Exam 4 - Musculoskeletal Flashcards
what is a dislocation?
joint surfaces are no longer in tact
what is subluxation?
articular cartilages are partially separated
what should you do for treatment of subluxation and dislocation?
check for neurovascular compromise
REDUCE
Stop movement
x-ray
what is a strain
tearing injury of muscle or tendon from bone
how is a strain start
over extension
over stretching
wrenching
twisting
how is a strain treated
RICE
what is a sprain?
stretching or tearing of ligaments
what is the treatment of sprain
RICE
NSAIDs
what are the four causes of fractures
stress
fatigue
trauma
pathological
what is a greenstick fracture
bone and bendy fracture
what is a spiral fracture
a fracture caused by a rotating force
what is a comminuted fracture
a fracture that splits into one or more pieces
what is a transverse fracture
break across the bone at a right angle to the long axis of the bone
what is a compound fracture
where it pierces the skin
what does displaced mean
two fractured bones are out of place and not in contact
what does non displaced mean
the two fractured parts are broken but may still be in contact
what does closed mean
not penetrating the skin
what is a complete fracture
the whole bone breaks all the way through
what does incomplete mean
bones break but not in two complete separate pieces
what is a compression fracture
when a bone breaks because it is being compressed (back)
what is an impaction fracture
when a bone breaks and collapses into another bone
what is an oblique fracture
basically at an angle??
what is avulsion
when a tendon or ligament pulls off a piece of bone
how do you assess a fracture
mechanism of injury physical exam history exam CT xray neurovascular exam
what are the 5 P’s
pain pallor parasthesia paralysis pulse
emergency care of fracture
immobilize
ice
cover open fractures
extensive local trauma severely comminuted space between bone fractures bone loss from injury or surgical excision decreased blood supply inaduqeate immobilization infection smoking medications post menopausal
can all do what
inhibit bone healing
bone fragment contact effective immobilization sufficient blood supply exercise and weight bearing activity nutrition adeuqate hormone levels
all can do what
heal a bone correctly
what is an open reduction
fixed surgically
what is closed reduction
fixed non surgically
how is realignment confirmed?
xray
neurovascular assessment
nursing considerations for cast care
inspect edges elevate window in for cast assessment keep dry no object itching
internal fixation
rods, pins, plate, screws
external fixation
wires placed through the skin and bone fragments and attached to external frame
pin site considerations
pain swelling redness loosening of pins tenting antibiotics
what is traction
use of weights rope and pulleys to immobilize and set a fracture
what is skin traction
applied to the skin
bucks traction
pulls leg straight out
bryants traction
pulls legs up in the air
compartment syndrome
dangerous increase in pressure in muscle compartment
steps of bone healing
- hematoma forms
- hematoma to granulation tissue
- callus forms
- osteoblatic proliferation
- bone remodel
- bone healing
where do compartment syndrome usually happen?
tibia fractures
forearm
why does compartment syndrome cause pain?
increase in edema takes a toll on the nerve endings
post op care for bone fracture
toradol for inflammation and pain
watch for infection
fat globules are released from yellow marrow into the blood stream and clog small blood vessels that supply vital organs, usually lungs, and impair organ perfusion
fat embolism syndrome
what fractures develop a fat embolism syndrome?
bones with a lot of marrow
pelvis, sternum, femur
signs and symptoms of fat embolism syndrome
low arterial o2 (hypoxemia)
dyspnea
tachypnea
petechia
who’s at the greatest risk for fat embolism
20 - 40 y/o men
70 - 80 year old
hip and pelvis fracture 24-72hr after injury or surgery
earliest sign of fat embolism
altered mental status
fat embolism treatment
bed rest gentle handling oxygen hydration fracture immobilization
risk factors for DVT
immobilization
dehydration
damage to veins
signs and symptoms of DVT
red hot swollen calf
pain
diagnosis of DVT
ultra sound
D dimer
venography
DVT treatment
elevation
movement
anticoagulation
compression socks
signs and symptoms of pulmonary embolism
tachycardia
dyspnea
pleuritic chest pain
how to diagnose a PE
chest CT
D dimer
V/Q scan
PE treamtent
resp support
anticoag
analgesics
surgery if needed
osteomyelitis
infection or inflammation of bone
signs and symptoms of osteomyelitis
erythema bone pain edema malasise fever
how is osteomyelitis diagnosed
x ray
bone scan
lab work
biopsy
treatment for osteomyelitis
surgery/debridement
antibiotics
avascular necrosis
bone that lost blood supply and died
delayed union
bone takes long to heal than usual
malunion
bone does not heal correctly
non union
bone does not heal
what drug should not be used on an older adult with a broken hip
meperidine or demerol
cause seizures
hip precautions
dislocation adduction of hip avoid flexion of hip greater than 90 no crossing leg no rotation of toes transfer on unaffected follow weight bearing activity carefully
acute indications of amputation
trauma
malignancy
peripheral arterial
chronic indications of amputatiaon
peripheral vascular disease
diabetes
osteomyleitis
peripheral circulation tests
doppler unltrasound
ankle-brachial index
angiography
