Flashcards in Exam #2 Part 2 Deck (157):
Who gets osteoporosis?
Caucasian/Asian postmenopausal women, sedentary lifestyle, decreased calcium intake, lack of Vitamin D, excessive alcohol use, cigarette smoking, excessive caffeine intake.
What are s/s of osteoporosis?
Dowager's Hump (Kyphosis), height decreases, back pain, fractures (high risk)
What health promotion can be done to minimize your risk of getting osteoporosis?
Ensure adequate calcium intake, avoid sedentary life style, continue program of weight-bearing exercises
What are some therapeutic interventions for osteoporosis?
Increase Calcium/Vitamin D supplements, hormone replacement therapy, parathyroid hormone, Alendronate (Fosamax), Risedronate (Actonel), Raloxifene (Evista), Teriparatide (Forteo)
What are the most common sites for fracture in osteoporosis?
Vertebrae (T-8 and below), Colle's (wrist), and hips
What is Osteomyelitis?
A bone infection caused by the invasion by one or more pathogenic microorganisms that stimulates the inflammatory response in bone tissue
What is the most common cause of Osteomyelitis?
What reaction does Osteomyelitis cause?
It stimulates an inflammatory response.
What are the s/s of Osteomyelitis?
Fever, redness, heat, pain, swelling
What are the different treatments for Osteomyelitis?
Prevention is key, drug therapy, infection control, and surgical management
What drug therapy is used for Osteomyelitis?
Long-term antibiotic therapy - IV antibiotics for several weeks followed by oral antibiotics. They do NOT have to be hospitalized for the tx. Can insert PICC line and have IV abx at home with possible home health care.
What infection control measures are taken for Osteomyelitis?
Sterile dressing changes and antibiotics (open wounds can lead straight to the bone)
What surgical management techniques are used for Osteomyelitis?
I&D (Incision & Drainage), Sequestrectomy (removal of dead infected bone & cartilage), amputation, bone grafting (if repeated infections), bone segment tx, muscle flaps
Describe the pathophysiology of Padget's disease.
Increased bone loss and disorganized bone deposition.
What are the s/s of Padget's disease?
Usually no s/s, but bowed legs eventually occurs.
Can anything help slow the progression of Padget's disease?
What can be done therapeutically for a pt with Padget's disease?
Relieve pain, teach, promote life quality.
What is the difference between an open and closed fracture?
Open fracture has a break in the skin (even if no bone is showing) and closed fractures do NOT break the skin
What are the 12 types of fractures?
Avulsion, comminuted, impacted, greenstick, interarticular, displaced, pathologic, spiral, longitudinal, oblique, stress, and transverse.
Describe an avulsion fracture.
A piece of bone breaks away, usually attached to a piece of tendon or ligament.
Describe a comminuted fracture.
Broken, splintered or crushed into a number of pieces.
Describe an impacted fracture.
One in which one fragment is firmly driven into the other.
Describe a greenstick fracture.
One side of a bone is broken, the other being bent.
Describe an interarticular fracture.
Into the articular space of a joint.
Describe a displaced fracture.
2 ends are separated sideways.
Describe a pathologic fracture.
From a disease inside the bone.
Describe a spiral fracture.
Its spiral like a spiral staircase.
Describe a longitudinal fracture.
Describe an oblique fracture.
Describe a stress fracture.
Describe a transverse fracture.
Straight across/still touching.
What are some causes of fractures?
Trauma (#1 cause) and pathological (from disease like bone CA)
What are s/s of a fracture?
Pain, decreased ROM, limb rotation, deformity/shortening of limb, bruising, and swelling (usually won't see a lot of swelling with a fracture - takes a few hours).
What are some emergency treatments for a fracture?
Splint it as it Lies!!! (do NOT straighten) and seek medical treatment.
What are some goals of fracture management?
Realignment of bone ends and immobilization.
What term describes manual manipulation to realign bones and how is immobilized afterwards?
Closed reduction followed by application of a cast.
What term describes a surgical procedure where the affected area is opened up and pins/screws are inserted?
ORIF. Open Reduction with Internal Fixation.
What term describes a surgical procedure where the affected area has pins/screws on the outside?
What is an external fixator?
