Nursing 4Th Musculoskeletal

Front 1

What are some of the functions of bones?

Back 1

support
protection of internal organs
voluntary movement
blood cell production
mineral storage

Front 2

Bones serve as an attachment for muscles, which are connected to bones by _____. Bones act as a lever for _____, Movement occurs as a result of of muscle contractions applied to these levers.

Back 2

Bones serve as an attachment for muscles, which are connected to bones by TENDONS. Bones act as a lever for MUSCLES, Movement occurs as a result of of muscle contractions applied to these levers.

Front 3

Describe the 3 types of bone cells.

Back 3

Osteoblasts- basic bone-forming cells (synthesize organic bone matrix)
Osteocytes- mature bone cells
Osteoclasts- participate in bone remodeling by assisting in the breakdown of bone tissue

Front 4

_____ _______ is the removal of old bone by osteoclasts (resorption) and the deposition of new bone by osteoblasts (ossification). The inner layer of bone is composed primarily of osteoblasts with a few osteoclasts.

Back 4

bone remodeling

Front 5

A _____ (articulation) is a place where the ends of two bones are in proximity and move in relation to each other. They are classified by the degree of movement that they allow.

Back 5

Joints

Front 6

Ligaments and tendons are both composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength.

_____ connect muscle to bone
and ______ connect bone to bone.
____ have a higher elastic content and provide stability while permitting controlled movement at the ____.

Back 6

Ligaments and tendons are both composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength.
Tendons connect muscle to bone
and ligaments connect bone to bone.
Ligaments have a higher elastic content and provide stability while permitting controlled movement at the joint.

Front 7

_______ is a rigid connective tissue in synovial joints that serves as a support to soft tissue and provides the articular surface for joint movement.

Back 7

Cartilage is a rigid connective tissue in synovial joints that serves as a support to soft tissue and provides the articular surface for joint movement.

Front 8

Why does cartilage heal so slowly?

Back 8

It is considered to be avascular, and it must receive nourishment by the diffusion material of synovial fluid. The lack of a direct blood supply contributes to the slow metabolism of cartilage cells an explains why cartilage heals slowly. Ligaments and tendons also have a relatively poor blood supply, usually making tissue repair a slow process after injury.

Front 9

What is the direct energy source for muscle fiber contraction?

Back 9

ATP (adenosine triphosphate)

Front 10

_____ refers to layers of connective tissue with intermeshed fibers that can withstand limited stretching.

Back 10

Fascia refers to layers of connective tissue with intermeshed fibers that can withstand limited stretching. Superficial fascia lies immediately under the skin. Deep fascia is a dense, fibrous tissue that surrounds the muscle bundles, nerves, and blood vessels. It also encloses individual muscles, allowing them to act independently and to glide over each other during contraction. In addition, fascia provides strength to muscle tissues.

Front 11

__________ are small sacs of connective tissue lined with synovial membrane and containing synovial fluid. They are typically located at bony prominences or joints to relieve pressure and decrease friction between moving parts.

Back 11

Bursae are small sacs of connective tissue lined with synovial membrane and containing synovial fluid. They are typically located at bony prominences or joints to relieve pressure and decrease friction between moving parts.

Front 12

______ is an inflammation of a bursa sac. The inflammation can be acute or chronic.

Back 12

bursitis

Front 13

Deficiency of what electrolyte can cause tetany, the involuntary contraction of skeletal muscle.

Back 13

calcium

Front 14

Aging can bring changes in a patient's balance, thus making the person unsteady, and
________, the awareness of self in relation to the environment, can be altered.

Back 14

proprioception

Front 15

The bone remodeling process is altered in the aging adult. Increased bone formation/resorption and decreased bone formation/resorption cause a loss of bone _____, contributing to the development of osteopenia and osteoporosis.

Back 15

The bone remodeling process is altered in the aging adult. Increased bone resorption and decreased bone formation cause a loss of bone density, contributing to the development of osteopenia and osteoporosis.

Front 16

Muscle mass and strength decrease with aging. A loss of ___ neurons can cause additional problems with skeletal muscle movement. Tendons and ligaments become less flexible, and movement becomes more rigid. Joints in the aging adult are also more likely to be affected by _______.

Back 16

osteoarthritis.

Front 17

True or False: Osteoarthritis and osteoporosis are the normal consequences of growing old.

Back 17

false

Front 18

As a result of aging, older patients have a reduced ability to store _____ and decreased ability to release it as a quick energy source during stress. This leads to slowed reaction times and reflexes as a result of slowing of _____ ______ along motor units, and earlier fatigue with activity.

Back 18

As a result of aging, older patients have a reduced ability to store glycogen and decreased ability to release it as a quick energy source during stress. This leads to slowed reaction times and reflexes as a result of slowing of impulse conduction along motor units, and earlier fatigue with activity.

Front 19

In the older adult, decreased muscle strength and bulk, abdominal _____, and flabby muscle is contributed to the increased/decreased number and diameter of muscle cells and replacement of muscle cells by ______ connective tissue.

Back 19

In the older adult, decreased muscle strength and bulk, abdominal protrusion, and flabby muscle is contributed to the decreased number and diameter of muscle cells and replacement of muscle cells by fibrous connective tissue.

Front 20

Loss of ______ in the older adult's ligaments and cartilage leads to decreased fine motor dexterity and decreased agility.

Back 20

Loss of elasticity in the older adult's ligaments and cartilage leads to decreased fine motor dexterity and decreased agility.

Front 21

What is crepitation?

Back 21

The noise produced by rubbing bone or irregular cartilage surfaces together, as in arthritis.

Front 22

Older adults have an increased risk for cartilage ____ that contributes to direct contact between bone ends and under/over growth of bone around joint margins. This leads to joint _____ness, decreased m____, limited ____, possible _________ on movement, and ___ with motion and weight bearing.

Back 22

Older adults have an increased risk for cartilage erosion that contributes to direct contact between bone ends and over growth of bone around joint margins. This leads to joint stiffness, decreased mobility, limited ROM, possible crepitation on movement, and pain with motion and weight bearing.

Front 23

Loss if water from disks between verebrae causes narrowing of intervertebral spaces. This can contribute to loss of ____ from disk compression and changes in p____.

Back 23

Loss if water from disks between verebrae causes narrowing of intervertebral spaces. This can contribute to loss of height from disk compression and changes in posture.

Front 24

Decrease in _____ ____ can contribute to loss of height due to vertebral compression, back pain, deformity such as dowager's hump (kyphosis) caused by vertebral compression

Back 24

Decrease in bone density can contribute to loss of height due to vertebral compression, back pain, deformity such as dowager's hump (kyphosis) caused by vertebral compression

Front 25

What skin marking can be an indication of neurofibromatosis?

Back 25

cafe au lait spots

Front 26

Range of motion is most accurately assessed with a ______, which measures the angle of the joint.

Back 26

goniometer

Front 27

Put the following assessment results in order (0-5) according to the muscle strength scale.
Active movement of body part with elimination of gravity
A barely detectable flicker or trace of contraction with observation or palpation
Active movement against full resistance without evident fatigue (normal muscle strength)
Active movement against gravity only and not against resistance
No detection of musc. contraction
Active movement against gravity and some resistance

Back 27

Muscle Strength Scale
0 No detection of musc. contraction
1 barely detectable flicker or trace of contraction with observation or palpation
2 active movement of body part with elimination of gravity
3 active movement against gravity only and not against resistance
4 active movement against gravity and some resistance
5 active movement against full resistance without evident fatigue (normal muscle strength)

Front 28

Review table 62-3

Back 28

Movement of synovial joints

abduction, adduction etc

Front 29

pain in posterior leg when running or walking initially; can progress to pain at rest (may be due to cumulative stress on this tendon resulting in inflammation)

Back 29

achilles tendonitis

Front 30

stiffnss and fixation of a join (may be due to chronic joint inflammation and destruction as in rheumatoid arthritis)

Back 30

ankylosis

Front 31

shortened stride with as little weight bearing as possible on the affected side (may be due to pain or discomfort in the lower extremity on weight bearing; can be r/t trauma or other disorders)

Back 31

antalgic gait

Front 32

staggering, uncoordinated gait often with sway (may be due to neurogenic disorders such as spinal cord lesion)

Back 32

ataxic gait

Front 33

flabby appearance of muscle leading to decreased function and tone (may be due to muscle denervation, contracture, prolonged disuse as a result of immobilization)

Back 33

atrophy

Front 34

finger abnormality that is typical of RA and psoriatic arthritis caused by rupture of extensor tendons over fingers

Back 34

Boutonniere deformity

Front 35

resistance of movement of muscle or joint as a result of fibrosis of supporting soft tissues (may be due to shortening of muscle or ligaments, tightness of soft tissue, incorrect positioning of immobilized extremity)

Back 35

contracture

Front 36

frequent, audible crackling sound with palpable grating that accompanies movement (may be due to fracture, dislocation, temporomandibular joint dysfunction, osteoarthritis)

Back 36

crepitation (crepitus)

Front 37

displacement of bone from its normal joint (may be due to trauma, disorders of surrounding soft tissue)

Back 37

dislocation

Front 38

While walking, the neck , trunk, and knees flex while the body is rigid; delayed start with short, quick, shuffling steps; speed may increase as if patient is unable to stop (may be due to neurogenic disorders like Parkinson's)

Back 38

Festinating gait
(festination-hurried gait)

Front 39

small fluid-filled bump or mass over a tendon sheath or joint, usually on dorsal surface of wrist or foot (inflammation of tissues around a joint, can increase in size or disappear)

Back 39

ganglion cyst

Front 40

forward bending of thoracic spine, slight flexion of knees; exaggerated thoracic curvature (may be due to poor posture, tuberculosis, arthritis, osteoporosis, growth disturbance of vertebral epiphisis)

Back 40

kyphosis (dowager's hump)

Front 41

dull ache along outer aspect of elbow, worsens with twisting and grasping motions (partial tearing of tendon at its insertion on epicondyle)

Back 41

lateral epicondylitis (tennis elbow)

Front 42

asymetrical scapulae and shoulders, exaggerated lumbar curvature (may be secondary to other spinal deformities, muscular dystrophy, obesity, flexion contracture of hip, congenital dislocation of hip)

