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A&C I > Musculoskeletal & Fractures, Amputations > Flashcards

Musculoskeletal & Fractures, Amputations Flashcards

1
Q

______ is composed of cells, protein matrix, and mineral deposits

A

Bone

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2
Q

Three basic cell types of bone are?

A

Osteoblasts
Osteocytes
Osteoclasts

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3
Q

–bone forming cells, secrete bone forming cells

A

osteoblasts

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4
Q

–mature bone cells, help with bone maintenance

A

osteocytes

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5
Q

–bone absorption cells, dissolving and reabsorbing bone

A

osteoclasts

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6
Q

t/f: bone development happens more rapidly in a kids than an adult, and the bone healing process is better in kids

A

true

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7
Q

bone regrowth slows at ____ years of age

physical activity helps bone growth

A

20

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8
Q

t/f: nutrient absorption is really important

hormones are really important for bone growth

A

true

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9
Q

______ = Bone formation

A

Osteogenesis

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10
Q

______and ______ – acts to stimulate bone formation and remodeling

A

Physical activity, weight bearing

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11
Q

Good diet is necessary for bone health – ______ mg of calcium is needed every day to maintain bone health

A

1500

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12
Q

___________ happens in four areas:

Bone marrow
Bone cortex
Periosteum
External soft tissue

A

Fracture healing

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13
Q

t/f: a fracture is a break

A

true

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14
Q

Bone marrow –where ______ are formed

A

osteoblasts

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15
Q

Bone cortex –where new ______ are formed

A

osteons

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16
Q

Periosteum –where __________________ is formed, formed through intramembranous ossification, this happens peripheral to the fracture, where cartilage is formed through endochondral ossification

A

hard callous or fibrous tissue

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17
Q

________ tissue –the tissue around the bone near the break where a bridging callous forms and it provides stability to the fractured bones

A

External soft

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18
Q

How many stages of healing are there in bone healing?

A

six

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19
Q

Give the order of the stages of bone healing

A

Stage 1: Hematoma Formation
Stage 2: Hematoma to Granulation Tissue
Stage 3: Callus Formation
Stage 4: Osteoblastic Proliferation
Stage 5: Bone Remodeling
Stage 6: Bone Healing Completed

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20
Q

___________________–generally a lot of pain, forms within 72 hours usually, a lot of bleeding possibly [bones are very vascularized], vasoconstriction occurs, cytokines are released and they trigger angiogenesis which is the growth of new blood vessels,

A

Stage 1: Hematoma Formation (aka the inflammatory stage)

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21
Q

Stage 2: Hematoma to Granulation Tissue -___________after the injury, granulation tissue invades the hematoma and starts forming fibrocartilage which is like the building block

A

3 days to two weeks

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22
Q

– due to vascular and cellular proliferation, fracture site is going to be surrounded by new vascular tissue and this is known as a _____

A

Stage 3: Callus Formation

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23
Q

–callous is turned into bone, this takes __________

A

Stage 4: Osteoblastic Proliferation, three to eight weeks

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24
Q

– starts 4-6 weeks after breaking a bone and can continue all the way up to a year, your dead bone or necrotic bone is being removed by osteoclasts and you are reshaping and replacing the new bone, they are going to do repeated X-rays to see how the growth is going along

A

Stage 5: Bone Remodeling

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25
Q

Bone Healing Completed

A

Stage 6:

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26
Q

– break across the entire cross-section of the bone

A

Complete fracture

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27
Q

– (green-stick) a break through only part of the cross-section of bone

A

Incomplete fracture

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28
Q

– produces several bone fragments

A

Comminuted fracture

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29
Q

– caused by a
loading force applied to the long axis
of cancellous bone (vertebrae)

A

Compression fracture

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30
Q

– one that does not cause a break in the skin

A

Closed fracture – (simple fracture)

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31
Q

– bone alignment is altered or disrupted

A

Displaced fracture

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32
Q

– the skin or mucous membrane wound extends to the fractured bone

A

Open fracture (compound or complex fracture)

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33
Q

– (spontaneous or pathologic) occurs after minimal trauma to a bone weakened by disease

A

Fragility Fracture

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34
Q

– due to excessive strain or stress on a bone

A

Fatigue (stress) Fracture

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35
Q

Open fractures are graded according to the following criteria:

