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NURS 313R > Exam 4: Musculoskeletal (Fractures/Casts/Amputations/Osteomyelitis) > Flashcards

Exam 4: Musculoskeletal (Fractures/Casts/Amputations/Osteomyelitis) Flashcards

1
Q

Fracture

A

A disruption or break in the continuity of the structure of bone.

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2
Q

Major cause of fractures include

A 
Traumatic (most common)
Pathological Fracture (d/t disease process)
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3
Q

Classification of Fracture according to type:

A
  • Avulsion
  • Comminuted
  • Displaced
  • Greenstick
  • Impacted
  • Interarticular
  • Longitudinal
  • Oblique
  • Pathologic
  • Spiral
  • Stress
  • Transverse
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4
Q

Avulsion Fracture

A

Due to pulling effect of tendon or ligament

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5
Q

Comminuted Fracture

A

More than one fragments

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6
Q

Displaced fracture

A

Overriding the other bone fragment, shortening the length of the bone.

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7
Q

Greenstick Fracture

A

Incomplete with one side splintered and the other bent

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8
Q

Impacted Fracture

A

More than one bone is driven into each other.

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9
Q

Interarticular Fracture

A

Extending into the articulate surface of the bone.

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10
Q

Longitudinal Fracture

A

Incomplete with fracture running in a longitudinal axis.

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11
Q

Oblique Fracture

A

Fracture line extended in an oblique direction.

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12
Q

Pathologic Fracture

A

Spontaneous at the site of bone disease

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13
Q

Spiral Fracture

A

Spiral direction along the shaft (twisted)

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14
Q

Stress Fracture

A

Area of repeated stress

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15
Q

Transverse Fracture

A

Line of fracture extends across the bone at a right angle.

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16
Q

Classification of Fracture According to: Communication or non-communication to the external environment

A
  1. Open fracture

2. Closed frature

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17
Q

Classification of Fracture According to: Anatomic Position or The Involved Bone

A
  1. Proximal
  2. Medial
  3. Distal
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18
Q

Classification of Fractures According to Stability

A
  1. Stable

2. Unstable

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19
Q

Stable Fracture

A

Intact periosteum

Fragments are stationary

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20
Q

Unstable Fracture

A

Grossly displaced site of poor fixation

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21
Q

Clinical Manifestations of Fractures

A
  • Localized pain
  • Decrease in function of affected limb
  • Inability to bear weight or use of the affected part
  • Guarding against movement
  • May or may not have deformity or shortening of a limb
  • Crepitation
  • Muscle Spasm
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22
Q

Collaborative Care Goals for Fractures

A
  • anatomic realignment of bone fragments
  • immobilization to maintain realignment
  • restoration of function
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23
Q

Types of Fracture Reductions

A
  • Close Reduction

- Open Reduction

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24
Q

Close Reduction

A
  • Non surgical manual realignment

- Traction and counter traction is applied.

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25
Q

Open Reduction

A
  • Use of surgical incision.

- Use of internal fixation such as wire plates, screw, pin rods and nails.

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26
Q

Traction

A

Devices that apply pulling forces on the fractured extremities while counter traction pulls in the opposite direction.

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27
Q

Skin traction

A

Is temporary for about 48-72 hours

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28
Q

Skeletal Traction

A

Pins and wires are placed into the bone -long term

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29
Q

Common Types of Traction’s

A
  • Buck’s Traction
  • Russel’s Traction
  • Bryant’s Traction
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30
Q

Buck’s Traction

A

Used for hip, knee, femur or back fracture.

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31
Q

Russel’s Traction

A

Used for femur or hip

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32
Q

Bryant’s Traction

A

Used for small children (under 2 years or <30 lbs in weight) for femur and hip joints.

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33
Q

Review other types of traction’s, its indications and nursing implications in

A

Chapter 61 pp. 1660-1661

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34
Q

Cast

A

Is a temporary circumferential immobilization device applied after close reduction.

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35
Q

How do you care for a new cast?

A
  • do not cover with blanket (to allow it to dry quickly)
  • do not subject to wetness or soiling
  • handle by palm rather than fingertips (fingertips apply more pressure)
  • petal edges when dry
  • assess circulation and sensation in affected extremity extremity
  • do not insert anything between the cast and the skin
  • support the extremity
  • reduce swelling by elevation
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36
Q

What should you assess for in patients with a new cast?

A

Cast syndrome

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37
Q

Cast Syndrome includes

A

Abdominal pain
Pressure
Nausea/Vomiting

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38
Q

Types of Casts

A
  • Sugar-tong splint
  • Short arm splint
  • Long arm cast
  • Body jacket cast
  • hip spica cast
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39
Q

Sugar-tong splint

A

Used for acute wrist injuries.

May allow space for swelling to occur.

40
Q

Short arm splint

A

Used in stable wrist or metacarpal fracture.

Provides an unrestricted elbow motion.