Back 42

lordosis (swayback)

Front 43

increased muscle tone (rigidity) with sustained muscle contractions (spasms), stiffness or tightness may interfere with gait, movement, and speech (may be due to neuromuscular disorders such as multiple sclerosis or cerebral palsy)

Back 43

muscle spasticity

Hint 43

g

Front 44

general muscle tenderness and pain (may be due to chronic rheumatic syndromes such as fibromyalgia)

Back 44

myalgia

Front 45

numbness and tingling, often describes as "pins and needles" (may be due to compromised sensory nerves, often due to edema in a closed space such as a cast or bulky dressing)

Back 45

paresthesia

Front 46

abnormal ____ of the foot is known as pes planus

Back 46

flatness

Front 47

burning sharp pain on sole of foot, worse in the morning (may be due to chronic degenerative/reparative cycle resulting in inflammation)

Back 47

plantar fasciitis

Front 48

asymetrical elevation of shoulders, scapulae, and iliac crests with lateral spine curvature (may be due to idiopathic or congenital condition, fracture or dislocation, osteomalacia)

Back 48

scoliosis

Front 49

A short-leg gait is a ___ unless corrective footware is used . A leg length discrepancy of greater than one ___ causes this, and is genreally due to a structural origin such as arthritis or a fracture.
A spastic gait is one with short/long steps and a dragging foot. It is jerky, uncoordinated, and involves cross-knee (scissor) movement.
A steppage gait is when there is increasd hip an knee ____ in order to clear the foot from the floor. Foot___ is evident, and the foot slaps down and along walking surface.

Back 49

A short-leg gait is a limp unless corrective footware is used . A leg length discrepancy of greater than one inch causes this, and is genreally due to a structural origin such as arthritis or a fracture.
A spastic gait is one with short steps and a dragging foot. It is jerky, uncoordinated, and involves cross-knee (scissor) movement.
A steppage gait is when there is increasd hip and knee flexion in order to clear the foot from the floor. Footdrop is evident, and the foot slaps down and along walking surface. (Spastic and steppage gait are often due to neurogenic disorders like cerebral palsy, hemiplegia, nerve and/or muscle injury/paralysis)

Front 50

A partial dislocation of a joint is known as ________. This is due to in______ of the joint capsule and supporting ligaments.

Back 50

A partial dislocation of a joint is known as subluxation. This is due to instability of the joint capsule and supporting ligaments.

Front 51

____ neck deformity is a typical deformity of rheumatoid and psoriatic arthritis caused by contracture of muscles and tendons.

Back 51

Swan neck deformity is a typical deformity of rheumatoid and psoriatic arthritis caused by contracture of muscles and tendons.

Front 52

____ing is an enlargement of a joint usually due to ____ collection. It generally leads to pain and stiffness and is a result of trauma or inflammation.

Back 52

Swelling is an enlargement of a joint usually due to fluid collection. It generally leads to pain and stiffness and is a result of trauma or inflammation.

Front 53

Tennosynovitis is superficial swelling, pain, and tenderness along a tendon sheath and is caused by inflammation that occurs with ________ motion. An example is _____ _____ syndrome.

Back 53

Tennosynovitis is superficial swelling, pain, and tenderness along a tendon sheath and is caused by inflammation that occurs with repetitive motion. An example is carpal tunnel syndrome.

Front 54

Torticollis (______) is when the ____ is twisted in unusual position to one side. This is due to prolonged contraction of neck muscles, either congenital or acquired.

Back 54

Torticollis (wryneck) is when the neck is twisted in unusual position to one side. This is due to prolonged contraction of neck muscles, either congenital or acquired.

Front 55

Ulnar deviation or ulnar drift is when the _____s drift to ulnar side of forearm. It is a typical deformity of RA due to tendon contracture

Back 55

Ulnar deviation or ulnar drift is when the fingers drift to ulnar side of forearm. It is a typical deformity of RA due to tendon contracture

Front 56

A _____ deformity, also known as knock-knees is when the knees are together and there is more than 1 inch or 2.5 cm between the medial malleoli. This can be due to poliomyelitis, congenital deformity, or arthritis.

Back 56

A valgum deformity, also known as knock-knees is when the knees are together and there is more than 1 inch or 2.5 cm between the medial malleoli. This can be due to poliomyelitis, congenital deformity, or arthritis.

Front 57

A ____ deformity (bowlegs) is when the knees are apart and the medial malleoli are together, a space of more than one inch exists.

Back 57

A varum deformity (bowlegs) is when the knees are apart and the medial malleoli are together, a space of more than one inch exists.

Front 58

Know how to teach someone how to use crutches

Back 58

..look in skills book

Front 59

If a med has anti-osteoclast activity, what does it do?

Back 59

prevents breaking down of bones

Front 60

Older adults have a decreased number and diameter of muscle cells. They lose elasticity in ligaments and cartilage. They have a reduced ability to store _____ and to do glyconeogenesis as well (can't mobilize and circulate glucose, leads to fatigue with activity). In assessments, you might see that the older adult has decreased muscle strength and bulk, abdominal ____, and muscle flabbiness. They often have decreased gross/fine motor ability and agility, and slowed reaction times.

Back 60

Older adults have a decreased number and diameter of muscle cells. They lose elasticity in ligaments and cartilage. They have a reduced ability to store glycogen and to do glyconeogenesis as well (can't mobilize and circulate glucose, leads to fatigue with activity). In assessments, you might see that the older adult has decreased muscle strength and bulk, abdominal protrusion, and muscle flabbiness. They often have decreased gross/fine motor ability and agility, and slowed reaction times.

Front 61

Some joint changes in older adults include erosion of ____ ______, which can cause bone to bone contact. Osteophytes are a form of _______ of bone around joint margins also known as a ___ ___. Loss of ____ from disks can lead to narrowing of joint vertebral spaces. Assessment of joints may show _____, which is caused by aging, wear and tear on the joint. This causes pain with with ____ exercises and joint ____ness. Older adults can lose inches in height, have joint subluxations, pain, and interruptions in their performance of ADL's.

Back 61

Some joint changes in older adults include erosion of articular cartilage, which can cause bone to bone contact. Osteophytes are a form of overgrowth of bone around joint margins also known as a bone spur. Loss of water (fluid) from disks can lead to narrowing of joint vertebral spaces. Assessment of joints may show osteoarthritis, which is caused by aging, wear and tear on the joint. This causes pain with with ROM exercises and joint stiffness. Older adults can lose inches in height, have joint subluxations, pain, and interruptions in their performance of ADL's.

Front 62

another word for Dowager's hump, which is caused by compression of vertebral bodies, is ____

Back 62

kyphosis

Front 63

________ is decreased bone mass without clinical changes (not yet clinical problem of osteoporosis)

Back 63

osteopenia

Front 64

What are some examples of assessment findings when looking at musculoskeletal system?

Back 64

joint or muscle pain, or joint swelling
decreasing strength/function
change in size of an extremity or muscle
deformity, spasm
changes in sensation
changes in gait, stiffness
crepitation

Front 65

look at assessment table 62-2
p. 1574

Back 65

....

Front 66

What are some diseases or disorders in a person's health history that can directly or indirectly effect a person's musculoskeletal system (may also have impact on recovery)

Back 66

diabetes (slow healing)
ostemalacia (adult form of rickets)
osteomyelitis
psoriatic arthritis
SLE
TB
arthritis (often familial)
Poliomyelitis
gout
hemophilia
parathyroid problems
rickets (vit D def)
scurvy (vit C def, imp for healing, cell wall integrity)
fungus (lose integrity of toe nail, nail protects toe)
past surgeries

Front 67

A patient with normal ROM at the shoulder should be able to perform:
a. circumduction, flexion, extension, adduction, abduction
b. flexion, extension, opposition
c. flexion, extension, rotation, inversion, and eversion
d. abduction, adduction

Back 67

a. circumduction, flexion, extension, adduction, abduction

Front 68

When doing an assessment on a fracture, look for possible complications in other organ systems. Ex- non symmetrical, bruising, swelling, could be bladder, bowel problems

Read and study about meds for musc. skeletal p. 5 of lecture...

Back 68

skeletal musc. relaxants

anti-rheumatoid agents

....more stuff

Front 69

What vitamins/ minerals/nutrients are important for a healthy, intact musculoskeletal system?

Back 69

Vit C
Vit D
Calcium
Protein

Front 70

A standard x-ray determines density of bone. What are some nursing implications?

Back 70

Explain procedure.
Avoid excessive exposure.
Before procedure, remove any radiopaque objects that can interfere with results.
Verify pt. is not pregnant.

Front 71

A diskogram permits visualization of intervertebral disk abnormalities. What are some nursing implications?

Back 71

Explain procedure.(contrast media is used before x-ray of cervical or lumbar intervertebral disk)
Assess pt. for possible allergy to contrast media.

Front 72

A _________ is used to identify soft tissue abnormalities, bony abnormalities, and various musculoskeletal trauma. An x-ray beam is used with a computer to provide a three-dimensional picture. What are 4 nursing implications?

Back 72

A CT- Scan is used to identify soft tissue abnormalities, bony abnormalities, and various musculoskeletal trauma. An x-ray beam is used with a computer to provide a three-dimensional picture. What are some nursing implications?

-Tell pt. procedure is painless.
-Tell pt. to hold still
-Verify pt. is not pregnant
-If using dye, ask about shellfish allergy

Front 73

A myelogram can be done with or without a CT scan. It involves injecting a _________ contrast medium into sac around nerve roots. A CT Scan may follow to show how bone is affecting nerve roots. It is a very sensitive test for nerve impingement and can detect very subtle lesions and injuries. What is the main risk? What should you tell the pt? Verify what before the test?

Back 73

Main risk- spinal headache
Inform pt that headache should resolve in 1-2 days with rest and fluids, but should be reported to health care provider.
Verify pt. is not pregnant.

