Musculoskeletal Flashcards
What are the clinical manifestations of fractures?
pain
crepitus
deformity
edema
ecchymosis
warmth/redness
decreased use of affected limb
What assessments should be performed for fractures?
neurovascular checks: sensation, skin temp, skin color, cap refill, pulses, movement of the limb
monitor VS & pain
What are the priority nursing interventions for fractures?
ABCs
position supine for injuries distal to the arm, pelvis, and lower extremities
position in a sitting position for injuries to the shoulder or upper arm
stabilize injured area
if pelvic fracture: assess for blood in the urine
elevate the affected limb & apply ice
admin analgesics
promote ROM of fingers, toes, & unaffected extremities
What are the therapeutic procedures for fractures?
Casting & traction
What are the nursing actions for casts?
assess perfusion & elevate above <3 for 1st 24-48 hrs
apply ice in the 1st 24hrs
assess skin & warmth
monitor for drainage
look for muffin top w/ a short arm cast
What should you educate your patient on with a cast?
when the cast is applied it will be warm but not burn you
how to properly use crutches
do not place foreign objects in the cast (use a hairdryer for itching)
skincare
how to do neurovascular checks
What should you report with casts?
pain that doesn’t go away 1 hour after pain meds
loss of neurovascular status
What is skin traction?
pulling force is applied by weights
using tape and straps applied to the skin along w/ boots or cuffs, weights are attached by rope to the extremity
What is skeletal traction?
Continuous pulling force that is applied directly to the skeletal structure/ specific bone
used when more force is needed
pin or rod is inserted through or into the bone
force is applied through the use of weights attached by a rope
weights are NEVER to be removed by the nurse
90/90 skeletal traction: leg is at 90 degrees
What are the nursing actions for traction?
maintain body alignment
manage pain & pin sites for infection
assess for changes in elimination
monitor skin integrity & temp
maintain weights so they hand freely & the knots do not touch the pulley
provide ROM
What should you educate your patient on regarding traction?
how to provide pin site care
s/sx of infection
What findings should be reported for traction?
s/sx of compartment syndrome
pain not relieved by pain meds
What are the complications of fractures?
Osteomyelitis & compartment syndrome
What are the nursing interventions for osteomyelitis?
skin, blood, & bone cultures
joint & bone biopsy
admin IV/oral antibiotics
monitor hepatic, hematologic & renal function
Immobilize & elevate extremity
WCS: amputation
What are the nursing interventions for compartment syndrome?
assess q hour for 24 hrs
space between skin & cast should be 1 finger
place extremity at heart level
loosen dressing or open cast
prepare for fasciotomy
What findings should be reported for compartment syndrome?
pain nor relieved by analgesics
pain that continues to increase
numbness or tingling
change of color in the extremity
What are the manifestations of scoliosis?
asymmetry in the scapula, ribs, flanks, shoulders, & hips
improperly fitting clothing (one leg shorter than the other)
What assessments are used to diagnose scoliosis?
screen during adolescence
the child bends over at the waist w/ arms hanging down & observe for asymmetry of ribs & flank
What is the plan of care for scoliosis treatment?
-bracing to slow the progression of the curve (assess skin)
-surgical intervention: spinal fusion w/ rod placement, used for curvatures >45 degrees
–preop: autologous blood donation
–postop: neuro checks, log roll, keep skin clean & dry, monitor drain sites for infection, monitor for dec H&H, watch for bleeding, encourage mobility ASAP
What is the patient teaching for scoliosis?
emphasize the importance of PT & proper positioning of spine
how to apply the brace
self-image issues
What are the types of Developmental Dysplasia of the hip (DDH)?
Acetabular dysplasia
Subluxation
Dislocation
What is acetabular dysplasia?
delay in the acetabular development
-the acetabular roof is shallow & oblique
What is a subluxation?
incomplete dislocation of the hip
What is a dislocation?
femoral head does not have contact w/ the acetabulum
What are the manifestations of DDH in infants?
asymmetry of gluteal & thigh folds
limited hip abduction
shortening of the femur
widened perineum
positive Ortolani test (hip is reduced by abduction)
positive Barlow test (hip is dislocated by adduction)
What are the manifestations of DDH in children?
one leg shorter than the other
positive Trendelenburg sign
walking on toes on one foot (shorter one)
walking w/ a limp
What is the plan of care for DDH?
Treatment starts as soon as dx
newborn to 6 months: Pavlik Harness
-wear for 12 weeks, check straps q 1-2 weeks for adjustment, neurovascular & skin checks
When adduction contracture is present: use Bryant Traction
What should you teach the parent about Pavlik Harness for DDH?
don’t adjust straps
teach how to place the harness
skincare (wear an undershirt, wear knee socks, massage under straps, avoid lotions & powders, diaper goes under the straps)
What is bryant traction?
skin traction
hips flexed at a 90 degree angle w/ the butt raised off of the bed
What should the nurse do for a pt in bryant traction?
neuro checks
maintain traction & alignment
skincare
What is a hip spica cast and what are the nursing actions?
needs to be changed to accommodate growth
neuro checks
ROM
assess skin in the diaper area
manage pain
hydration
What should the nurse teach the parent about hip spica cast?
position cast on pillows
keep cast elevated until dry
handle cast w/ palm of hand until dry
note the color & temp on the toes
sponge baths
waterproof barrier around the genital opening
What should you educate your patient about prednisone?
causes adrenal gland suppression (alt day dosing schedule & taper dose)
causes bone loss (weight-bearing activities, Ca & vit D, use a low dose)
Causes hyperglycemia & glycosuria (increase insulin)
causes myopathy (decrease dose)
causes peptic ulcer diseases (avoid NSAIDs, report s/sx of bleeding, admin w/ food)
causes infection (avoid large crowds & sick people)
causes disturbances in fluid & electrolyte balances
