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Med Surg > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What are the rules of thumb

A

alignment

CMS- circulation, motor, sensation

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2
Q

Ways to prevent strains and sprains

A

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

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3
Q

What are the S/S of sublux and dislocation

A 
Asymmetry of musculoskeletal contour (shorter legs)
Local pain
Tenderness
Loss of function
Swelling in the joint region
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4
Q

What are risk factor of factures

A

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

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5
Q

What are the manifestations of factures

A 
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
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6
Q

What do you need to check for in fractures

A

distal loss of pulse

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7
Q

What is the cardinal sign of fractures

A

deformities

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8
Q

What is closed reduciton

A

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

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9
Q

What is open reduciton

A

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

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10
Q

What is internal fixation

A

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

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11
Q

How ling is skin traction good for

A

48-72hrs

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12
Q

What is used in skin tracion

A

tape boots or slings

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13
Q

What does skin traction do and how many pounds are used

A

decreases muscle spasm

5-10 lbs

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14
Q

What is skeletal traction timeline

A

weeks

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15
Q

What is used in skeletal traction

A

nails
wires
tongs

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16
Q

What are the lbs of skeletal traction

A

4-45

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17
Q

What is the risk of skeletal traction

A

infection

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18
Q

What are some considerations for tractioni

A

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

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19
Q

What are the DO’s of cast care

A 
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
20
Q

What are the DO NOT”S of cast care

A

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

21
Q

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

A

feeling lots of heat

22
Q

When making a cast what should you do

A

smooth the edges

23
Q

What are some other things I should assess with cast care

A

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.

24
Q

What are some guidelines for pin care

A 
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
25
Q

What are the 6 P’s

A 
Pain
Especially severe & unrelieved
Pulses
Check both affected & unaffected
Paresthesia
Numbness or tingling
Pallor
Pale color
Paralysis
ROM
Strength
Polar 
Coolness
26
Q

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

A

check the good side first

27
Q

How long is antibiotics for fracture inf’s

A

7-10 days

28
Q

Should you keep assessing after applying a dressing/cast

A

4-12 hrs

29
Q

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

A

Elevate extremity ↑ heart or may slow arterial perfusion.

Apply cold compress, or may result in vasoconstriction.

30
Q

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

A

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.

31
Q

Why is venous thrombosis a comp of fracture

A

venous stasis

32
Q

What might be some causes of venous stasus

A

Incorrectly applied cast
Incorrectly applied traction
Prolonged bed rest & immobility

33
Q

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

A

ask them to wiggle toes

34
Q

Who is at risk for fat embolism

A

limited mobility

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

35
Q

What are the S/S of fat embolisms

A 
resp if travels to lung 
Change in mental status
Agitation→coma
Petechiae
-Around eyes
-Around armpits
-Around chest & neck
Oxygen desaturation
Tachycardia from hypoxia
36
Q

What are the interventions for fat embolism

A 
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
37
Q

What do we do for impaired mobility

A 
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
38
Q

What do we do for the risk of infection pats

A

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

39
Q

What do we do for high risk for constapation

A 
Fiber intake
Fluid intake
Exercise
Stool softeners
Use of laxatives if needed
40
Q

What are the SS of hip fractures

A 
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
41
Q

What are hip fracture pats at increased risk for

A

clots and bleeding in thigh

42
Q

What are we doing for hip frac pats prior to surgery

A

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

43
Q

How long does the glue in a total hip replacement last

A

10-14 yrs

44
Q

What are the DO NOT’s of hip repacement care

A

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

45
Q

What are the Do’s of hip replacement care

A

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

46
Q

What is knee replacement usu for

A

arthritis

47
Q

What are some things we do postop for knee replacement

A

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

Med Surg (35 decks)

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