41
Q

Long arm cast

A
  • Used for stable forearm or elbow fracture and unstable wrist fracture.
  • Restricts wrist and elbow.
42
Q

Body jacket cast

A
  • Used for stable spine injuries and thoracic lumbar spine.
  • Extended above the nipple line down to the pubis.
  • Window is left by the umbilicus.
43
Q

Hip spica cast

A

Used for femoral Fracture to immobilize the affected extremities and trunk.

44
Q

Fixators

A

Metallic devise composed of metal pins and plates inserted into the bone to stabilize the fracture while it heals.

45
Q

External Fixation

A

For simple fractures - temporary.

46
Q

External Fixation Nursing Care

A

Assess for loosening and infections.

Meticulous pin site care should be done.

47
Q

Internal Fixation

A

Uses pins, palates, rods and screws surgically inserted during realignment reduction - can be permanent.

48
Q

Drug Therapy for Fractures

A
  • Muscle relaxant for pain d/t spasm (soma, flexeril, robaxin)
  • Analgesia
  • ATB (cephalosporin)
  • Tetanus (diphtheria toxoid or immunoglobulin)
49
Q

Nutritional Therapy for Fractures

A
  • ample protein (1gm/kg of body weight): to rebuild bone and muscle tissue
  • vitamins D, B, C, calcium
  • adequate fluid intake
  • high fiber
  • six small meals for patients in body casts (d/t risk for cast syndrome)
50
Q

Colles’ Fracture

A

Fracture of the distal radius.

One of the most common fracture in adults.

51
Q

Colles’ Fracture usually happens when

A

An individual tries to break a fall with an outstretched hand

52
Q

Treatment for Colles’ Fracture includes

A
  • Immobilization, splint, cast, external fixation
  • Elbow is immobilized to prevent supination and pronation
  • Decrease edema
  • Neurovascular assessment
  • Encourage movement of thumb and fingers
53
Q

Hip Fracture

A
  • Common among older adults.
  • By age 80, 1 out of 5 will have hip fracture.
  • Fracture of the proximal third of the femur.
54
Q

Intracapsular fracture

A

Occurs within the hip joint (femoral neck)

55
Q

Fractures of the hips are associated with

A

Osteoporosis and minor trauma

56
Q

Clinical Manifestations of Hip Fractures

A
  • External rotation of affected limb
  • Muscle spasm
  • Shortening of affected extremity
  • Severe pain and tenderness in the region of the fracture
57
Q

Collaborative Care for Fractures

A
  • surgical repair is the preferred method of treatment

- buck’s traction while awaiting surgery (24-48 hours max)

58
Q

Nursing Therapeutics for Fractures: Preoperative Management

A
  • Stabilize general health
  • Analgesic or muscle relaxant
  • Health teaching such as exercise, use of gadgets, transfer and ambulation, weight bearing
59
Q

Nursing Therapeutics for Fractures: Postoperative Management

A
  • (ORIF) monitor VS, I&Os, respiratory activities (deep breathing and coughing), Pain Management, bleeding and signs of infection
  • decrease pain by positioning for proper alignment by keeping pillows or abductor splint between knees when turning patient.
60
Q

When can patient’s ambulate post surgery?

A

ambulation by 1st or 2nd day by PT, use of crutch or walker

61
Q

How can you prevent external rotation?

A

Use of sandbag to prevent external rotation

62
Q

Discharge of patient post op

A
  • to discharge home, pt must demonstrate safety

- may need rehabilitation for few weeks before returning home.

63
Q

When can patients begin weight bearing post operatively?

A

Until x ray shows adequate healing (about 6-12 weeks)

64
Q

Health Teachings to Prevent Hip Prosthesis Dislocation

A
  • Place a large pillow between patient’s leg when turning
  • Keep leg abductor splints on the patient except when bathing
  • Avoid hip flexion
  • Avoid turning the patient on the affected side until approved by the surgeon.
65
Q

Amputation

A

Removal of a limb, part or organ usually by surgery or mechanical force or trauma.

66
Q

Indications for Amputations

A
  • Circulatory Impairments
  • Peripheral Vascular Disorders
  • Traumatic Injuries
  • Thermal Injuries
  • Malignant Tumors
  • Uncontrolled or widespread infections of the limb
  • Congenital Disorders
67
Q

Collaborative Care/Nursing Therapeutics Goal for Amputations

A

Preserve extremity length as necessary

68
Q

Health Promotion for Amputations: Monitor

A

Changes of the extremity involved such as:

  • skin color changes
  • decrease or absence of sensation
  • pulsation/presence of adequate circulation
69
Q

Amputations: Preoperative Management

A

o Reinforce information: reason for amputation, proposed prosthesis, mobility training program
o Discuss about phantom limb sensation

70
Q

Amputations: Postoperative Management

A

o Assess, monitor VS and dressing
o Maintain *STERILE technique on wound dressing changes
o Pain Management

71
Q

Amputations: Acute Interventions

A
  • Notify surgeon immediately if bleeding occurs
  • Prosthetic fitting
  • Involve PT and OT services
  • Monitor flexion contracture (hip flexion)
  • Bandaging of the residual limb for proper prosthesis fitting
  • Compression bandage applications
  • Minimized edema of the ritual limb
  • Active ROM
72
Q

