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355 test 2
| Question | Answer |
|---|---|
| Sprains | Stretch and/or tear of one or more ligaments surrounding a joint Common sites: Ankle, knee, wrist 1st degree, 2nd degree or 3rd degree “Pop”, discoloration, pain, rapid swelling |
| severe sprain | Avulsion fracture-ligament is pulled so tightly that it pulls bone fragment with it, dislocation-joint is moved or hemarthrosis possible-blood in joint space |
| strains | Stretching injury to a muscle or muscle-tendon unit Common sites: Lower back, hamstring, calf 1st degree, 2nd degree or 3rd degree Pain, limited motion, spasms, swelling Usually resolves on its own If severe: May need surgical repair |
| RICE | Ice-24-48 hrs after injury and dont put ice directly on area Don’t ice more than 30 min each After acute phase apply heat to help bring blood back Compression limits swelling and monitor circultation snd prevent skin break down Elevate above heart |
| Dislocation: | Complete displacement or separation of the articular surfaces of the joint |
| Subluxation: | Partial displacement or separation |
| Dislocation and Subluxation manifestations | Pain Deformity Limited function Swelling near joint |
| Soft Tissue Injury Interprofessional Care | Care Circulation Goal: Realign the dislocated portion of the joint Pain Management: Immobilize injured joint |
| Carpal Tunnel Syndrome | Narrowing of carpal tunnel, compression of median nerve Etiology: Continuous wrist movements Pressure from trauma or edema Hormones Diabetes, PVD, Rheumatoid arthritis-all have decreased in perfusion |
| Carpal Tunnel Syndrome Manifestations | Numbness and tingling Pain Weakness |
| Carpal Tunnel Interprofessional Care treat | Prevention Adaptive devices for immobilization Ergonomic changes Physical therapy Medications: Corticosteroid injections Surgery: If symptoms last more than 6 months Neurovascular status Full recovery takes months |
| Rotator Cuff Injury | Gradual due to repetitive stress, aging, or injury Common in sports with overhead motions-tennis, Sudden: Trauma Shoulder weakness, pain Decreased ROM Drop arm test-if it falls suddenly its positive Pain when arm is abducted 60-120 degrees |
| Rotator Cuff Interprofessional Care | Confirmed with MRI Partial Tear Can treat conservatively Rest Ice and heat Medications Physical therapy-cornerstone of treatment |
| rotator cuff Unsuccessful conservative treatment / Complete Tear: | Surgery Immobilized with sling & abductor pillow after surgery Physical therapy after 6 weeks Avoid immobilization too long Arthrofibrosis-frozen shoulder |
| Meniscus injury | Crescent-shaped piece of fibrocartilage in the knee Athletes with rotational stress on the knee in varying degrees of flexion while foot planted Older pt / occupations with squatting or kneeling hardly any blood supply |
| Meniscus injury manifestations | Knee “clicks”, “pops”, “gives out” Pain with McMurray’s test Bend the knee, twist the leg, straighten the knee, listen / feel for click |
| Meniscus Injury Interprofessional Care | Diagnosed with MRI Conservative care: Prevention-stretching, exercising Ice Immobilization Crutches with weight bearing as tolerated Physical therapy |
| meniscus injury surgical repair | Repair meniscus or remove part of meniscus Meniscectomy Pain relief Rehab soon after surgery |
| Anterior Cruciate Ligament (ACL) Injury | Usually non-contact Pivots Landing from a jump Slows down from running or stops suddenly Manifestations: Hearing a “pop” Acute Pain and swelling Can result in partial or complete tear or an avulsion fracture |
| Anterior Cruciate Ligament (ACL) Injury diagnostics | Lachman’s test Bend knee slightly, hold thigh still, pull lower leg forward If shin slides forward, + Lachman MRI |
| ACL partial tear | Rest, Ice, Elevation NSAID’s Ambulation as tolerated with crutches Immobilizer-very bulky Physical therapy |
| ACL complete tear | Surgical repair of ACL with autologous or allograft tissue Immobilizer Physical Therapy |
| Bursitis | Friction between bursa and surrounding tissue Commonly occurs in shoulder, elbow, hand, knee, hip Manifestations: Warmth, pain, swelling, Limited ROM Collaborative Care: Rest and NSAID’s may be effective Fluid aspiration Surgery: |
| Fracture | Disruption or break in continuity of structure of bone Compression, torsion, severe muscle contraction, or disease |
| fracture type | Avulsion-ligament pulls parts of bone Comminuted-bone breaks in pieces Displaced- out of alignment Greenstick-chipped Intraarticular- within joint space Longitudinal- down the length Pathologic- caused by disease Stress-due to poor fitting shoes |
