Exam 3 Flashcards
With a SPRAIN in skeletal trauma the __[1]__ structure is affected, and the body parts __[2]__ & __[3]__ are most affected. Usually this is done through __[4]__ & __[5]__, After which you should do what intervention??
1: Ligment
2: Ankles
3: Knees
4: Twisting
5: Hyperextension
6: R.I.C.E.
With a STRAIN in skeletal trauma the __[1]__ & __[2]__ structures are affected, and the body parts __[3]__ & __[4]__ are most affected. Usually this is done through __[5]__, After which you should do what intervention??
1: Muscles
2: Tendons
3: Lower Back
4: Calves
5: Lifting
6: R.I.C.E.
What is the difference btwn a Subluxation and a Dislocation?
A Subluxation is a partial Dislocation
What are the 8 Clinical Manifestations of Skeletal Trauma?
- *Think ABC’s 1st!! ALWAYS assess Neuro!!!
- edema
- Pain
- Contusion/ecchymosis
- Decreased movement
- Crepitus
Severe:
- Shortening or rotation of extremity
- Inability to bear weight
- Muscle spasms
What is R.I.C.E.???
Rest
Ice
Compression
Elevation
(Immobilize but DO NOT reset joint)
(Remove Restrictive Items)
Fractures described by their “extent” would be described in what 4 ways?
Complete
Incomplete
Non-displaced
Displaced
Fractures are also described by their effect on surrounding tissues in what 2 ways?
-Closed (simple)
-Open (Compound)
o Skin Penetration
o Antibiotics will need to be used
o immunizations are up to date esp TDAP?
•__[1]__ reduction
o Non surgical
o Traction can be a closed reduction method
•__[2]__ reduction
o Surgical intervention
o ORIF
o immobilization May be used
1: Closed
2: Open
What is the Application of a pulling force to the body to provide reduction, alignment, and rest called?
Traction
What are the 6 main complications from fractures??
- Infection (to be discussed later)
- Compartment syndrome
- Venous thromboembolis (VTE)
- Fat Embolism Syndrome (FES)
- Shock
- Chronic complications: ischemic necrosis (avascular necrosis [AVN]), delayed bone healing or non union of bone
What is Normal Compartment Pressure?
0-10mm HG
>30= Bad JUJU
What are the 6 P’s to assess for Acute Compartment Syndrome (ACS)???
o Paraesthesia – may be first sign o Pain o Pressure o Pallor o Paralysis (Late Sign) o Pulselessness (Late Sign/Bad Juju)
When do you NOT use R.I.C.E. when dealing witha skeletal trauma?
• ACS: Do NOT elevate extremity in compartment syndrome & Do NOT apply ice
What must you be concerned about when muscle breakdown is occurring?
THE KIDNEYS!!
-It causes release of potassium and myoglobins
Which are large particles; They can clog the kidneys and cause renal failure.
-Released K+ can cause arrhythmia’s
What are the 4 main cinical manifestations of a Fat Embolism?
- Acute respiratory distress syndrome
- Changes in LOC
- Petechiae; on neck/upper arms/chest/abdomen
- Sense of impending doom
What are you most concerned about with chest fractures?
- Penetration of lungs, Heart, Or arteries.
- High risk for atelectasis/pneumonia (Shallow Breathing)
What are the 5 main Clinical Manifestations of a Hip fracture?
- External rotation of leg
- Shortening of leg
- Severe pain
- Tenderness/pain in leg or groin area
- disruption of blood flow -> avascular necrosis of femoral head
What is a Syme amputation?
Foot; Just below the ankle
With amputations… How do you treat residual limb pain different from Phantom Limb pain?
Residual: Opioids
Phantom: Beta blockers, Antiepileptics, antispasmotics, Nerontin, Lyrica
interventions post amputation?
ROM
Trapeze
Firm Mattress
Prone Postion Q3-4hrs/15min
Stump care Post Op?
Wash w/soap & Water
Stump Shrinker can be used to help with edema
_________ is a Bone infection caused by bacteria or other germs.
Osteomyelitis
What are the 3 steps in the patho of osteomyelitis?
- Initial Infection
- Site expands; Blocking Blood supply
- Bone Dies/separates/becomes sequestrum
Clinical Manifestations of Osteomeylitis?