Device used to keep the bones aligned. Used if fractures are complex with soft tissue damage or open wounds in the fractured area.
When performing post op care on a fracture patient, what 2 serious complications must be monitored for?
Fat embolism and Pulmonary Embolism (PE).
What is a fat embolism?
Bone marrow contains fat cells that can be dislodged during injury.
What is the #1 bone that a patient would get a fat embolism in and why?
In the femur because it is the largest and contains more bone marrow.
What are s/s of an embolism?
Tachycardia, tachypnea, SOB, and altered mental status.
What is done if an embolism is suspected?
Apply O2, place pt in the high Fowler's position, call MD, stay with the pt, and keep them on bedrest.
What is another assessment is done with a post op fracture pt other than fat embolism and PE?
What are casts usually made of?
Plaster, fiberglass, polyester/cotton.
What should the client be instructed to do while in a cast?
Apply ice to each side of cast and elevate extremity to decrease swelling. Wiggle toes or fingers to improve circulation. Don't stick foreign objects into cast. Instruct on s/s of decreased circulation.
What is the term for spitting a cast?
What is done for a patient with a cast if swelling occurs?
Elevate extremity above heart level and re-evaluate in 15-20 minutes FIRST! If not better, then notify MD, may have you cut the cast if appears to be too tight. MUST HAVE MD ORDER TO CUT CAST!
What assessments must be done for a patient in a cast?
Neurovascular checks (sensation and movement) distal to cast (report decreased sensation, pulse, coldness, cyanosis, inability to move digits, tingling or numbness). Note odor from cast that may indicate infection. Bleeding on cast if surgical client.
Why should a patient in traction be centered in their bed?
So the affected extremity doesn't touch the head or foot of the bed.
What are 2 types of traction named after the way they are attached?
Skin and skeletal.
What are the 3 styles of traction devices?
Buck's, Cervical and Pelvic.
What is Buck's traction?
Exerts straight pull on the affected extremity.
What is cervical traction?
Head halter attached to weights that hang over head of bed (for cervical spine alignment and reduce spasms).
What is pelvic traction?
Girdle with extension straps attached to ropes and weights (used for low back pain, to reduce spasms, and maintain alignment).
What type of traction devices are Buck's, cervical, and pelvic?
Skin traction. Weights are attached to a device that covers the affected limb.
How is a skeletal traction device used?
Applied directly to bones using pins, wires or tongs that are surgically inserted. Used for fractured femurs, tibias, humerus, and cervical spine.
What does the acronym "TRACTION" stand for?
T = Temperature of the extremity; R = Ropes hang freely; A = Alignment; C = Circulation Check (6 P's); T = Type & location of fracture; I = Increase fluid intake; O = Overhead trapeze; N = No weights on bed or floor
What is the treatment of choice for a broken hip, especially in the elderly?
Surgical repair - ORIF, which may include Intramedullary (IM) rod (rod goes into the bone marrow in the femur by use of a hammer), pins, a prosthesis, or a fixed sliding plate.
In post op care of a hip replacement patient, what leg movement must be restricted?
Hip adduction and external rotation.
What are some complications of fractures?
Nonunion, neurovascular compromise, hemorrhage, infection, thromboembolitic complications, acute compartment syndrome, and fat embolism syndrome.
What is fat embolism syndrome?
Serious complication resulting from a fracture; fat globules are released from yellow bone marrow into the bloodstream.
What are s/s of a fat embolism?
Tachypnea, confusion, restlessness, low O2 saturation.
What needs to be done if a fat embolism is suspected?
Need to immediately apply oxygen if patient exhibits s/s, THEN notify physician.
What are the s/s of ACS (Acute Compartment Syndrome)?
Six "P's": pain, parathesia, paralysis, pallor, pulselessness, poikilothermia.
What are the pathophysiologic changes occuring with ACS sometimes called?
In ACS, how long before damage occurs and how long before limb can become useless?
Within 4-6 hrs after the onset of ACS neuromuscular damage is irreversible; the limb can become useless within 24-48 hrs.
What is ACS (Acute Compartment Syndrome)?
Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area.
What do you need to monitor in ACS?
Prevention of pressure buildup of blood or fluid accumulation.
