Musculoskeletal Flashcards by Nick Wrobel

What are the rules of thumb

alignment

CMS- circulation, motor, sensation

How well did you know this?

Not at all

Perfectly

Ways to prevent strains and sprains

Exercise regularly to keep joints and muscles strong
Always stretch before activities
Use protective equipment
Wear shoes that fit
Maintain healthy weight
Body mechanics
Close to body, back straight, bend at knees, lift with legs, no twisting while lifting

How well did you know this?

Not at all

Perfectly

What are the S/S of sublux and dislocation

Asymmetry of musculoskeletal contour (shorter legs)
Local pain
Tenderness
Loss of function
Swelling in the joint region

How well did you know this?

Not at all

Perfectly

What are risk factor of factures

Trauma, Falls or Physical Abuse
High-risk lifestyle (participation in high risk sporting activities)
Malnutrition
Osteoporosis
Advanced age
Decreased circulation
Immunocompromised status
Presence of infection (systemic or osteomyelitis)
Neoplasms (or cancer, specifically of the bone)
Corticosteroid therapy
Cushings syndrome

How well did you know this?

Not at all

Perfectly

What are the manifestations of factures

Deformity
Abnormal position
Cardinal sign 
Pain &amp; tenderness 
Encourage splinting &amp; limit movement
Loss of function
Quick treatment preserves function
Could be a distal loss of pulse or sensation
Edema &amp; swelling
Can occlude circulation
compartment syndrome?
Muscle spasm
Can displace fracture more &amp; make it hard to reduce
Ecchymosis
Extravasation of blood
Usually several days later
Crepitation 
Grating of bony fragments

How well did you know this?

Not at all

Perfectly

What do you need to check for in fractures

distal loss of pulse

How well did you know this?

Not at all

Perfectly

What is the cardinal sign of fractures

deformities

How well did you know this?

Not at all

Perfectly

What is closed reduciton

non-surgical, manual realignment of bone fragments to the previous anatomical position. Traction is typically applied.

How well did you know this?

Not at all

Perfectly

What is open reduciton

reduction or correction of bone alignment through a surgical incision involving manipulation of bone

How well did you know this?

Not at all

Perfectly

What is internal fixation

use of wire, screws, pins, plates, rods or nails.

How well did you know this?

Not at all

Perfectly

How ling is skin traction good for

48-72hrs

How well did you know this?

Not at all

Perfectly

What is used in skin tracion

tape boots or slings

How well did you know this?

Not at all

Perfectly

What does skin traction do and how many pounds are used

decreases muscle spasm

5-10 lbs

How well did you know this?

Not at all

Perfectly

What is skeletal traction timeline

weeks

How well did you know this?

Not at all

Perfectly

What is used in skeletal traction

nails
wires
tongs

How well did you know this?

Not at all

Perfectly

What are the lbs of skeletal traction

4-45

How well did you know this?

Not at all

Perfectly

What is the risk of skeletal traction

infection

How well did you know this?

Not at all

Perfectly

What are some considerations for tractioni

CMS checks
Ropes & pulleys in alignment
Keep traction swinging free
Safe knots
Trapeze use- for cleaning
Frequent checking of skin and pin sites
Skin care
Prevent pressure injuries
Teach patient to move around using trapeze and other unaffected extremities. Never twist the affected area.
Teach client how to do skin assessment, pin site assessment
Healing – nutrition (protein and cals) – fluids – nursing interventions
Immobility – clots and atelectasis so perform interventions for these

How well did you know this?

Not at all

Perfectly

What are the DO’s of cast care

Apply ice X 24 hours &amp; keep dry
Dry if wet (blot, low power hair dryer)
Elevate X 24 hours
ROM above and below
Report signs of problems like
↑Pain with elevation, ice and analgesia
excessive swelling with pain
Discolored fingers or toes
Pain with movement
Burning or tingling under cast
Sores or foul odor under cast

What are the DO NOT”S of cast care

Get it wet
Remove any padding
Insert objects into cast
Weight bearing X48 hours. Check with HCP
Cover cast with plastic for any length of time

What is a way t =o assess for infeciton under a cast

feeling lots of heat

When making a cast what should you do

smooth the edges

What are some other things I should assess with cast care

CMS checks – always
Cap refill, movement, strength, cool/warm to touch
Any drainage – outline (sharpie) and time/date
Underlying wound – window cut out – assess
Infection assessments – normal ones (temp, etc.) but also feel for “hot spots” on the surface of the cast. You will be able to feel the heat through the cast.

