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MSK Flashcards

1
Q

ruptured cerebral aneurysm signs

A

astomaptic unless they rupture
“known as silent killers”
- no warning signs sometimes
“ worst headache”

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2
Q

what pt say if they have cerebral aneurysm rupture

A

WORST HEADACHE OF MY LIFE

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3
Q

clients with casted extremtities afer acture injury are at risk for

A

decreased peripheral perfusion due to increased edema and a cast that restricts the skins ability to expand CAUSING COMPAREMENT SYNDROME

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4
Q

expected symtoms of casted extremity

A
  • milf to moderate edema
  • warmth or thorrbing
  • pain on movement
  • pain that improves with anagesics
  • itching
  • dry skin under the cast
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5
Q

severe pain unresposnie to angesics

A

comparement syndome

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6
Q

compartment syndrome signs

A

severe pain unresp to anaglesics

  • immoblilty of digits
  • changes in sensation (numbess or tingling)
  • lack of pulse in distal extremity’
  • cool and pale dsital extremity
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7
Q

rheumatoid arithis

A

chronic
systemic
inflamm
autoimmune where the body attacks the joints leading to bone erosion and joint deformity

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8
Q

charasteritic of RA

A

symmetrical pain and swelling that affects the small joints of the hands and feet

  • mornings tiffness that last 60 min-sevreal hours
  • -elevated ESR and rhuematoid factor levels
  • cervical spine and doesnt invole any other spine
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9
Q

osteoarthyritis characterisic

A

assymetric pain

creiptus esp over knee joints

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10
Q

ankylosing spondylitis.

A

low back pain and stifness

worse in the morning and improves as day goes on

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11
Q

gout

A

pain
swelling
redness in one or more extremitiy joints

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12
Q

RA intital affects the

A

small joints of the wrists, hands and feet

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13
Q

halo external fixation

A

stablizes cervical and throacic fracture when there is damage to the liaments or spinal cord

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14
Q

halo traction nursing intervention

A

cleaning pin sites with sterile solution such as chorhexideine or water to prevent infection

  • keeping the vest liner clean and dry (changing weekly or when soiled, using cool dryer to dry)
  • placing foam inserts under pressure joints
  • placing small pullow under clients head when suprine to reduce pressure on the device
  • keeping correct sized wrench avialble at all times
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15
Q

who adjust the pins

A

provider

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16
Q

the nurse should avoid doing what with halo

A

grabbing the device frame when moving or position the client because it can cause the screws to loosena and alter the alignment

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17
Q

what is a contrindication to doing total joint replacement surgery

A

recent/current infection as wound infection is more liekly to occur in a client with preexting infection (so report burning urination to HCP)

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18
Q

what is expected in clients undergoing total knee replacement

A

severe knee pain

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19
Q

education before doing total knee placement

A

stop taking nsaids such as cox2 and celebrex 7 days before to decrease bleeding

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20
Q

prevnting hip flexion contractures

A

the limb should not be elevated esp after 24 hours of amputations (INSTEAD MANAGE THE EDEMA BY FIGURE EIGHT COMPRESSION)

  • bandage should be worn at all times
  • place pt prone with hup in extension for 30 mins 3-4 times a day
  • AVOID sitting in chair for more than one hour
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21
Q

hip dislocation following total hip replacement is prevented using

A

abductor pillow to maintain hip in straight and neutral poistion

  • also do not bend at the hip more than 990 degree
  • dont cross ankles or legs
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22
Q

buck traction

A

immbolizes hip and fremur fractures

  • a boot or traction tape is applied to the ext and a weight pulls the limb in traction
  • client is supine witht he foot of the bed raised to maintain countertraction
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23
Q

after new cast is placed

A

elevate the limb above the heart for the first 48 hours to decrease edema and increase venous return however dont elevate if compartment syndrome dev

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24
Q

dont do what to the leg if compartment sydrome happens

A

DONT elevate it

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25
Q

residual limb care after above knee ampution (AKA) or (BKA)

