Mobility - Fracture/Sprains/Strains/Injuries Flashcards
(103 cards)
1
Q
The spine has ___________ at birth and becomes __________ as you grow
A
The spine has CONVEX CURVES at birth and becomes S-SHAPED as you grow
2
Q
Epiphyseal plates close between __________
A
Epiphyseal plates close between 18 - 25 YEARS OLD.
3
Q
What is the Rhomberg Test?
A
The Rhomberg Test is used to detect cerebellar deficiencies.
Patient stands for 1 minute with feet together, arms at sides, eyes closed; swaying/loss of balance indicates a problem.
4
Q
__________ activity increases post menopause
A
OSTEOCLAST activity increases post menopause
5
Q
__________ is when muscle fibers atrophy and muscles lose tone, speed, and power.
A
SARCOPENIA is when muscle fibers atrophy and muscles lose tone, speed, and power.
6
Q
What are isotonic exercises?
A
involves contracting and relaxing your muscles through the full range of a joint’s motion:
- push ups
- pull ups
- crunches
- sit ups
- squats
- etc.
7
Q
What are isometric exercises?
A
exercise an exercise in which muscles contract but very little body movement takes place: -planks -side bridges -yoga -etc.
8
Q
General care guidelines for the IMMOBILIZED patient
A
- Frequent turning
- repositioning
- alignment
- skin assessment
- skin care
- Range of motion (should do active, but passive if not able)
- deep breathing
- isometric exercises
- isotonic exercises
- weight bearing exercises
- measures to optimize elimination (fluids and fiber to help with constipation)
- nutrition (adequate calcium intake)
- weight management
- assistive devices
- bandages
- binders
- braces
- wraps
- Hot and Cold therapy (cold prevents further swelling, heat promotes circulation)
9
Q
__________ is sometimes known as aggressive treatment. Its goal is to cure the patient’s condition and prolong his or her life.
A
CURATIVE TREATMENT is sometimes known as aggressive treatment. Its goal is to cure the patient’s condition and prolong his or her life.
10
Q
__________ slows disease spread, improves symptoms, lessens pain, and provides a better quality of life.
A
PALLIATIVE TREATMENT slows disease spread, improves symptoms, lessens pain, and provides a better quality of life.
11
Q
What is immobilization/what causes immobilization?
A
- casts
- splints
- wraps
- tapes
- braces
- traction
- slings
- should immobilizers
- pillows
12
Q
What are some examples of assistive devices?
A
- crutches
- canes
- walkers
- wheelchairs
- prostheses
- braces
- etc.
13
Q
Increased osteoclastic activity leads to __________
A
Increased osteoclastic activity leads to BONE DEMINERALIZATION.
14
Q
Immobilization can lead to _____calcemia and __________ formation
A
Immobilization can lead to HYPERcalcemia and RENAL STONE formation
15
Q
What are some negative consequences of immobility on the MUSCULOSKELETAL system?
A
- brittle bones
- contractures (shortening/hardening of muscles, joints, ligaments, tendons, etc.)
- muscle weakness/atrophy
- foot drop (difficulty lifting the front part of the foot)
16
Q
What are some negative consequences of immobility on the NERVOUS system?
A
- lack of stimulation
- feelings of anxiety
- feelings of isolation
- confusion
- depression
17
Q
What are some negative consequences of immobility on the DIGESTIVE system?
A
- decreased appetite
- low fluid intake
- constipation
- bowel obstruction
- incontinence
- electrolyte imbalance
18
Q
What are some negative consequences of immobility on the INTEGUMENTARY system?
A
- decreased blood flow
- pressure ulcers
- infections
- skin breakdown
- pressure ulcers
19
Q
What are some negative consequences of immobility on the CARDIOVASCULAR system?
A
- blood clots
- reduced blood flow
20
Q
What are some negative consequences of immobility on the RESPIRATORY system?
A
- pneumonia
- decreased respiratory effort
21
Q
What are some negative consequences of immobility on the URINARY system?
A
- reduced kidney function
- incontinence
- UTI’s
- urinary retention
22
Q
What types of fractures are there? (ICOCLOT)
A
I - incomplete C - complete O - open C - closed L - linear O - oblique T - transverse
23
Q
In an __________ fracture, the bone breaks through the skin and is exposed to air.
This creates a high risk for __________.
A
In an OPEN fracture, the bone breaks through the skin and is exposed to air.
This creates a high risk for INFECTION.
24
Q
__________ fractures in children are red flags for abuse.
A
SPIRAL fractures in children are red flags for abuse.
