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Med surg I > Orthopedic disorders > Flashcards

Orthopedic disorders Flashcards

1
Q

Fractures

A

Disruption or break in continuity of structure of bone
Majority of fractures from traumatic injuries
Some fractures secondary to disease process
Cancer or osteoporosis

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2
Q

Classification of fracture

A

Complete or incomplete
Complete: break is completely through bone
Incomplete: bone is still in one piece

Based on direction of fracture line
Linear/Longitudinal
Oblique
Transverse
Spiral

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3
Q

Clinical Manifestations of fracture

A

Localized pain
Decreased function
Inability to bear weight or use
Guard against movement
May or may not have deformity
Immobilize if suspect fracture!!!!

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4
Q

Fracture Healing

A

Multistage healing process (union)
Fracture hematoma
Granulation tissue
Callus formation
Ossification
Consolidation
Remodeling

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5
Q

Interprofessional Care

A

Overall goals of fracture treatment
Anatomic realignment (reduction)
Immobilization
Restoration of normal or near-normal function

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6
Q

Closed reduction

A

Nonsurgical, manual realignment of bone fragments
Traction and counter-traction applied
Under local or general anesthesia
Immobilization afterwards

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7
Q

Open reduction

A

Surgical incision
Internal fixation
Risk for infection
Early ROM of joint to prevent adhesions
Facilitates early ambulation

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8
Q

Traction purpose

A

Purpose
Prevent or ↓ pain and muscle spasm
Immobilize joint or part of body
Reduce fracture or dislocation
Treat a pathologic joint condition

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9
Q

Skin traction

A

Short-term (48-72 hours)
Tape, boots, or splints applied directly to skin
Traction weights 5 to 10 pounds
Skin assessment and prevention of breakdown imperative

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10
Q

Skeletal traction

A

Long-term pull to maintain alignment
Pin or wire inserted into bone
Weights 5 to 45 lbs
Risk for infection
Complications of immobility
Maintain counter-traction, typically the patient’s own body weight
Elevate end of bed
Maintain continuous traction
Keep weights off the floor

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11
Q

Fracture Immobilization

A

Cast
Temporary
Allows patient to perform many normal activities of daily living
Made of various materials
Typically incorporates joints above and below fracture

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12
Q

Upper Extremity Immobilization

A

Sling
To support and elevate arm
Contraindicated with proximal humerus fracture
Ensures axillary area is well padded
No undue pressure on posterior neck
Encourage movement of fingers and nonimmobilized joints

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13
Q

Vertebral Immobilization

A

Body jacket brace
Immobilization and support for stable spine injuries
Monitor for superior mesenteric artery syndrome (cast syndrome)
Assess bowel sounds
Treat with gastric decompression

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14
Q

Lower Extremity Immobilization

A

Long leg cast
Short leg cast
Cylinder cast
Robert Jones dressing

Elevate extremity above heart
Do not place in a dependent position
Observe for signs of compartment syndrome and increased pressure

Hip spica cast
Single spica
Double spica
Assess patient for same problems as body jacket brace

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15
Q

External Fixation

A

Metal pins and rods
Applies traction
Compresses fracture fragments
Immobilizes and holds fracture fragments in place
Assess for pin loosening and infection
Patient teaching
Pin site care

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16
Q

Nutritional Therapy

A

↑ Protein (1 g/kg of body weight)
↑ Vitamins (B, C, D)
↑ Calcium, phosphorus , and magnesium
↑ Fluid (2000-3000 mL/day)
↑ Fiber
Body jacket and hip spica cast patients: six small meals a day

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17
Q

Neurovascular Assessment

A

Peripheral vascular
Color and temperature
Capillary refill
Pulses
Edema

Peripheral neurologic
Motor function
Upper and lower extremities
Sensory function
Paresthesia

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18
Q

Postoperative Care

A

Monitor vitals
General principles of nursing care
Frequent neurovascular assessments
Minimize pain and discomfort
Monitor for bleeding or drainage
Aseptic technique
Blood salvage and reinfusion

