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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 goal | 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 treatment | 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 |
| Osteomyelitis | Severe infection of bone, bone marrow, and surrounding soft tissue Increasing pressure in bone leads to ischemia and vascular compromise Leading to obstruction of blood flow, necrosis, bone death Most common cause is Staphylococcus Aureus |
| Osteomyelitis risk factors | Bone trauma, open fracture, open or puncture wounds, IV drug use |
| Osteomyelitis: Assessment & Manifestations acute | Initial infection < 1 month Local Manifestations Constant pain that worsens with activity; unrelieved by rest Swelling, tenderness, warmth at site Restricted movement of affected part Systemic Manifestations Fever Night sweats Chills |
| Osteomyelitis: Assessment & Manifestations chronic | Infection lasting longer than 1 month or has failed to respond to initial antibiotic treatment Local Manifestations More commonly seen than systemic manifestations bc body is adapting to it Systemic Manifestations Lessened |
| Osteomyelitis: Diagnosis & Nursing Care | Bone or soft tissue biopsy Definitive Blood and/or wound cultures-before abx WBC count-elevated Erythrocyte Sedimentation Rate (ESR) C-Reactive Protein (CRP) X-Ray / MRI MRI most sensitive Bone Scans |
| Osteomyelitis: Diagnosis & Nursing Care treat | IV antibiotic therapy first Oral agents second Cultures or bone biopsy before antibiotics IV for 4-6 weeks; some need 3-6 months CVAD insertion SNF-skilled nursing facility, home health, LTAC |
| ESR/CRP- | inflammatory markers |
| Sarcoma | Malignant tumor found in bone, muscle, fat, nerve, or cartilage Most common: Osteosarcoma, chondrosarcoma, and Ewing’s sarcoma Common manifestations of osteosarcoma: Gradual onset of pain and swelling, Pain worse at night and with activity |
| Sarcoma causes what | Cause bone destruction and metastasize quickly Typically occurs in pelvis, long bones |
| Osteosarcoma: Nursing Care | Preoperative chemotherapy Limb salvage procedure if possible Nerve, blood vessel or extensive muscle involvement Limb salvage typically contraindicated Limb salvage or amputation followed by adjunct chemotherapy has increased 5-year survival |
| Metastatic Bone Cancer | Most common primary sites mnemonic: Particular Tumors Love Killing Bone Most common primary sites: Prostate, Thyroid, Lungs, Kidney, Breast Metastasize to: Spine, ribs, humerus, pelvis |
| Metastatic Bone Cancer manifestations | Pathologic fractures due to bone weakness Elevated serum calcium Released from bone |
| Metastatic Bone Cancer diagnostic studies | Radionuclide bone scans (after identification of primary lesion) Metastatic bone lesions may occur at any time after diagnosis and treatment of primary tumor, even years later |
| Metastatic Bone Cancer treat | Surgical: Stabilization of fracture Palliative: Radiation and pain management General principles of cancer nursing Strict pain control Prognosis: Depends on primary site and other areas of metastasis |
| Pain unrelieved with meds- | compartment syndrome |
| Muscular Dystrophy [MD] | genetic diseases characterized by symmetric wasting of skeletal muscles without neurologic involvement Duchenne MD: Early onset [5 years old] Primarily males, pelvic & shoulders, cardiomyopathy, respiratory failure, mental impairment severe, commom |
| Muscular Dystrophy: Diagnosis | Based on manifestations Genetic testing Muscle serum enzymes [CK] EMG-nerve conduction Muscle fiber biopsy Shows fat & connective tissue deposits, Degeneration & necrosis of muscle fibers Deficiency of muscle protein dystrophin ECG |
| Muscular Dystrophy: Nursing Care | Treatment goals: No cure… preserve mobility and independence Corticosteroids: Slow progression for up to 2 years, improve survival Monitor & support cardiac and respiratory functions: CPAP, trach and ventilation.education: ROM, nutrition |
| Herniation: | Center protrudes into the outer layer, causing nerve compression Painful radiation to:Shoulders, arms, hands, scapulae Paresthesia, numbness, weakness Management: Conservative unless neurological deterioration |
| Intervertebral Disc Disease: Diagnostic Studies | X-rays: Structural defects Myelogram-blood flow, MRI, or CT scan: Localizing damaged site EMG: Severity of nerve irritation or rule out other conditions Peripheral neuropathy-common wt diabetes |
| Intervertebral Disc Disease treat | NSAIDs, short-term corticosteroids, opioids, muscle relaxants, antiseizure drugs-gabapentin, antidepressants Epidural corticosteroid injections-decrease inflammation Back-strengthening exercises Body mechanics Avoid extreme flexion & torsion heal 6mn |
| Cervical Herniation Management | Bedrest to decrease pressure, inflammation, pain Immobilize cervical area with collar or brace Holds head in neutral to slightly flexed position Inspect the skin under the collar for irritation & breakdown Ice-swelling & Heat-blood flow/pain. |
