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Nursing > Ortho > Flashcards

Ortho Flashcards

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1
Q

Risk factors

A
  1. Age-related Changes: Loss of bone after 30; Vertebrae collapse; Muscle atrophy; Loss of cartilage; Lax ligaments
  2. Medical Hx: Paget’s Disease; Bone cancer
  3. Osteoporosis: 40 mil. Americans over the age of 50!; 40% of Caucasian women over the age of 50!
  4. Occupation
  5. Recreational activities
  6. Poor nutrition
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2
Q

Classification of fractures

A
  1. Extent of break: Complete; Incomplete
  2. Cause
    - Pathologic (spontaneous): bone cancer
    - Fatigue (stress): jogging
    - Compression: osteoporosis
  3. Extent of soft-tissue damage
    - Closed (simple): no visible wound
    - Open (compound): external wound
     Grade I : skin damage is minimal
     Grade II : skin and mascle damage
     Grade III : skin, muscle, nerve tissue and blood vessels damage
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3
Q

Impacted fracture

A

when force has come down on the bone : and one part of the bone smashed on the other part.

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4
Q

Greenstick fracture

A

common in children or newer bone ; after new tree branch…cant snap it

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5
Q

S/s :

A 
	Pain
	Loss of function
	Deformity
	Shortening
	Crepitus
	Swelling / discoloration
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6
Q

Diagnostics

A

• X-ray studies
- May need to be repeated with additional views
• CT scan
- Used to dx difficult-to-evaluate fractures (hip and pelvis)
• MRI
- Helps determine amount of soft-tissue damage

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7
Q

TX of fractures

A

• Reduction: restoration of bone fragramnets to anatomic allignment and rotation; performed right away
- Closed: bring ends together through amnipulation or manula traction them place cast or splint in order to immobilize it ;
- Open: surgery ; internal fixation
• Immobilization: hold bone fracture in correct allignment
- External
- Internal

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8
Q

Casts:

A
  • Used to immobilize, correct deformity, apply uniform pressure on underlying tissue, or support weakened joints
  • Location of fx dictates type used
  • Plaster ( rolls, wet with water; crystallized, 24-72 hrs to dry ) or non-plaster ( fiber glass, water resistant ( can take shower) ; less skin problems)
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9
Q

Casts: nursing management

A

• Education
-Controlling edema
- Controlling pain
- Exercises to maintain health of unaffected muscles
- Exercises to increase strength of supporting muscles
- Monitoring for potential complications
• Assessment of neurovascular status – 6 P’s: pain, pressure, pallor, pulselessness, paresthesia, paralysis
• Open fx – infection prevention

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10
Q

Assessment of neurovascular status – 6 P’s:

A
  1. pain
  2. pressure
  3. pallor
  4. pulselessness
  5. paresthesia
  6. paralysis
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11
Q

Traction:

A

application of a pulling force to a part of the body provide reduction, alignment and rest .
• Uses:
 Minimize spasms
 Reduce, align, and immobilize
 Reduce deformity
 Increase space between opposing surfaces
• Short-term intervention until external or internal fixation is possible
• Skin (Backs traction: Velcro boot)or skeletal ( pins, wires, tongs or screws are surgically inserted directly into bone) most common types
• Plaster, brace and circumferential

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12
Q

Pin care

A

• First 48-72 hours: clear fluid drainage or weeping expected
• Monitor pin sites every 8-12 hours for inflammation or possible infection:
 Drainage (purulent)
 Color (severe redness)
 Odor
• Chlorhexidine 2 mg/mL solution ( swab around the pin every 4-8 hrs)
• Follow agency protocol for pin site care!
Crusting around pin is natural barrier ( unless infection is present)

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13
Q

Traction: nursing management

A
  • Never remove weights without a prescription!
  • Good body alignment important
  • Ropes should be unobstructed
  • Weights must hang freely
  • Knots in the rope must not touch the pulleys or the bed
  • Assess neurovascular status every hour for first 24 hours after application, then every 4 hours
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14
Q

Acute Compartment Syndrome (ACS)

