Module 3 Surgical/ortho Flashcards
What do bones do?
•They Provide supporting framework
●Allows us to bare weight
●Protect vital organs
●Serve as a point of attachment for muscle and ligaments
●Bone marrow (inside bone) contains hematopoietic tissue that makes red/white blood cells
What are the 3 types of Muscle? And what do they require?
3 types:
●Cardiac
●Smooth
●Skeletal
●Require nerve impulses
●energy sources (ATP),
● electrolytes (calcium, phosphorous)
What are gerontological considerations related to bones?
●Loss of bone density
●Muscle mass/strength decrease by about 30% at 70 years old
●Loss of motor neurons
●Tendons/ligaments become more rigid
●Higher risk for Osteoarthritis and Osteoporosis
How would you care for the older adult?
●Know that these conditions limit their self-care and other activities
●they have Increased discomfort or chronic pain, immobility
●Risk for falls d/t loss of strength/ unawareness of limitations
●Assist with cane/wheelchair, room safety
●Review hx/meds that may effect musculoskeletal system
Health Hx Eval for the older Adult
• Health perception – health management pattern
• nutritional - metabolic pattern
• elimination pattern
• activity – exercise pattern
• sleep – rest pattern
• cognitive - perceptual pattern
• self – perception – self – concept pattern
• Role - relationship pattern
• sexuality – reproductive pattern
• coping – stress tolerance pattern
• value - belief pattern
What are the 4 basic diagnostic studies?
●X-ray
●Bone Scan
●CT Scan (computed tomography)
●MRI
What are the manifestations of fractures? (S/S) and what is the classic sign?
●Bruising
●Crepitation
●Edema
●Loss of function
●Muscle spasm
●Pain
● classic sign = deformity
What are the 6 ways we treat fractures?
•Reduction
•traction
•surgery
•cast
•splint
•brace
What is closed reduction?
●Local or general anesthesia is used
●Traction / countertraction used
●Casting, traction, braces, or splints may be applied after
What is open reduction?
●Usually includes interval fixation
●Risk associated
●ORIF (open reduction internal fixation) promotes early ambulation
What is traction and what are the most common types?
●Traction- application of pulling force to an injured body part
●types: skin and skeletal
What are the benefits of using traction?
●Prevents / reduces spasms
●Immobilizes the extremity
●Reduce a fracture / dislocation
●Promotes active and passive exercise
●Expands a joint space during surgery
What are the complications of using traction?
•Infection #1
•skin breakdown/pressure ulcers
•Non-union (pulled too much to heal from weight)
How long are tractions placed and what is the weight range?
•48-72 hours
•5-45 lbs
What are the 6 P’s of the Neurovasuclar Assessment?
•pain
•pulse
•pallor
•paresthesia (tingling)
•paralysis
•pressure
What is the Nursing Management for Fractures?
●Immobilize the extremity right away if fracture is suspected
●Neurovascular assessment (6 P’s) distal to the fracture
●Post-op:
●Nutritional therapy
●Work w/PT to get pt up when time
●Psychosocial issues
Pelvic Fracture overview
●Can be life threatening depending on mechanism of injury/ associated vascular damage.
●HIGH mortality rate d/t hemorrhage & complications.
●Abdominal assessment: local swelling, tenderness, deformity, bruising abnormal movement.
●Dx: X-ray and CT scan
What is involved in a Stable Pelvis Fracture?
●Involves a single bone
●May heal with conservative treatment: rest, pain meds, PT, walker
●Can take 8-12 weeks to heal
What is involved in an unstable pelvic fracture?
●“Open book” = separation of symphysis pubis, vertical or lateral position.
●Tx: stabilize pelvis, compressing bleeding vessels (treat the shock), after stabilization ORIF or external fixation.
Huge medical emergency
20% of unstable pelvic fractures require >15 units of blood in 24 hours!
Tx/Nursing management of Pelvic Fractures?
Depends on if stable vs. unstable.
●Stabilize first!
● Complex/displaced fractures will require external fixation or ORIF.
● Only turn the patient when ordered to do so by MD.
●Assess bowel and urinary elimination frequently.
●Distal neurovascular assessment (6 P’s!)
●Back/skin care when patient is raised from bed.
What are complications of Pelvic Fractures?
Internal injury to organs…especially bladder!
●Long term complications:
●Malunion (forms incorrectly)
●Nonunion (doesn’t heal at all)
●Residual gait disturbances
●Chronic back pain (walking problems/causes pain)
When is it considered a hip fracture?
When the proximal (upper) 1/3 of the femur is injured.
What is the most commonly noticed sign of a hip fracture?
Shortening and external rotation of the affected extremity
What is the Tx for a hip fracture?
●Immediate surgery is the standard of care.
●May initially be stabilized with Buck’s traction.
