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Acute and Chronic > 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 _________ _________ or ___________ _________ 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

Periosteum –where _________ _________ or __________ __________ 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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18
Q

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

A

External soft

stability

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19
Q

There are ____ stages of healing are there in bone healing.

A

six

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20
Q

Stage 1: ______________ Formation
Stage 2: Hematoma to ___________ Tissue
Stage 3: _______ Formation
Stage 4: ___________ Proliferation
Stage 5: Bone _____________
Stage 6: Bone __________ Completed

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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21
Q

__________ ___ _____________ ______________–painful, forms within 72 hours, bleeding cuz bones vascular, vasoconstriction occurs, cytokines are released and they trigger angiogenesis which is the growth of new blood vessels,

A

Stage 1: Hematoma Formation

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22
Q

Stage __: Hematoma to __________ Tissue -__ _____ to ___ _____after the injury, granulation tissue invades the hematoma and starts forming fibrocartilage which is like the building block

A

Stage 2: Hematoma to Granulation Tissue
2 days to 2 weeks

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23
Q

________ __ __________ ____________due to vascular and cellular proliferation, fracture site will be surrounded by new vascular tissue called a _____

A

Stage 3: Callus Formation

callus

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24
Q

__________ ____ _________________ ________________ callous reabsorbed and transformed into bone, in __ __ ___ ______

A

Stage 4: Osteoblastic Proliferation

3 to 8 weeks

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25
Q

4-6 weeks after breaking a bone and can continue for a year, dead bone or necrotic bone is being removed by osteoclasts and reshaping of the new bone occurs

A

Stage 5: Bone Remodeling

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26
Q

Bone Healing Completed

A

Stage 6:

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27
Q

_______________ ______________ break across the ________ cross-section of the bone

A

Complete fracture

entire

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28
Q

__________________ ______________ (green-stick) a break through only part of the ______________ of bone

A

Incomplete fracture

cross-section

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29
Q

– produces several bone fragments

A

Comminuted fracture

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30
Q

__________________ _________ caused by a loading _________ applied to the long axis of cancellous bone (vertebrae)

A

Compression fracture

force

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31
Q

____________ ______________ one that does not cause a break in the skin

A

Closed fracture – (simple fracture)

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32
Q

_________________ _____________ bone alignment is altered or disrupted

A

Displaced fracture

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33
Q

_____________ __________ the skin or mucous membrane wound extends to the fractured bone

A

Open fracture (compound or complex fracture)

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34
Q

_____________ __________ (spontaneous or pathologic) occurs after ________trauma to a bone weakened by disease

A

Fragility Fracture

minimal

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35
Q

___________ _______________-due to excessive strain or stress on a bone

A

Fatigue (stress) Fracture

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36
Q

Open fractures are graded according to the following criteria:

______ __ less than 1 cm long

A

Grade I

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37
Q

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

A

Grade II

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38
Q

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

A

Grade III

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39
Q

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

A

MANIFESTATIONS: fractures

Shortening
discoloration

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40
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

A

management for a fracture

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41
Q

regional nerve blocks

A

is a shot in a bone

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42
Q

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

A

Reduction

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43
Q

____________ __________ – bringing the bone fragments into opposition through manipulation and manual traction
Use of moderate ________
X-ray confirmation
Will then ____________ with orthotic device, cast, splint, __________

A

Closed reduction

sedation
immobilize, bandage

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44
Q

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

A

Open reduction

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45
Q

Immobilize a reduced fracture

___________ a deformity

Apply uniform pressure to underlying soft tissue

Support and ________ weak joints

A

What does a cast do?

Correct
stabilize

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46
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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47
Q

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

A

Long-arm

right

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48
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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49
Q

_________ From junction of the upper and middle third of the ______ to base of toes – knee may be slightly _____________

A

Long-leg

thigh
flexed

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50
Q

____________ ______ short or long-leg reinforced for strength

A

Walking cast

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51
Q

______ ____ encircles the trunk

A

Body cast

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52
Q

_________ ______body jacket that encloses trunk and shoulder and elbow

A

Shoulder spica

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53
Q

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

A

Hip spica

54
Q
A

body cast

55
Q
A

shoulder spica

56
Q
A

HIP spica

57
Q

in what age demographic are hip spicas seen?

A

children

58
Q

what are casts usually made out of?

A

nonplaster or fiberglass

59
Q

Which casting material is ligher?

A

fiberglass

60
Q

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

A

true

61
Q

t/f: you will not wait for swelling to go down before casting

A

false

62
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

63
Q

What are the 5 Ps for neurovascular assessment with casts?

A

Pain
Pulse
Pallor
Paresthesia
Paralysis

64
Q

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

A

true

65
Q

What are the two categories of complications?

A

early
delayed

66
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

67
Q

increased pressure in a confined space can cause __________ –compromised blood flow, ischemia, 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

68
Q

what is the hallmark sign of compartment syndrome?

A

PASSIVE RANGE OF MOTION INTENSIFIES PAIN

69
Q
A

pressure ulcer from cast

70
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

71
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

72
Q
A

pressure ulcer

73
Q

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

A

Potential complications – Disuse Syndrome

74
Q
A

disuse syndrome

75
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

76
Q

delayed union of fractures

A

potential complication

77
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

78
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

79
Q

systemic signs of infection
odor from cast
purulent drainage staining cast

A

observe patient for these things with pain assessment

80
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

81
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

82
Q

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

A

Pain
Pallor
Pulse
Parathesis
Paralysis

83
Q

Often hypovolemic shock due to _______

A

blood loss

84
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)

85
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 occluded stuff and cerebral edema. morbidity and mortality are super high and can happen in up to 90% of people with severe trauma

A

fat embolism

86
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

87
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.

88
Q

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

A

Deep Vein Thrombosis

89
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

90
Q

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

A

complications

91
Q

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

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

A

When cast is dry - teach:

92
Q

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

A

What do you need to tell them to report ?

93
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

94
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

95
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

96
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

97
Q

The application of a pulling force to part of the body

A

traction

98
Q

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

A

uses for traction

99
Q

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

A

traction

100
Q

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

A

traction

101
Q

______ must be continuous

Skeletal ______ is never interrupted (UNLESS NEED CPR)

Weights are never removed unless intermittent _______ is prescribed

A

principles for traction

Traction 3x

102
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

103
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
traction

104
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

105
Q

______ _____________ _________

unilateral or bilateral to lower leg
- Used to immobilize fractures of the proximal femur before surgical fixation
- Before traction is applied – observe for abrasions and circulatory disturbances
- One nurse elevates and supports the leg & another places boot with heel in boot heel unilateral or bilateral to lower leg

A

bucks extension traction

106
Q
A

Bucks extension traction

107
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

108
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

109
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

110
Q
A

skeletal traction

111
Q

Skeletal uses ________

A

7 to 12 kg

112
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

113
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

114
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

115
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

116
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

117
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

118
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

119
Q

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

A

monitor for these during traction

120
Q

Removal of a body part
Usually an extremity

A

amputation

121
Q

Often from progressive peripheral vascular disease

A

amputation

122
Q

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

A

potential causes of amputation

123
Q

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

A

why amputations are performed

124
Q

Level of amputation = ___________________

A

most distal point that will heal successfully

125
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

126
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

127
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

128
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

129
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

130
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

131
Q

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

A

true

132
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

Acute and Chronic (15 decks)

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