Muscoskeletal lec 2 Flashcards
what is Dupuytren contracture
thickening of the palmar fascia which causes flexion contracture of the 4th and 5th digits
what is a ganglion
round benign cyst, found on wrist, foot joint, or tendon
what is plantar fascitits
inflammation of the plantar fascia/arch of the foot
what are some ss of plantar fascitits
Severe pain in the arch of the foot
how do you treat plantar fascitits
ice, rest, stretching exercises, strapping of the foot arch, shoes with good support or with inserted orthotics
what meds can you use for plantar fascititis
NSAIDS and/or Steroids
what kind of surgical interventions can you do for plantar fascitits
Endoscopic surgery to remove inflamed tissue
what is hallux valgus deformity
great toe drifts laterally, first metatarsal head enlarges - Results in bunion
what surgical interventions can you do for hallux valgus deformity and what is the post op
bunionectomy: assess neurovascular status/pain post-op
what is the cause of knee injuries
Often the result of sports or strenuous physical activities
what age group do knee injuries normally affect
younger adults
what should you always assume for a knee injury
Always assume the injured body part is broken until Xray confirms otherwise
what does RICE mean for knee injury interventions
Rest (immobilize or splint the joint above and below the injury)
Ice (immediately for the first 24 to 48 hours)
Compression (elastic wrap for the first 24 to 48 hours)
Elevate (above level of heart)
what is the preferred surgrey for knee injuries
Arthroscopy
what should you do post op after a knee Arthroscopy
Analgesics, physical therapy, bracing or splinting
Neurovascular checks!!!!!!!!!!!!!!
what does a rotator cuff do
Rotator cuff stabilizes the humerus head
what are some ss of a rotator cuff injury
shoulder pain, unable to easily abduct the arm at the shoulder
what are some diagnostic testing for rotator cuff injuries
Drop arm test (unable to abduct arm)
Diagnosed: X-ray, MRI, Ultrasound, CT scan
what is the treatment for rotator cuff injury
NSAIDS, Steroid injections, PT, ice, heat, activity limitations
if the rotator cuff injury is full thickness or non healing then what is the treatment option
Surgery: Arthroscopic procedures
what are the post op interventions for Arthroscopic procedures for rotator cuff injuries
immobilization, exercises (progressing as time goes on), rehab (PT)
Neurovascular checks!!!!!!!!!!!!!!
what is a complete fracture
breaks across the entire width of the bone divided into 2 distinct sections
what is an incomplete fracture
the break does not divide the bone into two parts
what is a displaced fracture
bone alignment is altered
what is an open/compound fracture
skin surface is disrupted=open wound
what is a closed/simple fracture
skin surface isn’t disrupted= no open wound
what is a fragility fracture
pathologic or spontaneous fracture (bone cancer)
what is a fatigue/stress fracture
excessive stress on the bone (sports)
what is a compression fracture
caused by a loading force (osteoporosis)
what are some ss of hip fractures
Older adults may experience pain in groin or behind the knee of injured side, May have no pain at rest, but pain with standing
what are some complications of chest fractures
Major concern is multiple ribs and or sternal fractures, Potential to puncture (what lies behind them), High risk for pneumonia from shallow breathing from pain
what is the first thing you should do for a chest fracture
ABCs
what are some ss of pelvic fractures
Internal hemorrhage: Venous oozing/arterial bleeding, Hypovolemic shock, Assess for bleeding (internal abdominal trauma), Blood in urine/stool, Abdominal rigidity or distention
Ultrasound, peritoneal lavage, CT scan
what are some causes of compression fracture of the spine
Osteoporosis, bone cancer, multiple myeloma, Severe pain: possible deformity (kyphosis), neurologic compromise
what are some non surgical treatment options for compression fracture of the spine
bed rest, analgesics, nerve block, PT
what are some surgical interventions for compression fractures of the spine
Vertebroplasty/Kyphoplasty
what is a med used for spinal compression fractures
IV Toradol (Ketorolac to provide pain relief and reduce inflammation
May be given prior to surgical procedure- (common for this to occur) – check kidney levels
how long does it take healthy people for bones to heal
4-6 weeks
how long does it take older adults for bones to heal
often takes 3 months or longer for bone to heal in age 70+
what are some things that could affect bone healing
type of bone fracture, treatment at time of injury, infection, medical history
what is acute compartment syndrome
increased pressure within one or more compartments (that contains muscle, blood vessels, and nerves) reduces circulation to the area
what are some ss of acute compartment syndrome