A
  • clean the limb by washing it daily with soap and warm water and dry throughly
  • inspect signs of infection
  • keep limb socks, weaps, and appliances /prostheses clean and dry
  • dont apply irrtants such as etoh or lotion or power
  • perform daily ROM to improve muscle stength
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26
Q

complication of residual limb

A

hip flexion contratures

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27
Q

sprain

A

stretch or tear of a liagment

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28
Q

treatment for sprain

A

REST- acivity should be stopped and mov limited for 24-8 jours to promote healing

  • ice (cold, cyrotherpy) apply ice pack or cold thepy for 10-15 mins every hour for the first 24-48 hours. DONT apply ice directly to the skin
  • compression (ace wrap or splint) to prevent edema and promote fluid return
  • elevation- ext should be elvated above heart on pullows for 24-48 hours to help reduce swelling
  • Analgesia – Mild analgesia with a nonsteroidal anti-inflammatory drug (eg, ibuprofen) can be taken every 6 hours as needed to relieve pain and reduce swelling
  • Exercise rehabilitation program – This should be initiated as soon as possible after the injury (ie, when pain subsides) to restore range of motion, flexibility, and strength and prevent reinjury
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29
Q

tingling and hand hand weakness when using crutches

A

using incorrecntly and not ftted correctly

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30
Q

pain and swelling after injury

A

normal

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31
Q

RA stiffness intervnetion

A

take warm shower or bath when awking up

  • then do ROM
  • apply heat packs to stiff joints and ice packs to painful joints
  • plan freq rest periods
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32
Q

nsaids should not be taken

A

empty stomach

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33
Q

overtime with RA

A

reduced ability to perform actv of faily living (toileting, abthing, drssing) and engage in routine tasks (walking, opening doors)

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34
Q

fat emobli happens with

A

bone or pelvic fractures
pancreatitis
liposcution

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35
Q

symtoms of fat emobli

A

resp prob (dyspnea, tacypnea, hypoxemia)

  • neuro changes
  • petichae rash (neck, chest, axilla)
  • fever (>101.4 F)
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36
Q

paresthia includes

A

numbess, tingling and burning and these are sogns of compartment sydnrome

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37
Q

osteroarthrities (OA)

A

synovial joints (kneem fingers, hip)

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38
Q

maesnifications of OA

A
  • pain excerbated by weight bearing actv
  • crepitus
  • morning stiffness that subsides within 30 mins of arising
  • decreased joint mobility and ROM
  • atrophy of muscles due to dicuse-
  • typically noninflammtory
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39
Q

biomarker or lab tests for OA

A

none

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40
Q

biopartker for rhymatoic arthertis

A

rhumetoid factor

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41
Q

average length of stay after total knee arthoplasty

A

3-5 days

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42
Q

total knee arthroplasty after surgery

A

PT
isometric
should be fullyy weight bearing by discharge
-use asstive decies to help them sit, rise safely
-knee immbolizer to maintain extension during abulation and at rest for 4 week

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43
Q

complications total knee arthroplasty i

A

DVT
PE
bleeding (look for low hgb)
infection-look at WBC

44
Q

what should be prescribed after total knee arthroplasty i

A

anticogution for 2 wk after surgery

  • ankle excercises
  • anti emoblic stoccks
45
Q

compartment syndrome results from

A

compression from restrictive dressings and casts

-increased pressure within compartment (bleeding, indalmmation, and edema)

46
Q

6 P’s for compartment syndrome

A 
pain (unleved by respoistion or analgesics)
P-pallor
P-pulseness
P-parestesia
-poikilothermia (coolness)
-paralysis
47
Q

if compartment syndrome is suspected

A

elevate the ext at heart level to promote venous return and limit swelling

  • loosen tight bandaging and casting material
  • fasciotomy
48
Q

volkmann contracture occurs as a result of

A

compartment syndrome

49
Q

volkmann contrature causes

A

swelling which causes pressure restricting the arterial blood flow
-the ischemia that results from this leads to tissue damage
-wrist contractures
-inbailty to extend the fingers
“i have been having trouble extending my fingers “
-MED EM