What are some guidelines for pin care

Inspect site q 4-8 º
Clean pin site bid – sterile technique
H2O2
NS
Apply antibiotic ointment if ordered
Lite dressing or open to air
Place protective covers over ends of pins

What are the 6 P's

``` Pain Especially severe & unrelieved Pulses Check both affected & unaffected Paresthesia Numbness or tingling Pallor Pale color Paralysis ROM Strength Polar Coolness ```

When doing an assessment, what is a good habit to do to be able to compare bilaterally

check the good side first

How long is antibiotics for fracture inf's

7-10 days

Should you keep assessing after applying a dressing/cast

4-12 hrs

What are the do not's of cariing for compartment syn and why

Elevate extremity ↑ heart or may slow arterial perfusion. | Apply cold compress, or may result in vasoconstriction.

What are the Do's of treatment for compartment syn and why

Loosen the bandage or cast Possibly a bi-valve cast  cut in half to allow assessment ↓ traction weight to ↓ external circumferential pressures. Surgical decompression (fasciotomy) or opening of the tissues to ensure adequate soft tissue decompression.

Why is venous thrombosis a comp of fracture

venous stasis

What might be some causes of venous stasus

Incorrectly applied cast Incorrectly applied traction Prolonged bed rest & immobility

When treating compartment syn how do we know we have fixed it

ask them to wiggle toes

Who is at risk for fat embolism

limited mobility | fractures in the long bones especially, ribs, tibia & pelvis.

What are the S/S of fat embolisms

``` resp if travels to lung Change in mental status Agitation→coma Petechiae -Around eyes -Around armpits -Around chest & neck Oxygen desaturation Tachycardia from hypoxia ```

What are the interventions for fat embolism

``` Oxygenate O2 per nasal cannula or mask ↑HOB Monitor VS (continued assessment) IV access Stay with patient Notify physician This is an emergency! Usually transferred to ICU ```

What do we do for impaired mobility

``` Assist with position changes Teach use of assistive devices Crutches – next slide Walker Monitor limitations of movement Ensure proper alignment Alignment in bed – especially with traction Teach for home Lying Sitting ```

What do we do for the risk of infection pats

Prevention Teach hand washing to patient & family Use sterile technique with dressing change Pin care – see supplemental article Adequate diet & fluids Frequent assessment for infection Teach patient & family how to monitor Teach when to call HCP Antibiotics Teach patient to complete regimen when home

What do we do for high risk for constapation

``` Fiber intake Fluid intake Exercise Stool softeners Use of laxatives if needed ```

What are the SS of hip fractures

``` You’ll see external rotation Shortening of extremity C/O Severe pain & tenderness They could have avascular necrosis because of disrupted flow of blood to head of femur In the absence of infection ```

What are hip fracture pats at increased risk for

clots and bleeding in thigh

What are we doing for hip frac pats prior to surgery

Usually Buck’s traction for 24 to 48 hours IV fluids Teach patient if they need assistive device and how to use it and let them practice

How long does the glue in a total hip replacement last

10-14 yrs

What are the DO NOT's of hip repacement care

Force hip into 90 flexion Force hip into adduction Force hip into internal rotation Cross legs Put on own shoes or stockings until 8 weeks after surgery Sit on chairs without arms so you dont rock yourself up *applies if hip pinning

What are the Do's of hip replacement care

Use toilet elevator on toilet seat so not in flexion Place chair inside shower or tub Use pillow between legs for first 8 weeks after surgery when lying on good side or supine Keep hip in neutral, straight position when sitting, walking or lying Notify surgeon if severe pain, deformity or loss of function occurs. Inform dentist of presence of prosthesis before dental work so prophylactic antibiotics can be given

What is knee replacement usu for

arthritis

What are some things we do postop for knee replacement

Quadriceps setting Straight leg raises after 24º Use of passive-motion machine Degree of flexion & extension