Front 74

In an MRI, radio waves and magnetic field are used to view soft tissue. It is especially useful in the diagnosis of avascular necrosis, disk disease, tumors, osteomyellitis, ligament tears, and cartilage tears. Patient is placed inside scanning chamber. Godolinium may be injected IV to enhance visualization of structures. Open MRI does not require patient to be placed inside a chamber. Make sure pt. removes all metal, what are some examples of items that would need to be removed? Does gold need to be removed? Inform the patient that they must remain ___ during procedure. Administer what med if ordered and why would this med be indicated? An open MRI is available at some facilities, why would this be indicated for certain patients? You may offer the patient _____s because of the loud, clicking noises. ______ glasses can help with the claustrophobic factor.

Back 74

In an MRI, radio waves and magnetic field are used to view soft tissue. It is especially useful in the diagnosis of avascular necrosis, disk disease, tumors, osteomyellitis, ligament tears, and cartilage tears. Patient is placed inside scanning chamber. Godolinium may be injected IV to enhance visualization of structures. Open MRI does not require patient to be placed inside a chamber. Make sure pt. removes all metal, such as jewelery, snaps, zippers, credit cards, ask about metal implants etc.
Inform the patient that they must remain still during procedure. Administer anti-anxiety meds if ordered if pt. is claustrophobic or has high potential for anxiety during test. An open MRI is available at some facilities, may be indicated for certain patients. You may offer the patient earplugs because of the loud, clicking noises. Mirrored glasses can help with the claustrophobic factor.

Front 75

A DEXA (Dual energy x-ray absorptiometry) measures bone mass of spine, femur, forearm, and total body. It allows assessment of bone density with minimal radiation exposure; used to diagnose metabolic bone disease and to monitor changes in bone _____ with treatment. Inform patient what?

Back 75

A DEXA scan measures bone mass of spine, femur, forearm, and total body. It allows assessment of bone density with minimal radiation exposure; used to diagnose metabolic bone disease and to monitor changes in bone density with treatment. Inform patient that procedure is painless.

Front 76

A QUS, a quantitative _________, evaluates density, elasticity, and strength of bone using an _____ rather than radiation. A common area assessed is the calcaneus (___). Inform patient what?

Back 76

A QUS, a quantitative _________, evaluates density, elasticity, and strength of bone using an ultrasound rather than radiation. A common area assessed is the calcaneus (heal). Inform patient the procedure is painless.

Front 77

A Bone Scan involves the injection of _______ that is taken up by bone. A uniform uptake of the isotope is normal. Increased uptake is seen in _______, ______, and metastatic malignant lesions of bone, and certain fractures. Explain that a calculated dose of the radioisotope is given ___ h before procedure.
Nursing implications:
Verify what before procedure?
Make sure the patient has done what before procedure?
Explain to the patient... (2)
Are follow-up scans required?
Encourage pt. to do what after test?

Back 77

A Bone Scan involves the injection of radioisotope that is taken up by bone. A uniform uptake of the isotope is normal. Increased uptake is seen in osteomyellitis, osteoporosis and metastatic malignant lesions of bone, and certain fractures. Explain that a calculated dose of the radioisotope is given 2 h before procedure.
Nursing implications:
Verify pt. is not pregnant.
Make sure the patient has voided before procedure
Explain to the patient that procedure requires laying supine for 1 h, no pain or harm will result from isotopes.
No follow-up scans are required.
Encourage pt. to increase intake of fluids after exam.

Front 78

An __________ is a series of images, often X-rays, an MRI, or CT Scan of a joint area after injection of a contrast medium. The injection is normally done under a local anesthetic

Back 78

arthrogram

Front 79

An ________ involves insertion of an arthroscope into a joint, usually the 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 the meniscus, articular cartilage, ligaments, or joint capsule. Other structures that can be visualized in this way include the shoulder, elbow, wrist, jaw, hip, and ankle. Inform the patient that the procedure can be performed in an ______ setting with strict asepsis and that either ____ or ______ anesthesia is used. After the procedure, cover the wound with a _____ _______ dressing. Explain any postprocedure activity restrictions.

Back 79

An arthroscopy involves insertion of an arthroscope into a joint, usually the 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 the meniscus, articular cartilage, ligaments, or joint capsule. Other structures that can be visualized in this way include the shoulder, elbow, wrist, jaw, hip, and ankle. Inform the patient that the procedure can be performed in an outpatient setting with strict asepsis and that either local or general anesthesia is used. After the procedure, cover the wound with a sterile pressure dressing. Explain any postprocedure activity restrictions.

Front 80

An __________ or joint aspiration is usually performed for a synovial fluid analysis. It may also be used to instill medications to treat septic arthritis or to remove fluid from joints to relieve pain. It can help to diagnose joint inflammation, infection, meniscal tears, and subtle fractures. After skin has been cleaned, a local aesthetic is instilled. An 18-gauge or larger needle is inserted into the joint, and fluid is withdrawn. An appropriate sterile container should be readily available and the specimens should be sent to the lab immediately. Normal synovial fluid is either transparent and colorless or ____-colored. Where is the procedure usually done? What should be done after the procedure?

Back 80

An atherocentesis or joint aspiration is usually performed for a synovial fluid analysis. It may also be used to instill medications to treat septic arthritis or to remove fluid from joints to relieve pain. It can help to diagnose joint inflammation, infection, meniscal tears, and subtle fractures. After skin has been cleaned, a local aesthetic is instilled. An 18-gauge or larger needle is inserted into the joint, and fluid is withdrawn. An appropriate sterile container should be readily available and the specimens should be sent to the lab immediately. Normal synovial fluid is either transparent and colorless or straw-colored. Where is the procedure usually done? Exam room or at bedside. What should be done after the procedure? Apply compression dressing, observe for leakage of blood or fluid on dressing.

Front 81

Bone is the primary organ for calcium storage. Calcium provide bone with a rigid consistency. What can cause decreased serum calcium? (3)

Back 81

Bone is the primary organ for calcium storage. Calcium provide bone with a rigid consistency.
Decreased serum calcium:
osteomalacia
renal disease
hypoparathyroidism

Front 82

What can cause increased serum calcium? (2)

Back 82

hyperparathyroidism
bone tumors

Front 83

_____ ______ is the end product of purine metabolism and is normally excreted. It is not specific, but levels are usually elevated in _____.

Back 83

Uric acid is the end product of purine metabolism and is normally excreted. It is not specific, but levels are usually elevated in gout.

Front 84

This electrolyte can be increased in muscle trauma as cell destruction releases it into serum. Trauma patients should be monitored for cardiac dysrhythmias r/t its elevation.

Back 84

Potassium

Front 85

The amount of this electrolyte is indirectly related to calcium metabolism. Increased/decreased levels are found in osteomalacia. Increased/decreased levels are found in chronic kidney disease, healing fractures, and osteolytic metastatic tumors.

Back 85

Phosphorus
The amount of this electrolyte is indirectly related to calcium metabolism. Decreased levels are found in osteomalacia. Increased levels are found in chronic kidney disease, healing fractures, and osteolytic metastatic tumors.

Front 86

Find out if we need to know all the stuff on charts p 1578-80 table 62-7..
RF, ANA, Anti DNA antibody etc

Back 86

ask Jill

Front 87

What is the serological study that is a nonspecific index of inflammation? It measures the rapidity with which RBC's settle out of unclotted blood in one hour. Elevated levels are seen with any inflammatory process, especially RA, rheumatic fever, osteomyelitis, and respiratory infections)

Back 87

ESR- erythrocyte sedimentation rate

Front 88

This enzyme is produced by osteoblasts of bone and is needed for mineralization of organic bone matrix. Increases are found in healing fractures, bone cancers, osteoporosis, osteomalacia

Back 88

alkaline phosphatase

Front 89

Aldolase is a marker for muscle injury and is useful in monitoring ______ _____ and dermatomyositis.

Back 89

Aldolase is a marker for muscle injury and is useful in monitoring muscular dystrophy and dermatomyositis.

Front 90

The highest concentration of ______ ______is found in skeletal muscle. It's a nonspecific marker for muscle injury. Increased levels are found in muscular dystrophy, polymyositis, and traumatic injuries.

Back 90

The highest concentration of Creatine Kinase (CK) is found in skeletal muscle. It's a nonspecific marker for muscle injury. Increased levels are found in muscular dystrophy, polymyositis, and traumatic injuries.

Front 91

This is used to diagnose inflammatory diseases, infections, and active widespread malignancies. It is synthesized in the liver and is present in large amounts in serum 18-24 h after onset of tissue damage

Back 91

CRP - C-Reactive Protein

Front 92

What lab tells us about someone's nutritional status, especially protein?

Back 92

albumin
prealbumin- changes about every 7 days, see smaller changes

Look up more about albumin this was a flag!

Front 93

Review Table 63-1 Patient and Caregiver Teaching Guide-- Prevention of Musculoskeletal Problems in the Older Adult

Back 93

P. 1584

Front 94

A ______ is an injury of the soft tissues produced by blunt force-- leads to ruptured vessels which bleed into tissue (causing a bruised appearance)

Back 94

A contusion is an injury of the soft tissues produced by blunt force-- leads to ruptured vessels which bleed into tissue (causing a bruised appearance)

Front 95

Sprains, strains, dislocations, and subluxations are all ____ ____ injuries.

Back 95

Sprains, strains, dislocations, and subluxations are all soft tissue injuries.

Front 96

A ____ is an injury to the ligamentous structures surrounding a joint, usually caused by a wrenching or ______ motion. They commonly occur in the ankle and knee. This injury can be classified as 1st degree (mild), 2nd degree (moderate), or 3rd degree (severe). A severe injury of this type is a complete tearing of the ligament in association with moderate to severe swelling. A ___ in the muscle may be apparent or palpated through the skin if the muscle is torn.

True or False: Because areas around joints are rich in nerve endings, the injury can be extremely painful.

Back 96

A sprain is an injury to the ligamentous structures surrounding a joint, usually caused by a wrenching or twisting motion. They commonly occur in the ankle and knee. This injury can be classified as 1st degree (mild), 2nd degree (moderate), or 3rd degree (severe). A severe injury of this type is a complete tearing of the ligament in association with moderate to severe swelling. A gap in the muscle may be apparent or palpated through the skin if the muscle is torn.

True: Because areas around joints are rich in nerve endings, the injury can be extremely painful.

