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NUR 3020 exams > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

what are the functions of the musculoskeletal system (4)

A
  • provides protection for vital organs, including brain, heart, and lungs
  • serves as framework to support body structures
  • makes mobility possible
  • serves as reservoir for immature blood cells and essential minerals, including calcium, phosphorus, magnesium, and fluoride
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2
Q

what are the two types of bone maintenance (2)

A

1) remodeling (formation): old bone is removed and new bone is added to the skeleton
- physical activity, particularly weight bearing activity, acts to stimulate bone formation and remodeling

2) resorption: removal or destruction of bone
- prolonged bedrest causes increased bone resorption for calcium loss

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3
Q

what are osteoblasts

A

function in bone formation

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4
Q

what are osteoclasts

A

dissolving and reabsorbing bone
- bone breakdown

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5
Q

what are osteocytes

A

bone maintenance (bone cells)

TIP: mature bone cell -> bone maintenance

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6
Q

muscle strength grade 1-5 (description and type) assessment techniques

A

0) no palpable or observable muscle contraction (p)

1) palpable or observable contraction, but no motion (P)

2) moves without gravity loading over the full ROM (Aa)

3) moves against gravity less over the full ROM (A)

4) moves against gravity and moderate resistance over the full ROM (Ar)

5) moves against gravity and maximal resistance over the full ROM (Ar)

A= active
a= assistive
r= resistive

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7
Q

what is adduction

A

towards body

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8
Q

what is abduction

A

away from the body

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9
Q

supinate

A

limb upward (holding soup)

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10
Q

pronate

A

limb downward (holding hands down)

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11
Q

what are the 6 signs of poor circulation (6 Ps)

A
  • pain (relieved by rest)
  • pallor (cyanosis)
  • poikilothermia (body can’t regulate temp)
  • paresthesia (pins and needles, N/T/burning)
  • paralysis
  • pulselessess

TIP: gait assessment -> walk (observe balance, coordination, unsteadiness, irregular movements, symmetry, limping, shuffling)
- assessment: occupation, exercise, alcohol, tobacco, diet, health conditions, family hx, falls, previous trauma injury

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12
Q

what is back pain (what, length, cause, aggravated by, assess (6))

A

1) pain, most commonly in the lumbosacral and cervical vertebrae because these are the areas where the vertebral column is most flexible
- acute: <3 months
- chronic: >3 months

2) cause: obesity, postural problems, structural problems + overstretching (disc degeneration)

3) aggravated by activity, whereas pain d/t other conditions is not

4) assess patients gait, spinal mobility, reflexes, leg length, leg motor strength, and sensory perception (may be affected)

  • TIP: leaning forward (flexion), reflex (exertion), abdominal + thoracic muscles minimize stress on spine
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13
Q

back pain s/sx (7)

A
  • pain
  • radiculopathy (pinch/compressive nerve)
  • sciatica (pain, numbness, tingling in leg)
  • muscle spasm
  • N/T
  • leg weakness
  • bowel or bladder incontinence or retention

TIP: cauda equina syndrome (compression of causa equina) MEDICAL EMERGENCY

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14
Q

back pain (NI) (3, pharm - (3))

A
  • physical therapy
  • heat/cold applications
  • surgery: post pharmacological intervention

pharmacological:
- NSAIDs/muscle relaxants (acute)
- antidepressants/atypical anticonvulsants (chronic)
- opioids (acute, CI: CKD)

TIP: systemic corticosteroids + Tylenol NOT fully effective

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15
Q

back pain prevention (8)

A
  • use good posture and safe manual handling practices, with specific attention to bending, lifting, and sitting
  • assess the need for assistance with you household chores or other activities
  • participate in a regular exercise program, especially one that promotes back strengthening, such as swimming and walking
  • avoid prolonged sitting or standing, use footstool and ergonomic chairs and tables to lessen back strain. Be sure that equipment in the workplace is ergonomically designed to prevent injury
  • keep weight within 10% of ideal body weight
  • ensure adequate calcium and vitamin D intake
  • stop smoking
  • avoid wearing high-heeled shoes (promotes poor posture)
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16
Q

back pain nursing considerations (extra) (8)

