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Med surg I > Orthopedic disorders > Flashcards

Orthopedic disorders Flashcards

(43 cards)

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1
Q

Fractures

A

Disruption or break in continuity of structure of bone
Majority of fractures from traumatic injuries
Some fractures secondary to disease process
Cancer or osteoporosis

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2
Q

Classification of fracture

A

Complete or incomplete
Complete: break is completely through bone
Incomplete: bone is still in one piece

Based on direction of fracture line
Linear/Longitudinal
Oblique
Transverse
Spiral

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3
Q

Clinical Manifestations of fracture

A

Localized pain
Decreased function
Inability to bear weight or use
Guard against movement
May or may not have deformity
Immobilize if suspect fracture!!!!

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4
Q

Fracture Healing

A

Multistage healing process (union)
Fracture hematoma
Granulation tissue
Callus formation
Ossification
Consolidation
Remodeling

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5
Q

Interprofessional Care

A

Overall goals of fracture treatment
Anatomic realignment (reduction)
Immobilization
Restoration of normal or near-normal function

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6
Q

Closed reduction

A

Nonsurgical, manual realignment of bone fragments
Traction and counter-traction applied
Under local or general anesthesia
Immobilization afterwards

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7
Q

Open reduction

A

Surgical incision
Internal fixation
Risk for infection
Early ROM of joint to prevent adhesions
Facilitates early ambulation

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8
Q

Traction purpose

A

Purpose
Prevent or ↓ pain and muscle spasm
Immobilize joint or part of body
Reduce fracture or dislocation
Treat a pathologic joint condition

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9
Q

Skin traction

A

Short-term (48-72 hours)
Tape, boots, or splints applied directly to skin
Traction weights 5 to 10 pounds
Skin assessment and prevention of breakdown imperative

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10
Q

Skeletal traction

A

Long-term pull to maintain alignment
Pin or wire inserted into bone
Weights 5 to 45 lbs
Risk for infection
Complications of immobility
Maintain counter-traction, typically the patient’s own body weight
Elevate end of bed
Maintain continuous traction
Keep weights off the floor

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11
Q

Fracture Immobilization

A

Cast
Temporary
Allows patient to perform many normal activities of daily living
Made of various materials
Typically incorporates joints above and below fracture

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12
Q

Upper Extremity Immobilization

A

Sling
To support and elevate arm
Contraindicated with proximal humerus fracture
Ensures axillary area is well padded
No undue pressure on posterior neck
Encourage movement of fingers and nonimmobilized joints

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13
Q

Vertebral Immobilization

A

Body jacket brace
Immobilization and support for stable spine injuries
Monitor for superior mesenteric artery syndrome (cast syndrome)
Assess bowel sounds
Treat with gastric decompression

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14
Q

Lower Extremity Immobilization

A

Long leg cast
Short leg cast
Cylinder cast
Robert Jones dressing

Elevate extremity above heart
Do not place in a dependent position
Observe for signs of compartment syndrome and increased pressure

Hip spica cast
Single spica
Double spica
Assess patient for same problems as body jacket brace

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15
Q

External Fixation

A

Metal pins and rods
Applies traction
Compresses fracture fragments
Immobilizes and holds fracture fragments in place
Assess for pin loosening and infection
Patient teaching
Pin site care

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16
Q

Nutritional Therapy

A

↑ Protein (1 g/kg of body weight)
↑ Vitamins (B, C, D)
↑ Calcium, phosphorus , and magnesium
↑ Fluid (2000-3000 mL/day)
↑ Fiber
Body jacket and hip spica cast patients: six small meals a day

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17
Q

Neurovascular Assessment

A

Peripheral vascular
Color and temperature
Capillary refill
Pulses
Edema

Peripheral neurologic
Motor function
Upper and lower extremities
Sensory function
Paresthesia

