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131 Cards in this Set
- Front
- Back
define: diaphysis
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Shaft of a long bone
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define: Epiphysis
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Growth area of a long bone
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define: metaphysis
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the growing part of a long bone between the diaphysis and the epiphysis
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define: periosteum
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compact and cancellous tissues of bone together; beneath the hard outer shell of the periosteum, there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone; muscles, ligaments, and tendons may attach to the periosteum
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what sorts of problems can recieving an injury at the epiphysis cause?
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growth problems
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the center of bone contains what?
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bone marrow (red and yellow)
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what minerals is bone made of?
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calcium, phosphorus, and other minerals
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what is the best indicator of growth?
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bone development
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how does the pituitary affect growth?
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growth hormone
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how does the thyroid affect growth of bones?
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influences metabolism and growth, increases bone circumfrence
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what are the first centers of ossification (think developmentally)
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2 month old embryo
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how many centers of ossification are there by birth?
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400
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by 5-6 months, where are the growth centers?
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wrist
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to accurately determine bone age, what can be done?
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x-ray wrist bones and compare to developmental standards
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what is the most accurate measure of growth?
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x-ray of the degree of bone ossification
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why are infant's bones not as brittle as older people's?
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they have more organic material.
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bones are....% ossified by 8 months of age?
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65
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at what age does the anterior fontanel close?
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16-18 months
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why do the fontanels take so long to fuse?
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so that the head can expand in circumference
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if the head of the femur slips forward w/ pressure from behind, what assessment is it?
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ortalani's sign
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what are some things a nurse might look for to find dysplasia of the hip (aka, congenital hip dislocation)
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ortalani's sign, asymetry of gluteal folds, the affected limb will be shorter
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how does one treat hip dysplasia of an infant?
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maintain abduction
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define abduction:
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Moving or pushing an arm or leg away from the body
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how is abduction maintained?
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by a brace or pavlic harness
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when an infant is in a pavlic harness that is not removed, how should the infant be bathed?
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sponge bath
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what can be done to prevent skin break down in a harness
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always put an undershirt under the chest straps and knee socks under foot/leg pieces; check frequently for red areas under straps and clothing, gently massage healthy skin under the straps once/day; avoid lotions and powders;
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where should the diaper be placed in relation to the pavlic harness?
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under the straps
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describe a club foot
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foot that is twisted out of shape during uterine develpment or due to genetics
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what is the treatment for club foot
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series of casts; surgery
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what are the main goals of tx for club foot
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manual correction of deformity; maintenance of correction w/ casts if necessary; follow up observation to be sure correction is maintained
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what are fractures?
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a break in the coninuity of bone
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why are fractures uncommon in infants
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great deal of force is required to break bones because of increased flexibility of baby's bones
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what is some of the pathophysiology affecting fractures
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break in continuity of bone; torn blood vessel, clot and fibrin strands begin healing process; Ca salts deposited and callus is responsible for stability and new bone formation
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define: transverse fracture
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crosswise at right angles to the long axis of the bone
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define: oblique fracture
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slanting but straight between a horizontal and a perpendicular direction
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define: spiral fracture:
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slanting and circular, twisting around the bone shaft
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define: a 'bends' fracture:
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the bone straightens slowly when bent, but not completely, to produce some deformity
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define: buckel fracture
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compression of the porous bone produces a buckle or torus. appears as a raised or bulging projection at the fracture site. occur in porous bone near metaphysis and are more common in young children
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define greenstick fracture:
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occurs when a bone is angulated beyond the limits of bending. The compressed side bends and the tension side fails, causing an incomplete fracture similar to the break observed when a green stick is broken
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define: complete fracture
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divides the bone fragments. they often remain attached by a periosteal hinge, which can aid or hinder reduction
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what are the types of complete fractures
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transverse, spiral, oblique, comminuted, or butterfly
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what does a child with uncomplicated fracture and signs of shock need?
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immediate further investigation for other injuries
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what are some things to assess for fractures?
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pain, edema, immobility, crepitus, ecchymosis, muscle spasms, inability to bear weight
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what are the 5 p's of ischemia?
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pain, pallor, pulselessness, parasthesia, paralysis
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what diagnostic studies are done for fractures?
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x-ray, blood studies and enzymes (ast, ldh, cbc)
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what is the medical treatment for fractures
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emergency management and assessment; reduction/ repositioning of bone into normal alignment; retention and application of a device that will maintain alignment while healing; apply cold
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name some impromptu types of splints:
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immobilize w/ soft splint (towel) or hard splint (magazine)
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what is the usual method of closed reduction treatment for fractures
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cast
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when swelling is involved what type of closed reduction method may be used?
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traction
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what are some methods of open reduction for the treatment of fractures
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surgery w/ hospitalization (infection can be a problem)
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what are the retention methods of tx for fractures
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casts and splints
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why are heating fans or dryers not used to dry casts?
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because they cause the cast to dry on the outside and remain wet beneath, thus there is a potential for them to become moldy. They also can cause burns from heat conduction
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with what side of your hands should a wet cast be handled?