A
  • use strong quad muscles of thigh (feet placed apart -> bend -> tighten ab muscles -> lift with sooth motion)
  • avoid twisting, bending, lifting, reaching
  • shift weight and rest one foot on stool
  • should not stay on prolonged bed rest (periods of inactivity -> deconditioning)
  • avoid locking knees, bending forward
  • change positions frequently, limit sitting
  • weight reduction (harder to perform exercises if overweight)
  • avoid prone position accentuates lordosis)
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17
Q

carpal tunnel syndrome (3)

A

common condition in which the median nerve in the wrist becomes compressed, causing pain and numbness (potential tingling)
- median nerve supplies motor, sensory, and autonomic function for the first 3 fingers of the hand and the palmar aspect of the fourth (ring) finger
- d/t median nerve is close to other structures, wrist flexion causes nerve impingement and extension causes increased pressure in the lower portion of the carpal tunnel

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18
Q

carpal tunnel syndrome s/sx (8) (2 main!!)

A
  • paresthesias
  • numbness
  • pain (may be worse at night)
  • weak pinch
  • clumsiness (dropping things)
  • difficulty with fine motor movements (fingers)
  • (+) phalens test (flex weist against e/o, positive if N/T)
  • (+) tinel’s sign (lightly percuss median nerve, positive if N/T)
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19
Q

carpal tunnel syndrome NI (3, pharm-2)

A
  • splint/hand brace (prevents hyperextension/prolonged flexion)
  • acupuncture (helps w/ pain)
  • surgery: open nerve release (local anesthesia) -> endoscopic laser surgery (cuts carpal ligament to widen carpal tunnel) -> splint post surgery to limit use -> recovery takes wks to months

pharmacological:
- Nsaid: pain relief, inflammation
- corticosteroid injections

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20
Q

carpal tunnel syndrome health promotion activities to prevent carpal tunnel (5)

A
  • become familiar w/ federal and state laws regarding workplace requirements to prevent repetitive stress injuries such as carpal tunnel syndrome
  • when using equipment or computer workstations that can contribute to developing CTS -> assess ergonomically appropriate including: specially designed wrist rest devices, geometrically designed computer keyboards, chair height that allows good posture)
  • take regular breaks away from activities that cause repetitive stress, such as working at computers
  • stretch fingers and wrists frequently during work hours
  • stay as relaxed as possible when using equipment that causes repetitive stress
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21
Q

osteopenia

A

low bone mass

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22
Q

osteoporosis (what, _____ and _______ occur w?, most often at risk)

A

a chronic metabolic disease in which bone loss causes decreased density and possible fracture from reduced bone mass, deterioration of bone matrix and diminished bone architectural strength
- osteopenia and osteoporosis occur with osteoclastic (bone resoprtion) activity is greater than osteoblastic (bone building) activity
- spine, hip, wrist are most often at risk, although any bone can fracture

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23
Q

osteoporosis s/sx (9)

A
  • dowager’s hump/kyphosis
  • “shorter”
  • back pain, especially with activity
  • swelling
  • malalignment
  • constipation
  • abdominal distention + spinal curvature
  • reflex esophagitis (rib cage affects)
  • respiratory compromise
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24
Q

osteoporosis diagnostic labs (4)/diagnostic tests (3)

A

1) diagnostic labs:
- serum calcium
- vitamin D3
- phosphorus
- urinary calcium

2) diagnostic tests:
- BMD testing (bone mineral density): dual XR
absorptiometry (DXA, DEXA) scans at hip/spine
- T score: # of SD above/below (avg) of bone marrow density in healthy adult that is 30 yrs old -> provides info. about bone mass density
- XR: density results

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25
Q

osteoporosis NI (2, pharm -3)