19
Q

Ambulatory Care Cast Care

A

Frequent neurovascular assessments
Apply ice for first 24 hours
Elevate above heart for first 48 hours
Exercise joints above and below
Use hair dryer on cool setting for itching
Check with health care provider before getting wet

Dry thoroughly after getting wet
Report increasing pain despite elevation, ice, and analgesia
Report swelling associated with pain and discoloration OR movement
Report burning or tingling under cast
Report sores or foul odor under cast

20
Q

Ambulatory Care Cast Care Do not

A

Elevate if compartment syndrome
Get plaster cast wet
Remove padding
Insert objects inside cast
Bear weight for 48 hours
Cover cast with plastic for prolonged period

21
Q

Compartment Syndrome

A

Swelling and increased pressure within a confined space
Compromises neurovascular function of tissues within that space
Usually involves the leg but can occur in any muscle group

Two basic types of compartment syndrome
↓ Compartment size
↑ Compartment contents
Arterial flow compromised → ischemia → cell death → loss of function

Early recognition and treatment essential
May occur initially or may be delayed several days
Ischemia can occur within 4 to 8 hours after onset

22
Q

Compartment Syndrome Clinical Manifestations (6 p’s)

A

Pain – unrelieved by drugs and disproportional to injury
Pressure
Paresthesia – usually an early sign
Pallor
Paralysis
Pulselessness

23
Q

Compartment SyndromeInterprofessional Care

A

NO elevation above heart
NO ice
Surgical decompression (fasciotomy)

24
Q

Complications of Fractures

A

Majority heal without complication
Death is usually the result of
Damage to underlying organs and vascular structures
Complications of fracture or immobility
May be direct or indirect

25
Q

Infection

A

High incidence in open fractures and soft tissue injuries
Devitalized and contaminated tissue an ideal medium for pathogens
Prevention key
Can lead to chronic osteomyelitis

26
Q

Venous Thromboembolism

A

High susceptibility aggravated by inactivity of muscles
Prophylactic anticoagulant drugs
Antiembolism stockings
Sequential compression devices
ROM exercises

27
Q

Fat Embolism (FES)

A

Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury
Contributory factor in many deaths associated with fracture
Most common with fracture of long bones, ribs, tibia, and pelvis

28
Q

Fat Embolism (FES)Clinical Manifestations

A

Early recognition of FES is crucial
Symptoms 24 to 48 hours after injury
Fat emboli in the lungs cause a hemorrhagic interstitial pneumonitis.
Respiratory and neurologic symptoms
Petechiae – neck, chest wall, axilla, buccal membrane, conjunctiva

Clinical course of fat embolus may be rapid and acute
Patient frequently expresses a feeling of impending disaster
In a short time skin color changes from pallor to cyanosis
Patient may become comatose

29
Q

Fat Embolism (FES)Interprofessional Care

A

Treatment is directed at prevention
Careful immobilization and handling of a long bone fracture probably the most important factor in prevention
Management is supportive and related to symptom management

30
Q

Osteoporosis

A

Chronic, progressive metabolic bone disease marked by
Low bone mass
Deterioration of bone tissue
Leads to increased bone fragility

Over 54 million people in the United States
One in 2 women and 1 in 4 men over 50 will sustain an osteoporosis-related fracture
Known as the “silent thief”
Why more common in women?
Lower calcium intake
Less bone mass
Bone resorption begins earlier and becomes more rapid at menopause
Pregnancy and breastfeeding
Longevity

31
Q

Risk factors Osteoporosis

A

Risk factors
Advancing age (>65 yr)
Female gender
Low body weight
White or Asian
Current cigarette smoking
Prior fracture
Sedentary lifestyle
Family history
Diet low in calcium/vitamin D deficiency
Excessive use of alcohol (>2 drinks/day)
Low testosterone in men
Specific diseases
Certain drugs

32
Q

Interprofessional Care osteoporosis

A

Supplemental calcium
Take in divided doses
Calcium carbonate
40% elemental calcium
Take with meals
Calcium citrate
20% elemental calcium
Less dependent on stomach acid