| Fracture Manifestations | Immediate localized pain, tenderness, and muscle spasm Edema Contusion Decreased function Inability to bear weight or use and guard against movement Potential deformity Crepitation |
| Fracture Healing Process | Fracture hematoma-from bleeding Granulation tissue-osteoid starts Callus formation Ossification-callus gets hard, Consolidation-healing starts Remodeling |
| Complications of Fracture Healing | Delayed Union, Bone is healing slow, Nonunion, Bone stops healing completely…won’t unite, Malunion ,Bone heals in wrong position, Refracture,Bone breaks again,Myositis ossificans Bone forms in tissue |
| Fracture Interprofessional Care | Emergency care: Immobilize the fracture, maintain tissue perfusion, prevent infection Diagnosis: X-rays CT/MRI Medications: Pain medication Muscle relaxants Antibiotics that penetrate bone Cephalosporins |
| Closed Fracture Reduction | Nonsurgical, manual realignment of bone fragments Traction and countertraction manually applied Under local or general anesthesia Post-Operative Immobilization Traction, casting, splints, or braces |
| Open Fracture Reduction | Surgical incision Internal fixation Screws, pins, plates, rods or nails Risk for infection Facilitates early ROM of joint Prevents adhesions |
| Traction | Application of a pulling force to attain realignment of an injured or diseased body part or extremity Countertraction: Pulls in opposite direction Opposes traction Makes traction effective |
| traction purpose | Prevent or ↓ pain and muscle spasm Immobilize joint or part of body Reduce fracture or dislocation Treat a pathologic joint condition |
| Skin Traction | Short-term 48-72 hours While awaiting surgery Tape, boots, or splints applied directly to skin Traction Weights Typically 5 to 10 lbs Skin assessment & breakdown prevention imperative Maintain straight alignment |
| Skeletal Traction | Pt at risk for pressure injuries, muscle wasting, paralytic illeus Long-term Pin or wire inserted into bone Traction Weights 5 to 45 lbs Risk for infection Maintain countertraction Elevate end of bed must hang weight freely |
| Fracture Immobilization | Cast Provides temporary immobilization, typically incorporates joints above and below the fracture Petal cast edges despite material Ossification you can maybe remove cast |
| casts | Assess 6 P’s-pain, pallor, paresthesia, paralysis, pulse, poikilothermia Monitor for swelling No powder No prolonged periods of coverage Elevate extremity above heart first 48 hours ROM Hair dryer for itching Cool setting |
| External Fixation | Metal pins and rods Applies traction Compresses fracture fragments Immobilizes and holds fracture fragments in place Meticulous pin care Monitor for infection |
| Infection | More common with open fracture and soft tissue injuries Can occur with any complication that decrease blood supply Can lead to osteomyelitis-cephalosporins Aggressive surgical debridement Antibiotics |
| Compartment Syndrome | Swelling and increased pressure in limited space Compromise blood vessels, nerves, muscles, tendons within compartment Causes Decreased compartment size Increased compartment contents Can lead to limb loss, sepsis, nerve damage Ischemia |
| Compartment Syndrome manifestations | Change in any of the following Pain or Feeling of Pressure in compartment Paresthesia Pallor Paralysis Pulselessness or diminished pulses Poikilothermia Affected limb feels cooler than opposite side |
| Compartment Syndrome treat | Alleviate pressure Removal of cast or bivalve cast Fasciotomy No ice!-bc of perfusion No elevation!-bc of perfusion |
| Volkmann’s Contracture: | Ischemia, degeneration, and contraction of forearm muscles Compartment syndrome of elbow fracture |
| Venous Thromboembolism | Blood clot along intimal lining of a large vein Can lead to Venous insufficiency Pulmonary embolism |
| Venous Thromboembolism manifestations | Unilateral leg edema, pain, tenderness Sense of fullness in extremity, paresthesia or cramping of the affected extremity Warm skin, erythema Can be asymptomatic |
| Venous Thromboembolism meds | Low-molecular weight Heparins (enoxaparin, fondaparinux, rivaroxaban) Anticoagulants (warfarin) Factor Xa inhibitors (Xarelto-rivaroxaban, Eliquis-apixaban) Antiembolism stockings/sequential pumps |
| Fat Embolism Syndrome (FES) | Fat emboli originate from the fat released from marrow of injured bone into circulation Fat globules enter the bloodstream, combine with platelets Occlude small blood vessels, cause tissue ischemia |
| FES Manifestations | Early recognition is crucial! Confusion (ARDS) Petechiae: soft palate, conjunctiva, chest, neck, axilla, and upper arms May fade before noticed Fat cells in blood, urine, or sputum Prolonged prothrombin time-blood takes too long to clot |