What does a Fasciotomy do and what needs to be done afterwards?
It's done to relieve the pressure. The wound needs to be packed and dressed.
What are some possible results of ACS?
Infection, motor weakness, Volkmann's contractures, and Myoglobinuric renal failure (known as rhabdomyolysis).
What are some nursing diagnoses for fractures?
Acute pain; Impaired physical mobility; Impaired walking; Ineffective health maintenance; Risk for peripheral neurovascular dysfunction; Risk for ineffective tissue perfusion; Risk for ineffective skin integrity.
Why are surgical amputations done?
Ischemia from peripheral vascular disease, bone tumor, frostbite, congenital problems, and infections.
What is done when a body part has been severed?
Wrap it in cool, slightly moist cloth; place in sealed plastic bag submerged in cold water; transport to hospital.
What are the 4 levels of amputations?
Below-the-knee, Above-the-knee, Below-the-elbow, and Above-the-elbow.
What is BKA?
What is AKA?
What is BEA?
What is AEA?
What nursing care needs to be done postoperatively?
Hemorrhage prevention, infection, pain control, mobility and ambulation, prosthesis, and lifestyle adaptation.
What is a frequent complication of amputation?
How is phantom pain usually described?
Intense burning feeling, crushing sensation or cramping. Some clients feel that the removed body part is in a distorted position.
What is the difference between phantom and residual pain?
Residual, also called stump pain, originates in the nerve endings in the stump.
What drugs are not as effective for phantom pain?
What drugs are used for residual limb pain?
Neurontin & Elavil for nerve pain, Inderal (beta-blocker) for burning sensations, Dilantin for knife-like pain.
How long must the stump be elevated after an amputation?
The first 24 hours.
What bed position is discouraged in an AKA amputation and why?
Discourage Semi-Fowler's position in client with AKA to prevent contractures of the hip.
What should be applied to the stump after it is healed to prevent skin problems?
Do NOT apply anything to stump: Alcohol dries it & Lotion makes the skin too soft.
Why should a client be encouraged to wear his prosthesis all day?
To prevent stump swelling.
What is arthroscopy?
Fiber-optic tube inserted in joint for direct visualization.
What must be monitored after an arthroscopy?
Neurovascular checks on affected extremity, assessment of pulses distal to operative site, s/s of infection.
What needs to be monitored at least every hour post arthroscopy?
Must monitor DISTAL pulse. If arthroscopy done on knee - access pedal pulse; if arthroscopy is done on the shoulder - assess radial pulse.
What drugs are used for arthroscopy pain?
What surgery usually involves replacing the head of the femur only?
Hemiarthroplasty. (can also be shoulder where head of humerus is replaced).
When is a hemiarthroplasty usually done?
Usually done due to a fracture close to the femur head.
After a hip replacement, what do you instruct the patient not to do?
Cross legs or bend past 90 degrees.
After a hip replacement, what would you instruct the patient to do?
Use an abductor pillow, use raised toilet seat, don't sit in really low chairs and don't bend down to put shoes/socks on.
What is an autologous blood donation?
Donating your own blood and have it banked for your surgery.
What drugs are given to deter embolisms?
Enoxaparin (Lovenox), Warfarin (Coumadin), and LMH (Low Molecular Heparin)
What device is used for post op knee replacement?
Continuous Passive Motion Machine (CPM).
What is a common injury that results from a fall or a direct blow to the shoulder?
Fracture of the clavicle (collar bone).
What is the treatment for a fractured clavicle?
Closed reduction and immobilization.
Where do most clavicular fractures occur?
In the middle third of the clavicle.
What is the treatment for a clavicular fracture located in the middle third?
A clavicular strap (figure-eight bandage) may be used to pull the shoulders back, reducing and immobilizing the fracture. A sling may be used to support the arm and relieve pain.
How is a fracture of the distal third of the clavicle, without displacement and ligament disruption treated?
With a sling and restricted motion of the arm.
How is a fracture of the distal third of the clavicle with a disruption of the coracoclavicular ligament that connects to coracoid process of the scapula and the inferior surface of the clavicle, the bony fragments are frequently displaced treated?
