Final Flashcards
– tightening of muscle. Pt in cast needs to perform isometric exercise to prevent atrophy (wasting away) of muscle. Atrophy à lack of muscle movement.
Isometric
– an interruption in cartilage. An injury sustained from repetitive movements or an athletic event. Cartilage doesn’t grow back. When nose and ears get frostbitten, they do not grow back.
Osteoarthritis
– toes to nose. Used to evaluate for DVT. Homen’s sign. Prophylactic measures, we put pt on heparin or Lovenox. To test for DVT, we flex the toes to the nose. If pt has calf pain, we suspect the pt has DVT. Dorsi flexion with pt who has knee replacement causes pain. Instruct pt to differentiate btw calf pain and knee pain
Dorsiflexion
– downward pointing. Bibinsky is abnormal reflex, we find it in head trauma pts.
Plantar flexion
– bilateral or one sided. When comparing osteoarthritis vs. RA, RA is always bilateral. In RA, every joint in their body will be affected. Osteoarthritis can be one sided.
Joint pain
– also known as a Dowingers hump. Dowinger hump is when patient’s vertebral column begins to collapse, it crumbles. This is a sign of osteoporosis. As vertebral column collapses, the person loses height. One muscle group, usually the dominant side will pull away from the other side of the body and the patient will develop a hump or a buildup of muscle tissue. If you see pt with Dowinger’s hump, you can say that they have osteoporosis or you would want to test them for osteoporosis.
Kyphosis
– occurs before the age of 18. It is an adolescent disease. Occurs in the year of greatest growth, when the pt grows 2, 4, 6 inches. One muscle group pulls, pulling out the spinal column, giving it an S shape.
Scoliosis
for carpal tunnel. Flex wrists for 60 seconds. Numbness, tingling, or burning indicates carpal tunnel syndrome.
Phalen’s Test
sign is used to ID Carpal Tunnel Syndrome. This test is elicited by percussing lightly over the median nerve, located on the inner wrist until numbness, tingling and pain are felt.
Positive Tinel’s
– in osteoarthritis.
• Assess for excess fluid on the knee.
• Milk upward on medial side of knee, and then tap lateral side of the patella. It will balloon out or bulge.
• It indicates joint swelling vs. soft tissue swelling - arthritis.
Bulge Sign (Balloon Sign
– a tube of blood is spinned.
• The amount of time it takes to separate blood cells from plasma
• The more WBCs, particularly large ones (lymphocytes, monocytes) the longer it takes to spin down à increased sedimentation rate .
• An increase in inflammation in RA, MS, scleroderma leads to increased sedimentation rate.
Sedimentation rate
– (HLA) Done during the pt’s flare up.
• We can actually see that pt has an inflammatory disease.
• Used to detect autoimmune diseases such as lupus, RA, scleroderma, etc.
Antinuclear Enzymes
caused by breaking a fall – a sign of osteoporosis.
Colles fx
– shortening of muscle. Builds muscle = hypertrophy.
Isotonic
– pull of muscle – excessive stretch of muscle and tendon
• Muscle is highly vascular – tearing causes bleeding, hematoma.
• S/S pain, muscle soreness, edema.
• Rx - RICE
Strain
– stretching of ligament causing joint to come out of position.
• Causes loss of stability, depending on severity, it might need casting (esp. in knee area).
• Might cause shaving of bone
• S/S – pain, rapid swelling, joint tenderness, limited ROM
Sprain
- Immobilization
- Timely correction of Displacement
- Application of Ice
- Adequate amounts of growth hormone, V-D and calcium
- Adequate blood supply
- Absence of infection
- Moderate activity level prior to injury
Factors influencing bone healing – positive
• Delay in correction of displacement • Open fracture • Presence of foreign body – compound Fx • Immuno compromised – HIV, RA circulation • Malnutrition • Osteoporosis – bones wear • Osteomalacia – absence of Vit D, soft bone disease, called rickets in children. • Advanced age – $ bone integrity.