25
In a __________ fracture, tiny pieces are broken off.
In a COMMINUTED fracture, tiny pieces are broken off.
26
In an __________ fracture, just a chip is broken off of the end of the bone
In an AVULSION fracture, just a chip is broken off of the end of the bone
avulsion: act of tearing/pulling away
27
In a __________ fracture, the bone is not aligned.
In a DISPLACED fracture, the bone is not aligned.
28
In a __________ fracture, the bone is aligned
In a NON-DISPLACED fracture, the bone is aligned
29
In an __________ fracture, the bone is smashing into itself
In an IMPACTED fracture, the bone is smashing into itself
30
__________ fractures usually occur on the skull
DEPRESSED fractures usually occur on the skull
31
__________ fractures usually occur on the spine
COMPRESSION fractures usually occur on the spine
32
Hip and pelvic fractures are at an increased risk for __________
Hip and pelvic fractures are at an increased risk for BLOOD LOSS.
33
S/S of fractures include:
- deformity (out of alignment)
- swelling (edema)
- bruising
- spasms
- pain
- tenderness
- crepitus (grating sound/sensation produced by friction between bone and cartilage)
- neuromuscular symptoms
- vasodilation
- loss of mobility (function)
- exudate of WBC's
* HIP fractures - shortening of leg and external rotation
* *INFLAMMATION (heat, pain, redness, swelling)
34
Stage 1 of fracture healing is __________ which takes _________
Stage 1 of fracture healing is HEMATOMA FORMATION which takes 0 - 2 WEEKS.
35
Stage 2 of fracture healing is __________ which takes __________
Stage 2 of fracture healing is SOFT CALLUS FORMATION which takes 2 - 3 WEEKS.
36
Stage 3 of fracture healing is __________ which takes __________
Stage 3 of fracture healing is HARD CALLUS FORMATION which takes 3 - 6 WEEKS.
37
Stage 4 of fracture healing is __________ which takes __________
Stage 4 of fracture healing is BONE REMODELING which takes 8 WEEKS - 2 YEARS.
38
In fracture healing, weight bearing allows for __________
In fracture healing, weight bearing allows for CALCIFICATION.
39
ABCs assessment of TRAUMA inlcudes:
```
A - airway
B - breathing
C - circulation + C-spine
D - disability
E - expose + examine
F - full vitals + family
G - give comfort (O2, pain meds, labs)
H - head to toe + history
I - inspect posterior
```
40
Fracture patients need to be __________ because they may need surgery
Fracture patients need to be NPO (nothing by mouth) because they may need surgery
41
In a fracture patient, you need to make sure the __________ matches the __________
In a fracture patient, you need to make sure the INJURY matches the HISTORY.
42
In an open fracture, __________ need to be started early - check orders from HCP
In an open fracture, ANTIBIOTICS need to be started early - check orders from HCP
43
__________ refers to bringing the bone into alignment
REDUCTION refers to bringing the bone into alignment
44
__________ is the stabilizing and immobilizing of the bone
FIXATION is the stabilizing and immobilizing of the bone
45
Fixation can be __________
Fixation can be INTERNAL or EXTERNAL.
46
Reduction can be ________
Reduction can be OPEN or CLOSED.
47
__________ is a type of reduction.
| It can be either __________ or __________
TRACTION is a type of reduction.
It can be either SKIN or SKELETAL.
48
A cast is a type of _______
A cast is a type of FIXATION.
49
What does a neurovascular assessment include?
```
6 P's:
P - pain
P - pallor
P - paresthesia
P - pulses
P - poikilothermic (thermal instability)
P - paralysis
```
50
Neurovascular check should be done __________ for the __________
then __________ for __________
then __________ depending on treatment and type of fracture
Neurovascular check should be done EVERY HOUR for the FIRST 4 HOURS;
then EVERY 2 HOURS for the FIRST 8 HOURS;
then EVERY 2 - 4 HOURS + PRN, depending on treatment and type of fracture
51
__________ is the use of weights, ropes and pulleys to apply force to a fractured bone to maintain proper alignment of the bone for healing.
TRACTION is the use of weights, ropes and pulleys to apply force to a fractured bone to maintain proper alignment of the bone for healing.
52
What is the purpose of traction?
to decrease pain & spasm - pulls bone into alignment and decreases muscle spasms.
53
When/why is traction generally used?
Traction is generally used to STABILIZE the patient for SURGERY.
54
Should pain occur during traction?
