Musculoskeletal Flashcards
What are the rules of thumb
alignment
CMS- circulation, motor, sensation
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
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
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
What are the manifestations of factures
Deformity Abnormal position Cardinal sign Pain & tenderness Encourage splinting & limit movement Loss of function Quick treatment preserves function Could be a distal loss of pulse or sensation Edema & swelling Can occlude circulation compartment syndrome? Muscle spasm Can displace fracture more & make it hard to reduce Ecchymosis Extravasation of blood Usually several days later Crepitation Grating of bony fragments
What do you need to check for in fractures
distal loss of pulse
What is the cardinal sign of fractures
deformities
What is closed reduciton
non-surgical, manual realignment of bone fragments to the previous anatomical position. Traction is typically applied.
What is open reduciton
reduction or correction of bone alignment through a surgical incision involving manipulation of bone
What is internal fixation
use of wire, screws, pins, plates, rods or nails.
How ling is skin traction good for
48-72hrs
What is used in skin tracion
tape boots or slings
What does skin traction do and how many pounds are used
decreases muscle spasm
5-10 lbs
What is skeletal traction timeline
weeks
What is used in skeletal traction
nails
wires
tongs
What are the lbs of skeletal traction
4-45
What is the risk of skeletal traction
infection
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
What are the DO’s of cast care
Apply ice X 24 hours & 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