Front 97

A ____ is an excessive stretching of a muscle, its fascial sheath, or a tendon. Most of them occur in large muscle groups including the lower back, calf, and hamstrings. They can also be classified as 1st degree (mild), 2nd degree (moderate), or 3rd degree (severe). Severe would be a severely torn or ruptured muscle.

Back 97

A strain is an excessive stretching of a muscle, its fascial sheath, or a tendon. Most of them occur in large muscle groups including the lower back, calf, and hamstrings. They can also be classified as 1st degree (mild), 2nd degree (moderate), or 3rd degree (severe). Severe would be a severely torn or ruptured muscle.

Front 98

The clinical manifestations of strains and sprains are similar and include pain, edema, and decrease in function, and contusion. ______ develops in the injured area because of tiny hemorrhages within the disrupted tissues and the ensuing local inflammatory response. They are both due to a recent traumatic injury, possibly of an inversion or twisting nature, or recent exercise activity. Mild sprains and strains are usually self-___ with full function returning within __ to __ weeks.

Back 98

The clinical manifestations of strains and sprains are similar and include pain, edema, and decrease in function, and contusion. Edema develops in the injured area because of tiny hemorrhages within the disrupted tissues and the ensuing local inflammatory response. They are both due to a recent traumatic injury, possibly of an inversion or twisting nature, or recent exercise activity. Mild sprains and strains are usually self-limiting with full function returning within 3 to 6 weeks.

Front 99

tear within the muscle or tendinoligamentous structures of shoulder
What is the tx (minor/major)?

Back 99

rotator cuff


Minor tear- rest, NSAIDs, and gradual mobilization with ROM and strengthening exercises
Major tear- surgery

Front 100

Inflammation along anterior aspect of calf from periostitis caused by improper shoes, overuse, or running on hard pavement

What's the tx?

Back 100

shin splints

Tx: Rest, ice, NSAIDs, proper shoes, gradual increase in activity. If pain persists, x-ray to rule out stress fracture

Front 101

inflammation of a tendon as a result of overuse or incorrect use

What's the tx?

Back 101

tendinitis

Tx- Rest, Ice, NSAIDs, gradual return to sport activity, protective brace (orthosis) may be necessary if symptoms recur

Front 102

A ligament injury is a tearing or stretching of a ligament, usually as a result of inversion, eversion, shearing, or torque applied to a joint. It is characterized by sudden pain, swelling, and instability. Treatment includes ice, NSAIDs, protection of affected extremity by use of brace, and if symptoms persist, surgical repair may be necessary.

A _____ injury is an injury to the fibrocartilage of the knee characterized by popping, clicking, tearing sensation, effusion, and swelling. Tx includes rest, ice, NSAIDS, gradual return to regular activities. If symptoms persist an ____ is done to diagnose the injury and arthroscopic surgery may be be done.

Back 102

A ligament injury is a tearing or stretching of a ligament, usually as a result of inversion, eversion, shearing, or torque applied to a joint. It is characterized by sudden pain, swelling, and instability. Treatment includes ice, NSAIDs, protection of affected extremity by use of brace, and if symptoms persist, surgical repair may be necessary.

A meniscal injury is an injury to the fibrocartilage of the knee characterized by popping, clicking, tearing sensation, effusion, and swelling. Tx includes rest, ice, NSAIDS, gradual return to regular activities. If symptoms persist an MRI is done to diagnose the injury and arthroscopic surgery may be be done.

Front 103

Review Emergency Management of acute soft tissue injuries. Table 63-3

Back 103

p. 1585

Front 104

Explain the nursing implications with cryotherapy and compression. Oh, and you better know what RICE stands for!

Back 104

Cryotherapy-
Application of ice or other cold therapy causes vasoconstriction and a reduction in the transmission and perception of nerve pain impulses. These changes result in analgesia and anesthesia, reduction of muscle spasm without changes in muscular strength or endurance, reduction of local edema and inflammation, and reduction of local metabolic requirements. It is most useful when applied immediately after the injury has occurred. Ice application should not exceed 20 to 30 min per application, and ice should not be applied directly to the skin. (It is best used for the first 24-48 h to decrease swelling and then moist heat can be used to bring in the elements of healing, reduce swelling, and for comfort)

Compression- helps limit swelling, which can lengthen healing time. An elastic compression bandage can be wrapped around the injured part. The bandage should be wrapped starting distally (at the point farthest from midline) and progressing proximally (toward midline) to encourage fluid return. The bandage is too tight if numbness is felt below the area of compression or there is additional pain or swelling beyond the edge of the bandage. The bandage can be left in place for 30 min and then removed for 15 min. However, some elastic wraps are left on during training, athletic, and occupational activities.

Front 105

Following a soft tissue injury, NSAIDS may be recommended to decrease edema and pain. Discourage/encourage the patient to use the limb, the joint should be protected by means of casting, bracing, taping, or splinting. Movement of the joint maintains nutrition to the cartilage, and muscle contraction improves circulation and resolution of the contusion and swelling.

Back 105

Following a soft tissue injury, NSAIDS may be recommended to decrease edema and pain. Encourage the patient to use the limb, provided that the joint is protected by means of casting, bracing, taping, or splinting. Movement of the joint maintains nutrition to the cartilage, and muscle contraction improves circulation and resolution of the contusion and swelling.

Front 106

A _______ is a severe injury of the ligamentous structures that surround a joint. It results in the complete displacement or separation of the articular surfaces of the joint. ____ is a partial or incomplete displacement of the joint surface with similar, but less severe clinical manifestations and the healing time is also decreased in comparison.

Back 106

A dislocation is a severe injury of the ligamentous structures that surround a joint. It results in the complete displacement or separation of the articular surfaces of the joint. Subluxation is a partial or incomplete displacement of the joint surface with similar, but less severe clinical manifestations and the healing time is also decreased in comparison.

Front 107

Dislocation and subluxations can be congenital, pathologic (due to a disease), or due to a traumatic force. The most obvious clinical manifestation of a dislocation is ______. For example, if a hip is dislocated in a posterior or backward direction, the limb can be shorter and is often internally rotated on the affected side. Additional manifestations include local pain, tenderness, loss of function of the injured part, and swelling of the soft tissues in the region of the joint. There are changes in length when a joint is dislocated because the muscle ______s and pulls on it. What are the major complications that can happen?

Back 107

Dislocation and subluxations can be congenital, pathologic (due to a disease), or due to a traumatic force. The most obvious clinical manifestation of a dislocation is deformity. For example, if a hip is dislocated in a posterior or backward direction, the limb can be shorter and is often internally rotated on the affected side. Additional manifestations include local pain, tenderness, loss of function of the injured part, and swelling of the soft tissues in the region of the joint. There are changes in length when a joint is dislocated because the muscle spasms and pulls on it.
Major complications:
open joint injuries
intraarticular fractures
avascular necrosis (bone cell death as a result of inadequate blood supply) and damage to adjacent neurovascular tissue.

Front 108

True or False: A dislocation requires prompt attention and is considered an orthopedic emergency

Back 108

True
The longer the joint remains unreduced, the greater the possibility of avascular nevrosis. Compartment syndrome may also occur after a dislocation, and dislocation is often associated with significant vascular injury. Neurovascular assessment is critical!!

Front 109

True or False: The first goal of management of a dislocationi is to realign the dislocated portion of the joint in its original anatomic position.

Back 109

true

Front 110

______ is often necessary to produce muscle relaxation so that bones can be manipulated.

Back 110

anesthesia

Front 111

Nursing management of subluxation and dislocation is directed toward relief of pain and support and protection of the injured joint. After the joint has been reduced and immobilized, by either ___ or ____ reduction, motion is usually restricted. A carefully regulated rehabilitation program can prevent fracture instability and joint dysfunction. Gentle ROM may be started if the joint is stable and well supported. An exercise program slowly restores the joint to its original ROM without causing another dislocation. A patient should gradually return to normal activities. A patient who has dislocated a joint may be at a greater risk of what?

Back 111

Nursing management of subluxation and dislocation is directed toward relief of pain and support and protection of the injured joint. After the joint has been reduced and immobilized, by either open or closed reduction, motion is usually restricted. A carefully regulated rehabilitation program can prevent fracture instability and joint dysfunction. Gentle ROM may be started if the joint is stable and well supported. An exercise program slowly restores the joint to its original ROM without causing another dislocation. A patient should gradually return to normal activities. A patient who has dislocated a joint may be at a greater risk for repeated dislocations because of loose ligaments. Activity restrictions may be imposed on the use of the affected joint to decrease the risk of repeatedly dislocating the joint.

Front 112

_____ _____ injury has also been called cumulative trauma disorder, repetitive trauma disorder, work related musculoskeletal disorder, and even "nintendinitis." These terms describe injuries resulting from prolonged force, or repetitive movements and awkward postures. RSI can be prevented through education and ________, the consideration of the interaction of humans and their work environment). What are some considerations for people who work at a desk? What is the treatment for RSI once it is diagnosed?

Back 112

Repetitive strain injury has also been called cumulative trauma disorder, repetitive trauma disorder, work related musculoskeletal disorder, and even "nintendinitis." These terms describe injuries resulting from prolonged force, or repetitive movements and awkward postures. RSI can be prevented through education and ergonomoic, the consideration of the interaction of humans and their work environment). What are some considerations for people who work at a desk?
Keep knees & hips flexed at 90* with feet flat.
Keep wrist straight to type
Have top of computer monitor even with forehead.
Take hourly stretch breaks.

Tx: I
Identify precipitating activity
Pain mgmt including heat/cold
NSAIDS
rest
Physical therapy for strengthening and conditioning exercises
Lifestyle changes

Front 113

_____ _____ ____ is a condition caused by compression of the median nerve. It is the most common compression neuropathy in the upper extremity. This syndrome is associated with hobbies or occupations that require continuous wrist movement such as musicians, painters, carpenters, and computer operators.

Back 113

Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve, which enters the hand through the narrow confines of the carpal tunnel. It is the most common compression neuropathy in the upper extremity. This syndrome is associated with hobbies or occupations that require continuous wrist movement such as musicians, painters, carpenters, and computer operators.