Should pain occur during traction? NOOOO!
IF there is pain, there may be a problem with the traction setup!
55
In __________, force is applied to soft tissues using a small amount of weight.
In SKIN TRACTION, force is applied to soft tissues using a small amount of weight.
56
What types of skin traction are there?
- Bucks
- Halter
- Pelvic
- Russells
- Dunlop
- Bryants
57
What is bucks traction?
Buck's traction is a type of skin traction that is widely used for femoral, hip, and acetabular fractures, which are fractures in the socket portion of the "ball-and-socket" hip joint:
-pulling extremity outwards
58
What is halter traction?
Halter traction is used for short term cervical traction. Uses include minor neck injuries without obvious fractures e.g. Whiplash injury, neck muscle spasm, conservative treatment of cervical disk lesions:
-around neck pulling upwards
59
What is pelvic traction?
Pelvic traction is a therapy program designed to relieve pain in the lower back, hips and legs normally associated with low back disorders. Traction refers to the set of mechanisms for strengthening broken bones, immobilization or relieving pressure on the skeletal system:
-around waist, pulling outwards/downwards
60
What is Russels traction?
A form of traction used to align a fractured femur. The lower leg is supported in a sling just below the knee and pulling forces are exerted upwards and longitudinally by means of pulleys and weights
61
What is Dunlop traction?
Skin traction is placed on the forearm and A special frame used on the side of the bed. ... If a supracondyar fracture cannot be reduced to over 90 degrees elbow flexion, this method of traction is an alternative to invasive methods such as a percutaneous K-wires. It allows swelling to subside.
62
What is Bryants traction?
Bryant's traction is used for developmental dislocated hip(s) (DDH). In Bryant's traction, the child's body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket.
63
External devices on the surface of the skin (skin traction) can apply __________; so be aware of __________
External devices on the surface of the skin (skin traction) can apply SHEAR; so be aware of SKIN BREAKDOWN.
64
Skeletal traction increases risk for __________
Skeletal traction increases risk for INFECTION.
65
Types of SKELETAL TRACTION include:
- Balanced Suspension
- Thomas ring
- Pearson attachment
- 90-90
- Gardner-wells or Crutchfield tongs
- Halo
66
Pin care for skeletal traction should be performed __________.
Pin care for skeletal traction should be performed EVERY 4 HOURS and includes:
- rinsing with sterile water
- checking for drainage
67
Pin care for skeletal traction helps prevent __________ and/or __________
Pin care for skeletal traction helps prevent OSTEOMYELITIS and/or WOUND INFECTION.
68
What does nursing care for a patient in TRACTION look like?
- pin care for skeletal traction
- ropes/pulleys/weights: hanging freely, never on floor, all knots secured: check EVERY 2 HOURS
- counter - traction
- position/alignment
- trapeze
- skin care
- elimination - fracture pan (specialized bedpan)
- hygiene
- neurovascular check
- bed making variation
69
Handle casts with __________ until dry.
Make sure all sides are __________
Handle casts with PALMS until dry.
Make sure all sides are EXPOSED TO AIR.
70
It is important to check __________ before cast application
It is important to check SKIN before cast application
71
__________ in a cast allows for swelling. it is an emergent intervention.
BIVALVE in a cast allows for swelling. it is an emergent intervention.
*Bivalve - small slits to allow airflow
72
Can you walk on a cast that has a bivalve?
NO!
73
Encourage patient with a cast to perform __________
Encourage patient with a cast to perform ISOMETRIC EXERCISES:
- strength training
- yoga exercises
74
All fractures are at risk for __________
All fractures are at risk for OSTEOMYELITIS.
75
__________ is gastric dilatation with partial or complete obstruction of the duodenum. Although rare, it is most frequently seen in orthopedic patients who have had spinal surgery or who are in hip spica or body casts (kids with congenital hip problems).
CAST SYNDROME is gastric dilatation with partial or complete obstruction of the duodenum. Although rare, it is most frequently seen in orthopedic patients who have had spinal surgery or who are in hip spica or body casts (kids with congenital hip problems).
76
Fracture of long bones and pelvis are most at risk for __________.
Can also occur post arthroplasty (hip surgery)
Fracture of long bones and pelvis are most at risk for FAT EMBOLISM.
Can also occur post arthroplasty (hip surgery)
77
__________ is caused by pressure and swelling which decreases perfusion.
It is most common in femoral neck or shoulder fractures.
**Dead bone = surgery
AVASCULAR NECROSIS is caused by pressure and swelling which decreases perfusion.