| Cervical Herniation Management meds | analgesics, sedatives, anti-inflammatories, corticosteroids worry about airway |
| Lumbar Disc Disease: Manifestations | Compression of multiple nerve roots (Cauda Equina Syndrome) Severe low back pain Progressive weakness Bowel and bladder incontinence or retention Saddle anesthesia Loss of or altered sensation of the perineum, buttocks |
| Lumbar Disc Disease with saddle anesthesia is a | Medical emergency! Requires immediate surgical decompression to prevent permanent paralysis |
| Discectomy: | Removal of herniated disc tissue & related matter |
| Laminectomy: | Excision of part of the vertebra (lamina) to remove the disc |
| Laminotomy: | Division of the lamina of a vertebra |
| Spinal Surgery: Post-Op Care | neurovascular checks:Every 2 to 4 hours during first 48 hours post- surgery. Monitor GI function, Assess dressing & drains.Turn, Cough, Breathe.Pain,log roll, firm matress, monitor CSF leak-report clear/yellow drainage-lay flat and test glucose |
| Cervical Disc Surgery: Post-Op Care | Monitor for respiratory difficulty Monitor laryngeal nerve damage Hoarseness & ineffective cough Throat sprays & lozenges for sore throat Avoid anesthetics that may numb throat & increase choking risk Soft diet for dysphagia. Have suction and O2 |
| Low Back Pain | Localized pain Discomfort in specific area Radicular pain Irritation of nerve root Pain follows nerve distribution Example: sciatica nerve Referred pain Source of pain is another location from where it is felt Example: heart attack |
| Low Back Pain risks | Lack of muscle tone Excess body weight Stress Poor posture Cigarette smoking Prior compression fractures Congenital spinal problems Occupational hazards |
| Lumbar Spinal Stenosis | Narrowing of spinal canal, low back pain Pain starts in low back and radiates to buttock and leg Pain increases with walking/ standing Numbness, tingling, weakness, heaviness in legs/butt Pain decr when bending forward or sitting, worsen in cold |
| Low Back Pain: Testing | Positive straight leg raise test Raise affected leg Sharp, shooting pain down affected leg Positive for disc herniation when radicular pain occurs |
| Low Back Pain: Nursing Care | Mild pain: Outpatient: NSAIDs, muscle relaxants, massage, heat/cold Severe pain: Corticosteroids, Opioids Avoid activities that increase pain: Lifting, bending, twisting, prolonged sitting Prevention is key Physical therapy as needed: |
| NSAIDS can cause | GI bleed and harm kidneys |
| Kyphosis | Excessive angulation of normal posterior curve of the thoracic spine Postural kyphosis: Slumping posture Structural kyphosis: Congenital malformation, other disorders, or surgery Manifestations: Moderate back pain “Hunchback” |
| Scoliosis | Lateral curvature of the spine: Postural scoliosis: Curve corrects with bending Structural scoliosis: Curve does not correct with bending Manifestations: One shoulder higher than the other, prominent hip, projecting scapula. Pain, GI disturbance |
| Kyphosis & Scoliosis | Diagnosis: X-ray Treatment: Conservative Bracing Weight reduction Active and passive exercises Surgery: When > 50° angle Metal reinforcement rods |
| Foot Problems: Risk Factors | Ill-fitting shoes: Crowding Angulation Older adult is at increased risk related to: Poor circulation Atherosclerosis Decreased sensation [especially DM] |
| Foot Problems nursing care | Podiatry referral Conservative treatments: NSAIDs, corticosteroid injections Physical therapy, stretching Footwear changes, orthotics Surgical treatments: Pins or wires through toes |
| Morton’s Neuroma: | Paresthesia, burning [usually between 3rd & 4th toes] Sock is rolled up under toes |
| Hallux Valgus: | Deviation of great toe toward other toes |
| Osteomalacia | A disorder of decreased mineralization Results in bone breaking down faster than it can form Vitamin D Deficiency Most common cause Bone loses calcium and becomes soft Vitamin D is essential for calcium absorption SOFT BONE |
| Osteomalacia: Manifestations | Bone pain Worse at night; affects lower back, pelvis, hips, legs, and ribs Muscle weakness and progressive deformity Problems walking Waddling gait Fractures with delayed healing Progressive deformities of the spine, bowed leg |
| Osteomalacia: Nursing Care | Correct Vitamin D Deficiency Vitamin D3 / D2 Calcium or phosphorus supplements Dietary Eggs, meat, oily fish, fortified milk & cereals Exposure to sunlight Weight-bearing exercise Fall prevention |
| Osteoporosis | Bone demineralization Loss of calcium & phosphorus Fragile bones Subsequent risk for fracture Bone resorption accelerates as formation slows Occurs most commonly in wrist, hip, vertebral column Silent thief POROUS BONE |
