Week 1 Flashcards
What are common conditions of the upper extremities?
Musculoskeletal - upper extremities
Bursitis
* inflammation of bursae which are fluid-filled sacs that surround joints
Tendonitis
* inflammation of muscle tendon sheath (due to repetitive stretching)
Loose bodies (“joint mice”)
* breakdown of bone causing discomfort
* knees, hips, ankels, etc.
Impingement (shoulder injury)
Carpal tunnel syndrome
* Caused by repetition
* Affects the median nerve
* Tests: Tinel’s sign & Fallen sign
Ganglion (Cyst)
Dupuytren Contracture
* contraction of 4th & 5th finger
What are Tinel’s sign & Fallen sign and what are they used for?
Musculoskeletal - upper extremities
Used to check for Carpal Tunnel Syndrome
- Tinel’s Sign: tap on median nerve & see if pt has numbness or tinglng
- Fallen Sign: numbness & tingling in hands = carpel tunnel
What is dupuytren contracture?
Musculoskeletal - upper extremities
Contraction of the 4th & 5th finger
What are common conditions of the lower extremities / feet?
musculoskeletal - lower extremities
- Plantar Fasciitis
Corn & Callus
* overgrowth of thick layers of skin
Ingrown Toenail
* free edge of nail penetrates skin putting pt at risk of infection
Hammer toe
* wear open toed shoes
Hallux valgus (Bunion)
Flat Feet (pes planus)
What is osteoarthritis?
Musculoskeletal
Inflammation & breakdown of cartilage from wear & tear
- specific to certain joints
- characterized by discomfort, pain, swelling, warmth at the site
What are the two types of osteoarthritis?
Musculoskeletal
Primary: idiopathic
Secondary: result of another issue / dx
What re common risk factors for osteoarthritis?
Musculoskeletal - KNOW THIS!!!
- Older women
- Occupation with repetition
- Obesity
- Hx of frequent injury to a specific site
What is osteoarthritis? What are the 2 types? What are signs & symptoms?
Musculoskeletal - KNOW THIS!!!
Non-inflammatory degenerative disorder of the joints
1.) Primary: idiopathic; no known cause
2.) Secondary: result from prior injury or disease
Signs & Symptoms
* limited movement of affected joint
* pain
* stiffness (morning stiffness for first 30 minutes after waking up)
* slow decrease in ROM
* functional impairment
* NO SYSTEMIC SX
What are signs & symptoms of osteoarthritis?
Musculoskeletal - KNOW THIS!!!
- pain
- limited movement of affected joint
- morning stiffness
- slow decrease in ROM
- functional impairment
What are bone spurs?
musculoskeletal
bone enters the joint space causing the joint space to narrow
What is osteoporosis? What are known risk factors? What are the signs & symptoms? How is it treated?
Musculoskeletal - KNOW THIS!!!
decrease in bone mineral density & bone mass due to low calcium levels
Risk Factors: Age & hormonal changes (post menopause, underweight, certain meds, etc.)
Tx: calcium & vitamin D, bisphosphonates (give w/ full glass of water
Signs & Symptoms:
* Fractures
* Rounding of upper back (hunchback)
* Asymptomatic
* Inches of height
* Lower back pain
What is osteoporosis?
Musculoskeletal - KNOW THIS!!!
Low mineral density & bone mass due to low levels of calcium
Risk factors for osteoporosis
Musculoskeletal - KNOW THIS!!!
- Age & Hormonal changes
- Lifestyle
- LOW CALCIUM INTAKE
- Caucasian or Asain
- Inherited
- Underweight
- Medications
post-menopause, underweight, certain medications
Signs & Symptoms of Osteoporosis
Musculoskeletal - KNOW THIS!!!
- Fractures
- Rounding of upper back (hunchback)
- Asymptomatic
- Inches of height
- Lower back pain
What is the treatment for osteoporosis?
Musculoskeletal - KNOW THIS!!!
