Exam 4 Musculoskeletal Disorders Flashcards
1
Q
DISPLACED
GREENSTICK
SPIRAL
OBLIQUE
A
- SPIRAL
- OBLIQUE
These are common in Abuse cases
2
Q
Stability of Fractures
A
- A stable fracture occurs when a piece of the periosteum is intact across the fracture, and either external or internal fixation has rendered the fragments stationary.
- Stable fractures: transverse, spiral, or greenstick
- An unstable fracture is grossly displaced during injury and is a site of poor fixation.
- Unstable Fractures: comminuted or oblique
3
Q
Pathophysiology
A
- Fracture occurs when stress placed on the bone is more than the bone can withstand
- Localized tissue injury results in muscle spasm, edema, hemorrhage, compressed nerves, and ecchymosis.
- ICE + ELEVATION
4
Q
Assessment findings
A
- Immediate localized pain aggravated by motion
- Tenderness over the fracture site
- Loss of function or motion, inability to bear weight
- Edema, Ecchymosis
- Crepitus
- Affected leg that appears shorter (fractured hip)
- Deformity
- False motion
- Paresthesia
5
Q
Diagnostic findings
A
- X-ray: break in the continuity of the bone
- Hematology: decreased Hgb and Hct
- ALWAYS CHECK FOR THIS LAB!
- When you break a bone, BLOOD IS RELEASED, into the interstial fluid
6
Q
Medical management
A
- Fracture reduction
- Closed reduction: non-surgical manual alignment of bones to previous position
- Open reduction: Correction of bone alignment through a surgical incision. May include internal fixation with wires, screws, pins, plates, rods, or nails. (ORIF) → must go to OR (operating room)
- Traction devices: apply a pulling force on the fractured extremity resulting in realignment while counter traction pulls in the opposite direction.
- Immobilization with casting, external fixator
7
Q
Nursing management
A
- Pain relief
- Neurovascular assessment
- Distal to site of fracture
- Preoperative and postoperative management
- Infection risk reduction
- Observe casts/dressings for signs of bleeding, drainage
- Prevention of constipation due to immobility and pain medications
8
Q
DUH!
DON’T DO THIS TO YOUR CAST!
A
DO NOT GET WET
DO NOT STICK THINGS INSIDE OF CAST
DO NOT PULL PADDING OUT FROM INSIDE THE CAST
DO NOT TRIM OR ALTER YOUR CAST BY YOURSELF
CALL YOUR DR. BEFORE TAKING ANY ANTI-INFLAMMATORIES
9
Q
Stages of fracture healing
A
- Reparative process of self-healing called Union
- Fracture hematoma- bleeding and edema surround ends of bone fragments
- Granulation tissue- active phagocytosis absorbs products of local necrosis
- Callus formation- minerals are deposited in the osteoid forming an unorganized network-callus
-
Ossification- ossification of callus → Take cast off here
- Occurs 4-6 weeks (young); 6-8 weeks (older)
- matrix forms here
- muscular atrophy occurs with 3+months of casts
- Consolidation- distance between bone fragments diminishes
- Remodeling- excess bone cells are absorbed and union is completed
10
Q
Possible complications
A
Nursing Intervention for INCREASE IN PAIN
- DO NEURO CHECK
- COLOR, MOTION, SENSATION, TEMP
- IF POSSITIVE → CALL SURGEION ASAP → CAN LOOSE LIMB
Possible complications
- DVT Deep vein thrombosis
- Anemia
- Lab values of Hgb + Hct
- Fat embolism
- For large bones → glob of fat breaks off and goes to lungs
- Pulmonary embolism
- Compartment syndrome
- swelling that compressess vascular of extremity
- Nonunion
- bone did not heal correctly
- Osteomyelitis
- bone infection (common in diabetics)
- Avascular necrosis of the femoral head (fractured hip)
11
Q
Hip Fracture
A
- Common in older adults
- Occur more often in women > 65 years of age due to osteoporosis.
- due to loss of estrogen
- Test for Osteoporosis in Hips, wrists, and spine
- Most times the hip breaks first and then they fall not the other way around.
- 14-36% of hip fracture patients die within a year due to complications caused by the fracture or immobility.
- Only half of patients with hip fractures are able to return home and be independent.
12
Q
Clinical Manifestations
A
- Manifestations of a hip fracture are external rotation, muscle spasm, shortening of the affected extremity, and severe pain at the fracture site.
- Displaced femoral neck fractures cause serious disruption of the blood supply to the femoral head which can cause avascular necrosis.
13
Q
Preoperative Management
A
- Monitor for severe muscle spasms which can increase pain. Provide analgesics or muscle relaxants. Traction may be helpful if surgery is delayed.
- Provide overhead trapeze to help with mobility, turning, and changing positions.
- Provide physical therapy to begin teaching bed and chair transfers.
- Discharge planning begins.
14
Q
Postoperative management
A
- Administer pain medication, monitor vitals, I/O, etc.
- Turn, cough deep breath, incentive spirometry
- Observe dressing and incision for signs of bleeding and infection
- Monitor extremity for neurovascular impairment: motor function, temp, color, sensation, distal pulses, cap refill, edema, pain
- Pillows should be used to prevent external rotation of the extremity
- Ambulation with PT will begin 1st or 2nd post-op day.
- Patient and family must know the positions to avoid to prevent dislocation.
- Patient will go home w/specific insctruction of hip movement
15
Q
Joint Replacement
A
- Description:
- Arthrodesis: surgical removal of cartilage from joint surfaces to fuse a joint into a function position
- Synovectomy: removal of the synovial membrane from a joint, using an arthroscope, to reduce pain
- Arthroplasty: total joint replacement: surgical replacement of a joint with a metal, plastic, or porous prosthesis
25
Q
Osteoporosis
A
- MOST COMMON IN SMALL WHITE WOMEN
- Porous bone, (fragile bone disease), is a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility.
- Metabolic illnesses or medications that cause osteoporosis increase the risk of skeletal fracture.
- It is estimated that 1 in 2 women and 1 in 8 men over age 50 will sustain an osteoporosis-related fracture during their lifetime.