Factors influencing bone healing – Negative
- The leg is held longitudinal – straight up
- Toes to ceiling
- It pulls it in a straight method
- It comes down and 5-8lbs weight is hung from it
Bucks skin traction
Nails, screws and wire are put through the bone
• Connect bone
• We tend to vector:
• We need to put as much as 25lb added weight
Do not allow pt’s foot to touch foot of bed – there is no more traction
2. Do not allow weights to touch the floor – there is no more traction
Pt must stay in the center of the bed
Rule: traction is NEVER interrupted
Skeletal traction
- Make sure ropes are not frayed
- Knots are tight
- No knots on pulleys
- Weights are off floor
NI for traction
- Dermatitis or other skin irritations
- Impaired circulation -
- Varicose ulcers
- Peripheral neuropathy
- Pressure sores
Bucks traction contraindications
• Sterile technique
• Prepare a solution of 50% hydrogen dioxide, 50% NS
• Clean pin w/ swap once and toss – repeat until clean
• Never double dip
• Mix solution in urine cup and date it
• Each pin gets its own sterile applicator to clean
• Initially the wound is sanguineous for 24 hours
• Sanguineous à serous
• After 2-3 days, pins are grown into wound
• Pins can shift – measure both sides of pins to make sure it hasn’t shifted inwards
• Risk for infection:
o Local inflammation: red, swollen, pain, LOF, warm
o Systemic – fever, inc. WBC
▪ If drainage in wound becomes purulent, assess, check WBC
▪ Osteomyelitis (bone infection) is the worst thing to happen to a pt
Skeletal traction pin care
o Always check distal to injury
o Pulse
o Capillary refill
o Ask pt about numbness, tingling, pins and needles
Neurovascular assessment
– we inject dye – the dye will show up on x-ray.
• We check for consistency and contour of bone.
• We have to find out if there is a bee-sting allergy. Depending on reaction, they may Rx steroids and Benadryl and may give dye anyway
Arthrography
– measure density of bone, depth and integrity in osteoporosis.
• Typically done in (usu. lower) spine, the narrow neck of the femur bone adjoining the hip, and the bones of the wrist and forearm.
• Using the norms for size and age, they look for bone loss.
• Typically this is done on menopausal women where estrogen is no longer being produced; men don’t show osteoporosis until they are in their
Bone density
– You are given dye by IV, it goes through your body and ends up in the bladder, and then you pee it out.
Bone Scan
– a needle is injected and synovial fluid (should look like extra virgin olive oil) is aspirated.
• The synovial fluid is then checked for protein, antibodies, WBC.
• Is it infected w/ RA. In this case, it will come out cloudy, milky color
• Impaired skin integrity is a concern.
• TEST RESULTS: Protein means bones breaking down and WBC count means it is inflamed and/or infected.
Arthrocentesis
–the use of a dye to check blood circulation.
• This is not commonly done in M/S, more likely seen in renal, heart, and brain.
Angiography
- # w/ bone growth, in fractures and bone repair
Alkaline phosphate
– stretching of ligament causing joint to come out of position.
• Causes loss of stability, depending on severity, it might need casting (esp. in knee area).
• Might cause shaving of bone
• S/S – pain, rapid swelling, joint tenderness, limited ROM
Sprain
- Pain - N
- Pulselessness – V
- Paresthesia – N
- Paralysis – N
- Pallor$ – V
- Polar – V - cool or cold extremity distal to injury
6 P’s – Neurovascular Assessment
– absence of Vit D, soft bone disease, called rickets in children.
Osteomalacia
- Soft tissue damage – always bleeding. Always look at underlying structures, if it is ribs, etc.
- Hemorrhage
- Ruptured tendons
- Severed nerve
- Damaged blood vessels
- Body organ injuries
Complications of trauma
Between 5-8 lbs
Asses pain
Asses area at least 2-3x each shift must remove boot
Reposition patient for skin integrity
Nursing implications Bucks traction
Allergic rxn
Skin irritation
Perineal nerve palsy circulation impairment
Pressure ulcers
Complications of Bucks fractures
– when injury continues to develop under cast
o The cast is squeezing on the muscle underneath and can cause damage
o Perform neurovascular assessment, the 6 Ps on distal areas of cast
o Check for capillary refill, pulse, heat
o Tissue necrosis or infection can occur
o Hemorrhage – nerve damage can occur
• Cast compartment syndrome
Headache Drowsiness Irritability/Confusion/ Agitation Sense of impending doom Tachycardia Tachypnea/ wheezing use of accessory muscle Petechiae on neck and chest wall
Fat emboli
• Typically, pressure inside fascia is 8mm/Hg
• Once it reaches 20mm/Hg cells begin to die
• ALL CELLS BEGIN TO DIE AT 20mm/Hg
• During musculoskeletal trauma
• S/s UNRELENTING PAIN
• Pain is not relieved by narcotics
• Prevention: RICE
• The minute you suspect compartment syndrome RICEing isn’t permitted
• Since it lowers blood supply, it can cause further damage
o At this point we need to inc. blood circulation to muscle
o Don’t elevate for same reason as above
• If pressure is > 8mm/Hg, you know something is going on
Compartment Syndrome