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18
Q

Postoperative Care

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A

Monitor vitals
General principles of nursing care
Frequent neurovascular assessments
Minimize pain and discomfort
Monitor for bleeding or drainage
Aseptic technique
Blood salvage and reinfusion

19
Q

Ambulatory Care Cast Care

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A

Frequent neurovascular assessments
Apply ice for first 24 hours
Elevate above heart for first 48 hours
Exercise joints above and below
Use hair dryer on cool setting for itching
Check with health care provider before getting wet

Dry thoroughly after getting wet
Report increasing pain despite elevation, ice, and analgesia
Report swelling associated with pain and discoloration OR movement
Report burning or tingling under cast
Report sores or foul odor under cast

20
Q

Ambulatory Care Cast Care Do not

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A

Elevate if compartment syndrome
Get plaster cast wet
Remove padding
Insert objects inside cast
Bear weight for 48 hours
Cover cast with plastic for prolonged period

21
Q

Compartment Syndrome

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A

Swelling and increased pressure within a confined space
Compromises neurovascular function of tissues within that space
Usually involves the leg but can occur in any muscle group

Two basic types of compartment syndrome
↓ Compartment size
↑ Compartment contents
Arterial flow compromised → ischemia → cell death → loss of function

Early recognition and treatment essential
May occur initially or may be delayed several days
Ischemia can occur within 4 to 8 hours after onset

22
Q

Compartment Syndrome Clinical Manifestations (6 p’s)

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A

Pain – unrelieved by drugs and disproportional to injury
Pressure
Paresthesia – usually an early sign
Pallor
Paralysis
Pulselessness

23
Q

Compartment SyndromeInterprofessional Care

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A

NO elevation above heart
NO ice
Surgical decompression (fasciotomy)

24
Q

Complications of Fractures

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A

Majority heal without complication
Death is usually the result of
Damage to underlying organs and vascular structures
Complications of fracture or immobility
May be direct or indirect