| FES Interprofessional Care | Treatment is directed at: Prevention Management is directed at: Symptom management Careful immobilization and handling of a long bone fracture Most important factor in prevention Coughing and deep breathing Administer O2 Intubation |
| Complications of Immobility | Prevent complications of immobility Constipation Renal calculi Cardiopulmonary deconditioning |
| Wrist Fracture | Colle’s fracture Distal radius Bony deformity, immediate pain, numbness, weakness, decreased ROM of the fingers, swelling Fall on outstretched arm and hand (FOOSH) Usually managed with closed reduction of the fracture and cast |
| Radial and/or Ulnar Fracture | Fracture of the Radius and/or Ulna: If both, cannot supinate the hand Nursing Care: Alleviating pain Immobilization Education |
| Pelvic Fracture | Paralytic ileus Hemorrhage Laceration of urethra, bladder or colon Fat embolism syndrome Assess abdomen and lower extremity Collaborative care: Bedrest Pelvic sling traction Surgical repair if displaced |
| Hip Fracture Manifestations | External rotation Muscle spasm Shortening of extremity Pain tenderness Complication: Avascular necrosis Higher risk with intracapsular fracture |
| Hip Fracture Interprofessional Care | Traction: Decrease muscle spasms prior to surgery Buck’s Traction Surgery: ORIF (Open Reduction Internal Fixation) Pins, screws, nails, or plates |
| hip fracture arthroplasty | Arthroplasty Intracapsular fractures Hemiarthroplasty Replacement of either the femoral head OR acetabulum with prosthesis Total Hip Arthroplasty Femoral head AND acetabulum are replaced |
| Arthroplasty Post-Op Care | Avoid: Hip flexion greater than 90 degrees Adduction Internal rotation Pillow between legs for first 6 weeks while lying on non-operative side Abductor pillow to turn 6P’s Pain control |
| Fracture of the Vertebrae: | Typical to lumbar vertebral body; less common in cervical and thoracic Potential spinal cord damage Lightweight bracing for stable fractures Vertebroplasty Balloon Kyphoplasty |
| Fracture of the Clavicle: | Usually midclavicular Can damage subclavian vessels or lung Pneumothorax Decreased movement of arm on affected side |
| Fracture of the Skull: | Assess patient for neurologic changes Document LOC Depressed skull fracture can cause neurologic damage |
| Fracture of the Face: | Maintain a patent airway Manifestations: Hematomas Pain Edema Bony deformity |
| Mandibular Fracture | Post-Operative: Monitor airway Communication Adequate nutrition Wire cutter/scissors Readily available Oral hygiene |
| Crutch Walking | Proper sizing to avoid pressure on brachial plexus Elbows flexed 20-30 degrees Assist patient on their affected side Do not rest on axilla Look forward, not down Crutch should be 4-6 inches diagonally in front of foot |
| Amputation | Partial or total removal of an extremity by surgery or trauma PVD is main cause of lower extremity amputation Risk Factors: Hypertension Diabetes Peripheral Neuropathy Smoking Hyperlipidemia PVD Osteomyelitis |
| Amputation post op | Rigid or compression dressing-minimize edema Sterile dressing changes Monitor for bleeding Antibiotics, analgesics, PPI’s, Stool softener |
| Ambulatory and Home Care amputation | Wear residual limb sock and clean daily ROM Build support muscle groups Do not elevate limb on pillow Avoid dangling for prolonged periods Avoid sitting in chair for > 1 hour Lay prone with hip in extension for 30 min 3-4 times daily |
| Amputation Complications Delayed Healing | Infection Circulatory or cardiac problems Pre-existing conditions Electrolyte imbalances Improper diet Smoking |
| Amputation Complications Pain | Chronic stump pain: Neuromas cause severe burning pain Medications, nerve blocks, TENS, surgery Phantom limb pain: Pain management TENS Mirror therapy Brain sees movement that isn’t really happening |
| amputation contractures | Do not elevate stump for prolonged periods Bed positioning |
| Traumatic Amputation | Supine position with legs elevated Firm pressure on the bleeding area Wrap the amputated part in a clean cloth Amputated part in plastic bag and put bag on ice Send amputated body part to the ED |
| Axial Portion | Cranium, vertebra, ribs |
| Appendicular Portion | Limbs, shoulders (scapulae, clavicles), hips (pelvis) |
| Bone Types | Long-femur, humerus, tibia Short-carpals, tarsals Flat-pelvis, skull Irregular Sesamoid-patella |
| we have | 206 bones |
| Cortical Bone: | Compact and dense Dense bone covers spongy bone Forms a cylinder around a central marrow cavity Better able to withstand longitudinal forces than horizontal forces |