A
  • prevention is best and needs to start early in life
  • life style modifications (wt. bearing exercises)

pharmacological:
- calcium & vitamin D3 supplements (SE: constipation, increased calcium)
- biphosphonates: slow bone resorption by biding with crystal elements in the bone, take w/ empty stomach w/ water only, reabsorbs by decreased osteoclast, sit up for 30 min., avoid esophageal irritation (esophagitis) (ex: alendronate (fosamax), ibandronate (boniva), risedronate (actonel, atelvia)
- estrogen agonist/hormone therapy (TBD)

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26
Q

osteoporosis complications (4)

A
  • osteoporosis results in more than 1.5 million fragility fractures each year
  • a woman who experiences a hip fracture has a 4 times greater risk for a second fracture
  • mortality rate for older patients w/ hip fratcures is very high, especially within first 6 months, and the debilitating effects can be devastating)
  • reported 1 year mortality after sustaining a hip fracture has been estimated to be 14-15%
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27
Q

osteomalacia (what, causes, equivalence)

A
  • loss of bone related to vitamin D deficiency
  • causes softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix
  • adult equivalent of rickets or vitamin D deficiency in children
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28
Q

osteomalacia s/sx (4)

A
  • muscle and bone weakness
  • spinal kyphosis and bowed legs
  • waddling and unsteady gait
  • bone pain/tenderness
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29
Q

osteomalacia RF (3)

A
  • decreased sunlight
  • decreased vitamin D
  • crohn’s/celiac disease
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30
Q

osteomalacia diagnostic labs (4)

A
  • low serum calcium
  • low phosphorus
  • low urine excretion of calcium
  • increased PTH
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31
Q

osteomalacia diagnostic tests

A

XR

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32
Q

osteomalacia interventions (prevention, pharmacological (3))

A
  • prevention: for all at risk patients, teach them which HIGH CALCIUM and VIT D foods to eat and the importance of adequate daily sunlight

pharmacological:
- active vit D (calcitriol)
- adequate daily sunlight
- pain mgmt

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33
Q

osteoarthritis (what, 5)

A

degenerative joint disease (DJD)
- over inflammatory, localized progressive deterioration and loss of cartilage and bone in one or more joints (excessive wear and tear)
- NOT systemic, NOT autoimmune disease
- as cartilage and bone beneath the cartilage begin to erode, joint space narrows and osteophytes (bone spurs) form
- secondary joint inflammation can occur when joint involvement is severe
- starts is 30s, PEAK 50S

extra: most common (idiopathic, secondary)

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34
Q

osteoarthritis RF (3)

A

obesity, age, female

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35
Q

osteoarthritis s/sx (8) (2 BIG)

A
  • joint stiffness/pain
  • pain that diminishes after rest and worsens with activity
  • functional impairment
  • possible tenderness
  • crepitus (crunching sound)
  • heberden’s nodes (dip -> DISTAL)
  • bouchard’s nodes (pip -> PROXIMAL interpheringeal)
  • joint effusions

EXTRA: in weight bearing joints, can be PIP + DIP (both)
- SLOW ONSET

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36
Q

osteoarthritis interventions (4, pharm (3))

A
  • supportive care: heat
  • PT/OT (exercise! -> 30min/day)
  • surgery/joint arthroplasty (replacing all joints)
  • pt. education: wt loss/exercise, rest w/ activity, heat -> stiffness, ice -> acute exacerbation/pain

pharm:
- acetaminophen, NSAIDs, or COX2 inhibitors, opioids
- cortisone injections Q3 months (decrease inflammation + pain)
- topical analgesic agents such as diclofenac sodium gel, capsaicin (burning sensation, similar to chili peppers), methylsalicylate

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37
Q

osteoarthritis: joint arthroplasty (surgical, what, result (3), contraindication (2), indications (4))

A
  • surgical removal of an unhealthy joint and replacement of joint surfaces with metal or synthetic materials
  • total joint arthroplasty (total joint replacement): replacement of all components of an articulating joint
  • result: pain relief, return of joint motion, improved functional status and quality of life (scope of improvements depends in part on patient’s preoperative soft tissue condition and general muscle strength)
  • contraindication: advanced osteoporosis, infection

indications:
- osteoarthritis, rheumatoid arthritis, fractures, failure of previous reconstructive surgeries (failed prosthesis, etc.)