A
  • Anatomic compartment – 36 out of 46 in the body are in the extremities
  • Within 4-6 hours, neurovascular and muscle damage irreversible
  • Limb can become useless in 24-48 hours
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15
Q

ACS:

A

serious condition in which increased pressure within one or more compartments reduces circulation to the area. (most common: lower leg and forearm ).
The pressure to the compartment can be from :
External source: bulky dressing and cast
Internal: blood and fluid accumulation

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16
Q

ACS: S/s

A
  • Pain – out of proportion with injury; increases with passive ROM
  • Sensory deficits or paresthesia
  • Pale color, cool to touch
  • Weak pulses
  • Affected area is palpably tense
  • If not treated – cyanosis, tingling, numbness, paresis, and severe pain
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17
Q

ACS: TX

A

• Treatment

  1. Elevation
  2. Bi-valve ( cut the cast longways ; cast open to relieve the pressure )
  3. Fasciotomy : cut muscle into fascia to relieve the pressure ; open wound is packed and dressed daily; until secondary healing occurs; might need skin graft to promote healing )
18
Q

Crush Syndrome (CS)

A

• External crush injury that compresses one or more compartments in leg, arm or pelvis
• Potentially life threatening!
• Muscle becomes ischemic and necrotic
• Myoglobin released into circulation
 May occlude distal renal tubules and cause renal failure

19
Q

Myoglobulin

A

muscle protein that injured muscle tissue releases into circulation where it can clog the renal tubules and cause acute renal failure.

20
Q

CS: S/s

A
  • ACS
  • Hypovolemia
  • Hyperkalemia
  • Rhabdomyolosis ( release of myoglobulin into blood stream )
  • Acute tubular necrosis
  • Dark brown urine
  • Muscle weakness and pain
21
Q

CS: management

A
  • Focuses on preventing ATN and cardiac dysrhythmias from hyperkalemia
  • IVF, diuretics, low-dose dopamine to increase renal perfusion
  • Goal of UO=100-200 mL/hr
  • Kayexalate to reduce serum K+ levels
  • Dialysis if K+ remain high or kidney failure occurs
22
Q

Hypovolemic shock

A 
•	Bone is very vascular!
•	Risk for bleeding with bone injury
•	Trauma to nearby arteries can cause hemorrhage – rapidly developing hypovolemic shock
•	PELVIC Fx
	Possible internal organ damage
	Assess VS, skin color, LOC
23
Q

Venous thromboembolism (VTE)

A

 DVT and PE
 Most common complication of LE (lower extremity) surgery or trauma
 Most often fatal complication of MS surgery!

24
Q

Fat embolism syndrome (FES)

A

 Fat globules released from marrow into bloodstream
 12-48 hours after injury
 Clog small blood vessels that supply major organs – lungs
 First sign is AMS (altered mental status) secondary to low arterial O2
 Petechiae is classic sign, but can be a late sign
 Can result in respiratory failure or death

25
Q

Fracture Complications – Chronic complications

A

• Ischemic necrosis (avascular necrosis)
- Blood supply to bone is disrupted – death of bone tissue
- Most common with hip fx or fx with displacement (long term Prednisone :corticosteroid at risk)
• Delayed union
 Fx that has not healed in 6 months
 Some NEVER heal: nonunion
 Some heal incorrectly: malunion

26
Q

Fractures of upper extremities

A

• Colles’ fracture – distal radius (deformed wrist, pain, numbness). Check sensation at the tips od the fingers, cap refil, ROM.
• Humerus fractures
- Neck
- Shaft ( brachial vessels must be involved)
Place sling on.