| Cancellous Bone: | Spongy Located in ends of long bones & center of flat & irregular bones Can withstand forces from multiple directions |
| Microscopic Structure Cell Types | Osteoblasts: Bone-forming cells Osteocytes: Mature bone cells Osteoclasts: Breakdown bone tissue Resorption: raises serum calcium levels |
| osteocytes | Mature bone cells Maintain bone matrix Facilitates diffusion of nutrients, wastes, and gases between blood vessels and bone tissue |
| bone remodeling | Removal of old bone by osteoclasts Deposit of new bone by osteoblasts |
| Bone Functions | Voluntary movement (point of attachment for muscles, tendons & ligaments), support, blood cell production, mineral storage, protect organs |
| Bone Remodeling pt 2 | Adults replace 25% of trabecular bone every four months Triggered by hormonal regulation & micro-damaged bones ↓Ca triggers release of PTH → stimulates osteoclast activity Osteoclast stimulates resorption ↑ Ca inhibits PTH & Calcitonin is released |
| wolfs law | Bone remodels & develops itself to resist stress placed on it |
| joints | Allows movement between bones Formed where two bones join Surfaces are covered with cartilage Ligaments hold the bone & joint in the correct position Articulation is the meeting point of two or more bones |
| Classification of Joints: Function | A – Synarthrotic Fibrous or fixed joints, immovable-skull B & C – Amphiarthrotic Cartilaginous joint, slightly movable, pelvis (birth) D & E – Diarthrodial Synovial joint, ball-and-socket joint, freely movable-hip |
| Muscles | Made up of bundles of muscle fibers Provide the force to move bones Assist in maintaining posture Assist with heat production-shivering |
| Ligaments and Tendons | Poor blood supply, causing slow repair after injury Tendons: Attach muscles to bones Enables bones to move when muscles contract Ligaments: Attach bones to bones Provide joint stability during movement More elastic Enhance joint strength |
| Fascia: | Layers of connective tissue that provide strength to muscles Superficial Deep |
| bursae | Small sacs of connective tissue found at bony prominences or joints to relieve pressure and decrease friction Prepatellar, olecranon, subacromial, and trochanteric bursae Bursitis: inflammation of bursa sac Not treated you may need surgery |
| Radiography & MRI | Handle injured areas carefully & support extremities above & below joint Administer analgesics as prescribed before procedure Remove radiopaque & metallic objects MRI: No metal implants with magnetic properties such as stents, pacemakers |
| Arthrocentesis | Used to diagnose joint inflammation & infection Aspirating synovial fluid, blood, or purulent drainage via needle inserted into a joint cavity Sterile procedure Bedside Corticosteroid injections… why? Informed consent required |
| Arthrocentesis post | Compression dressing Ice & elevate for pain control & swelling Analgesics for pain control Rest joint for 24 hours post-procedure |
| Arthroscopy | diagnose acute & chronic problems of joint Endoscopic examination Assess cartilage abnormalities, remove tissue, debris, repair torn ligaments & tendons, obtain biopsy Informed consent required NPO before procedure May require general anesthesia |
| Arthroscopy post | Neurovascular checks-check blood flow Compression dressing Ice & elevate for pain control & swelling Analgesics Rest joint; non-weight bearing until sensation returns |
| Bone Mineral Density Measurements | Dual-energy x-ray absorptiometry (DEXA): Measures bone mass of the spine, wrist and hip bones, and total body Used to diagnose metabolic bone disease Remove all metal objects |
| Bone or Muscle Biopsy | Done through aspiration, punch biopsy, needle biopsy, or during surgery Informed consent required Monitor for bleeding, swelling, hematoma, severe pain Ice & elevate for pain control & swelling Pain control |
| Electromyography (EMG) | Done to evaluate muscle health & nerves that control them Especially in presence of weakness Measures electrical potential associated with contraction Needs inserted into the muscle & records electrical activity Informed consent required. RICE |
| Myelogram with or without CT | injecting a radiographic contrast medium into sac around nerve roots in spine CT scan may follow to show how bone is affecting the nerve roots Sensitive test for nerve impingement, can detect subtle lesions and injuries, void |
| Myelogram post | patient flat for 1-2 hours to prevent spinal headache. Encourage fluids – relieves headache, replenishes CSF, promotes excretion of contrast. Monitor neurologic signs and VS Headache, nausea, and vomiting may happen |
Created by:
cwehner125