50
Q

to prevent hip prosthesis dislcation following total knee arthroplasty

A

do not force the hup >90 degree of flexion
so when using chair with arm rests, place the arm on the arm rest while lowering themselves onto the seat
-dont bend forward when getting into a chair bc that creates >90 degree
-should not twist from the waist, reach acorss the affected ext, bend forward when dressing, putting slippers shoes.
-use asstive equipment when getting dressed such as reacher/grabber, sock puller

51
Q

excercises for total knee arthroplasty to prevnt dislocation

A

leg excercises 2-3 X/day

  • isometric quadriceps and gluteal setting
  • leg raises
  • abduction excercises from supine and postion poistions
52
Q

most common mechanisms of pevlic fractures

A

MVC

MOTORCYLE CRASHES

53
Q

when caring for a client with fractured pelvis assess for

A

internal hemmorhage (abdominal distention, vitals igns, hgb /hct)

  • parlytic ileus
  • neurovascular deficits (ext circulation, sensation, mov)
  • abdominal and GU organ injries (hematuria, UOP)
54
Q

what is expect with fractures

A
  • eccymosis UNLESS IT IS OVER THE SUPRAPUBIC REGION
  • tenderness
  • burisshing
55
Q

prioity manibular fracture

A

maintaining patent airway so suction if this didnt work then cut the wires but DO NOT CUT THE WIRE unless ARDS OR CARDIAC ARREST requiring intubation

56
Q

what must be taoed to the bed for mandibular fracture

A

wire cutter

57
Q

cutting the wires on mandibular fracture

A

can worsen the airway prob

58
Q

preventing disease process in RA

A

joint protection- fibrosis from ra can shorten tendons and ligaments so body aligners and immbolizers should be used to keep ext straight

  • remain active but take rests during painful episodes
  • meds such as metthotrexate should be used regarless of the symtoms
59
Q

obesity is a risk factor for

A

osteroarthirits not RA

60
Q

colles fracture

A 
wrist fracture (fork)
-occurs when the client tries to break the fall with outstretched arm or hand and lands on the heels of the hand
61
Q

colles is related to

A

osteopenia

osteroporosis

62
Q

colles intervention

A

neuro assessment (pulses, cap , sensation, mov)

  • pain meds
  • ice pack
  • elevate the ext on pillow above the heart to reduce edmea
  • instruct the client to move fingers
63
Q

osteopneia

A

more than normal bone loss for clients age and sex

64
Q

calcium foods

A 
MILK AND MILK PRODUCTS 
cheese
ice cream
green veg
almonds
tofu
salon
sardines
yogurt
cereal
65
Q

vit d

A 
milk 
yogurt
salmon
sardines
cereeak
tuna
oily fish
egg yoak
liver oil
66
Q

relieve itching under cast

A

cool setting of hair dryer

  • never place any object, lotions, pwders in or around the cast area
  • persistent itching should be reported to hcp
67
Q

total knee arthroplasty to prevent adduction

A

place abduction pullow bwtween legs

68
Q

casts (fiberglass, plaster) care

A

report foul ordors and hot areas- infection

  • avoid getting cast wet
  • elevate the affected ext above heart level for first 8 hours to reduce edema
  • perform ismoteric and ROM to prevent atrophy.
69
Q

osteroporosis treatment

A

biphosphonate meds (fosamax, risedronate)

70
Q

external fixator

A

device used to stablize broken bones

71
Q

the nurses should promote what in clients with external fixation devices

A

early mobilization

sometimes right after surgery

72
Q

clean pin site with

A

chlorhexidine

sterile normal saline

73
Q

carpal tunnel

A

pain and paresthsia of the hand caused by nerve compression

74
Q

symtoms of carpal tunnel is exacerbated during

A

sleep because of the prolonged and unintentiaonal wrist flexion

75
Q

how to manage carpal tunnel symtoms

A

wrist immbolization splints esoucally the wrist during sleep

-surgery

76
Q

what can worsen symtoms of carpal tunnel

A

performing repeitve hand excecises

wearing compression hose

77
Q

buck traction

A

skin tracTion used to immbolize hip fractures and reduce pain and spasms
-SIDE TO SIDE INCREASE INJURY so dont repoistion client