Front 114

Carpal tunnel is often caused by pressure from trauma or edema caused by inflammation of a tendon (tenosynovitis), neoplasm, rheumatoid arthritis, or soft tissue masses such as ganglia. Who is at greater risk of getting Carpal Tunnel?

Back 114

Diabetics
People with hypothyroidism
Women (often associated with hormonal times such as menses, pregnancy, menopause)

Front 115

What are some clinical manifestations of carpal tunnel? What action can relieve symptoms?

Back 115

weakness (especially thumb)
burning pain
numbness
(or impaired sensation and distribution of median nerve)
clumsiness in performing fine hand movements
numbness and tingling may awaken the patient at night
Shaking the hands will often relieve symptoms.

Front 116

Physical signs of Carpal Tunnel include _____ sign and ____ sign. Describe each.

Back 116

Tinel's sign- can be elicited by tapping over the median nerve as it passes through the carpal tunnel in the wrist. A positive response is a sensation of tingling in the distribution of the median nerve.

Phalen's sign- can be eliccited by allowing the wrists to fall freely into maximum flexion and maintain the position for longer than 60 seconds. A positive response is a sensation of tingling in the distribution of the median nerve over the hand.

(In the late stages there is atrophy of the thenar muscles around the base of the thumb, resulting in recurrent pain and eventual dysfunction of the hand. )

Front 117

In late stages of carpal tunnel synrome, there is a____ of the thenar muscles at the base of the thumb, resulting in recurrent p____ and eventual ______ of the hand.

Back 117

In late stages of carpal tunnel synrome, there is atrophy of the thenar muscles at the base of the thumb, resulting in recurrent pain and eventual dysfunction of the hand.

Front 118

What are some strategies that are useful in preventing CTS?

Back 118

Educate about risk factors
Use adaptive devices such as wrist splints that may be worn to hold the wrist in a slight extension to relieve pressure on median nerve
Use special keyboard pads and mouses to prevent repetitive pressure
Ergonomic changes like workstation modifications, change in body positions, and frequent breaks from work-related activities

Front 119

Care of the patient with CTS is directed toward relieving the underlying ____ of the nerve compression. The early symptoms can usually be relieved by stopping the aggravating movement and resting the hand and wrist by ____ing them in a hand ____. These may be worn at night to help to keep wrist in a _____ position and may reduce night pain and numbness. Injection of a ________ drug directly into the carpal tunnel may provide short/long term pain relief. Because CTS can cause impaired sensation, instruct patients to avoid extremes in _____ and ____ because of risk of thermal injury. The patient may be required to consider a change in occupation because of discomfort and sensory changes.

Back 119

Care of the patient with CTS is directed toward relieving the underlying cause of the nerve compression. The early symptoms can usually be relieved by stopping the aggravating movement and resting the hand and wrist by immobilizing them in a hand splint. Splints may be worn at night to help to keep wrist in a neutral position and may reduce night pain and numbness. Injection of a corticosteroid drug directly into the carpal tunnel may provide short term pain relief. Because CTS can cause impaired sensation, instruct patients to avoid extremes in hot and cold because of risk of thermal injury. The patient may be required to consider a change in occupation because of discomfort and sensory changes.

Front 120

Carpal tunnel _____ is generally recommended if symptoms last for more than ___ months.

Back 120

Carpal tunnel release is generally recommended if symptoms last for more than 6 months.

Front 121

Surgery for CTS involves severing the band of tissue around the wrist to reduce pressure on median nerve. Surgery is done under general/local anesthesia and does/does not require an overnight hospital stay. The two types of surgery include open release surgery and endoscopic carpal tunnel release. Which type may allow faster functional recovery and less postop discomfort?

Back 121

Surgery for CTS involves severing the band of tissue around the wrist to reduce pressure on median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. The two types of surgery include open release surgery and endoscopic carpal tunnel release. Which type may allow faster functional recovery and less postop discomfort? Endoscopic approach

Front 122

True or False: Although symptoms may be relieved immediately after surgery, full recovery may take months.

Back 122

true

Front 123

After CTS surgery, assess ________ status of hand before discharge. Instruct patient about wound care and appropriate assessments to perform at home.

Back 123

After CTS surgery, assess neurovascular status of hand before discharge. Instruct patient about wound care and appropriate assessments to perform at home.

Front 124

The ____ ____ is a complex of four muscles in the shoulder. These muscles act to stabilize the humeral head in the glenoid fossa while assisting with the ROM of the shoulder joint and rotation of the humerus. A tear may occur as a gradual, degenerative process resulting from aging, repetitive stress (especially over-head arm motions), or injury to the shoulder while falling. The rotator cuff can tear as a result of sudden adduction/abduction forces applied to the cuff while arm is held in adduction/abduction. In sports, repetitive overhead motions, such as in swimming, racquet sports, and baseball, are activities that can cause injury. What are some other causative factors (4)?

Back 124

The ____ ____ is a complex of four muscles in the shoulder. These muscles act to stabilize the humeral head in the glenoid fossa while assisting with the ROM of the shoulder joint and rotation of the humerus. A tear may occur as a gradual, degenerative process resulting from aging, repetitive stress (especially over-head arm motions), or injury to the shoulder while falling. The rotator cuff can tear as a result of sudden adduction forces applied to the cuff while arm is held in abduction. In sports, repetitive overhead motions, such as in swimming, racquet sports, and baseball, are activities that can cause injury. What are some other causative factors?
-falling onto an outstretched arm and hand
-a blow to the upper arm
-heavy lifting
-repetitive work motions

Front 125

What are some s/s of rotator cuff injury?
The ____ ___ test, in which the arm falls suddenly after the patient is asked to slowly lower the arm to the side after it has been abducted 90 degrees, is another sign of rotator cuff injury. What test can confirm this injury?

Back 125

-shoulder weakness & pain
-decreased ROM
-severe pain when arm is abducted between 60-120 degrees (painful arc)
The drop arm test, in which the arm falls suddenly after the patient is asked to slowly lower the arm to the side after it has been abducted 90 degrees, is another sign of rotator cuff injury. What test can confirm this injury? MRI

Front 126

The goal of tx emphasizes maintaing passive ROM and the return of abduction strength. The patient with a partial tear or cuff inflammation may be treated conservatively with....
If the patient does not respond to conservative treatment or a complete tear is present, what may be necessary?

Back 126

The goal of tx emphasizes maintaining passive ROM and the return of abduction strength. The patient with a partial tear or cuff inflammation may be treated conservatively with rest, ice & heat, NSAIDs, corticosteroid injections into the joint, and PT.
If the patient does not respond to conservative treatment or a complete tear is present, what may be necessary? Surgery, done through an arthroscope. If an extensive tear is present, acromioplasty (surgical removal of part acromion to relieve compression of rotator cuff during movement) may be necessary. A sling or a shoulder immobilizer may be used to immediately after surgery to limit shoulder movement.However, the shoulder should not be immobilized for too long a period because "frozen" shoulder or arthrofibrosis may occur. Pendulum exercises and PT begin the FIRST post-op day.

Front 127

The ______ are crescent-shaped pieces of fibrocartilage in the knee. Injuries to this part are closely associated with ligament sprains commonly occurring in sports that produce _____ stress when the knee is in varying degrees of ____ and the foot is planted or fixed. A ___ to the knee can also cause a tear. People who require squatting or kneeling and older patients may be at risk for degenerative tears.

Back 127

The menisci are crescent-shaped pieces of fibrocartilage in the knee. Injuries to this part are closely associated with ligament sprains commonly occurring in sports that produce rotational stress when the knee is in varying degrees of flexion and the foot is planted or fixed. A blow to the knee can also cause a tear. People who require squatting or kneeling and older patients may be at risk for degenerative tears.

Front 128

Meniscus injuries usually don't cause significant _____ because most of the cartilage is avascular. However, an acutely torn meniscus may be suspected when localized tenderness, pain, and effusion are noted. Pain is elicited by flexion, internal rotation, and then extension of the knee, known as _____'s test. The patient may feel the knee is unstable and often reports that the knee may click, pop, lock, or "give way." Quadriceps _____ is usually evident if the injury has been present for some time. Traumatic arthritis may occur from repeated meniscus injury and chronic inflammation. How is diagnosis confirmed? _____ may be indicated for a torn meniscus.

Back 128

Meniscus injuries usually don't cause significant edema/swelling because most of the cartilage is avascular. However, an acutely torn meniscus may be suspected when localized tenderness, pain, and effusion are noted. Pain is elicited by flexion, internal rotation, and then extension of the knee, known as McMurray's test. The patient may feel the knee is unstable and often reports that the knee may click, pop, lock, or "give way." Quadriceps atrophy is usually evident if the injury has been present for some time. Traumatic arthritis may occur from repeated meniscus injury and chronic inflammation. How is diagnosis confirmed? MRI
Surgery may be indicated for a torn meniscus, performed by arthroscopy. A menisectomy may be necessary, which involves surgical repair or excision of part of the meniscus.

Front 129

Because meniscal injuries are commonly caused by sports injuries, teach athletes to do warm-up activities. Examination of the acutely injured knee should occur within ___ h. Initial care of this injury involves application of ___, immoblization, and ___ ___ as tolerated with ___. Most meniscal injuries are treated in an inpatient/outpatient setting. Use of a knee brace or immobilizer during the first few days after injury protects the knee and offers some pain relief. If surgery is done, ____ or other analgesics can be given for pain. Rehabilitation starts soon after surgery, including _____ and ____ _strengthening exercises and ___. When the patient's strength is back to its preinjury level, normal activities may be resumed.

Back 129

Because meniscal injuries are commonly caused by sports injuries, teach athletes to do warm-up activities. Examination of the acutely injured knee should occur within 24 h. Initial care of this injury involves application of ice, immoblization, and weight bearing as tolerated with crutches. Most meniscal injuries are treated in an outpatient setting. Use of a knee brace or immobilizer during the first few days after injury protects the knee and offers some pain relief. If surgery is done, NSAIDs or other analgesics can be given for pain. Rehabilitation starts soon after surgery, including hamstring and quad strengthening exercises and ROM. When the patient's strength is back to its preinjury level, normal activities may be resumed.