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palms to prevent indenting the cast and creating pressure areas and supported by a pillow covered w/ plastic
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what is the chief concern in the first few hours after the cast is applied?
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swelling; the cast could act as a tourniquet, shutting off circulation and producing a neurovascular complication
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how might the nurse reduce the risk of swelling after a cast is applied?
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elevate the body part
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once a cast is in place, permanent muscle and tisue damage can occur after how long?
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6-8 hrs
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if "hot spots"--places that are wet or foul smelling--are noticed, what should the nurse do?
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report it, it may be infection
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what is often done to a cast on an extremity that has sustained an open fracture?
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a window is left over the wound area to allow for observation and for dressing the wound
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the parent should be told to see the health care professional if what happens after cast placement?
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it becomes too loose
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what are the types of traction?
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manual, skin, skeletal
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describe manual traction:
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applied w/ hand distal to fractures
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describe skin traction:
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exerts force on skin; non invansive, well tolerated, skin breakdown can occur
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describe skeletal traction
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pin inserted in bone and traction applied to bone when significant pull is needed. infection can be a problem
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when is the likelyhood of using external and internal fixation devices the greatest?
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when damage to bone is great
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what should the nurse check for those w/ traction?
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circulation, 5 p's, line pull, weights, body alignment, cleanliness of pin sites
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how should weights be hanging for a pt in traction?
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freely, not leaning against bed or floor
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what should the nurse do about releasing traction?
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the nurse should not release traction
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how often should pin sites be assesed and cleaned?
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every 4 hours
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when would the nurse remove pins?
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never
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what are some complications of traction and fractures?
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circulatory impairment, nerve damage, compartment syndrom, kidney stones, pulmoary embolism
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what is compartment syndrome?
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increased pressure w/in closed space rises and compromises circulation to the muscle and nerves w/in the space.
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what are s/s of compartment syndrome?
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motor weakness, pain out of proportion to injury requiring opioids for pain control. May occur as early as 30 min. after ischemia develops. tenseness on palpation
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what is the tx for compartment syndrome
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relief of pressure, sometimes requiring a fasciotomy
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why are kidney stones a problem for bone injuries?
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urinary stasis, immobilzation, hypercalcemia
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what complication might the nurse watch for w/ multiple fractures?
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pulmonary embolism
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describe scoliosis
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complex spinal deformity involving 3 dimensions
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what are the dimensions of scoliosis?
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lateral curvature, spinal rotation, rib cage deformity
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for whom is scoliosis the most common?
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girls 10 years old and adolesant girls
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what are the manifestations of scoliosis?
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visible curvature, rib hump when bending forward, asymmetrical rib cage, uneven shoulders, pelvis higher on one side, reduced vital capacity
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what is the tx for scoliosis?
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bracing, milwakee brace, boston brace, surgery
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how long must braces usually be worn?
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16-23 hours per day
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what stands out about the milwakee brace?
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it can't be hidden
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where is the boston brace found?
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underarms
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where is the bone graft taken for fusion in surgery for scoliosis?
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iliac crest
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identify three nursing dx's for immediate postoperative time and home care of scolosis
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risk for injury r/t surgery, acute pain r/t surgical procedure, impaired urinary elimination r/t surg; imp. physical mobility r/t spinal surgery; risk for interrupted family process
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what are some interventions for post op scoliosis surgery
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assess extremities for circulation/warmth/color, cap refill, sensation, motion, pedal pulses; keep flat; HOB can be elevated 2nd day; log roll after 12 hours; pt for exercises on calves, walking w/ assistance by 6th day
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how must a log roll be done?
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with another person
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what are some interventions for home care of post op scoliosis surgery?
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wound care; nutritious diet, avoid twisting/bending at waist, activity restriction 6-9 months, resource person for Q's, follow up visits
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what activities should a post op scoliosis client avoid for 6-9 months?
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active play like biking, rollerblading, skiing
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describe osteomylitis
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a severe infection of the bone, bone marrow, and surrounding soft tissue
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what organisms often cause osteomylitis?
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E. coli, salmonella, Neisseria gonorrhea, staph epideridis, and pseudomonas aeruginosa
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indirect entry of microorganisms in osteomyelitis most frequently affects whom? p 1692 lewis
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boys less than 12
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direct entry osteomylitis can occur when? p 1692 lewis
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at any age when there is an open wound
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what are the clinical manifestations of acute osteomylitis? p 1693 lewis
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fever, night sweats, chills, restlessness, nausea, malaise, constant bone pain, swelling, tenderness, warmth in infection site
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what are late signs of osteomylitis? p 1693 lewis
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drainage from sinus tracts to skin and/or fracture site
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what are local signs of chronic osteomylitis? p 1693 lewis
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constant bone pain, swelling, tenderness, warmth at infection site
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what is the definitive way to determine the causitive microorganism of a case of osteomylitis? p 1693 lewis
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bone/soft tissue biopsy is the difinitive way to determine causitive microorganism.