78
Q

nurse should ensure what with clients with buck traction

A

alignment of the limb and that the limb remains straight in neutral poistion

79
Q

Ankylosing spondylitis (AS),

A

inflalmtory disease affecting the spine causing restricted spinal mobility

80
Q

classic findings of Ankylosing spondylitis (AS),

A

low back pain

morning stiffness

81
Q

clients with Ankylosing spondylitis (AS), should

A

promote extension of the spine with proeper posture, dialy stretaching such as swimming, racquet sports

  • practice breathing excercises to increase chest expansion and reduce lung complication
  • pain mangement with MOIST heat and nsaids
  • take immunosupp and antiinflammtory meds
  • REST during flare ups
  • SLEEP on their backs on firm matterss NOT SOFT
82
Q

rhabdomyolysis

A

msucle fibers are released into the blood after muscle injury from excercise, heat stroke, physical trauma

83
Q

complications of ehbaymyolsis

A

renal failure ad in order to prevtn renal damage GIVE FLUID RES to flush it out

84
Q

signs of rhabdomyolsis are

A

dark, bloody urine, oliguria

fatigure

85
Q

priotiy for rbacdoymosis

A

fluid

86
Q

pain and paresthesia over first 2 1/3 fingers

A

carpal

87
Q

rotator cuff

A

rotatoion of the arm and gets injured from repritive overheda motion (swimming, tennis, basebal, weight lifting)

88
Q

cahracteritsitc of rotator cuff

A

shoulder pain and weakness

  • severe pain when arm is abducted between 60-120 degree
  • shoulder pain with arm abduction
89
Q

common clinical manesifitcations of hip fractures

A

eccymosis and tednerness over the thigh and hip

  • groin and hip pain with weight bearing
  • muscle spalsms in the injured area
  • shorterning of the affected ext
  • abduction or adduction
  • affected ext externally rotated
90
Q

bucks skin traction positioning

A

suprine of semi foweler (max of 20-30)

  • eelvating head more than this causes sliding
  • assess neuro status and skin tegrity
  • when change is made with the application of the boot such as loosen or tightening check the nuero in 30 mins
  • frcacture pan to pee pee
  • weights should be free hanging at all times and should never touch the floor so have someone support the weight while the client is respoistioned
91
Q

preventing adduction in total hip replacement

A

abductor wedge

or place 2-3 pillows between knees

92
Q

HOB of pt with total hip replacement

A

≤60 degrees

93
Q

the affected side of total hip replacement should

A

not be slept on or turned on or poistoned on the operative side unless HCP said so

94
Q

fitting crutches the weight should be supported on

A

hands and arms not the axillae

95
Q

when abulating there should be how much space

A

1-2 in (2.5-5 cm) space between armpit and armpit clutch pad

96
Q

gout causes what to increase in the blood

A

uric acid

97
Q

gout complkcation

A

kidney stones bc or the increases uric acid

98
Q

imrpovements in uric acid control is often seen when

A

weight loss and dietary mod

99
Q

modifications when gout

A

increase fluid to elominate uric

  • low pruine (avoid organ meats such as liver, kidney, brain, sadines and shellfish)
  • limit etoh espiclaly beer
  • low fat
  • dont need to avoid protein
100
Q

reducing risk of fat emolbi

A

EARLY STABILZATION OF THE INJURY and surgery asap

  • minmize movmeent of the injured ext
  • prophalutic anticogulation, scd and early abulation is for DVT NOTTT for fat emboli
101
Q

brace for scolosis

A

do not cure existing spinal deformities but do prevent further worsening

102
Q

brace for scholiss intervention

A

wear cotton t shirt under the brace to prevent breakdown

  • dont use lotion or powder
  • build strength and can remove when exercising
103
Q

how long should the brace be worn for

A

18-23 hours a day and remove for bathing and excercising

104
Q

important prob with brace

A

psochosical

105
Q

cane length

A

should be equal the distance from the clients greater trochanter to the floor

106
Q

teaching points for using cane

A

52

107
Q

HOB during autnomic dstflexia

A

45 or high flower to lower bp

random (15 decks)

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