Weight-bearing exercise
Build up and maintain bone mass
Increase strength, coordination, balance
Walking, hiking, weight training, stair climbing, tennis, dancing
Quit smoking
Decrease alcohol intake

33
Q

Calcitonin

A

Inhibits bone resorption
Give IM form at night to minimize side effects
Alternate nostrils when using nasal form
Calcium supplementation is needed

34
Q

Osteoarthritis (OA)

A

Slowly progressive noninflammatory disorder of the diarthrodial joints

35
Q

Etiology and Pathophysiology OA

A

Gradual loss of articular cartilage
Formation of osteophytes
Not normal part of aging process
Cartilage destruction
Begins between ages 20 and 30
Symptoms do not manifest until after age 50–60
After age 50, women > men

Caused by direct damage or instability
Risk factors
Age
Decreased estrogen at menopause
Obesity
Anterior cruciate ligament injury
Frequent kneeling and stooping
Regular exercise can help prevent

Inflammation is not the primary cause
Secondary synovitis (inflammation of synovial joint) may result
Contributes to early pain and stiffness
Pain in later disease when articular cartilage is lost and bony joint surfaces rub on each other

36
Q

Clinical ManifestationsJoints OA

A

Joint pain
Primary symptom ranging from mild discomfort to significant disability
Pain worsens with joint use
Early stages: rest relieves pain
Later stages: pain with rest and trouble sleeping due to increased joint pain

Joint stiffness occurs after periods of rest or unchanged position
Early morning stiffness usually resolves within 30 minutes
Overactivity → mild joint effusion, temporarily ↑ stiffness
Crepitation
Asymmetrical

37
Q

Clinical ManifestationsDeformity OA

A

Specific to involved joint
Heberden’s nodes (DIP joint) and Bouchard’s nodes (PIP joint)
Red, swollen, and tender
No significant loss of function
Visible deformity
Knee: bowleg, knock-kneed
Hip: one leg shorter

38
Q

Interprofessional Care Rest and Joint Protection OA

A

Balance rest and activity
Rest during acute inflammation
Functional positioning
Do not be immobilized > 1 week
Modify activities to ↓ joint stress
Avoid prolonged standing, kneeling, squatting (knee OA)
Assistive device as needed

39
Q

Interprofessional Care Drug Therapy OA

A

Based on severity of patient’s symptoms
Mild to moderate joint pain
NSAIDS (ibuprofen, enoxaparin)
Topical agent (e.g., capsaicin cream [Zostrix])
OTC creams (BenGay, ArthriCare)
Topical salicylates (e.g., Aspercreme)

40
Q

Joint Replacement OA

A

Joint replacement may be needed if pain incapacitating
Artificial knee
Artificial hip

Most common joints for replacement

41
Q

Rheumatoid Arthritis (RA)

A

Chronic, systemic autoimmune disease
Inflammation of connective tissue in diarthrodial (synovial) joints
Periods of remission and exacerbation
Extraarticular manifestations

Affects all ethnic groups
Incidence ↑ with age, peaks between ages 30 and 50
Estimated 1.5 million Americans
Three times as many women as men

42
Q

Etiology and Pathophysiology RA

A

Autoimmune etiology
Combination of genetics and environmental triggers
Antigen triggers formation of abnormal immunoglobulin G (IgG)
Autoantibodies develop against the abnormal IgG
Rheumatoid factor (RF)
Without adequate treatment
More than 60% may develop marked functional impairment within 20 years
Need of mobility aids
Loss of self-care ability
Need for joint reconstruction
By end-stage patients experience loss of independence, require daily care

43
Q

Drug Therapy: DMARDs-Disease-modifying anti-rheumatic drugs

A

↓ Permanent effects of RA
Methotrexate
Monitor for bone marrow suppression and hepatotoxicity
Sulfasalazine (Azulfidine)
Hydroxychloroquine (Plaquenil)
Baseline and then yearly eye exam

Corticosteroid therapy
Intra-articular injections
Low-dose oral for limited time
NSAID and salicylates
Anti-inflammatory, analgesic, and antipyretic
May take 2 to 3 weeks for full effectiveness

Med surg I (11 decks)

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