- Vitamin D & Calcium
- Bisphosphonates (give w/ full glass of water & on empty stomach)
What is Osteomalacia and what is the cause? What are signs & symptoms? What can this diagnosis lead to?
Musculoskeletal - KNOW THIS!!!
Softening & weakening of long bones (Rickets in children) due to Vitamin D deficiency
Signs & Symptoms:
* pain
* tenderness
* bowing of bones
* pathological fractures
* changes in gait
Can cause: GI disorders, hyperparathyroidism, renal insufficiency, dietary deficiency
What is osteomalacia & what causes it?
Musculoskeletal - KNOW THIS!!!
softening or weakening of long bones due to vitamin D deficiency
What are signs & symptoms of osteomalacia?
Musculoskeletal
- pain
- tenderness
- bowing of long bones
- changes in gait
- pathological fractures
What is Paget’s disease?
Musculoskeletal
localized bone turnover
Risk Factors: men, aging, familial predisposition
- usually asymptomatic
What is Septic Arthritis? What are the signs & symptoms? What is the treatment? Who is at risk for it?
Musculoskeletal - KNOW THIS!!!
infection of joint (synovial) fluid & joint tissues
Signs & Symptoms:
* warm
* painful joints
* decreased ROM
* signs of infection (fever, warmth, chills, etc.)
Treatment: immobilization of joint, pain releif, & abx
Risk: older adults & those with comorbidities (DM, HTN, etc.)
What is septic arthritis?
Musculoskeletal - KNOW THIS!!!
infection of joint (synovial) fluid & joint tissues
What are signs & symptoms of septic arthritis?
Musculoskeletal - KNOW THIS!!!
- painful joints
- warmth
- signs of infection (fever, chills, diaphoresis, erythema, edema, pain)
- decreased ROM
What is the treatment for septic arthrits?
Musculoskeletal - KNOW THIS!!–RED!
- Immobilization of Joints (for pain relief)
- Antibiotics
- Pain relief
What is osteomyelitis? What causes it? How does it spread? What are the signs & symptoms?
Musculoskeletal
Infection of the bone
Causes:
* due to soft tissue infection (pressure injury that went deep to bone)
* direct bone contamination - bone surgery w/ unclean tools
Bloodborne (spreads from one site to the next)
Signs & Symptoms
* pain
* edema
* drainage
* leukocytosis
* fever
* swelling
* redness
Malignant Bone Tumor:
Signs & symptoms
Musculoskeletal - KNOW THIS!!!
S&S of hypercalcemia due to bone loss from immoblity
- Decreased neuro excitement
- Bone pain
- Dysrhythmias
- Constipation
- Nausea & Vomiting
What measures should be taken for patients who have undergone hip prosthesis?
Musculoskeletal - KNOW THIS!!!
- Position the leg in ABDUCTION (to prevent dislocation)
- Do not flex hip more than 90 degrees
- Avoid internal rotation
Discharge Instructions for patients who have undergone joint replacements
Musculoskeletal - KNOW THIS!!!
- Take pain medications as directed
- Wear supportive stockings
- Schedule a specific appointment for staple removal
- Check for infection
- Provide HCPs, dentists, etc. information about joint replacement
- Don’t sit for more than 30 - 45 minutes
- Don’t cross your legs
A patient presents to the ED after falling from a roof. A fracture of the femoral neck is suspected. Which of these assesments best supports this diagnosis?
a.) The patient reports pain in the affected leg
b.) A large hematoma is visible in the affected extremity
c.) The affected extremity is shortened, abducted, & extremely rotated
d.) The affected extremity is edematous
Musculoskeletal
c.) The affected extremity is shortened, abducted, & extremily rotated
The morning of the second post-op day following hip surgery for a fractured right hip, the nurse will ambulate the patient. The first intervention is to:
a.) Get the patient up in a chair after dangling at the bedside
b.) Use a walker for balance when getting the patient out of bed
c.) Have the patient put minimal weight on the affected side when getting up
d.) Practice getting the patient out of bed by having her slightly flex her hips
Musculoskeletal
d.) Practice getting the patient out of bed by having her slightly flex her hips
The nurse is caring for a patient wiht a pelvic fracture. Which is the nurse’s priority action to prevent complications?
a.) monitor temperature daily
b.) insert a urethral catheter
c.) monitor BP frequently
d.) turn the patient every 2 hours
Musculoskeletal
c.) monitor BP frequently
What is a contusion?