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38
Q

osteoarthritis: hip replacement post op care (8)

A
  • abduction pillow or splint to prevent adduction after surgery if patient is restless/confused
  • heel’s off bed to prevent PI
  • do NOT rely on fever as a sign of infection -> decreased LOC (better)
  • move pt. slowly to prevent orthostatic hypotension
  • encourage the patient to cough and deep breathe, use the incentive spirometry
  • as soon as permitted, get patient up and out of bed
  • anticipate patient’s need for pain relief
  • expect temp. change in mental state immediately post surgery as a result of the anesthetic and unfamiliar sensory stimuli (reorient the patient frequently)

extra
- hip precaution 4 months
- bedpan -> flex unaffected hip -> use trapeze to lift pelvis
- when turning patient, operative hip in abduction can cause dislocation
- NEVER flexed greater than or equal to 90 degrees
- take abx before dental/invasive procedure
- elevated toilet seat, no low chairs
- hip high then knee when sitting
- knee apart, pillow between, don’t cross legs, no bending, high seated chair, no flexing, don’t turn inward

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39
Q

osteoarthritis: knee replacement post op care (4)

A
  • apply continuous passive motion (CPM) as soon as it is ordered
  • manage the patient’s pain to provide comfort, increase participation in activity and improve joint mobility
  • maintain the knee in neutral position and NOT rotated internally in or externally (knee immobilizer -> elevate when sitting)
  • teach patients that they are able to partially weight bear UNLESS their prosthesis is NOT cemented

extra
- pain mgmt: ice/cold to decrease swelling/bleeding
- active flexion Q1H
- no pillows under

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40
Q

osteoarthritis complications of total joint arthoplasty (5)

A
  • dislocation (hip fully flexed, adducted, rotated)
  • venous thromboembolism (VTE) ( exercise/ambulation, SCD + prophylaxis)
  • infection (CHG bath)
  • neurovascular compromise (6 P’s)
  • pressure injury: cradle boots -> prevents leg rotation -> support heel off the bed)
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41
Q

osteomyelitis (what, caused by, treat?, RF)

A
  • infection in the bone
  • caused by: bacteria, viruses, or fungi
  • can be severe and difficult to treat
  • RF: recent trauma, surgery, systemic disease (diabetes -> foot ulcers)
42
Q

osteomyelitis types (3)

A

1) vascular insufficiency: seen most commonly with diabetes, PVD, most commonly affecting the feet
2) hematogenous: organisms are carried by the bloodstream from other areas of infection in the body
3) contiguous: bone infection results from contamination from surgery, open fracture, traumatic injury

43
Q

osteomyelitis s/sx (active) (8)

A
  • fever (38.8+)
  • tachycardia
  • general malaise
  • swelling around the affected area
  • erythema of affected area
  • increased heat in that area
  • tenderness of the affected area
  • bone pain that is constant, localized, pulsating that intensifies with movement
44
Q

osteomyelitis s/sx (chronic) (4)

A
  • foot ulcers
  • sinus tract infection
  • localized pain
  • drainage from the affected area
45
Q

osteomyelitis diagnostic labs (3)

A
  • leukocytosis
  • elevated ESR
  • blood cultures/wound cultures
46
Q

osteomyelitis diagnostic tests (2)

A
  • radionuclide scans
  • MRI
47
Q

osteomyelitis interventions (5, pharm (2))

A
  • prevention
  • general supportive measures (hydration, diet high in vitamins and protein, etc.)
  • improve physical mobility with avoidance of stress on that bone
  • wound care
  • surgery/debridement (promote sterility, cut out infected bone)

pharmacological:
- antibiotics: broad abx first, often IV (4-6 weeks)
- pain mgmt

extra
- debridement cuts out infected bone, derided cavity may be packed w/ cancellous bone graft -> stimulates healing

48
Q

contusion (2)

A
  • soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising)
  • hematoma develops from bleeding at the site of impact, leaving a characteristic “black and blue” appearance
49
Q

contusion s/sx (3)