Osteomyelitis

A

a severe infection of the bone, bone marrow and surrounding tissues

73
Q

Osteomyelitis is most often caused by

A

Staphylococcus aureus

74
Q

Limited supply of blood to the bone can cause

A

Limited amount of antibodies to the infection site -> more time for bacteria to multiply

75
Q

Causes of Osteomyelitis include

A 
Indirect Entry:
-Blunt Trauma
-Vascular Insufficiency (DM)
Direct Entry:
-Open wounds
-Foreign bodies (implant or orthopedic prosthetic devices)
76
Q

Common Sites for Osteomyelitis

A

Pelvis
Tibia
Vertebrae

77
Q

Pathophysiology of Osteomyelitis

A
  • Predisposing or precipitating factors (entrance of microorganisms)
  • Lodge to area with slow circulation
  • Microorganism multiplies
  • Increase pressure in the bone area
  • Ischemia/vascular compromise
  • Infection to the bone cortex
  • Cortical devascularization
  • Spread to other parts
78
Q

Clinical Manifestations of Osteomyelitis: Localized

A 
o	Bone pain
o	Swelling
o	Tenderness
o	Warmth in site
o	Restricted movement
o	Drainage (serosanguinous to purulent drainage)
79
Q

Clinical Manifestations of Osteomyelitis: Systemic

A 
o	Fever
o	Night sweats
o	Chills
o	Restlessness
o	Nausea and malaise
80
Q

Diagnostic Studies of Osteomyelitis

A
  • Bone tissue biopsy (biopsy is a histologic study) – identifies atypical cells, malignancy
  • Blood and wound culture
  • CBC
  • Radiologic
  • MRI/CT Scan
81
Q

Collaborative Care for Osteomyelitis

A
  • Vigorous prolonged IV antibiotic therapy
  • Culture and bone biopsy prior to ABT
  • Surgical debridement and decompression
  • Discharge patient home on rehab on ABT
  • Bone Graft (helps restore blood flow)
  • Amputation
82
Q

Nursing Management of Osteomyelitis: Health Promotion

A

o Control infection
o Educate about osteomyelitis
o Report symptoms

83
Q

Acute Interventions for Osteomyelitis include

A 
o	Immobilization d/t pain
o	Care of handling of affected limb
o	Monitor pain control
o	Handle soiled dressing carefully and use sterile technique
o  Good body alignment and frequent position changes (prevents complications associated with immobility)
o	Bed rest
o	Prevent complication of immobility
o	Monitor ABT therapy side effects
o	Emotional support
84
Q

Ambulatory Care for Osteomyelitis

A

o Continue ABT
o Care of access device
o Dressing change

85
Q

Sequestrum

A
  • Dead bone

- May also be a reservoir for microorganisms that spread systemically -> lungs and brain

85
Q

Involucrum

A
  • new bone (makes it difficult for successful antibiotic therapy)
  • Antibiotics and WBC have difficult time reaching sequestrum
86
Q

Fracture of the Pelvis

A

Life-threatening

Highest mortality rate (d/t increase bleeding)

87
Q

Clinical Manifestations of the Pelvis include

A
  • Abdominal swelling
  • Tenderness
  • Deformity
  • Unusual pelvic movement
  • Ecchymosis on the abdomen
88
Q

Pelvic Fracture: Assess

A 
Neurovascular status (CMS) of lower extremities
X-ray studies demonstrate fractures
89
Q

Complications of Pelvic Fractures

A
  • Intraabdominal injury
  • Paralytic ileus
  • Hemorrhage
  • Laceration of urethra,bladder and colon
  • Sepsis
  • FES
  • Thromboembolism (DVT)
  • Acute pelvic compartment syndrome
90
Q

Open book fracture (antero-posterior compression)

A
  • Pelvis is pulled apart
  • usually caused by high speed motor vehicular accident or skiing
  • can cause life threatening hemorrhage
91
Q

Closed book fracture (lateral compression)

A

Lateral force impact

92
Q

Treatment for Stable, Nondipslaced Pelvic Fractures

A

Only requires conservative therapy:

  • Immobility, bed rest for up to 6 weeks
  • Early ambulation is encouraged
93
Q

Treatment for more complex pelvic fractures include:

A
  • Pelvic sling traction
  • Skeletal traction
  • External fixation
  • Open reduction
  • Or combination of methods
94
Q

A displaced pelvic fracture may require

A

ORIF

95
Q

More Treatment for Pelvic Fractures include

A
  • Careful handling and moving of patients (turn patient only by physician older)
  • Assess bowel and urinary function
  • Assess distal neurovascular status
  • Provide back care when patient is raised from bed by independent use of trapeze or with adequate assistance
  • Restrict weight bearing on affected side until bone is healed
  • May use walker to distribute weight bearing between upper and lower extremities

NURS 313R (18 decks)

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