Musculoskeletal Trauma - KNOW THIS!!!
soft tissue injury
- ecchymosis / hematoma
What is a strain?
Musculoskeletal Trauma - KNOW THIS!!!
Injury to muscle or tendon
- pain
- swelling
What is a sprain?
Musculoskeletal Trauma - KNOW THIS!!!
Torn or stretched ligament
- pain
- swelling
What is a joint dislocation?
Musculoskeletal Trauma - KNOW THIS!!!
Articulating surfaces of the joint are not in contact
- pain
- deformity
What is subluxation?
Musculoskeletal Trauma - KNOW THIS!!!
Partial or incomplete dislocation
How are soft tissue injuries treated?
Musculoskeletal Trauma - KNOW THIS!!!
- Rest
- Ice
- Compression
- Elevation
- Immobilization
What do pelvic & femur fractures put patients at high risk of developing?
Musculoskeletal Trauma
Hemorrhage & fat emoblisms
What is a fat embolism? What are signs & symptoms? What can cause this?
Musculoskeletal Trauma - KNOW THIS!!!
Fat globules move into the blood stream & block blood vessels after long bone fractures occur
Signs & Symptoms:
* Hypoxemia
* Neuro compromise
* PETECHIAE w/out blancing
* Tachypnea
* Tachycardia
* Chest pain
* Low-grade fever
* Crackles
What is a fat emoblism?
Musculoskeletal Trauma - KNOW THIS!!!
Fat globules move into the blood stream & occlude major blood vessels
What causes fat embolisms to occur?
Musculoskeletal Trauma - KNOW THIS!!!
long bone fractures
What are signs & symptoms of fat emboli?
Musculoskeletal Trauma - KNOW THIS!!!
- Hypoxemia
- Neuro compromise
- PETECHIAE RASH W/OUT BLANCHING
- Tachypnea
- Tachycardia
- Chest pain
- Low grade fever
- Crackles
What is compartment syndrome? What are signs & symptoms? How is it treated?
Musculoskeletal Trauma - KNOW THIS!!!
Compromised circulation due to high pressure (swelling or bleeding) within a muscle compartment (of an extremity)
Signs & Symptoms:
* UNRELENTING PAIN OUT OF PROPORTION TO INJURY
* Pain medications DON’T help
* Decrease in pulse strength (late sign)
* Numbness & tingling (middle sign)
Treatment: Fasciotomy
What are signs & symptoms of compartment syndrome?
Musculoskeletal Trauma - KNOW THIS!!!
- UNRELENTING PAIN OUT OF PROPORTION TO INJURY
- Pain medications DON’T help
- Numbness & tingling (mid stage)
- Decrease in pulse strength (late stage)
Cast Care
- How to deal with an itch
- Purpose
- Positioning
- Signs & Symptoms to Report
- Cast Assessment
Musculoskeletal Trauma
- Don’t cover with plastic & keep the cast dry
- Don’t put anything in/down it for itching & don’t scratch; use antihistamines
- Purpose: immobilize a reduced fracture, correct a deformity, apply uniform pressure to soft tissue, support to stabilize a joint
- Positioning: Elevate extremity & use a sling
Signs & Symptoms to report:
* persistent pain or swelling
* changes in sensation
* movement
* skin color or temperature changes
* signs of infection or pressure areas
Assessment: Monitor neurovascular status & for potential complications
Non-Plaster (fiberglass): lighter, HEAT activated
Plaster: heavier, cold activated
What is Buck’s Traction?
Musculoskeletal Trauma - KNOW THIS!!!
Skin Traction
- Uses: fractures, broken bones, correct contractures or deformities, knee immobilization
Uses weights as traction
Traction Care Assessment
Musculoskeletal Trauma - KNOW THIS!!!