A
  • local symptoms: pain, swelling, possible discoloration
50
Q

contusion mgmt (5)

A

PRICE therapy
- P: protection
- R: rest (prevents additional injury)
- I: ice (vasoconstriction, alterante Q15-20 minutes)
- C: compression (controls bleeding, edema, provides support)
- E: elevation (controls swelling)

51
Q

strain (what, acute, chronic)

A

excessive stretching of a muscle or tendon when it is weak or unstable
- AKA “muscle pulls”
- acute strain: single injurious accidents
- chronic strain: improper mgmt of acute strain

52
Q

strain classifications (mild, moderate, severe)

A

1) first degree (mild) strain
- causes mild inflammation but little bleeding
- swelling, ecchymosis (bruising), tenderness present
2) second degree (moderate) strain
- tearing of the muscle or tendon fibers w/o complete disruption
- muscle function impaired
3) third degree (severe) strain
- ruptured muscle or tendon with separation of muscle from muscle, tendon from muscle, or tendon from bone
- severe pain and disability result from severe strains and surgery may be neededs

53
Q

strain mgmt (5)

A
  • cold and heat applications
  • exercise
  • activity limitations
  • NSAIDs (pain mgmt)
  • muscle relaxant
54
Q

sprain (what, classified by?)

A

excessive stretching of a ligament, caused by a twisting motion or hyperextension (forcible) of a joint
- classified according to severity similar to strains

55
Q

sprain mgmt (3)

A

1) first degree (mild tearing): PRICE therapy
2) second degree (partial tearing): immobilization, such as elastic bandage and air stirrup ankle brace or splint, and partial weight bearing while the tear heals
3) third degree (complete rupture): immobilization for 4-6 weeks is necessary, arthroscopic surgery may be done

56
Q

tendon is ____ to ______

A

muscle, bone

57
Q

ligament is ______ to _______

A

muscle to muscle

TIP: ligament -> like

58
Q

joint dislocation

A

when the ends of two or more bones are moved away from e/o and no longer in anatomic alignment

59
Q

subluxed

A

joint is only partially dislocated (or incomplete, not much deformity)

TIP: complete traumatic dislocation -> emergency (structures, nerves, blood supply displaced)

60
Q

joint dislocation s/sx (4)

A
  • pain (B/L assessment will make it apparent)
  • decreased mobility
  • deformity
  • deviation in length and rotation of the extremity
61
Q

joint dislocation mgmt (2, pain mgmt (4))

A
  • immobilization
  • closed reduction of the joint (ortho surgery)

pain mgmt:
- analgesic
- muscle relaxants
- anesthesia
- Neurovascular assessment Q15 min until stable

62
Q

fractures

A

break or disruption in the continutiy of a bone that often affects mobility and sensory perception

63
Q

fractures classification (7)

A
  • complete
  • incomplete
  • open (compound)
  • closed (simple)
  • pathologic (spontaneous)
  • fatigue (stress)
  • compression
64
Q

complete fracture

A
  • break is through the bone in such a way that the bone is divided into two distinct sections
65
Q

incomplete fracture

A
  • the fracture is through only part of the bone
66
Q

open (compound)

A
  • the skin surface over the broken bone is disrupted, so there is an external wound
67
Q

closed (simple)

A
  • does not extend through the skin and therefore has no visible wound
68
Q

pathologic (spontaneous)

A
  • occurs after minimal trauma to a bone that has been weakened by disease
69
Q

fatigue (stress)

A

results from excessive strain and stress on the bone

70
Q

compression

A

produced by a loading force applied to the long axis of cancellous bone

71
Q

fractures pathophysiology (what, results in, body organs may be)

A

when bone is broken, adjacent structures also affected
- results in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels
- body organs may be injured by the force that caused the fracture or by fracture fragments

72
Q

fractures s/sx (6)

A
  • moderate to severe pain
  • muscle spasm, paresthesias
  • loss of function
  • ecchymosis, edema
  • deformity, shortening of the extremity
  • subcutaneous emphysema, crepitus
73
Q

fractures RF (5)