Front 130

What is the most commonly injured knee ligament? They usually occur from noncontact when the athlete pivots, lands from a jump, or slows down when running. Patient's often report coming down on the knee, ___ing, and hearing a ____, followed by chronic/acute knee ___ and _____. Athletes usually cannot continue playing, and the knee may feel unstable. An injury can result in a partial tear, a complete tear, or an _____ (tearing away) from the bone attachments that form the knee.

Back 130

What is the most commonly injured knee ligament? ACL (anterior cruciate ligament) They usually occur from noncontact when the athlete pivots, lands from a jump, or slows down when running. Patient's often report coming down on the knee, twisting, and hearing a POP, followed by acute knee pain and swelling. Athletes usually cannot continue playing, and the knee may feel unstable. An injury can result in a partial tear, a complete tear, or an avulsion (tearing away) from the bone attachments that form the knee.

Front 131

Examination of the knee with an ACL tear may produce a positive Lachman's test. This test is performed by flexing the knee 15 to 30 degrees and pulling the tibia forward while the femur is stabilized. The test is considered positive for an ACL tear if there is _____ motion of the tibia with the feeling of a soft or indistinct endpoint. X-rays and MRI are often used to diagnose coexisting conditions including a fracture, meniscus tearing, and collateral ligament injuries.

Back 131

Examination of the knee with an ACL tear may produce a positive Lachman's test. This test is performed by flexing the knee 15 to 30 degrees and pulling the tibia forward while the femur is stabilized. The test is considered positive for an ACL tear if there is forward motion of the tibia with the feeling of a soft or indistinct endpoint. X-rays and MRI are often used to diagnose coexisting conditions including a fracture, meniscus tearing, and collateral ligament injuries.

Front 132

Conservative treatment for an intact ACL injury includes rest, ice, NSAIDs/Opiates, dependent positioning/elevation, and immobility/ambulation as tolerated. If there is a tight, painful effusion, it may be ______. A knee mobilizer/immobilizer or hinged knee ___ may be helpful in supporting the knee. Physical therapy often assists the patient in maintaining knee joint motion and muscle tone. Reconstructive surgery is usually recommended in physically active patients who have sustained severe injury to the ligament and meniscus. In reconstruction, the torn ACL tissue is removed and replaced with ____ or _____ tissue. ROM is encouraged soon after surgery and the knee is place in a brace or immobilizer. Rehabilitation with PT is critical with progressive _____ ____ing determined by the degree of surgical repair. A safe return to the patient's prior level of function can take up to how long? Persons with a hx of ACL injury have a higher risk of developing knee _______ later in life.

Back 132

Conservative treatment for an intact ACL injury includes rest, ice, NSAIDs, elevation, and ambulation as tolerated. If there is a tight, painful effusion, it may be aspirated. A knee immobilizer or hinged knee brace may be helpful in supporting the knee. Physical therapy often assists the patient in maintaining knee joint motion and muscle tone. Reconstructive surgery is usually recommended in physically active patients who have sustained severe injury to the ligament and meniscus. In reconstruction, the torn ACL tissue is removed and replaced with autologous or allograft tissue. ROM is encouraged soon after surgery and the knee is place in a brace or immobilizer. Rehabilitation with PT is critical with progressive weight bearing determined by the degree of surgical repair. A safe return to the patient's prior level of function can take up to 6-8 months. Persons with a hx of ACL injury have a higher risk of developing knee osteoarthritis later in life.

Front 133

______ are closed sacs that are lined with synovial membrane and contain a small amount of synovial fluid. They are located at sites of friction, such as between tendons and bones and near the joints.

Back 133

Bursae are closed sacs that are lined with synovial membrane and contain a small amount of synovial fluid. They are located at sites of friction, such as between tendons and bones and near the joints.

Front 134

Bursitis, inflammation of the bursa, results from repeated or excessive _____ or friction, g____, r_______ a_______, or i______.

Back 134

Bursitis, inflammation of the bursa, results from repeated or excessive trauma or friction, gout, rheumatoid arthritis, or infection.

Front 135

What are the primary clinical manifestations of bursitis?
What are some common sites where it occurs?
What are some common causes?

Back 135

Warmth, pain, swelling, and limited ROM in the affected part.

Sites it commonly occurs: hand, knee, greater trochanter of hip, shoulder, elbow

Causes: improper body mechanics
repetitive kneeling (carpet layers, coal miners, gardeners)
jogging in worn out shoes, and prolonged sitting with crossed legs

Front 136

Identification of the cause of the bursitis is attempted, and ____ is often the only treatment needed. Icing the area will decrease pain and may reduce local inflammation. Affected part may be immobilized in a _____ dressing or splint. _____ can help with pain and inflammation. Aspiration of the bursal fluid and intraarticular injection of a ____ may be necessary. If the bursal wall has become thickened and continues to interfere with noraml joint function, surgical excision (bursectomy) may be necessary. _____ bursae usually require surgical incision and drainage.

Back 136

Identification of the cause of the bursitis is attempted, and rest is often the only treatment needed. Icing the area will decrease pain and may reduce local inflammation. Affected part may be immobilized in a compression dressing or splint. NSAIDs can help with pain and inflammation. Aspiration of the bursal fluid and intraarticular injection of a corticosteroid may be necessary. If the bursal wall has become thickened and continues to interfere with noraml joint function, surgical excision (bursectomy) may be necessary. Septic bursae usually require surgical incision and drainage.

Front 137

After a fracture, renal ____ can develop as a result of bone demineralization. The hyper/hypo-calcemia from demineralization causes a decrease/increase in urine pH and___ formation resulting from the precipitation of calcium. Unless contraindicated, a fluid intake of _____ ml/day is recommended. _____ juice or ______ acid (500-1500 mg/day) may be recommended to acidify/alkaline the urine and prevent calcium precipitation in the urine.

Back 137

After a fracture, renal calculi can develop as a result of bone demineralization. The hypercalcemia from demineralization causes an increase in urine pH and stone formation resulting from the precipitation of calcium. Unless contraindicated, a fluid intake of 2500 ml/day is recommended. Cranberry juice or ascorbic acid (500-1500 mg/day) may be recommended to acidify the urine and prevent calcium precipitation in the urine.

Front 138

Review pages 1490-1602
MS notes p. 10 - 16

Back 138

Fractures, types of etc
Neurovascular Checks
Casts
Traction!
Ambulation post-fracture
(crutch, cane, walker)

Do This! :)

Front 139

True or False: the majority of fractures heal without complications.

Back 139

True. If death occurs after a fracture, it is usually the result of damage to underlying organs and vascular structures or from complications of the fracture or immobility.

Front 140

Complications of fractures may be direct or indirect. Direct complications include problems with _______, bone union, and a_____ n____. Indirect complications of fractures are associated with blood vessel and nerve damage resulting in conditions such as compartment syndrome, venous thromboembolism, rhabdomyolysis, fat embolism, and traumatic or hypovolemic shock. Although most musculoskeletal injuries are not life threatening, ____ fractures or fractures accompanied by severe ___ ____ and fractures that damage vital organs (e.g. lung heart) are medical emergencies requiring immediate attention.

Back 140

Complications of fractures may be direct or indirect. Direct complications include problems with infection, bone union, and avascular necrosis. Indirect complications of fractures are associated with blood vessel and nerve damage resulting in conditions such as compartment syndrome, venous thromboembolism, rhabdomyolysis, fat embolism, and traumatic or hypovolemic shock.
Although most musculoskeletal injuries are not life threatening, open fractures or fractures accompanied by severe blood loss and fractures that damage vital organs (e.g. lung heart) are medical emergencies requiring immediate attention.

Front 141

Open fractures and soft tissue injuries have a high incidence of _____.

Back 141

Open fractures and soft tissue injuries have a high incidence of infection.

Front 142

Open fractures require aggressive surgical _______. The wound is initially cleansed by pulsating _____ lavage in the operating room. Gross contaminants are irrigated and mechanically removed. Contused, contaminated and devitalized tissue such as muscle, subcutaneous fat, skin, and fragments of bone are surgically excised via debridement. The extent of the soft tissue damage determines whether the wound will be closed at the time of surgery, whether closed suction drainage may be necessary, and whether skin grafting will be needed. Depending on the location and extent of the fracture, reduction may be maintained by external fixation or traction. During surgery the wound may be irrigated with antibiotic solution. Antibiotic-_____ ____s may also be placed in the surgical site. During the postop phase, the patient will have antibiotics administered ____ (route) for 3 to 7 days/weeks. The use of ________, in conjunction with aggressive surgical management, have greatly reduced the occurrence of infection.

Back 142

Open fractures require aggressive surgical debridement. The wound is initially cleansed by pulsating saline lavage in the operating room. Gross contaminants are irrigated and mechanically removed. Contused, contaminated and devitalized tissue such as muscle, subcutaneous fat, skin, and fragments of bone are surgically excised via debridement. The extent of the soft tissue damage determines whether the wound will be closed at the time of surgery, whether closed suction drainage may be necessary, and whether skin grafting will be needed. Depending on the location and extent of the fracture, reduction may be maintained by external fixation or traction. During surgery the wound may be irrigated with antibiotic solution. Antibiotic-impregnated beads may also be placed in the surgical site. During the postop phase, the patient will have antibiotics administered intravenously for 3 to 7 days. The use of antibiotic, in conjunction with aggressive surgical management, have greatly reduced the occurrence of infection.

Front 143

Compartment syndrome is a condition in which elevated intracompartmental ____within a confined myofascial compartment compromises the ________ function of tissues within that space. This causes c______ perfusion to be reduced below a level necessary for tissue viability.

Back 143

Compartment syndrome is a condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space. This causes capillary perfusion to be reduced below a level necessary for tissue viability.

Front 144

What are the 2 basic causes of compartment syndrome?

Depending on the patient's age and body mass, the expected range of intracompartmental pressure readings is ___ to ____ mm Hg. Reading of ___ mm Hg or higher indicate compartment syndrome.

Back 144

2 basic causes of compartment syndrome:

1.) decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closing of fascia and
2.) increased compartment contents related to bleeding, edema, chemical response to snakebite, or IV infiltration.