May be treated with ORIF, don't elevate the arm above the shoulder level for approx 6 wks but encourage the pt to exercise elbow, wrist, and fingers as soon as possible.
How is a non-displaced impacted fracture of the surgical neck of the humerus treated?
Doesn't require reduction, arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk, pendulum exercises.
How is a displaced impacted fracture of the surgical neck of the humerus treated?
Closed reduction, ORIF, or total shoulder replacement.
What are most humeral shaft fractures caused by?
Direct trauma that results in a transverse, oblique, or comminuted fracture. An indirect twisting force that results in a spiral fx.
What are the treatments for a humeral shaft fracture?
Requires immediate attention. Well padded splints are used to initially immobilize the upper arm & to support the arm in 90 deg of flexion at the elbow; A sling or collar & cuff support the forearm; External fixators are used to tx open fxs; ORIF is necessary with nerve palsy, blood vessel damage, comminuted fx or displaced fx; functional bracing; pendulum shoulder exercises; isometric exercises.
What is functional bracing?
A contoured thermoplastic sleeve is secured in place with interlocking fabric (velcro) closures around the upper arm, immobilizing the reduced fx. As swelling decreases, the sleeve is tightened, and uniform pressure and stability are applied to the fx. The forearm is supported with a collar and cuff sling.
How is a broken humeral neck treated if not displaced?
Immobilized and secured to trunk.
What is a serious complication of a broken elbow and what must be assessed?
Nerve damage (radial, ulnar, median nerves). Assess for paresthesia and circulation in forearm and hand.
What is Volkmann's contracture and what is assessed to prevent it?
Claw hand (an acute compartment syndrome which results from antecubital swelling or damage to the brachial artery). Assess swelling, nail bed, capillary refill, temperature, extension and flexion of fingers
How are non-displaced fractures of a phalanx treated?
Splinted for 3-4 weeks.
What are 2 common complications of a broken hip?
Hemorrhage of the iliac artery and shock.
Who is more likely to experience a lacerated urethra when breaking a hip, men or women?
Men, with an anterior break.
Name the 3 regions of the femur that are prone to breakage.
Intracapsular, trochanteric, subtrochanteric.
How are blood flow and tissue damage affected by these three types of breaks?
Intracapsular - blood supply to head affected. Extracapsular - more tissue damage.
How is an elbow fracture that is not displaced treated?
The arm is immobilized in a cast or posterior splint with the elbow at 45-90 degrees of flexion and placed in a sling. A thermoplastic splint is used to support the fracture.
How is an elbow fracture that is displaced treated?
ORIF. Excision of bone fragments may be necessary. Additional external support with a splint is then applied.
How is a nondisplaced radial head fracture treated?
Immobilization is accomplished with a splint. The pt is instructed not to lift with the arm for approx 4 weeks.
How is a displaced radial head fracture treated?
Surgery is typically indicated, with excision of the radial head when necessary. Post op, the arm is immobilized in a posterior plaster splint and sling and an appropriate exercise regimen.
When does displacement occur in radial and ulnar shaft fractures?
When both bones are broken.
How is a radial and ulnar shaft fracture treated if the fragments are not displaced?
Closed reduction with a long-arm cast applied from the upper arm to the proximal palmar crease. The arm is elevated to control edema. Frequent finger flexion and extension are encouraged to reduce edema.
How are displaced fractures of the radial and ulnar shaft treated?
ORIF, using a compression plate with screws, intramedullary nails, or rods. The arm is usually immobilized in a plaster splint or cast. Open and displaced fractures may be managed with external fixation devices.
How are fractures of the distal radius (Colles fracture) treated?
Closed reduction and immobilization with a short-arm cast.
How are fractures of the distal radius (Colles fracture) treated with extensive comminution?
ORIF, arthroscopic percutaneous pinning, or external fixation. The wrist and forearm are elevated for 48 hours after reduction to control swelling.
What is the patient taught to reduce swelling and stiffness in a post ORIF fracture of the wrist?
Hold the hand at the level of the heart; Move the fingers from full extension to flexion. Hold and release. (repeat at least 10X every hr when awake); Use the hand in functional activities; Actively exercise the shoulder and elbow, including complete ROM exercises of both joints.