Systemic S&S
-Fever, Chills, Restlessness, nausea, malaise
Local S&S
-Pain, swelling, tenderness, and warmth
** Treatment is Longterm Antibiotics(centeral line needed)/surgical debrisment/antibiotic beads/
This autoimmune disease leads to cephalic demyelination Of the nerve fibers of the brain and spinal cord. Occurs in exacerbations and remissions. And ultimately results in permanent loss of function.
Multiple sclerosis
-Usually affects women 20-50yo
Why is MS associated with Exacerbations and remissions?
Because in early stages the Myelin she is regenerated.
What replaces the Myelin sheath after it can no longer regenerate?
a Glial Scar
What drugs are used in acute Exacerbations of MS?
- Adrenocorticotropic hormone (ACTH)
- Methylprednisone/prednisone
PD affects which brain area & structure?
Which neurotransmitter is involved?
basal ganglia
substantia nigra
Dopamine (controls movement)
Pro-banthine/Ditropan are what kind of drugs? And used to treat what in MS?
- Anticholinergics
- Helps Prevent Bladder Spasm
- For MS Pt’s having issues with frequency
Valium/Lioresal/Dantrium/Zanaflex are what kind of drugs used in the Treatment of MS?
-Muscle Relaxants
PD affects which brain area & structure?
basal ganglia
substantia nigra
Valium/Lioresal/Dantrium/Zanaflex are what kind of drugs? And used to treat what in MS?
- Muscle Relaxants
- Used to help treat the Rigid/Shakiness of MS
Acetylcholinesterase Inhibitor (Aricept) are what kind of drugs? And used to treat what in MS?
- Muscle Stimulator
- Helps with initiating Movements
(Ampyra) is a Nerve Conduction enhancer are used to treat what in MS?
Help improve walking speed.
Phosphate Receptor Modulators like Fingolimod are used to treat what in MS?
-Help Prevent Disease progression by preventing T-cells (What attacks the Myelin) from getting to the CNS
Trauma, immunizations, birth, stress, and climate change are all Involved with MS in what way?
They are Triggers for Exacerbations
What is Fasiculation?
Muscle Twitching
This is an autoimmune disease characterized by symmetrical Ascending polyneuropathic paralysis caused by peripheral demyelination of the cranial Peripheral nerves. It IS Recoverable.
(1.5X more likely in M’s)
- Guillian Barre syndrome
- Often Triggered by a Virus, Truama, HIV, or
- IN 30%of cases Campylobacter Jejuni
How is PD Dx ?
What is the ultimate confirmation of PD?
2 out of 3 s/s of the Triad
Clinical presentation & Hx
+ve response to antiparkinsonian drugs
This disease results in less motor neurons in the brain stem and spinal cord which cuts communication between the brain and muscles And results in death in 2 to 6 years after diagnosis.
Usually affects people 40-70 y/o and occurs in more M than F.
ALS or Lou Gehrig’s disease
Weakness in the upper extremities, dysarthria, dysphagia, muscle twitching/fasiculation, & nasal sounding speech are S&S of what disease.
(Death is usually the result of respiratory infection)
ALS or Lou Gehrig’s disease
- Pt Does remain cognitively intact
- the Drug Rilotek, is used to Decrease Gluconate in brain
A patient has trouble starting to walk and trouble stopping. Is he most likely to have a Dx of MS, PD, or MG?
PD - trouble initiating actions and executing them due to lack of dopamine
List risk factors for Parkinsons
exposure to chemicals - especially in rural areas.
Well H2O, pesticides, herbicides, industrial chemicals
Dental fillings: amalgam - lead
Females >40 years old with decreased estrogen
genetic factors
What is the primary expected outcome for a pt. with PD? progressive difficulty w/mobility severe dementia malnutrition difficulty w/effective communication
ALL ARE CORRECT ****progressive difficulty w/mobility***** best answer severe dementia - late stage malnutrition - late stage difficulty w/effective communication
What is the primary goal for a pt. w/ PD
stay independent with ADLs for as long as possible
PD has 5 stages. Pt. do not necessarily progress through the stages in order. The stages exist to organise Tx.
The goal is to keep pt. in stages A____ - B______
The goal is to keep pt. in stages __1_- _3___ bc pt. can complete ADLs
Stages 4 & 5 SNIFs or ATC care
levodopa levodopa/carbidopa (Sinimet, Parcopa) Tx which disease? Class? Action? Tx which Sx's? Side effects
Tx PD
Class: dopamine precursors
Action: cross BBB converted to dopamine in basal ganglia
Tx bradykinesia, tremor, rigidity
SE: ortho hypotension, drowsiness, hallucinations,