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What diagnostic studes would be done for osteomylitis?
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wbc, erythrocyte sedementaion rate (ESR), radiologic, MRI, radionuclide bone scans, CT
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describe septic arthritis: p 1735, lewis
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infections or bacterial arthritis; invasion of joint cavity w/ microorganisms
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what is the etiology for septic arthritis? p 1735
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bacteria travel via blood to site of infection resulting in hematogenous seeding of joint
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what organisms are likely to cause septic arthritis? p 1735 lewis
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staph. aureus is most common, strep hemolyticus is also seen; neisseria gonorrhoea is most common in sexually active adults
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what is the comparisson between the incidence of septic arthrits compared with osteomylitis? 1735 lewis
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septic arthritis occurs twice as often
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what factors increase the risk of infection w/ septic arthritis? 17335lewis
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leukemia, diabetes mellitus, tx w/ corticosteroids, debilitating chronic diseases
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what is a common location for septic arthritis? 1735 lewis
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large joints such as knee or hip
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what are the clinical manifestations of septic arthritis? pp slide # 23
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severe pain, loss of motion, red / swollen joint, fever, chills
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what diagnostic procedures are used to dx septic arthritis? slide # 23
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blood cultures, joint fluid cultures, films +/-
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what is the tx for septic arthritis? slide # 24
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IV antibiotics: 2-8 weeks of therapy; Surgery: incision/ drainage, leaving wound open; pain control, gentle ROM when swelling subsides, aseptic tech., diversional activity
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what type of fluid usually lubricates many joints? slide 26
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synovial
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what is the most common form of joint disease?
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osteoarthritis
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what type of arthritis involves the formation of new joint tissue in response to trauma/damage? slide 27
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osteoarthritis
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what type of inflammatory process does osteo arthritis have? slide 27
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it doesn't have one. It is non inflammatory
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what are the risk factors for osteoarthritis? slide 28
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males age 45+, female age 55+, trauma, obesity
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what are the types of osteoarthritis? slide 29
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ideopathic: no known cause; secondary: direct damage to cartilage and injury resulting in joint instability
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what diagnostic procedures are used to diagnose osteoarthritis? slide 30
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bone scan, ct, mri, plain films, synovial studies
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what are the clinical manifestations of osteoarthrits? slide 31
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pain worsens as the joint is used during the day, changes in barometric pressure, increase pain,stiffness occurs as the disease progresses crepitation (in more than 90% of patients)
asymmetrical deformity Heberden’s nodes - DIP Bouchard’s nodes - PIP |
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which joints are often involved w/ osteoarthritis? slide 33
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hips, knees, carpals, proximal and distal interphalangeal, cerv and lumbar vert
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describe rheumatoid arthritis:
slide 34 |
Chronic, systemic disease
inflammation of connective tissue exacerbations and remissions, multi-system manifestations |
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what are some demographics for rheumatoid arthritis? slide 34
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most common among women, native americans, but happens in all cultural groups
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what are thought to be some etiologies of rheumatoid arthritis? slide 35
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autoimmune, Igg produced resulting ultimately in breakdown of articular cartilage
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what sorts of diagnostic procedures might be used for someone who may have rhuematoid arthritis? slide 37
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Erythrocyte Sedementation Rate; rheumatoid factor; antinuclear antibodies; c-reactive protein, synovial fluid analysis
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what are the clinical manifestations of rheumatoid arthritis? slide 38
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Remission/exacerbation; High wbc; Elevated esr; Ulnar drift; Mostly small joints; A lot of stiffness; O golly; Insidious onset; Disease is systemic
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what are the most common clinical manifestations of rheumatoid arthritis? slide 39
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subcutaneous, small, firm, nontender over extensor surfaces of small joints spine, back of head, sclera, lungs
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what is Sjorgren syndrome (associated w/ rheumatoid arthritis--slide 39)
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diminished lacrimal and salivary secretions
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what is Felty syndrome? (associated w/ rheumatoid arthritis--slide 39)
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inflammatory eye problems
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describe stage I rheumatoid arthritis: (slide 42)
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no destructive changes on x-ray; +/- osteoporosis
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describe stage II rheumatoid arthritis: (slide 42)
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osteoporosis present; + / - bone destruction; nodules and stiffness
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describe stage III rheumatoid arthritis: slide 42
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bone destruction; osteoporosis; deformity of joints; nodules
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describe stage IV rheumatoid arthritis: slide 42
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terminal, fibrous or bony ankylosis
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what are the complications of rheumatoid arthritis w/o treatment? slide 43
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joint destruction begins within one year of onset
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what are some other complications of rheumatoid arthritis? slide 43
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scleral nodules:cataracts/ loss of vision; superficial nodules:breakdown – infected; vocal cord nodules: hoarseness
vertebral body: severe pain - immobility |
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what are some tx options for rheumatoid arthritis? slide 44-487
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aspirins, NSAIDS, non opioid analgesics, opioids, corticosteroids, intra articular injections, immunosuppressant, DMARDs, apheresis, nutrition
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