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musculoskeletal modalities Flashcards

1
Q

what are some indications for casting

A
  • immobilize fracture
  • correct prevent deformity
  • support weakened joints
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2
Q

describe application of casting

A

fliberglass or plaster of paris
joints proximal and distal

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3
Q

what are some complications of casting

A
  • pressure ulcers (need uniformity of cast)
  • compartment syndrome
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4
Q

describe nursing focus and education for casts

A
  • neurovascular checks (6Ps)
  • cold therapy (reduce inflammation)
  • keep clean, dry and elevate
  • do not scratch -> infection
  • discuss potential complications
  • casting options
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5
Q

what are your expctations of vital signs when experiencing pain?

A

increased BP, HR, and respirations

so dont focus too much on it if someones chillin with a broken bone

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6
Q

what are the 6 Ps of neurovascular assessment

A
  • pain
  • pallor
  • paralysis
  • pulselessness
  • parasthesias
  • poikilothermia
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7
Q

what are some causes of compartment syndrome

A
  • trauma
  • fracture
  • severely bruised muscle
  • severe sprain
  • cast/bandage (when theyre put on too soon)
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8
Q

what is happening with compartment syndrome

A
  • fascia covers muscle -> this shit DOES NOT expand
  • muscles, nerves, blood supply, and fascia in compartments
  • swelling occurs = nowhere to go
  • increased pressure in compartment
  • blood flow is compromised
  • worst case = ischemia and limb death
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9
Q

how will a client with compartment syndrome present

A
  • pain disproportionate to injury
  • numbness and tingling to extremity; paleness
  • NO pain relief despite analgesics
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10
Q

whats a diagnostic test for compartment syndrome

A

stryker

this thing gets stuck in the swelling part and tests pressure inside

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11
Q

what are some acute interventions for compartment syndrome

A
  • remove cast
  • fasciotomy
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12
Q

how can nurses hep with compartment syndrome

A

education

  • immobilized fx should not hurt
  • numbness and tingling to extremity/warmth and pain out of proportion is bad
  • keep clean and dry
  • report fever or S&S of infection
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13
Q

describe fasciotomy care

A
  • negative pressure wound therapy with instillation has been used effectively to assist in granulation in acute, subacute, and chronic wounds
  • leaves a giant ass scar
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14
Q

what are some indications for external fixation

A
  • fx with soft tissue damage or wounds
  • complicated fracture

its a little bridge until you can fix it w surgery

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15
Q

whats happening with external fixation

A
  • surgical pins inserted through skin to bone
  • metal external frame attached to pins
  • holds proper alignment (until healed or surgery)
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16
Q

what are some benefits of external fixation

A
  • immediate fx stabilization
  • minimize blood loss (ORIF)
  • increased comfort
  • improved wound care
  • early mobilization
17
Q

what are some complications of external fixation

A
  • pin loosening
  • infection/osteomyelitis
  • compartment syndrome (can bleed into muscle)
18
Q

how can nurses help with external fixation

A

education
- pin cleaning
- altered body image
- discuss complications (what to looks for)
- monitor neruvascular status (24hrs)
- may need casting/splint after removal

19
Q

describe pin cleaning

A
  • use sterile water, gauze, and cotton swab
  • use a new swab for each pin
  • massage skin around pin
  • circle pin with sterile swab
  • dont double dip
  • clean length of each pin
20
Q

when can a person shower after getting external fixation

A

10 days post op

21
Q

what are some indications of skeletal traction

A
  • short term fx management
  • decrease msucle spams/pain
  • fx with soft tissue damage/wounds
  • maintain alignment while waiting for surgery
  • correct/prevent deformities
22
Q

describe the mechanism of action of skeletal traction

A
  • local anesthesia used
  • traction and countertraction (pt is countertraction)
  • patients body weight and weight on pullies
  • weights on pullies should be chillin
  • pulling reduces painful muscle spasms
23
Q

what can a client expect with skeletal traction

A
  • pressure/pain during exertion
  • weights attached to pins/wires
  • complete bed rest during therapy, trapeze provided
  • adjustment of weights as muscles relax
24
Q

what are some nursing considerations for skeletal traction

A
  • check throughout shift and Q8 (NV status and VTE)
  • pain control
  • prevent skin breakdown
  • prevent shearing injuries
  • PT consult for AROM and PROM
  • pin care
  • anxiety reduction
25
Q

what are some complications of skeletal traction

A
  • atelectasis/pneomonia
  • constipation
  • anorexia
  • infection
  • VTE
  • CAUTI (if unable to use trapeze)
26
Q

describe skin traction

A
  • used less frquently
  • bucks (lower leg) used most frequently
  • short term stabolization without pins/wires (used for less complicated fx)
  • weights attached by velcro, tape, straps, boots, or cuffs
  • be cautious not to exceed tolerance of skin (4.5lb-8lb per extremity)
27
Q

what are some nursing considerations for skin traction

A
  • inspect area under traction
  • assess NV status
  • encourage ROM
  • same considerations as skeletal
  • complications of immobility
28
Q

compare and contrast skeletal traction and external fixation

A

skeletal traction:
- short term fx management
- pt immobile - weights placed to pins
- weights cannot be removed
- keeps anatomical alignment until surgery is an option

external fixation:
- short term or longer term fx management
- pt mobile - use of crutches and nonweight bearing on affected extremity
- no weights
- maintains anatomical alignment until surgery is an option

29
Q

what are some indications for orthopedic surgery

A
  • unstable fx
  • deformity
  • joint disease (arthoplasty)
  • necrotic or infected tissue and tumors
  • amputation
30
Q

what are some goals of orthopedic surgery

A
  • improve function
  • restore motion
  • relieve pain and disability
  • improve quality of life
  • safer than most surgeries with rare complications
31
Q

what are some complications of orthopedic surgery

A
  • blood loss (up to 1500ml anticipated)
  • acute post op bleeding common
  • post op anemia
  • infection
32
Q

what are some indications of arthoplasty

A
  • hip and knee most common
  • OA (bone on bone), RA (synovial fluid probs), trauma, deformity
  • avascular necrosis (traumatic injury, steroid usage, alcohol)
33
Q

whats the mechanism of action of arthoplasty

A

remove bad and replace with new

34
Q

what are some complications of arthoplasty

A
  • blood loss
  • infection
35
Q

describe nursing care and educations for arthoplasty

A
  • IV antibiotics 60mins prior to incision
  • complications of immobility: VTE prophylaxis, pressure ulcers, pneumonia/atelectasis
  • assess NV status
  • pain management
  • promote ambulation
  • home care

hip: abductor pillow <90 degrees

knee: knee immobilizer

adults (51 decks)

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