______ – less than 1 cm long

A

Grade I

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36
Q

Open fractures are graded according to the following criteria:
______ – without extensive soft tissue damage

A

Grade II

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37
Q

Open fractures are graded according to the following criteria:
_________– extensive soft tissue damage

A

Grade III

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38
Q

Acute pain
Loss of function
Deformity
Shortening of extremity
Crepitus
Local swelling and discoloration
Pain is continuous and increases until the
fragments are immobilized

A

MANIFESTATIONS: fractures

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39
Q

Ensure emergency care for airway, breathing, and circulation is not needed OR call 911 OR provide this care
Immobilize the body part before moving the patient
Splint adequately – including joints both proximal and distal to the injury
Pain management -opioids for a bit but as short as possible

regional nerve blocks are also sometimes done

A

management for a fracture

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40
Q

______ – “setting the bone” – restoration of the fracture fragments to proper alignment and rotation

A

Reduction

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41
Q

______ – bringing the bone fragments into opposition through manipulation and manual traction
Use of moderate sedation
X-ray confirmation
Will then immobilize with orthotic device, cast, splint, bandage

A

Closed reduction

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42
Q

_______ – surgical procedure using internal fixation devices – screws, pins, wires, etc

A

Open reduction

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43
Q

What does a cast do?

A

Immobilize a reduced fracture

Correct a deformity

Apply uniform pressure to underlying soft tissue

Support and stabilize weak joints

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44
Q

– below the elbow to the palmar crease and secured around the base of the thumb – if the thumb is included can be also known as a thumb-spica or gauntlet cast

A

Short-arm

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45
Q

– from axillary fold to proximal palmar fold – elbow is usually immobilized at a right angle

A

Long-arm

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46
Q

__________ – from below the knee to base of toes with foot flexed at a right angle in a neutral position

A

Short-leg

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47
Q

– From junction of the upper and middle third of the thigh to base of toes – knee may be slightly flexed

A

Long-leg

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48
Q

– short or long-leg reinforced for strength

A

Walking cast

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49
Q

– encircles the trunk

A

Body cast

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50
Q

– body jacket that encloses trunk and shoulder and elbow

A

Shoulder spica cast

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51
Q

– encloses trunk and lower extremity – double hip includes both legs

A

Hip spica cast

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52
Q
A

body cast

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53
Q
A

shoulder spica

54
Q
A

HIP spica

55
Q

in what age demographic are hip spicas seen?

A

children

56
Q

what are casts usually made out of?

A

nonplaster or fiberglass

57
Q

Which casting material is ligher?

A

fiberglass

58
Q

t/f: heat is given off and can in some instances be uncomfortable when applying the cast

A

true

59
Q

t/f: Usually will wait for swelling to go down before casting

A

true

60
Q

make sure you don’t put the cast on too tight bc it can cut off circulation

patient education: keep dry, don’t take off, don’t shove things in there bc it can cause a wound,

cast should provide support but not increase pain

for first couple of days, does the pain get worse or better?

can you feel their pulse? capillary refill ? –make sure its not too tight

A

assessment for casts

61
Q

What are the 5 Ps for neurovascular assessment with casts?

A

Pain
Pulse
Pallor
Paresthesia
Paralysis

62
Q

t/f: Fractures may require weeks even months to heal

A

true

63
Q

What are the two categories of complications?

A

early
delayed

64
Q

What are the the early complications that can occur with a fracture?

A

Shock
Fat embolism syndrome
Compartment syndrome
Thromboembolic complications – Deep vein thrombosis (DVT) and pulmonary embolus (PE)
DIC (Disseminated Intravascular Coagulation)
DIC –body clots and your body overreacts and you bleed out

65
Q

increased pressure in a confined space can cause __________ –compromised blood flow, eskemia, irreversible nerve and tissue damage,

-the 5 Ps are important, unrelenting pain is a sign
can also happen if your body is swelling

A

compartment syndrome

66
Q

what is the hallmark sign of compartment syndrome?

