Musculoskeletal trauma and Ortho Surgery Flashcards

Question

What can you not do with a cast?

Answer 1

get cast wet remove any padding insert objects inside the cast bear weight on new cast for 48hrs (not all casts are made for weight bearing; check with HCP when unsure) Cover cast with plastic for prolonged periods

Answer 2

Apply ice directly over fracture site for 1st 24 hours Check with HCP before getting fiberglass cast wet Dry cast thoroughly after exposure to water blot dry with towel use hair dryer on low setting until cast is thoroughly dry Elevate extremity above level of heart for 1st 48hrs Move joints above and below cast regularly Use hair dryer on cool setting for itching Report signs of possible problems to HCP Increasing pain Swelling associated with pain and discoloration of toes or fingers Pain during movement Burning or tingling under cast Sores or foul odor under the cast Keep appointment to have fracture and cast checked

Answer 3

It's a surgical procedure There is an incision over the fracture site Internal fixation with the use of wires, screws, pins, plates, intramedullary rods or nails Usually with open (compound) fractures

Answer 4

Placement of internal hardware to "fix" the fragments in place Using rods, pins, nails, screws, metal plates Promotes early mobility Preferred for older adults

Answer 5

A surgical Incision to correct bone alignment | Use of wires, screws, pins nails or rods

Answer 6

Similar to internal fixation, but pins inside the bone are attached to a frame outside the body With extensive soft tissue damage or infection, external fixation allows easy access to the site and facilitates wound care Allows early mobility while relieving pain Pin track infection occurs in about 10%

Answer 7

Application of a pulling force to an injured or diseased part of the body/extremity while countertraction pulls in the opposite direction

Answer 8

Prevent/reduce pain/spasms Immobilize a joint or a part of the body Reduce the fracture or dislocation Treat a pathologic joint condition

Answer 9

``` Skin - uses light weights short term tape, boots or splints Skeletal - heavier weights used longer pins or wires inserted into the bone ```

Answer 10

used for fractures of the hip and femur

Answer 11

``` Assist in set up Don't remove weights without an order Weights should hang freely Inspect skin a minimum of every 8 hours Watch areas with pins, wires screws Assess neurovascular status of affected body part ```

Answer 12

``` impaired circulation inadequate bone alignment skin breakdown soft tissue injury pin track infection (10%) osteomyelitis ```

Answer 13

``` Muscle relaxants Carisoprodol (Soma) Cyclbenzaprine (Flexaril) Methocarbamol (Robaxin) Tetanus and antibiotics for an open fracture Pain medications ```

Answer 14

``` Ample protein (1g/kg of body weight) Vitamins (B,C,D) Calcium Phosphorus Magnesium Needed to: Promote muscle strength and tone Build endurance Provide energy for ambulation and gait-training skills Adequate fluid intake 2-3L/day High fiber diet with fruits and vegetables If in a body cast (6 small meals a day) ```

Answer 15

Have physiologic healing without associated complications Obtain satisfactory pain relief Achieve maximal rehab potential Anatomic realignment of bone fragments Immobilization to maintain realignment Restoration of normal or near-normal function of injured parts

Answer 16

``` Inadequate immobilization Excess movement Poor alignment Infection Poor nutrition ```

Answer 17

Acute compartment syndrome Shock Fat emboli Venous Thromboembolism

Answer 18

Compartments have increased pressure compromising nerves and circulation Resulting in pressure on nerve endings and reduced blood flow Two sources of pressure decreased compartment size from casts, splints or dressings increased compartment content Relatively rare MEDICAL EMERGENCY Ischemia in 4-12 hours Limb useless or limb loss within 24-48 hours

Answer 19

Ischemia occurs Increased pain change in color paresthesia

Answer 20

fasciotomy

Answer 21

``` Paresthesia Pain Pressure Pallar Paralysis Pulselessness ```

Answer 22

bone is vascular femur fracture-patient can lose 1L of blood Large blood volume loss associated with fractures

Answer 23

fluids | blood replacement

Answer 24

Includes: DVT - deep vein thrombosis PE - pulmonary emboli Most common complication of lower extremity surgery or trauma Aggravated by inactivity of muscles that normally assist in pumping action of venous blood

Answer 25

anticoagulants compression devices - TEDS, sequential stockings early ambulation ROM exercises

Answer 26

Fat globules are released from exposed marrow into blood stream May migrate to lungs Too large to pass through pulmonary circulation Lodge in capillaries Break down into fatty acids

Answer 27

``` Most patients manifest symptoms 24-48 hours after injury Respiratory distress is first Tachycardia Tachypnea Fever Confusion Decreased LOC Petechiae over neck, upper arms, chest or abdomen ```

Answer 28

``` prevention fluid resuscitation encourage coughing and deep breathing gentle handling oxygen ventilatory support diuretics for pulmonary edema corticosteroids (controversial) ```

Answer 29

Arteriogram: x-ray exam with the use of contrast material to visualize the blood flow to the arteries; invasive procedure Venogram: x-ray exam with the use of contrast material to visualize the blood flow to veins; invasive procedure Doppler studies: can detect the arterial and venous blood flow patterns; non-invasive procedure

Answer 30

circulatory impairment traumatic or thermal injuries malignant tumors widespread infection of extremity

Answer 31

``` prevention and detection of problems assess dressing, change as indicated infection, bleeding compression bandages pain control psychosocial issues prosthetic fitting ```

Answer 32

Prevention of infection is paramount PT and OT to assist in ADL's Wrapping stump correctly for reducing edema to help prepare for prosthesis

Answer 33

Preserve extremity length and function while removing all infected, pathologic, or ischemic tissue Relief from underlying health problems Satisfactory pain control Reach maximal rehabilitation potential with prosthesis (if indicated) Cope with body image change Make satisfying lifestyle adjustments Keep chronic health problems under control (diabetes, COPD)

Answer 34

Health promotion: Control of the causative illness such as: PVD, DM, pressure ulcers Psychologic and Social implications Allow the patient to go through the grieving process Pre-operative management Post-operative management

Answer 35

``` hemorrhage infection phantom limb pain flexion contractures psychosocial issues ```

Answer 36

body's defense interrupted superficial wound infection to deep wound clostridial infection - gangrene osteomyelitis - bone infection - open fracture

Answer 37

prevention debridement surgery antibiotics

Answer 38

``` Intracapsular head and neck of hip Extracapsular trochanteric area Femoral neck Intertrochanteric Common in elderly due to falls ```

Answer 39

bucks traction ORIF rods, pins, prosthesis, plates If femoral head or neck fractured-may need prosthetic device implanted Total hip replacement

Answer 40

usually result of major trauma | patient can lose up to 1-1.5L of blood in thigh

Answer 41

stable or unstable | patient can lose up to 2-3 L of blood

Answer 42

vertebral fractures associated with osteoporosis bone mass diminishes

Answer 43

``` always check ABC's first visualize area of concern Assess Immobilize/splint Non-surgical interventions (closed reduction - moderate sedation) Surgical interventions ```

Answer 44

``` acute pain risk for peripheral neurovascular dysfunction impaired physical mobility risk for infection impaired nutrition potential for elimination disturbances ```

Answer 45

``` concern for blood loss pain control mobility-need to know do's and don'ts neurovascular assessment incision assessment nutrition and elimination ```