stand by, client moves away from operative side, proper footwear, client pushes off with their hands

Front 102

most common site for arthritis

Back 102

knee

Front 103

w/c part of knee receives more stress

Back 103

medial side

Front 104

facts about OA on hip and knee

Back 104

OA of knee is bettr tolerated; at rest, knee is not painful

Front 105

treatment of knee arthritis

Back 105

anti-inflammatory meds
analgesics
wt. loss
activity modification

Front 106

surgical treatment of knee arth.

Back 106

TKR or arthroplasty

Front 107

resurfacing of the arth. joint using metal and polyethylene prosthetic components

Back 107

TKR

Front 108

contraindications to TKR

Back 108

< 65 yrs, weighing more than 250 lbs or extremely active

Front 109

3 components of TKR

Back 109

Femoral component,
tibial place,
patellear button

Front 110

facts about TKR

Back 110

Incision extends 5 inches above patella and 3 inches below

Flexion contractures or deformities are corrected

Wound drains - GISH

CPM machine

Front 111

complications of TKR

Back 111

Infections - 2 %
Venous thromboembolism
Patellar subluxation or dislocation
Impaired wound healing
Knee stiffness
Loosening of prosthesis

Front 112

is a simple system that yields immediate availability of a patient's shed blood. This is a post-operative auto-transfusion system and also serves as an effective closed wound drainage system

Back 112

Gish wound drain

Front 113

nursing mgmt. TKR

Back 113

emphasize knee exercise
ROM
consistent PT and/or CPM machine

Front 114

what to know about CPMs

Back 114

take it off during meals
it can only be adjusted by PT
CPM starts at 0 degrees of extension and 10-40 deg of flexion. settings increase to achieve 90 deg.
Used 6-8 hours/day
client supine w/ HOB at < 15 deg
knee immobilizer used when client is Out Of Bed (OOB)
no pillows under knees

Front 115

nsg mgmt (contd) post op TKR

Back 115

Arterial pumps
PT - isometric exercises, continue up to 6 wks ff. surgery
weight bearing during early ambulation

Front 116

cemented vs non cemented

Back 116

cemented - WBAT
Non cemented - NWB or TTWB ( toe touch weight bearing)