A

PASSIVE RANGE OF MOTION INTENSIFIES PAIN

67
Q
A

pressure ulcer from cast

68
Q

causes tissue anoxia and then goes to an ______. patient will complain of a hot spot and that it really hurts, cast may feel warmer, may drain, may be stinky

A

ulcer

69
Q

Pain and tightness in area
Warm area on cast (underlying tissue erythema)
Skin breakdown
Drainage and odor
Can be extensive loss of tissue
Monitor for ______________ development
To inspect area – may have to window the cast

A

SIGNS AND SYMPTOMS: pressure ulcer

70
Q
A

pressure ulcer

71
Q

encourage them to use their muscles so they don’t get this, wiggle fingers and toes etc

A

Potential complications – Disuse Syndrome

72
Q
A

disuse syndrome

73
Q

While in cast – teach patient to tense or contract muscles (isometrics without moving the part)
Helps reduce muscle atrophy and maintain muscle strength
Leg cast – teach to “push down” the knee
Arm cast – make a fist
Muscle-setting exercises – to maintain muscles used for walking

A

disuse syndrome nursing interventions

74
Q

delayed union of fractures

A

potential complication

75
Q

Knowledge of the treatment regimen
Relief of pain
Improved physical mobility
Achievement of maximum level of self-care
Healing of trauma-associated lacerations and abrasions
Maintenance of neurovascular function
Absence of complications

A

goals

76
Q

Have patient indicate where and describe intensity and character

In most cases – elevate, apply cold packs as ordered, and pain med.

The unrelieved pain level must be immediately reported to the physician to avoid possible paralysis and necrosis

A

pain interventions

77
Q

systemic signs of infection
odor from cast
purulent drainage staining cast

A

observe patient for these things with pain assessment

78
Q

______ – natural response to trauma - may complain that the cast is too tight
Vascular insufficiency & nerve compression due to unrelieved swelling can lead to compartment syndrome

A

Edema

79
Q

Circulation
Motion
Sensation of the affected extremity –assess fingers or toes of casted extremity and compare them to the other extremity

A

assessments for neurovascular in a cast

80
Q

The five “P’s of neurovascular compromise and compartment syndrome to assess are?

A

Pain
Pallor
Pulselessness
Parathesia
Paralysis

81
Q

Often hypovolemic shock due to _______

A

blood loss

82
Q

Can happen when a patient has sustained major injuries such as a long bone fracture
Can progress into ________________which can lead to multisystem failure
It is believed that the ____ emboli leads to occlusion to microvasculature triggering an inflammatory response resulting in multisystem complications

A

Fat embolism
Fat Embolism Syndrome (FES)

83
Q

major trauma leads to cascade of inflammation which leads to ______ which goes to the vascular system which also causes a systemic inflammatory response. in the lungs it can cause acute respiratory syndrome, nervous system can cause occulded stuff and cereberal edema. morbidity and mortality are super high and can happen in up to 90% of people with severe trauma

A

fat embolism

84
Q

resp distress, delirious, LOC change, unusual skin rashes (capillary rash on upper torso), tachycardic, fever, changes in renal function, retinal changes (petichia), jaundice (affects liver), acute drop in hemoglobin, low levels of platelets, ESR is elevated [lots of inflammation], can start having seizures.

A

s/s: of fat embolism

85
Q

what are the treatments for a fat embolism?

A

Treatments: supportive care, theres not really a treatment, just have to fix things as they come. may use corticosterioids for inflammation.

86
Q

_________ – when a blood clot (thrombus) forms in one or more of the deep veins in the body

A

Deep Vein Thrombosis

87
Q

– sudden blockage in a lung artery; often caused by a blood clot that travels to the lung from a vein in the leg

A

Pulmonary Embolus

88
Q

What are the long term complications that can happen?

A

Delayed:
Delayed union and nonunion
Avascular necrosis
Complex regional pain
syndrome
Heterotopic ossification- -abnormal bone formation, a random bone in some place, may be more common in a trauma

89
Q

When cast is dry - teach:

A

Move about as normally as possible – avoid excessive use of injured extremity – avoid wet, slippery floors or sidewalks

Perform prescribed exercises regularly

Elevate casted extremity to heart level frequently –avoids swelling

Do not scratch skin under cast

Cushion rough edges with heavy adhesive tape (called pettaling the cast)

Keep cast dry but don’t cover with plastic or rubber – unless taking a shower

90
Q

What do you need to tell them to report ?