Depending on the patient's age and body mass, the expected range of intracompartmental pressure readings is 0 to 10 mm Hg. Readings of 30 mm Hg or higher indicate compartment syndrome.

Front 145

Compartment syndrome is associated with what 4 kinds of injuries?

Back 145

trauma
fractures (esp. long bones)
extensive tissue damage
crush injury

Front 146

Prompt, accurate diagnosis of compartment syndrome is critical. Prevention and early recognition is key. Regular _______ assessments should be performed and documented on all patients with fractures, but especially those of the distal ______ and proximal ____, the most common fractures associated with compartment syndrome.

Back 146

Prompt, accurate diagnosis of compartment syndrome is critical. Prevention and early recognition is key. Regular neurovascular assessments should be performed and documented on all patients with fractures, but especially those of the distal humerus and proximal tibia are the most common fractures associated with compartment syndrome.

Front 147

Ischemia from compartment syndrome always occurs within two hours from the original injury.

Back 147

Ischemia can occur within 4 to 8 hours after the onset of compartment syndrome. It may occur initially from the physiological response of the body or may be delayed for several days from the original injury.

Front 148

What are the characteristics of compartment syndrome?
Of these,what 2 are late signs?
What is one of the first indications of impending compartment syndrome?

Back 148

One or more of the six P's
1. Parasthesia (numbness/tingling)
2. Pain- Pain distal to the injury not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment.
3. Pressure increases in the compartment
4. Pallor, coolness, and loss of normal color of extremity
5. Paralysis or loss of function
6. Pulselessness or diminished/absent peripheral pulses

Late signs include pulselessness and paralysis.

Pain unrelieved by drugs and out of proportion to the level of injury is one of the indications of impending compartment syndrome.

Front 149

Because of the possibility of muscle damage in compartment syndrome, what should be monitored?

Back 149

Urine output.

Front 150

Because of the possibility of muscle damage in compartment syndrome, monitor urine output. ______ released from damaged muscle cells precipitates as a gel-like substance and causes ______ of renal tubules. This condition results in acute ____ ____ and acute _____ _____. Common signs are dark/light _____ish ____ urine and clinical manifestations associated with acute kidney injury.

Back 150

Because of the possibility of muscle damage in compartment syndrome, monitor urine output. Myoglobin released from damaged muscle cells precipitates as a gel-like substance and causes obstruction of renal tubules. This condition results in acute tubular necrosis and acute kidney injury. Common signs are dark reddish brown urine and clinical manifestations associated with acute kidney injury.

Front 151

In compartment syndrome, syndrome, how should the extremity be positioned? Should the application of cold compress be avoided or implemented? It may be necessary to remove or loosen the bandage and bivalve or split the cast in half. An increase/decrease in traction weight may also decrease external circumference pressures.

Back 151

In compartment syndrome, syndrome, how should the extremity be positioned? Elevation may lower venous pressure and slow arterial perfusion, thus the extremity should not be elevated above heart level.

Should the application of cold compress be avoided or implemented? Avoided because it may result in vasoconstriction and worsen the problem. It may be necessary to remove or loosen the bandage and bivalve or split the cast in half. A decrease in traction weight may also decrease external circumference pressures.

Front 152

In treating compartment syndrome, surgical decompression, a _______ of the involved compartment may be necessary. The site is left open for several days to ensure adequate soft tissue decompression. ______ resulting from delayed wound closure is a potential problem following this procedure. Severe compartment syndrome may require a_______ to decrease myoglobinemia or to replace a functionally useless extremity with a prosthesis.

Back 152

In treating compartment syndrome, surgical decompression, a fasciotomy of the involved compartment may be necessary. The site is left open for several days to ensure adequate soft tissue decompression. Infection resulting from delayed wound closure is a potential problem following this procedure. Severe compartment syndrome may require amputation to decrease myoglobinemia or to replace a functionally useless extremity with a prosthesis.

Front 153

Because of the high risk of venous thromboembolism in orthopedic surgical patients, prophylactic anticoagulant drugs such as warfarin, low-molecular-weight heparin such as ______, or fondaparinux (A_____) may be ordered. In addition to wearing compression stockings (antiembolism hose), and using SCD's, instruct the patient to move (plantar flex and dorsiflex) the fingers and or toes of the affected extremity against ____ and to perform ____ exercises on the unaffected lower extremities.

Back 153

Because of the high risk of venous thromboembolism in orthopedic surgical patients, prophylactic anticoagulant drugs such as warfarin, low-molecular-weight heparin such as ______, or fondaparinux (A_____) may be ordered. In addition to wearing compression stockings (antiembolism hose), and using SCD's, instruct the patient to move (plantar flex and dorsiflex) the fingers and or toes of the affected extremity against resistance and to perform ROM exercises on the unaffected lower extremities.

Front 154

Fat embolism syndrome is characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury. It is a contributory factor in many deaths associated with fractures. What kinds of fractures most often cause FES?

Back 154

Fat embolism syndrome is characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury. It is a contributory factor in many deaths associated with fractures. The kinds of fractures that most often cause FES are those of long bones, ribs, tibia, and pelvis. It has also been known to occur following total joint replacement, spinal fusion, liposuction, crush injuries, and bone marrow transplantation.

Front 155

There are two main theories as to the origin of fat emboli suggests that fat is released from the marrow of injured bone and enters the systemic circulation where the fat embolizes to other organs such as the brain. A second theory postulates that a biochemical change initiated by injury sets up an inflammatory response causing a biochemical injury to the lung parenchyma. What tissues or areas of the body are most often effected?

Back 155

There are two main theories as to the origin of fat emboli suggests that fat is released from the marrow of injured bone and enters the systemic circulation where the fat embolizes to other organs such as the brain. A second theory postulates that a biochemical change initiated by injury sets up an inflammatory response causing a biochemical injury to the lung parenchyma. What tissues or areas of the body are most often effected?
lungs, brain, heart, kidneys, and skin

Front 156

Early recognition of a fat embolism (FES) is crucial in preventing a potentially lethal course. Most patients manifest symptoms within ___ to ____ hours of injury. Fat globules transported to the lungs cause a hemorrhagic interstitial _____ that produces s/s of acute respiratory distress syndrome such as ____ pain, t_______, ____pnea, ___pnea, c_____, a_______, and decreased partial pressure of arterial oxygen (PaO2). All of these symptoms are caused by poor oxygen exchange. Because they are frequently the presenting symptoms, change in ___ ___ as a result of hypoxemia are important to recognize. _____ loss, ____lessness, c______ (change in color), elevated _______, and head___ should prompt further investigation so that CNS involvement is not mistaken for alcohol withdrawal or acute head injury. The continued change in LOC and ______ located around the neck, anterior chest wall, axilla, buccal membrane, and conjunctiva of the eye helps distinguish fat emboli from other problems. The ______ may appear due to intravascular thromboses caused by decreased oxygenation.

Back 156

Early recognition of a fat embolism (FES) is crucial in preventing a potentially lethal course. Most patients manifest symptoms within 24 to 48 hours of injury. Fat globules transported to the lungs cause a hemorrhagic interstitial pneumonitis that produces s/s of acute respiratory distress syndrome such as chest pain, tachycardia, tachypnea, dyspnea, cyanosis, apprehension, and decreased partial pressure of arterial oxygen (PaO2). All of these symptoms are caused by poor oxygen exchange. Because they are frequently the presenting symptoms, change in mental status as a result of hypoxemia are important to recognize. Memory loss, restlessness, confusion, elevated temperature, and headache should prompt further investigation so that CNS involvement is not mistaken for alcohol withdrawal or acute head injury. The continued change in LOC and petechiae located around the neck, anterior chest wall, axilla, buccal membrane, and conjunctiva of the eye helps distinguish fat emboli from other problems. The petechiae may appear due to intravascular thromboses caused by decreased oxygenation.

Memory loss, restlessness, confusion, elevated temperature, and headache

Front 157

True or False: The patient experiencing FES will often express a feeling of impending doom and the clinical course may be rapid and acute.

Back 157

true

Front 158

True or False: A diagnosis of FES can be verified by a complete blood count.

Back 158

False, no specific lab exam is available to aid in the diagnosis.

Front 159

Some diagnositc abnormalities may be present in FES such as...

Back 159

fat cells in blood, urine, or sputum
decrease of the PaO2 to less than 60 mm Hg
ST segment changes on ECG
decrease in PLT & HCT
Prolonged PT Time

Front 160

A chest x-ray of a person with FES may reveal areas of pulmonary infilitrate or multiple areas of consolidation. This is sometimes referred to as the "____ ____" effect.

Back 160

A chest x-ray of a person with FES may reveal areas of pulmonary infilitrate or multiple areas of consolidation. This is sometimes referred to as the "white out" effect.

Front 161

Treatment for fat embolism is directed at prevention. What is probably the most important factor in its prevention?

Back 161

Treatment for fat embolism is directed at prevention.Careful immobilization of a long bone fracture is probably the most important factor in its prevention?

Front 162

Management of fat embolism is essentially symptom related and supportive. Treatment includes ____ resuscitation to prevent hypovolemic _____, correction of acidosis/alkalosis,and replacement of blood loss. Discourage/encourage coughing and deep breathing. Re______ the patient as little as possible before fracture immobilization or stabilization because of the danger of dislodging more fat droplets into the general circulation. Use of corticosteroids is controversial. _____ is administered to treat hypoxia. Intubation may be necessary if ABG values are not acceptable. Some patients may develop pulmonary ___, ARDS, or both, leading to an increased mortality rate. Most people survive FES with few sequale

Back 162

Management of fat embolism is essentially symptom related and supportive. Treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Encourage coughing and deep breathing. Repositoin the patient as little as possible before fracture immobilization or stabilization because of the danger of dislodging more fat droplets into the general circulation. Use of corticosteroids is controversial. Oxygen is administered to treat hypoxia. Intubation may be necessary if ABG values are not acceptable. Some patients may develop pulmonary edema
, ARDS, or both, leading to an increased mortality rate. Most people survive FES with few sequale

Front 163

A _____ fracture is a fracture of the distal radius and is one of the most common fractures in adults. It most often occurs in adults over ____ years old whose bones are ________. When does this kind of injury usually occur?
What are the clinical manifestations?
What are the major complications? (2)

Back 163

A Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults. It most often occurs in adults over 50 years old whose bones are osteoporotic.
This injury usually occurs when a person attempts to break a fall with an outstretched arm and hand.
Clinical manifestations are pain in immediate area of injury, pronounced swelling, and dorsal displacement of the distal fragment (silver-fork deformity). This displacement will appear as an obvious deformity of the wrist.
The major complication associated with a Colles' fracture is vascular insufficiency secondary to edema. Carpal tunnel syndrome may be a later complication.