Edema causes increased pressure on nerve endings causing severe pain!!!, Pain is greater than expected after a fracture, Reduced perfusion results in ischemia, Serious, limb/life threatening condition
what happens if you dont treat acute compartment syndrome
Cyanosis (lack of perfusion), Tingling, Numbness and paresthesia (sensory perception deficit), Necrosis (adequate perfusion not available)
what are the early signs of fat embolism syndrome
Hypoxemia, Dyspnea, Tachypnea
what are some late signs of fat embolism syndrome
Headache, Lethargy, Agitation, Decreased LOC/confusion, Seizures, Vision changes, Petechiae (usually the last sign)
what is the risk of fat embolism syndrome - how does it work
Fat globules are released into the bloodstream within 12-48 hrs. after injury, Clog small blood vessels that perfuse vital organs (often the lungs), May cause respiratory failure or death by causingPulmonary Edema
what are some chronic complications of bone infections
Avascular necrosis, Delayed bone healing, Complex regional pain syndrome
what is complex regional pain syndrome
Often results from fractures or traumatic musculoskeletal trauma, Poorly understood, Severe and persistent chronic pain
what are the ss of complex regional pain syndrome
Abnormalities of ANS (changes in color, temperature, and sensitivity of skin in affected are, excessing swelling, edema), Motor symptoms (paresis, muscle spasms, loss of function), Altered sensory perception (burning pain)
how do you prevent shock
supine position & keep warm
if your giving a patient med in emergency care what should you do
cardiac monitoring - espically over 50
how much space should be allowed with a cast
a finger between cast and skin
what are some interventions for casting
For home care: teach to assess skin and neurovascular status daily (at least)
Keep injured extremity elevated higher than heart
For plaster casts - gets warm with application; less common
what could be some causes of impaired mobility
Skin breakdown (may lead to infection), Pneumonia, Atelectasis, Thromboembolism, Constipation- get them up ASAP, Osteoporosis/arthritis , Joint contraction, Muscle atrophy
what is traction intervention
Pulling forces to a part of the body to provide reduction, alignment and rest , Also, can be a last resort to decrease muscle spasm for decreased pain, Weights should be freely hanging at all times
what is skin traction
uses a Velcro boot (Buck’s traction), belt or halter usually secured around affected leg
Purpose is to decrease painful muscle spasms that are caused by hip and femur fractures
what is skeletal fraction
screws are surgically inserted directly into the bone
Heavier weights are used with longer traction times
Pin site care is required to prevent infection
Monitoring neurovascular status for extremity is crutical
what is open reduction surgrey
allows surgeon to directly view the fracture)
what is internal fixation surgrey
Metal, pins, screws, rods, plates, or other prostheses immobilize the fracture
what is external fixation
Metal is through the skin into the bone (visible from the outside)
Advantages- minimal blood loss, early ambulation & exercise, maintains bone alignment when casts can not
what is Low-intensity Pulsed Ultrasound
uses mechanical waves to stimulate regeneration and anti-inflammatory effects on biological tissues, Used for slow healing fractures as an option to avoid surgery, 20 minutes per day
who should not use Low-intensity Pulsed Ultrasound
No contraindications or adverse effects yet noted
what is the first symptom of infection in older adults
The first symptom may be acute confusion or delirium
what are risk factors of amputations
PVD/DM, trauma, MVC, occupation, military, thermal injury (frostbite/burns/electrocution), malignancy, age, PVD leading to ischemia/gangrene, osteomyelitis
what is the nursing assessment before amputation
Pulses (doppler), color, temperature, cyanosis, wounds/drainage, gangrenous skin, capillary refill, edema, s/s suspected necrosis, lack of hair distribution due to poor perfusion
what are some diagnostic tests done before amputation
Ankle-brachial index (ABI) difference of ankle and brachial systolic artery pressures, Doppler: Speed of blood flow in the limb, Transcutaneous oxygen pressure (TcP02)
what are some complications of amputation
Hemorrhage/hypovolemic shock, Infection, Phantom limb pain (REAL), Neuroma (pinched nerve), Flexion contractures (teach range of motion exercises)
what is needed for a lower extremity amputation
firm mastress
what are the steps after someone cuts their finger off
Wrap the severed finger(s) in sterile gauze (if sterility is an option)
Place in watertight, sealed plastic bag, then place bag in ice water
Never place directly on ice (1 part ice to 3 parts water)
Avoid direct contact with ice/causes tissue damage