- Temperature
- Ropes hang freely
- Alignment
-
Circulation Checks
- Pallor
- Paresthesia
- Pain
- Paralysis
- Pulse (late sign of compartment syndrome)
- Type & location of fracture
- Increased fluid intake
- Overhead trapeze
- No weights on the bed or floor
How often should pin sites for patients with traction be checked & cared for?
Musculoskeletal Trauma - KNOW THIS!!!
Every 8 hours
What is phantom limb pain?
Musculoskeletal Trauma - KNOW THIS!!!
Perception of pain or discomfort of a limb that’s no longer there
- Experienced immediately to post-op up to 2-3 months after amputation
- Feeling that extremity is crushed, cramped, twisted into abnormal position, (might be) intense burning, cramping, etc.
The nurse is caring for a patient iwth Buck’s traction & is monitoring the patient for complications of the traction. Which assessment finding indicates a complication?
a.) Weak pedal pulses
b.) Drainage at the pin sites
c.) Complaints of discomfort
d.) Warm toes with brisk capillary refills
Musculoskeletal Trauma
a.) Weak pedal pulses
How often must the nurse inspect the traction pin site for signs of inflammation & evidence of infection?
a.) Every 2 hours
b.) Every 4 hours
c.) Every 8 hours
d.) Every 16 hours
Musculoskeletal Trauma
c.) Every 8 hours
Which patient is NOT at risk for osteoporosis?
a.) A 50-year-old female whose last menstrual period was 7 years ago
b.) A 45-year-old male patient who has been taking glucocorticoids for the last 6 months
c.) A 30-year-old male who drinks alcohol occasionally & has a BMI of 28
d.) A 35-year-old female who has a history of seizures & takes Dilantin regularly
Musculoskeletal Trauma
c.) A 30-year-old male who drinks alcohol occasionally & has a BMI of 28
Amputations
- Nursing Interventions
- Complications
Musculoskeletal Trauma - KNOW THIS!!!
Nursing Interventions:
* Assist the patient with achieving physical mobility
Complications: Phantom limb pain, infection, etc.
List & explain the different types of burns
Burn Management
First Degree: superficial
* sunburn
Second Degree: partial thickness
* dermis & epidermis ; shiny & moist; red/pink; blisters present; scars left behind; blanching is present
Third Degree: full thickness
* epidermis, dermis, hair follicles, sweat glands, & nerves destroyed; skin will not heal; black, yellow, or red; matte / dry; eschar (burned, dead tissue)
Fourth Degree: deep full thickness
* all layers of skin are destroyed
* extends to muscles, ligaments, & bone
* black & charred
* no sensation
* skin graft needed
What are the phases of burn injury?
Burn Management
1.) Emergent / Resuscitative: onset of injury –> completion of fluid resuscitation
2.) Acute / Intermediate: beginning of diuresis –> wound closure
3.) Rehabilitation: wound closure –> return of physical & psychosocial adjustment
What are the primary goals during the EMERGENT (resuscitative) phase of burn injury?
Burn Management - KNOW THIS!!!
- Stop the injury: extinguish flames, cool the burn, irrigate chemical burns
- ABCs: establish airway, breathing, & circulation
- Start O2 & large bore IVs
- Remove restrictive objects & cover all wounds
What are the primary goals during the ACUTE (intermediate) phase of burn injury?
Burn Management - KNOW THIS!!!
- Begin fluid resuscitation
- Insert foley catheter
- Patient w/ burns exceeding 20 - 25% shoudl have NG tube & suction
Nursing Management of Patients with Burn Injury?
Burn Management - KNOW THIS!!!
- ABCs
- Vitals & hemodynamic status
- Monitor for fluid volume deficit
- Assess extent of burn
What are complications & collaborative problems associated with burns?
Burn Management - KNOW THIS!!!
- Acute respiratory failure
- Acute renal failure
- Heart failure & pulmonary edema
- Sepsis
