skin/bone Flashcards
How does impaired circulation happen w casts
exothermic reaction from plaster= vasodilation= edema= impaired circulation
Whys osteomyelitis hard to treat
a capsule (sequestrum) forms which is a ring of dead tissue w/o blood flow WBC and ESR elevated
2point gait
3 point
4 point
swing
2-crutch opposite of leg
3- both crutches w non weight bearing leg
4- r crutch, l foot, l crutch, R foot
swing- both crutches forward, swing foot past crutches
Whats Lupus
inflammatory autoimmune disease affecting JOINTS, BUTTERFLY RASH, renal, seizures, arrythmias, peri neuropathy
LUPUS dx
ANA 99%, RF 15-35, ^ESR, gamma globulin, decreased WBCs and PLTs
LUPUS meds
nsaids for arthalgia
antimalarials for inflammation
steroids for exacerbations
Immunosuppressive ctoxan, immuran
Osteoarthritis
MEN{NONinflammatory decrease in weight bearing cartilage
Osteoarthritis S/s
pain releived w rest, worse w activity, assymetric, herbeden (distal), bouchard ( prox), bow legged, one leg shorter
Osteoarthritis dx
synovial fluid has bone chips, cartilage is yellow
Osteoarthritis treatment
apply heat or cold to help pain/stiffness, intraarticular injections of corticosteroids for pain w effusion, hylauronic acid
Rheumatoid arthritis
WOMEN{systemic autoimmune inflammatory, worse in morning
RA comps
ulnar deviation, swan neck, joint subluxulation, subq nodules
RA dx
^esr, rf, ana (inflammatory),
RA treatment
heat/cold for pain stiffness NOT in acute flares, antiinflammatory, antirheumatics (antimalarial, gold, penicillamine, sulfasalazine) if aggressive w erosions=dmards (immunosuppressant), systemic steroids to counteract flares, inject into problem joints
Knee replacement activity, Drainage,
more active than hip, cpm machine, 200ml 1st 8hrs, decrease to less than 25 ml 48hrs
Carpal tunnel phalen test
wrists together one minute
Carpal tunnel tinels test
tap on medial nerve
Incomplete fracture
bending/crushing
Simple fracture
closed reduction
comminuted
multiple pieces (open reduction)
Open/ compound fracture
surgical debridement
early movement with
open reduction w/ internal fixation
skin traction, bucks
48-72 hrs until skeltal traction, bucks stops hip flexion, decreases muscle spasms
Skeletal traction
long term keeps bones aligned w pins, wire
Hip fracture s/s
external rotation, muscle spasms, shortening of leg, displaced femoral head=necrosis
hip fracture post op
OOB day one, assess sense/function, keep pillow between legs 6 wks, anterior more stable post op; 350 ml drain 1st 24hrs
After Hip replacement do NOT
climb stairs (3mo) flex hips>90 degrees (low chairs) adduct, internal rotation, cross legs
S/s of hip prosthesis dislocation
sudden pain, lump in butt, limb shortening, external rotation
Osteoporosis
imbalance between osteoclasts &blasts, secondary to long term steroid therapy
osteoporosis DX
DXA measures hip &spine density (accurate), Bone sonometer measures heel and peripheral sites (easy)
Osteoporosis drugs
biphosphanates ( slow clasts,^bone mass), fosamax (empty stomach, upright 30min), calcitonin IM SQ Nasal, SERMS mimick estrogen in decreasing bone reasborption=hot flash, leg cramps
repositioning chair vs bed
2hrs bed, 1hr chair
stage two pressure ulcer
partial thickness, shallow pink wound bed OR intact/open blister w serum in it
stage 3 pressure ulcer
full thickness tissue loss, subq fat, undermining, and tunneling
stage 4 pressure ulcer
full thickness loss w exposed bone, tendon, or muscle, undermining, tunneling
What to use to clean pressure ulcers
noncytoxics bc they dont damage fibroblasts