25
Infection
High incidence in open fractures and soft tissue injuries Devitalized and contaminated tissue an ideal medium for pathogens Prevention key Can lead to chronic osteomyelitis
26
Venous Thromboembolism
High susceptibility aggravated by inactivity of muscles Prophylactic anticoagulant drugs Antiembolism stockings Sequential compression devices ROM exercises
27
Fat Embolism (FES)
Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury Contributory factor in many deaths associated with fracture Most common with fracture of long bones, ribs, tibia, and pelvis
28
Fat Embolism (FES) Clinical Manifestations
Early recognition of FES is crucial Symptoms 24 to 48 hours after injury Fat emboli in the lungs cause a hemorrhagic interstitial pneumonitis. Respiratory and neurologic symptoms Petechiae – neck, chest wall, axilla, buccal membrane, conjunctiva Clinical course of fat embolus may be rapid and acute Patient frequently expresses a feeling of impending disaster In a short time skin color changes from pallor to cyanosis Patient may become comatose
29
Fat Embolism (FES) Interprofessional Care
Treatment is directed at prevention Careful immobilization and handling of a long bone fracture probably the most important factor in prevention Management is supportive and related to symptom management
30
Osteoporosis
Chronic, progressive metabolic bone disease marked by Low bone mass Deterioration of bone tissue Leads to increased bone fragility Over 54 million people in the United States One in 2 women and 1 in 4 men over 50 will sustain an osteoporosis-related fracture Known as the “silent thief” Why more common in women? Lower calcium intake Less bone mass Bone resorption begins earlier and becomes more rapid at menopause Pregnancy and breastfeeding Longevity
31
Risk factors Osteoporosis
Risk factors Advancing age (>65 yr) Female gender Low body weight White or Asian Current cigarette smoking Prior fracture Sedentary lifestyle Family history Diet low in calcium/vitamin D deficiency Excessive use of alcohol (>2 drinks/day) Low testosterone in men Specific diseases Certain drugs
32
Interprofessional Care osteoporosis
Supplemental calcium Take in divided doses Calcium carbonate 40% elemental calcium Take with meals Calcium citrate 20% elemental calcium Less dependent on stomach acid Weight-bearing exercise Build up and maintain bone mass Increase strength, coordination, balance Walking, hiking, weight training, stair climbing, tennis, dancing Quit smoking Decrease alcohol intake
33
Calcitonin
Inhibits bone resorption Give IM form at night to minimize side effects Alternate nostrils when using nasal form Calcium supplementation is needed
34
Osteoarthritis (OA)
Slowly progressive noninflammatory disorder of the diarthrodial joints
35
Etiology and Pathophysiology OA
Gradual loss of articular cartilage Formation of osteophytes Not normal part of aging process Cartilage destruction Begins between ages 20 and 30 Symptoms do not manifest until after age 50–60 After age 50, women > men Caused by direct damage or instability Risk factors Age Decreased estrogen at menopause Obesity Anterior cruciate ligament injury Frequent kneeling and stooping Regular exercise can help prevent Inflammation is not the primary cause Secondary synovitis (inflammation of synovial joint) may result Contributes to early pain and stiffness Pain in later disease when articular cartilage is lost and bony joint surfaces rub on each other
36
Clinical Manifestations Joints OA
Joint pain Primary symptom ranging from mild discomfort to significant disability Pain worsens with joint use Early stages: rest relieves pain Later stages: pain with rest and trouble sleeping due to increased joint pain Joint stiffness occurs after periods of rest or unchanged position Early morning stiffness usually resolves within 30 minutes Overactivity → mild joint effusion, temporarily ↑ stiffness Crepitation Asymmetrical
37
Clinical Manifestations Deformity OA
Specific to involved joint Heberden’s nodes (DIP joint) and Bouchard’s nodes (PIP joint) Red, swollen, and tender No significant loss of function Visible deformity Knee: bowleg, knock-kneed Hip: one leg shorter
38
Interprofessional Care Rest and Joint Protection OA
Balance rest and activity Rest during acute inflammation Functional positioning Do not be immobilized > 1 week Modify activities to ↓ joint stress Avoid prolonged standing, kneeling, squatting (knee OA) Assistive device as needed
39
Interprofessional Care Drug Therapy OA
Based on severity of patient’s symptoms Mild to moderate joint pain NSAIDS (ibuprofen, enoxaparin) Topical agent (e.g., capsaicin cream [Zostrix]) OTC creams (BenGay, ArthriCare) Topical salicylates (e.g., Aspercreme)
40
Joint Replacement OA
Joint replacement may be needed if pain incapacitating Artificial knee Artificial hip Most common joints for replacement
41
Rheumatoid Arthritis (RA)
Chronic, systemic autoimmune disease Inflammation of connective tissue in diarthrodial (synovial) joints Periods of remission and exacerbation Extraarticular manifestations Affects all ethnic groups Incidence ↑ with age, peaks between ages 30 and 50 Estimated 1.5 million Americans Three times as many women as men
42
Etiology and Pathophysiology RA
Autoimmune etiology Combination of genetics and environmental triggers Antigen triggers formation of abnormal immunoglobulin G (IgG) Autoantibodies develop against the abnormal IgG Rheumatoid factor (RF) Without adequate treatment More than 60% may develop marked functional impairment within 20 years Need of mobility aids Loss of self-care ability Need for joint reconstruction By end-stage patients experience loss of independence, require daily care
43
Drug Therapy: DMARDs-Disease-modifying anti-rheumatic drugs
↓ Permanent effects of RA Methotrexate Monitor for bone marrow suppression and hepatotoxicity Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) Baseline and then yearly eye exam Corticosteroid therapy Intra-articular injections Low-dose oral for limited time NSAID and salicylates Anti-inflammatory, analgesic, and antipyretic May take 2 to 3 weeks for full effectiveness

Med surg I (11 decks)

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