A
  • osteoporosis
  • pager’s disease
  • long term steroids
  • substance abuse
  • trauma (fall)
74
Q

fractures emergency care of an extremity fracture (8)

A
  • assess ABCs, perform quick H2T
  • immobilize extremity by splinting, including joints above and below injury
  • remove the clothing to inspect the affected area
  • remove jewelry on affected extremity in case of swelling
  • apply direct pressure if there is bleeding
  • keep patient warm and in SUPINE position
  • assess neuro-vascular status (check 6 P’s)
  • cover any open wounds with a sterile dressing
75
Q

fractures interventions: (4, pain mgmt: 3))

A
  • reduce and immobilize (traction, splints/casts)
  • assess neuro vascular and neuromusclar system frequently
  • PRICE therapy
  • surgery: screws, pins, rods

pain mgmt: open fracture -> abx (prevent infection)
- non-opioid
- opioid analgesics w/ anti-inflammatory drugs and muscle relaxants (if muscle spasms)

76
Q

external fractures

A

immobilize fracture stability, decreased blood loss, increased comfort, early mobilization (risk for infection however)

77
Q

fractures potential complications w/ immobilization devices (6)

A
  • compartment syndrome
  • pressure ulcers
  • infection (osteomyelitis)
  • disuse syndrome
  • immobility
  • anxiety
78
Q

fractures complications (7)

A
  • acute compartment syndrome (surgical emergency: increased pressure (reduces circulation) within 1 or more compartment - tissue necrosis + dysfunction)
  • crush syndrome
  • hypovolemic shock
  • fat embolism syndrome (comes from bone -> goes into lungs, s/sx: dyspnea, confusion, increased HR, pettiache, decreased O2)
  • VTE
  • infection
  • chronic complications (ischemic necrosis, delayed union)
79
Q

acute compartment syndrome

A
  • increased pressure within one or more compartments encased by bone or fascia, which reduces circulation to the area

TIP: neurovascular exams, keep at heart level to increase blood flow
- assess I/O, pain

80
Q

acute compartment syndrome s/sx (5)

A
  • sensory perception deficits or paresthesia (usually 1st sign)
  • pallor, pulses weaken
  • affected area is palpably tense (hard + swollen)
  • pain w/ movement (unrelieved w/ meds)
  • cyanosis, numbness, paresis, paralysis, and necrosis

TIP: 5 P’s = pain, pallor, pulselessness, paresthesia, paralysis

81
Q

acute compartment syndrome mgmt

A

fasciotomy: incision to relieve pressure
- cover would w/ saline dressing
- no elevation or cold (vasoconstriction)

82
Q

crush syndrome

A
  • systemic manifestation of muscle cell damage resulting from pressure or crushing
82
Q

crush syndrrome systemic manifestations (caused by, leads to, prevention)

A
  • caused by traumatic rhabdomyolysis d/t muscle reperfusion injury when compressive forces on the tissues are released
  • leads to: local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia
  • prevention of renal failure is IMPORTANT

tx: alkaline diuresis and mannitol therapy is recommended. Hemodialysos is recommended for acute renal failure

82
Q

hypovolemic shock

A

from a loss of blood
- bone is very vascular, bleeding is a risk
- trauma can cut nearby arteries and cause HEMORRHAGE

83
Q

hypovolemic shock mgmt (6)

A
  • stablize the fracture to prevent further bleeding
  • restore blood volume and circulation
  • provide proper immobilization and protect from further injury
  • pain relief
  • lower HOB (decreased BP is HOB is elevated, need BF to brain)
  • IV vasopressins (norepi + dopamine)
83
Q

s/sx hypovolemic shock (5)

A
  • cold + clammy skin
  • decreased BP (less than 80 sys.)
  • increased HR
  • decreased cardiovascular pressure (increase fluids IV)
  • decreased urine output
84
Q

fat embolism syndrome

A

similar to PE
- fat globules are released from the yellow bone marrow into the bloodstream causing clots

85
Q

fat embolism syndrome s/sx (3)