Front 164

Fractures involving the shaft of the humerus are a common injury among what age groups? The prominent clinical manifestations are an obvious displacement of the humerus shaft, lengthened/shortened extremity, abnormal mobility, and pain. What are the major complications?

Back 164

Fractures involving the shaft of the humerus are a common injury among young and middle-aged adults. The prominent clinical manifestations are an obvious displacement of the humerus shaft,shortened extremity, abnormal mobility, and pain. Major complications: radial nerve injury and vascular injury to the brachial artery as a result of laceration, transection, or muscle spasm

Front 165

The tx of a fracture of the humerus depends on the location and displacement of the fracture. Nonoperative treatment may include a ___ing arm cast, sh_____ immobilizer, or sling and swathe, which a type of immobilization that prevents glenohumeral movement. The swathe encircles the trunk and humerus as an additional binder. It is often used after surgical repairs and shoulder dislocation. When these devices are used, _____ the HOB to assist gravity in reducing the fracture. Don't allow/Do allow the arm to hang freely when the patient is sitting and standing. Be sure to protect the ____ and prevent skin maceration. Carefully place powdered absorbable dressing pads in the axilla and change them twice daily or PRN. Skin or skeletal traction may be used for reduction and immobilization. During the rehab phase, what is extremely important for recovery?

Back 165

The tx of a fracture of the humerus depends on the location and displacement of the fracture. Nonoperative treatment may include a hanging arm cast, shoulder immobilizer, or sling and swathe, which a type of immobilization that prevents glenohumeral movement. The swathe encircles the trunk and humerus as an additional binder. It is often used after surgical repairs and shoulder dislocation. When these devices are used, elevate the HOB to assist gravity in reducing the fracture. Do allow the arm to hang freely when the patient is sitting and standing. Be sure to protect the axilla and prevent skin maceration. Carefully place powdered absorbable dressing pads in the axilla and change them twice daily or PRN. Skin or skeletal traction may be used for reduction and immobilization. During the rehab phase, it is extremely important for recovery to involve an exercise program geared toward improving strength and motion. Exercises should include assisted motion of hand and fingers; the shoulder can also be exercised if the fracture is stable. This helps to prevent stiffness secondary to frozen shoulder or fibrosis of the shoulder capsule.

Front 166

What type of rare fracture is associated with the highest mortality rate?
While patients may survive the initial injury, they may die from complications such as sepsis, FES, or thromboembolism.
These fractures may cause serious intraabdominal injury such as a paralytic ileus, hemorrhage, and laceration of the urethra, bladder, and colon.

Back 166

Pelvic fracture

Front 167

Preoccupation with more obvious injuries at the time of a traumatic event may result in an oversight of pelvic injuries. The clinical manifestations of a pelvic injury include local swelling, tenderness, deformity, unusual pelvic movement, and ecchymosis on the abdomen.
Treatment depends on the severity of the injury. Stable, nondisplaced fractures require limited intervention and early _____ is encouraged. Bed rest for stable pelvic fractures is maintained from a few days to ___ weeks. More complex fractures may be treated with pelvic sling traction, skeletal traction, hip spica casts, external fixation, open reduction, or a combination of these methods. Extreme care in handling or moving the patient is important to prevent serious injury from a displaced fracture fragment. How often should the pt. be turned?
Because a pelvic fracture can damage other organs, what should be assessed?
Provide back care while patient is raised in bed (by trapeze or adequate assistance).

Back 167

Preoccupation with more obvious injuries at the time of a traumatic event may result in an oversight of pelvic injuries. The clinical manifestations of a pelvic injury include local swelling, tenderness, deformity, unusual pelvic movement, and ecchymosis on the abdomen.
Treatment depends on the severity of the injury. Stable, nondisplaced fractures require limited intervention and early mobilization is encouraged. Bed rest for stable pelvic fractures is maintained from a few days to 6 weeks. More complex fractures may be treated with pelvic sling traction, skeletal traction, hip spica casts, external fixation, open reduction, or a combination of these methods. Extreme care in handling or moving the patient is important to prevent serious injury from a displaced fracture fragment. How often should the pt. be turned? Only when ordered by health care provider
Because a pelvic fracture can damage other organs, what should be assessed?
bowel and urinary elimination
distal neurovascular status

Provide back care while patient is raised in bed (by trapeze or adequate assistance).

Front 168

True or False: Hip fractures are common in older adults with 90% of them due to a fall. About 30% of these patients will die within 1 y of injury because of medical complications caused by the fracture or resulting immobility.

Hip fractures occur more often in women because of ______.

Back 168

True.
Hip fractures occur more often in women because of osteoporosis.

Front 169

A hip fracture refers to a fracture of the proximal third of the femur, which extends up to 5 cm below the lesser trochanter. The clinical manifestations are internal/external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region. Displaced femoral neck fractures cause serious disruption in the blood supply to the femoral head, which can result in _______ _____ of the femoral head. What is the preferred method of managing intracapsular and extracapsular hip fractures?
Initially the affected extremity may be temporarily immobilized by ____'s ______. until the patient''s physical condition is stabilized and surgery can be performed. This relieves painful muscle ____s and is used for up to a maximum of 24 to 48 h.

Back 169

A hip fracture refers to a fracture of the proximal third of the femur, which extends up to 5 cm below the lesser trochanter. The clinical manifestations are external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region. Displaced femoral neck fractures cause serious disruption in the blood supply to the femoral head, which can result in avascular necrosis of the femoral head. What is the preferred method of managing intracapsular and extracapsular hip fractures?
Initially the affected extremity may be temporarily immobilized by Buck's traction. until the patient''s physical condition is stabilized and surgery can be performed. This relieves painful muscle spasms and is used for up to a maximum of 24 to 48 h.

Front 170

After hip surgery, edema can be alleviated by elevation of the leg whenever the patient is in a chair. The pain resulting from poor alignment of the affected extremity can be reduced by keeping pillows (or an abductor splint between the knees when the patient is turning to either side. Sandbags and pillows are also used to prevent external rotation. Read about nursing implications and teaching for a hip fracture on page 1607

Back 170

..
some important stuff here

Front 171

True or False: The goal of amputation surgery is to preserve extremity length and function while removing all infected, pathologic, or ischemic tissue.

Back 171

true

Front 172

Don't call the remaining part of an amputated limb a "stump," call it a _____ ____. A syme amputation is a form of disarticulation at the ____.

Read about amputations, teaching guide & nursing implications 1610-13

Back 172

Don't call the remaining part of an amputated limb a "stump," call it a residual limb. A syme amputation is a form of disarticulation at the ankle.


:) are we on to renal yet...

Front 173

Read about joint surgeries....


Look up answer to nclex question on P. 20 of notes

Back 173

synovectomy, osteotomy, debridement, arthroplasty, arthrodesis...
nursing implications :)

Front 174

Excess vitamin ___ can promote kidney stones.

Back 174

C

Front 175

What are some major complications of reconstructive joint surgeries?

Back 175

dislocation (major)
wound drainage
DVT
infection
(acute- up to 3 mo)
(delayed- 4-24 mo)

Front 176

Know Dr's orders about flexion at hip! It will usually be less than or equal to about ____ degrees.

Back 176

Know Dr's orders about flexion at hip! It will usually be less than or equal to about 45 degrees.

Front 177

There is usually a great increase/decrease in drainage amt on postop day 2 compared to postop day 1. You can expect up to ____ ml on the first/second day.

Back 177

There is usually a great decrease in drainage amt on postop day 2 compared to postop day 1. You can expect up to 500 ml on the first day.

Front 178

What are some indications for reconstructive joint surgery?

Back 178

RA
osteoarthritis
trauma
congenital deformity
avascular necrosis (d/t dislocation or sublux)

Front 179

Know about abductor pillows, know about s/s of a DVT, Review teaching about crutches

Back 179

look this stuff up and more and more and more!

Front 180

Phenothiazines like compazine are anti_____. How can this med effect the musc/skeletal system?

Back 180

Phenothiazines like compazine are antiemetics How can this med effect the musc/skeletal system? --> gait disturbance

Front 181

Potassium depleting diuretics can cause muscle _____. Anti____ meds like phenytoin (Dilantin) can contribute to osteomalacia.

Back 181

Potassium depleting diuretics can cause muscle cramps. Anticonvulsant meds like phenytoin (Dilantin) can contribute to osteomalacia.

Front 182

Is acetaminophen (Tylenol) an NSAID?

Back 182

NO!

Front 183

True or False: SCD's promote venous return.

Back 183

False. While this is a nice simple way to explain the concept to a patient, SCD's promote the release of our own natural TPA- tissue plasminogen activator.

Front 184

Who is at risk of osteomyelitis?

Back 184

poorly nourished
elderly
obese
diabetic
RA
previous joint surgery
concurrent sepsis
prolonged wound drainage
wound dehiscence
incisional necrosis

Front 185

Wound ______ tends to happen at 7-10 days postop. It is usually due to a decrease in protein, where there is underlying adipose tissue (? check this) There is an increase in drainage when not expecting it, days after surgery ( a risk for development of osteomyelitis).

Back 185

Wound dehisence tends to happen at 7-10 days postop. It is usually due to a decrease in protein, where there is underlying adipose tissue (? check this) There is an increase in drainage when not expecting it, days after surgery ( a risk for development of osteomyelitis).

Front 186

How do we prevent hip flexion contractures?

Back 186

Lay prone 3-4 times a day for 30 min at a time. (need to get muscles extended)

Front 187

Lots of flags in 2nd half of musc. skeletal.... back pain, muscular dystrophy, etc... review lecture... too many flashcards in this section....

Back 187

no more!!!