m2 day 5 Flashcards
initial treatment of fractures
- Ensure ABCs
- Check for impaired circulation (colour movement sensation)
- Control external bleeding with direct pressure or sterile pressure dressings and elevation of extremity.
- Check neurovascular status distal to injury before and after splinting.
- Apply ice packs to the affected area (20 minutes)
- Obtain X-rays of the affected area.
- Administer tetanus and diphtheria prophylaxis.
- Mark location of pulses to facilitate repeat assessment.
ongoing monitoring of fractures
Vital signs → pain, changes/ baseline
Peripheral pulses
CSM to affected limb (colour – sensation- movement)
compartment syndrome
- pressure within the muscles builds to dangerous levels
- Most commonly associated with trauma, fracture (especially of the long bones), extensive soft tissue damage, and crush injury.
- Characterized by excessive 6 P’s - pain, pallor, paresthesia, paralysis, and pulselessness (emergency)
- Pain unrelieved by medications and out of proportion to the level of injury
- Ischemia can occur within 4–8 hours after onset.
caring for compartment syndrome
- The extremity should not be elevated above heart level.
- Elevation may raise venous pressure and slow arterial perfusion.
- Application of cold compresses may result in vasoconstriction and may exacerbate compartment syndrome.
- Do not want any ice
- May be necessary to remove or loosen bandage or split cast
- open up the cast/splint up
- surgical decompression may be necessary.
fracture healing and remodolling
Depends on
- Which bone, density, some will never heal
- Femur takes 6months - a year
- Healing time of fractures increases with age
- healthy individual 6-8 wks (while some take longer) or may Not at all
Remodelling: up to a year after injury
- Excess bone tissue is reabsorbed
- Union is complete
- Gradual return to preinjury structural strength and shape occurs
fracture reduction
Closed reduction
- Nonsurgical, manual realignment of bone fragments to previous anatomical position using traction
Open reduction
- Correction of bone alignment through surgical intervention
- Internal fixation with the use of wires, screws, pins, plates, intramedullary rods, or nails
- ORIF → open reduction and internal fixation
- NO MRI for pins
traction pins
purpose, types and observations
Purpose:
- Prevent or reduce muscle spasm
- Immobilization
- Reduce a fracture or dislocation
- Promote exercise
- Expand a joint
Types
- Skin
- Skeletal
Inspect exposed skin regularly
- Pressure over bony prominence –> pressure necrosis.
Observe skeletal traction pins for infection.
- Pin care
External rotation of the hip can occur when skin traction is used on lower extremities.
- The nurse can correct this position by placing a pillow, sandbag, or rolled-up draw sheet along the greater trochanteric region of the femur, a “trochanter roll.”
casts
use? observe for what
- Restricts tendon and ligament movement
- Assisting with joint stabilization while the fracture heals
- Allows patient to perform many ADLs
- Elevate extremity onto pillows above the heart for the first 24 hours NOT FEMUR
- After 24 hours, casted extremity should not be placed in a dependent position because of the possibility of excessive edema.
Observe for
- signs of pressure
- Swelling above and/or below cast
- Discoloration of digits
- Increased pain or paresthesia
- Spasm
Degrees of weight-bearing ambulation
Non–weight-bearing ambulation
Touch-down/toe-touch weight-bearing ambulation
Partial–weight-bearing ambulation
Weight bearing as tolerated
Full–weight-bearing ambulation
osteoarthritis
what is it and signs
Slowly progressive noninflammatory disorder
Osteopenia is a decrease in bone density → osteoarthritis is severe
Joints
- Range from mild discomfort to significant disability;
- localized pain and stiffness, crepitation
Deformity
- Specific to joint involved (e.g., Herberden’s nodes)
- Can appear as early as 40 years of age
signs
- Dowager’s hump (outward curvature of the upper spine)
- Kyphosis of the dorsal spine
- Loss of height
- Pathological fractures
osteo care target and tests
- Bone scan
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Radiological studies
- Blood studies (ESR)
- Synovial fluid analysis
Care Target
- Managing pain and inflammation
- Preventing disability
- Maintaining and improving joint function
osteo pharmacological managment
Bisphosphonates
- Alendronate, etidronate, zoledronic acid, ibandronate, pamidronate, risedronate
- Selective Estrogen Receptor Modulators
- Raloxifene HCL
- Teriparatide
- Recombinant Parathyroid Hormone
Rheumatoid arthritis
what is it? Clinical manifestations
Chronic, systemic autoimmune disease
- Unknown cause
- Sjögren syndrome –> Decreased fluid like tears/saliva
- Felty syndrome
- Those affected usually have high levels of biomarkers such as rheumatoid factor (RF).
Clinical manifestations
- Joint destruction first year of disease without treatment.
- Flexion contractures and hand deformities
- Nodular myositis and muscle fibre degeneration
- Cataracts and loss of vision
- Later, cardiopulmonary effects
- Depression
RA objective data
general, INT, Cardio, resp, GI, MSK
General
- Lymphadenopathy, fever
Integumentary
- Subcutaneous rheumatoid nodules on forearm, elbows
- Swelling –> Tight shiny, skin over-involved joints
- peripheral edema
Cardiovascular
- Symmetrical pallor and cyanosis of fingers (Raynaud’s phenomenon)
Respiratory
- Chronic bronchitis, tuberculosis (due to rheumatoid nodules)
Gastrointestinal
- Splenomegaly (Felty’s syndrome)
Musculoskeletal
- Symmetrical joint involvement with swelling, erythema, heat, tenderness, and deformities
- enlargement of proximal phalangeal and metacarpophalangeal joints
- limitation of joint movement; muscle contractures; muscle atrophy
diagnostic tests for RA
- Positive RF occurs in ~80% of patients.
- Antinuclear antibody (ANA) titres
- Erythrocyte sedimentation rate (ESR)
- Anti-citrullinated protein antibody
- Synovial fluid analysis
Radiological studies
- Xray
- MRI
- Ultrasound (narrowed joint space)