A
  • hypoxemia, dyspnea w/ tachypnea
  • decreased LOC, agitation, confusion
  • petechial rash (late sign)
86
Q

fat embolism syndrome mgmt (2)

A
  • reduce the risk w/ immobilization and maintenance of fluid and electrolytes
  • supportive care w/ mechanical ventilation, vasopressors, and corticosteroids
87
Q

venous thromboembolism (VTE) (includes (2))

A
  • includes DVT and PE and its major complications
  • most common complication of lower extremity surgery or trauma and the most often fatal complication of musculoskeletal surgery
88
Q

VTE RF (9)

A
  • cancer/chemotherapy
  • surgical procedures (>30 minutes)
  • smoking
  • obesity
  • heart disease
  • prolonged immobility
  • oral contraceptives
  • history of VTE
  • older adults
89
Q

infection (4)

A
  • osteomyelitis: most common w/ open fractures in which skin integrity is lost and after surgical repair of a fracture
  • wound infections: most common type of infection resulting from orthopedic trauma
  • they range from superficial skin infections to deep wound abscesses
  • infection can also be caused by implanted hardware used to repair a fracture surgically, such as pins, plate, or rods
90
Q

chronic complications types (2)

A

1) avascular necrosis: blood supply to the bone is disrupted causing decreased perfusion and death of bone tissue
- most often a complication of HIP FRACTURES or any fracture in which there is displacement of bone. Surgical repair of fractures also can cause necrosis bc hardware can interfere w/ circulation

2) delayed union: fracture that has not healed within 6 months of injury
- some fractures never achieve union, that is they never completely heal
- malunion: when the bone heals incorrectly

91
Q

amputations (4)

A
  • removal of a part of the body
  • considered only after other interventions have not restored circulation, sometimes referred to as limb salvage procedures
  • circulatory status of the limb is evaluated through physical examination and diagnostic studies
  • muscle and skin perfusion is important for healing
92
Q

amputations s/sx (6)

A
  • poor circulation (6 P’s)
  • discolored skin
  • edema
  • ulcers
  • necrosis
  • hair distribution (uneven -> d/t oxygenation/perfusion)
93
Q

amputations diagnostic labs/tests (4)

A

diagnostic labs: none
diagnostic tests:
- ankle branchial index (ABI)
- doppler ultrasonography
- laser doppler flowmetry
- transcutaneous oxygen pressure (TcPO2)

94
Q

amputations interventions (6, pain mgmt)

A
  • monitor for signs of sufficient tissue perfusion
  • monitor and control for bleeding and infection
  • control edema through compression dressings
  • prevent joint contractures
  • collaborate w/ rehab to improve ambulation and self care
  • psychological and behavioral health

pain mgmt:
- analgesics + beta blockers, anti epileptic drugs, antispasmodics, antidepressants

extra: avoid elevating stomp, prone 20-30 min/ 3-4 hours

95
Q

amputations complications (5)

A
  • hemorrhage
  • infection
  • phantom limb pain
  • flexion contractures
  • skin breakdown
96
Q

phantom limb pain (PLP) (3)

A
  • when sensation is felt in the amputated part and it persists and is unpleasant or painful
  • often described as intense burning, crushing, cramping, or that the part is in a distorted or uncomfortable position
  • for most patients, pain is triggered by touching the residual limb or by temperature or barometric pressure changes, concurrent illness, fatigue, anxiety, or stress
97
Q

phantom limb pain (PLP) mgmt (2)

A
  • IV infusions of calcitonin (miacalcin, calcimar) during the week after amputation can reduce phantom limb pain
  • inhibits prostaglandins + cytokines (anti-inflammatory effects)
98
Q

flexion contractures (5)

A
  • occur usually in the hip or knee in patients with amputations of the lower extremity
  • this complication must be avoided so that the patient can ambulate with a prosthetic device
  • proper positioning and active range of motion exercises help prevent this complication (prone 20-30 mins to stretch flexor muscles)
  • avoid sitting for long time
  • don’t place residual limb on pillow

NUR 3020 exams (11 decks)

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