TOPIC 10 - musculoskeletal Flashcards
neurovascular assessment
1) Pain
2) Paresthesia
3) Pallor
4) Paralysis
5) Pulselessness
6) Poikilothermia
types of fractures
transverse
spiral
greenstick
comminuted
oblique
pathologic
stress
care for closed reduction fracture (not open)
splint first to align bone
cast placed once swelling goes down
traction
fracture of hip, femur, etc
need all in alignment to heal (need something pulling/weight)
bucks
skeletal
surgeries for fractures
open reduction and internal fixation
external fixation devices
hip replacement
cast care
immoblize, PRICE (protection, rest, ice, compression, elevation)
when pt should call the doctor with cast
increased or severe pain
warm or painful spot
problems with the cast (skin burns, too tight, swelling, new fever, drainage, foul smell), food or hand is cool or pale, numbness and tingling, trouble moving extremities, blot clot symptoms (pain, redness, swelling), if cast is breaking apart, you are not getting better as expected
traction definition
application of pulling force to a part of the body to provide reduction, alignment, rest, decrease muscle spasm, correct deformity and tissue damage
purpose of skin traction
decrease painful muscle spasms, stabilize fracture, involves velcro boot, weights are used as pulling force, weights should hang freely, skin assessment is crucial
purpose of skeletal traction
decrease painful muscle spasm, stabilize fracture, pins and wires are inserted into skin and bone for external fixation, provide pin care, assess signs of infection at pin sites
ORIF pre op
neurovascular status of affected limb, vitals, pain and spasms, bucks traction, NPO, consent, skin integrity, DVT
total joint arthroplasty definition
surgical removal of a diseased or fractures joint and replaced with a metal or plastic joint
can be partial or total
what to assess for total joint arthroplasty
risk factors (including meds), musculoskeletal, mobility and function, pain, weight bearing
if the femur neck is broken …
hip replacement
primary concern with hip replacement
assessment and prevention of neurovascular dysfunction or compromise (can decrease arterial perfusion and increase risk of complications)
hip replacement assessment / prep
perform neurovascular assessment, evaluate circulation, movement, sensation, assess skin color and temp, sensation, mobility, pain, pulses distal to fracture, leg length, external rotation, adduction
risk factors specific to hip fractures
female
over 80
hx osteoporosis
low estrogen / menopausal
imbalance and falling
diagnostics with hip fractures
standard X-rays (reveal bone disruption, malalignment, deformity)
CT is useful for complex fractures / identify compression fractures of the spine
MRI is useful in determining amount of soft tissue damage / visualize avascular necrosis
ECG - cardiac issues
labs for hip fractures
CBC
BMP
UA
C&S
BG for diabetics
liver enzymes
post op care for hip fractures
cough and deep breath
stocking and compression to decrease risk of DVT or stasis
turn every 2 hr
leg abduction
pain control
walk asap
mobilize asap
assess under client for drainage and blood
complications of hip fractures
DVT
neurovascular - bleeding, swelling
atelectasis
pneumonia
pressure ulcer
urinary retention
infection
nonunion
symptoms of dislocation
sudden onset pain
inability to move leg
shortening and external rotation of leg
post op care of hip fracture
abduction pillow
floating heels
assess infection
assist with mobility for ortho hypo
TCDB
get out of bed when appropriate
pain management
reorient as needed
discharge prep
hip precautions
pain management
incision care
when to call 911
follow up
exercises
DVT prevention
difference in complications (knee vs hip replacement)
knee is at less risk for fat embolism
potential complications of fractures
compartment syndrome - 6 P’s, fasciotomy
rhabdomyolysis - CK, CKMM, IV fluids, monitor Crt
hypovolemic shock - fluids, PRBC
fat embolism
VTE - SCD, lovenox
osteomyelitits - WBC, VS, antibiotics
delayed union - surgery, ORIF
risk factor for amputation
previous amputation for foot ulcers
diabetic
collaborative problems for orthopedic client
Pain
Neurovascular alteration
Altered Mobility
Risk for Falls
Risk of Infection
Risk of Constipation
Activity Intolerance
Knowledge Deficit
Psych-Social