A

Report:
Persistent pain
Swelling that doesn’t respond to elevation
Changes in sensation, decreased ability to move fingers or toes
Changes in skin color and temperature
Report a broken cast to the physician – do not try to fix it yourself
Cast removal:
Removed with a vibrating cast cutter
Padding is cut with scissors
Skin will be dry and scaly – use lotion

91
Q

Arm cast – will be one-handed – can have fatigue; weight of cast may increase fatigue – may need extra rest
Elevate to control swelling
May use sling
*Watch for signs of cyanosis, swelling and inability to move fingers

A

patient care for cast

92
Q

Impaired circulation in the arm can lead to ______________________ – a specific type of compartment syndrome

Obstructed arterial blood flow to forearm and hand
can’t extend fingers
has abnormal sensation
unrelenting pain; pain with passive stretching
diminished circulation – permanent damage develops within a few hours – do frequent neurovascular checks

A

Volkman’s contracture

93
Q

Causes a degree of immobility
Support leg on pillows to heart level – control swelling
Ice-packs over fracture site for 1 or two days
Lay down a couple times /day & elevate
Observe carefully for color, temp, & capillary refill

A

long leg cast care instructions

94
Q

Monitor for cast syndrome – happens as a result of psychological and physiological responses to confinement

Cracking or denting is prevented by support on a firm mattress with waterproof pillows until cast is dry

Position pillows next to each other
– close – as spaces between pillows allow
the damp cast to sag
No pillow under the head of a patient in a body cast while drying as it will cause pressure on their chest
Turn patient – log roll – every two hours to relieve pressure and allow cast to dry
It takes at least three people to turn – use palms of hands to support properly
The stabilizing abduction bar (located usually about the knees) should never be used to turn
Turn to prone position twice a day – postural drainage of bronchial tree and relieve pressure on back

Usually use fracture bed pans
Perineal area must be large enough for hygienic care

A

care for body or spica cast

95
Q

The application of a pulling force to part of the body

A

traction

96
Q

minimize muscle spasms
reduce, align, & immobilize fractures
reduce deformities
increase space between opposing surfaces

A

uses for traction

97
Q

Effects of _____ are evaluated with x-rays
Usually short term intervention

A

traction

98
Q

Usually, the patient’s weight and bed position apply the needed counter ______

A

traction

99
Q

______ must be continuous

Skeletal ______ is never interrupted (UNLESS NEED CPR)

Weights are never removed unless intermittent _______ is prescribed

A

Traction, principles for traction

100
Q

The patient must be in good body alignment in the center of the bed when ______ is applied
Ropes must be unobstructed
Weights must hang freely and not rest on the bed or floor
Knots in the rope or the footplate must not touch the pulley or the foot of the bed

A

traction

101
Q

Control muscle spasms

Immobilize an area before surgery

_______ is accomplished by using a weight to pull on ______ tape or on a foam boot attached to the skin

A

Skin traction

102
Q

No more than ______ (4.5 to 8 lbs) of traction for an extremity and ______ (10 to 20 lbs) depending on the weight of the patient

A

2 to 3.5 kg, 4.5 to 9 kg

103
Q
A

bucks extension traction

104
Q
A

Bucks extension traction

105
Q

Secure velcro strap around leg
Avoid excessive pressure over the malleolus and proximal fibula to prevent pressure ulcers and nerve damage
Older adults are at greater risk for complications due to sensitive, fragile skin

A

considerations/care for bucks extension traction

106
Q

Skin breakdown Prevention:
Remove foam boots to inspect skin, ankle, and achilles tendon 3x/day – 2nd nurse is necessary to support the extremity during inspection and skin care

Palpate area of tapes for tenderness – daily

Provide back care every 2 hours

Use special mattress overlays

Nerve damage:
Regularly assess sensation and motion
Immediately investigate any complaints of a burning sensation under traction, bandage, or boot
Immediately report altered sensation or impaired motor function

Circulatory impairment:
Following application of traction – assess circulation of foot or hand within 15 to 30 minutes and then every 1 to 2 hours
Assessment consists of:
Peripheral pulses, color, capillary refill and temperature
Indicators of DVT, including unilateral calf tenderness, warmth, redness and swelling
Encourage patient to perform active foot exercises every hour – while awake