How are displaced fractures and open fractures of the hand treated?
Often requires extensive reconstructive surgery. ORIF using wires or pins.
Why are pelvic fractures serious and have a high mortality rate?
At least two thirds of affected pts have significant and multiple injuries. Related to hemorrhage, pulmonary complications, fat emboli, thromboembolic complications, and infection.
Why do most fractures of the pelvis heal rapidly?
The pelvic bones are mostly cancellous bone which has a rich blood supply.
How are stable pelvic fractures treated?
With a few days of bed rest and symptom management until discomfort is controlled. Fluids, dietary fiber, ankle and leg exercises, anti-embolism stockings to aid venous return, logrolling, deep breathing, and skin care reduce the risk of complications and increase the patient's comfort.
How are unstable pelvic fractures treated?
Stabilization of the pelvic bones and compressing bleeding vessels with a pelvic girdle. Once the pt is hemodynamically stable, tx generally involves external fixation or ORIF.
How are stable, nondisplaced acetabulum fractures treated?
May be managed with traction and protective weight bearing so that the affected foot is only placed on the floor for balance.
How are displaced acetabulum fractures treated?
Open reduction, joint debridement, and internal fixation or arthroplasty.
How is a femoral shaft fracture treated?
Immobilized so that additional soft tissue damage doesn't occur. Skeletal traction or splinting is used to immobilize fracture fragments until the pt is physiologically stable and ready for ORIF procedures.
What kind of internal fixation device is used for a midshaft (diaphyseal) femoral shaft fracture?
Intramedullary locking nail devices.
What internal fixation devices are used in a supracondylar femoral shaft fracture?
Depending on the pattern, intramedullary nailing or screw plate fixation may be used. A thigh cuff orthosis may be used for external support.
When are compression plates and intramedulllary nails removed?
12-18 months due to loosening. After the plates are removed, a thigh cuff orthosis is used for several months to provide support while bone remodeling takes place.
How are middle femoral shaft and distal fractures treated?
Infrequently because of pt risk associated with anesthesia and surery, may be managed with skeletal traction.
When is the skeletal traction removed in a femoral middle shaft and distal shaft fracture removed?
Between 2 and 4 weeks after injury, when pain and swelling have subsided and then the pt is placed in a cast brace.
What is a cast brace?
A total contact device (ie, encircles the limb) and holds the reduced fracture. The muscle, through hydrodynamic compression, stabilizes the bone and stimulates healing.
When might an external fixator be used in a fermoral shaft fracture?
If the patient has experienced an open fracture, has extensive soft tissue trauma, has lot bone, has an infection, or has hip and tibial fractures.
How are knee (patellar) fractures treated?
Pts with significant joint effusions may benefit from arthrocentesis to provide relief of intra-articular pressure. NSAIDs.
How are nondisplaced knee (patellar) fractures treated?
6 weeks of immobilization and gradual increases in weight bearing
How are displaced knee (patellar) fractures treated?
How is a closed tibial fracture treated?
Closed reduction and initial immobilization in a long-leg walking cast or a patellar tendon-bearing cast.
How are comminuted fractures of the tibia and fibula treated?
Skeletal traction, internal fixation with intramedullary nails or plates and screws, or external fixation.
How are open fractures of the tibia and fibula treated?
External fixation. Distal fractures with extensive soft tissue damage heal slowly and may require bone grafting.
Why is chest strapping to immobilize rib fractures not used?
Decreased chest expansion may result in atelectasis and pneumonia.
How long does it take for rib fractures to heal?
The pain associated with rib fractures diminishes significantly in 3 or 4 days, and the fracture heals within 6 weeks.
Why is immobilization essential during the initial assessment in a thoracolumbar spinal fracture?
They have to determine if there is any spinal cord injury and whether the fracture is stable or unstable.
How is a stable spinal fracture treated?
Conservatively with limited bed rest. The HOB is elevated less than 30 degrees until the acute pain subsides (several days). A spinal brace or plastic thoracolumbar orthosis may be applied for support during progressive ambulation and resumption of activities.
What is a patient with a stable spinal fracture monitored for?
A transient paralytic ileus caused by associated retroperitoneal hemorrhage.