Families exam 4 - musculoskeletal Flashcards
What are manifestations of a fracture?
- pain
- crepitus
- deformity
- edema
- ecchymosis
- warmth
- redness
- not using the affected area
What does a neurovascular assessment include?
- sensation
- skin temp
- skin color
- cap refill
- pulses
- movement
What type of fractures needs a supine position?
- distal arm
- pelvis
- lower extremities
What type of fractures needs a sitting position?
- shoulder
- upper arm
What should be assessed when a pelvic fracture is present?
blood in the urine
What should be done to relieve pain with a fracture?
- elevate
- apply ice packs (no > 30 mins)
- analgesics
How long should an extremity be elevated with a cast?
for the first 24-48 hours
How long should ice be used with a cast?
for the first 24 hours
What should you watch for with a cast?
- increased warmth
- hot spots on the cast
- drainage
- skin breakdown
How can itching be relieved with a cast?
hair dryer
How is force applied with skin traction?
- weights are attached by a rope to the extremity
- tape and straps are applied to the skin along with boots/cuffs
How is force applied with skeletal traction?
- directly to the skeletal structure and/or specific bone
- insertion of pin/rod
- use of weights attached by a rope
Can nurses remove weights for traction?
NO
What should pin sites be assessed for?
- pain
- redness
- swelling
- drainage
- odor
What type of fracture most commonly causes osteomyelitis?
open fracture
What does osteomyelitis look like?
- swollen
- red
- constant pain that increases with movement
- tender
- warm
- tachycardia
What type of cultures should be done for osteomyelitis?
- skin
- blood
- bone
What type of biopsy should be done for osteomyelitis?
- joint
- bone
What medications are given for osteomyelitis?
antibiotics (IV or oral)
Should you elevate the extremity with osteomyelitis?
YES
Should you elevate the extremity with compartment syndrome?
NO, keep at heart level
Do pain meds help with compartment syndrome?
NO
What are the 5 P’s for compartment syndrome?
- pain
- paresthesias
- pallor
- paralysis
- pulselessness
What are characteristics of the skin with compartment syndrome?
- pale
- cold
- cyanotic nail beds
How much space should there be between skin and cast?
1 finger
What can the nurse do for compartment syndrome?
- loosen dressing
- open cast
What procedure can be done for compartment syndrome?
fasciotomy
Where does asymmetry occur with scoliosis?
- scapula
- ribs
- flanks
- shoulders
- hips
- legs (one is shorter than the other)
When should a scoliosis screening be done?
adolescence
What slows the progression of scoliosis?
bracing
When is a spinal fusion with rod placement done with scoliosis?
for curvatures > 45 degrees
What should be monitored after spinal fusion surgery?
- neurovascular status
- skin
- drain sites for infection
- decreased H&H
- bleeding
What is subluxation?
incomplete dislocation of the hip
What is dislocation?
when the femoral head does not have contact with the acetabulum
Is DDH painful at birth?
no
What is a positive trendelenburg sign, and when does it occur?
- when the pelvis tilts down while bearing weight on the affected side
- child DDH
What is a positive ortolan test, and when does it occur?
- the hip is reduced by abduction
- infant DDH
What is a positive barlow test, and when does it occur?
- the hip is dislocated by adduction
- infant DDH
What are characteristics of walking in a child with DDH?
- walking on toes on the shorter leg
- walking with a limp
What bone is shortened in an infant with DDH?
femur
What happens to gluteal and thigh folds in an infant with DDH?
they are asymmetric
How long is the pavlik harness worn?
12 weeks
How often are the straps on the pavlik harness checked/adjusted?
q 1-2 weeks
What should be worn with the pavlik harness?
an undershirt and knee socks
Can lotions/powders be used with the pavlik harness?
NO
How should a diaper be worn with the pavlik harness?
under the straps
What type of traction should be used when adduction contracture is present?
bryant traction
What is bryant traction?
skin traction where the hips are flexed at a 90 degree angle with the butt raised off the bed
How should a hip spica cast be handled until it dries?
- elevated
- with palm of hand
Can you get a hip spica cast get wet?
NO
What should be assessed with a hip spica cast?
- neurovascular status
- skin in the diaper area
- pain
- hydration status
- color and temp of toes
What can prednisone cause?
- adrenal suppression
- bone loss
- hyperglycemia, glycosuria
- myopathy
- PUD
- infection
- F&E imbalances
What should be done for adrenal suppression caused by prednisone?
- altered day dosing schedule
- taper dose
What should be done for bone loss caused by prednisone?
- weight-bearing activities
- calcium and vitamin D
- low dose
What should be done for hyperglycemia and glycosuria caused by prednisone?
increase insulin dose
What should be done for myopathy caused by prednisone?
decrease the dose
What should be done for PUD caused by prednisone?
- avoid NSAIDS
- report s/sx of bleeding
- admin with food
What should be done for infection caused by prednisone?
avoid large crowds and sick people