It is most common in femoral neck or shoulder fractures.
**Dead bone = surgery
78
__________ causes hypoxemia:
Increased pressure from an embolism causes pulmonary edema > Heart work increases > Hemorrhage of pulmonary system > alveolar collapse
FAT EMBOLISM causes hypoxemia:
Increased pressure from an embolism causes pulmonary edema > Heart work increases > Hemorrhage of pulmonary system > alveolar collapse
79
What are the S/S of FAT EMBOLISM?
- dyspnea
- respiratory failure tachypnea
- hypoxia
- decreased LOC
- petechial rash on trunk, upper body & oral mucosa
- frothy, pink tinged sputum
80
What does treatment for a FAT EMBOLISM look like?
- administer O2
- fluids
- dobutamine
- respiratory support
81
Prevention of FAT EMBOLISMS:
- avoid moving fractured areas prior to immobilization
| - immobilize early, give corticosteroids prophylactically
82
__________ improves blood pressure and myocardial pump
DOBUTAMINE improves blood pressure and myocardial pump
83
S/S of compartment syndrome:
- pain; extreme; out of proportion
- paresthesia (tingling, prickling of skin)
- pallor (paleness)
- paralysis (loss of function)
- pulselessness
- swelling
84
What does treatment of compartment syndrome look like?
- release wrap
- bi-valve the cast
- hydration
- fasciotomy (surgical procedure to relieve pressure/pain)
85
Unrelieved compartment syndrome may lead to __________ or __________
Unrelieved compartment syndrome may lead to AMPUTATION or VOLKMANNS CONTRACTURE (permeant flexion)
86
__________ elevate or apply ice to a leg with compartment syndrome. Need to INCREASE perfusion, not decrease it!!
DO NOT elevate or apply ice to a leg with compartment syndrome. Need to INCREASE perfusion, not decrease it!!
87
__________ is a thrombus with vein inflammation.
| Usually iliac of femoral veins, but superficial veins can be affected.
DVT - DEEP VEIN THROMBUS is a thrombus with vein inflammation.
Usually iliac of femoral veins, but superficial veins can be affected.
88
What causes DVT?
- stasis
- endothelial damage
- blood HYPERcoagulability
89
What are common risk factors for DVT?
- surgery
- immobility (bedrest)
- trauma (fracture)
- pregnancy
- obesity
- cancer
- estrogen therapy
- long distance travel
90
What are the S/S of DVT?
- edema
- pain
- tenderness w/ palpation
- veins
- sense of fullness
- warm skin
- erythema (skin rash)
91
What is VIRCHOWs TRIAD?
- HYPERcoagulable state
- endothelial injury
- venous stasis
92
What does PT measure?
WARFARIN
93
What does PTT measure?
HEPARIN
94
__________ is when a ligament is torn or stretched
SPRAIN is when a ligament is torn or stretched
95
__________ is when a musculotendinous unit is stretched or torn
STRAIN is when a musculotendinous unit is stretched or torn
96
For sprain or strain, rest for first __________; but afterwards, based on extent of injury, it is helpful to do re-mobilization in a safe manner
For sprain or strain, rest for first 24 HOURS; but afterwards, based on extent of injury, it is helpful to do re-mobilization in a safe manner
97
Sprain/Strain treatment: POLICE
```
P - protection
O - optimal
L - load
I - ice
C - compression
E - elevation
```
98
With sprain and strain, __________ first, then __________
With sprain and strain, ICE first, then HEAT
99
Wrap sprains/strains from __________ to _________
Wrap sprains/strains from PROXIMAL to DISTAL.
100
What are the types of sprains/strains?
- carpal tunnel
- rotator cuff
- anterior cruciate ligament
101
__________ is the compression of nerve as it passes along wrist in the channel. Causes numbness, tingling, pain, dry skin, thickened skin.
CARPAL TUNNEL is the compression of nerve as it passes along wrist in the channel. Causes numbness, tingling, pain, dry skin, thickened skin.
102
What does a positive PHALENS MANEUVER look like?
Maintained flexion of the wrist at a 90 degree angle for 30-60 seconds reproduces CTS symptoms of tingling or pain.
103
When the nurse assesses dry skin over the thumb and the first two fingers of the hand of a 43-year-old computer programmer, the nurse suspects that the programmer suffers from __________.
When the nurse assesses dry skin over the thumb and the first two fingers of the hand of a 43-year-old computer programmer, the nurse suspects that the programmer suffers from CARPAL TUNNEL.