A

complications/prevention interventions for traction

107
Q

Traction is applied directly to the bone by a metal pin or wire (Steinman pin, Kirschner wire) inserted through the bone, distal to the fracture

To immobilize cervical fractures: tongs are applied to the head (Gardner-Wells or Vinke tongs) affixed to skull

A

skeletal traction

108
Q
A

skeletal traction

109
Q

Skeletal uses ________

A

7 to 12 kg

110
Q

Overbed frame is used with trapeze to help movement
When discontinued, extremity is gently supported while weights are removed. Pin is cut close to skin and removed by physician

A

skeletal traction

111
Q

Always check the traction apparatus
Never remove weights unless a life-threatening situation occurs
Maintain alignment of patient’s body
Position foot to avoid footdrop
May support foot in a neutral position by using various orthopedic devices (foot supports)

A

interventions for traction

112
Q

Elbows may become sore from pushing while trying to reposition
Also use the heel of the unaffected leg to push up
Trapeze is best– pt can raise themselves off the bed for sheet change, bedpan, etc

A

skin breakdown measures for traction

113
Q

Assess every hour at first & then every 4 hours
Remind pt to inform nurse of any changes in sensation
Assess for DVT
Do active flexion-extension ankle exercises and isometric contraction of calf muscles

A

neurovascular assessment for people in traction

114
Q

Temperature
ropes hang freely
alignment
circulation check (5 ps)
type and location of fracture
increase fluid intake
overhead trapeze
no weights on bed or floor

A

care of client in traction

115
Q

Avoid infection & development of osteomyelitis
Covered with sterile gauze for first 48 hours
Assess frequently
Inspect every day for signs of a reaction
Inspect ______ at least every 8 hours

A

pin site

116
Q

Reduce anxiety
Achieve a maximum level of comfort
Achieve maximum amount of self-care
Encourage exercise and maintain positioning

A

interventions for a client in traction

117
Q

Pressure ulcers
Pneumonia
Constipation & anorexia
Urinary stasis & infection
Venous thromboembolism

A

monitor for these during traction

118
Q

Removal of a body part
Usually an extremity

A

amputation

119
Q

Often from progressive peripheral vascular disease

A

amputation

120
Q

gangrene, trauma (crushing injuries), burns, frostbite, electrical burns, congenital deformities, chronic osteomyelitis, or a malignant tumor

A

potential causes of amputation

121
Q

relieve symptoms
to improve function
save or improve the life of the patient

A

why amputations are performed

122
Q

Level of amputation = ___________________

A

most distal point that will heal successfully

123
Q

Hemorrhage
Infection
skin breakdown
phantom limb pain
joint contracture
Phantom limb pain is caused by the severing of peripheral nerves
Neuroma

A

potential complications from amputation

124
Q

massage the remaining part of the limb to help with phantom limb pain. _____ unit can also be used for phantom limb pain, local anesthesia can also be used. ______ is also really encouraged to help.

A

TENS, Activity

125
Q

joint contracture: continue moving all joints to prevent that which can form a ______ which is a tumor consisting of damaged nerve cells (often seen in upper body amputations rather than lower ones more often) can be removed surgically but pain is often worse after surgery if it comes back

A

neuroma

126
Q

Relief of pain absence of altered sensory perceptions
wound healing
acceptance of altered body image
resolution of the grieving process
independence in self-care
restoration of physical mobility
absence of complications

A

goals for amputation

127
Q

low self esteem, inability to cope
impaired skin integrity
risk for infection
risk for ineffective tissue perfusion
impaired physical mobility

A

potential complications from amputation after the fact

128
Q

ROM, encourage them to do prescribed exercise, refer to physical therapy, refer to occupational therapy, provide stump care on a regular basis, measure circumference of the stump to make sure its not swelling, instruct patient to lie in a prone position at least twice a day as tolerated which prevents contracture of the hip,

A

care for amputation

129
Q

t/f:
make sure youre not putting a pillow under the stump all the time bc it can cause permanent flexion

A

true

130
Q

When should you begin exercise?
Why exercise the remaining limb?
What factors should be considered to determine type of prothesis?

A

things to consider after amputation

A&C I (8 decks)

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