27
Q

Pelvic fractures

A 
•	Pelvic fractures
-	Stable
- Unstable 
•	High mortality rate
•	Signs and symptoms: ecchymosis, tenderness, local edema, numbness and tingling , cant bear weight; hypovolemic shcok (high risk)
•	Nursing responsibilities/assessments
28
Q

Stable pelvic fx

A

 Single pubic or ischial rami
 Pelvic wing of the ilium
 Sacrum or coccyx
• Treatment

29
Q

Unstable pelvic fx

A
  • Rotational instability
  • Vertical instability
  • Combination of both
30
Q

Hip fractures

A

• Most common injury in older adults
• Most frequent injury in any health care setting
• High mortality rate: Osteoporosis - biggest risk factor for hip fx
• 2 major types
 Intracapsular
 Extracapsular

31
Q

Hip fracture : S/s

A 
•	Signs and symptoms
- Groin pain
- Pain behind knee
- back pain
- No pain
•	Treatment
	ORIF (open reduction, internal fixation)
	Nonsurgical options
32
Q

Joint surgery

A 
•	Used to correct/repair:
	Unstabilized fx
	Deformity
	Joint disease (DJD)
	Necrotic or infected tissue
	Tumors
•	Most common procedures 
	ORIF
	Closed reduction with internal fixation
	Most common:  total joint arthroplasty or total joint replacement
33
Q

Joint replacement contraindications

A

: infection anywhere in body, advanced osteoporosis, rapidly progressive inflammation
 Uncontrolled DM or HTN: risk for major postop complications and possible death
• Most common are the hip and knee, but also can replace the finger, shoulder, elbow, wrist, and ankle
• Infection prevention
• Ambulation promotion

34
Q

Total hip arthroplasty (THA)

A

• Indications
- Pain interrupts pt’s sleep
- Pain limits ADLs
- Drug therapy no longer controls pain
- Pt must be able to participate in PT after surgery
• Primary arthroplasty - First time pt has THA
• Revision arthroplasty - Performed if implant loosens
• Most often performed in patients older than 60

35
Q

THA: complications

A
  1. Dislocation (subluxation or total dislocation)
    - Leg slightly abducted
    - Prevent hip flexion beyond 90 degrees
    - Assess for pain, rotation, shortening
  2. VTE (DVT and PE)
    - Most potentially life-threatening complication
    - Older, obese, hx of VTE – more at risk
    - Prevention – antiembolism stockings/SCDs, anticoags (LMWHs), early ambulation
  3. Infection
    - Can occur during hospitalization, or months/years after
    - Monitor incision and VS
    - Watch for elevated temp, excessive or foul-smelling drainage
    - Older pt may just have confusion!
36
Q

Knee Replacement

A 
•	Indications
•	Nursing management
•	Complications
- Excessive drainage
- DVT
- Infection
37
Q

Osteomyelitis

A

• Can occur in 1 of 3 ways…
- Exogenous – surgery, open fx, traumatic injury
- Endogenous/Hematogenous - spread from other sites of infection (most common)
- Contiguous – results from skin infection of adjacent tissues
• May be acute or chronic
• Most are staph
 Can also be Proteus, Pseudomonas, or E. Coli

38
Q

Osteomyelitis

A
  • Acute infection occurs more often in children
  • Chronic infection more common in adults (esp. with compromised blood supply)
  • Men > women
  • Malnutrion, ETOH, DM, kidney or liver disease, immune suppressing disorders increase risk and complicate Tx
39
Q

Osteomyelitis: S/s

A 
•	Acute infection
	Fever (usually above 38 degrees C)
	Swelling 
	Erythema/heat
	Tenderness
	Bone pain – constant, localized and pulsating – intensifies with movement 
•	Chronic infection
	Ulceration of skin
	Sinus tract formation
	Localized pain
	Drainage from affected area
40
Q

Osteomyelitis: S/s

A

• Signs and symptoms
 Hematogenous – septic manifestations and local symptoms
 Direct bone contamination or spread of adjacent infection – only local symptoms
 Chronic – continuously draining sinus, may have recurrent pain, inflammation, and swelling
• Diagnostics
 X-ray, radioisotope bone scan, MRI
 Blood studies, wound and blood culture

41
Q

Osteomyelitis: TX

A 
	Antimicrobial therapy
	Pain control
	Infection control 
	HBO
	If not effective, may need surgical intervention (Eg. bone graft, amputation)
42
Q

Acute Compartment Syndrome: early signs

A
  1. Pain
  2. Pressure
  3. Paralysis
  4. Paresthesia
  5. Pallor
  6. Pulselessness

Nursing (18 decks)

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