| Osteoporosis: Risk Factors | Smoking Early menopause & estrogen deficiency Family history Gender: Female > male Prior fracture Increasing age Sedentary lifestyle Insufficient calcium intake |
| Osteoporosis diagnostics | Dual-energy x-ray absorptiometry (DEXA): Initial bone density test in women over age 65 Repeat in 15 years if normal |
| Osteoporosis: Manifestations | May be asymptomatic Back pain after lifting, bending, or stooping Pelvic or hip pain especially with weight-bearing Problems with balance Decline in height from vertebral compression Kyphosis of the dorsal spine |
| Dowager’s Hump osteoporosis | Compression fractures from osteoporosis → vertebrae collapse → spine curves forward |
| Osteoporosis: Nursing Care | Prevention: Nutrition, activity, & exercise Medications that decrease bone resorption: Calcitonin, bisphosphonates- 30 30 full- take 30 min before u eat, sit up 30 min after, with full glass water Promote bone formation Calcium & Vitamin D |
| calcium | Maximizes bone growth early in life & maintains bone integrity later in life |
| vitamin d | Ensures calcium absorption |
| Minimally invasive procedures to treat osteoporotic vertebral fractures: | Vertebroplasty: Bone cement is injected into fractured vertebrae to stabilize the spine and relieve pain Kyphoplasty: Inflating a balloon to restore bone height then injecting bone cement into the vertebral body |
| Paget’s Disease [Osteitis Deformans] | Chronic skeletal bone disorder Excessive bone resorption followed by replacement of normal marrow with vascular, fibrous, connective tissue New bone is larger, disorganized, weaker Not a common disorder – 5% of adults in US Exact cause unknown |
| Paget’s Disease [Osteitis Deformans] often affects | Often affects pelvis, long bones, spine, ribs, sternum, and skull |
| Paget’s Disease: Diagnosis | Diagnostic Studies: Elevated serum alkaline phosphatase X-rays Bone scans |
| Paget’s Disease: manifestations | Asymptomatic with mild forms Gradual bone pain, progressing to severe, intractable pain Fatigue Waddling gait Height decreases & head becomes larger Headaches, dementia, vision & hearing deficits Spinal cord or nerve root compression |
| Paget’s Disease: Complications | Pathologic fractures May be first sign |
| Paget’s Disease: Nursing Care | Symptomatic & Supportive Surgical intervention Braces Calcium, Vitamin D supplementation Monitor serum alkaline phosphatase Pain management, PT, firm matress |
| Osteoarthritis: Degenerative Joint Disease | Progressive deterioration of the articular cartilage Bone buildup & loss of articular cartilage in peripheral & axial joints Not a normal part of aging process! |
| Osteoarthritis: Degenerative Joint Disease affects | Weight-bearing joints Joints that receive the greatest stress Hips, knees, lower vertebral column, hands |
| Osteoarthritis: Degenerative Joint Disease risks | Age Decreased estrogen at menopause Obesity Anterior cruciate ligament injury Frequent kneeling and stooping |
| Osteoarthritis: Assessment & Diagnosis | Bone scan, CT scan, MRI: Show early joint changes X-rays: Detect joint space narrowing, increased bone density, and osteophytes |
| Osteoarthritis: Manifestations | Joint pain Diminishes after rest Worsens after activity Early morning stiffness Usually resolves within 30 minutes Aggravated by temperature change & humidity Difficulty getting up after prolonged sitting |
| Osteoarthritis nodes | Heberden Nodes: Distal IP joints Bouchard’s Nodes: Proximal IP joints Joint swelling, crepitus, limited ROM Inability to perform ADLs |
| Osteoarthritis: Nursing Care | No cure Pain & inflammation control NSAIDs for inflammation + pain Muscle relaxants for spasms Joint corticosteroid injections Prevent Disability Fall prevention PT |
| Osteoarthritis surgical management | Osteotomy: Bone resection to correct joint deformity, promote realignment, reduce joint stress Total Joint Replacement / Arthroplasty: When all measures of pain relief have failed |
| Rheumatoid Arthritis [RA] | affects whole body,Chronic systemic inflammatory, autoimmune disease Genetic + environmental factors Autoantibodies form against IgG: Rheumatoid factor (RF) RF: Autoantibody (mistakenly attacks the body’s own IgG antibodies) Onset: women over men.30 |
| Rheumatoid Arthritis [RA] explained | Joint connective tissue & synovial membrane destruction permanent deformity of joint.Blood flow can become impeded Leading to organ or organ system malfunction and failure caused by tissue ischemia Physical and emotional stress & fatigue- exacerbate it |
| Rheumatoid Arthritis: Assessment | History and physical findings Criteria for diagnosis: Joint involvement Serology RA, ANA Duration of symptoms >6 weeks |
| Rheumatoid Arthritis: Diagnosis | Positive RF occurs in about 80% of adults with RA: Does not guarantee diagnosis Negative RF does not exclude disease Titers may rise during active disease Anti-CCP: Antibody specific to RA Often appears before symptoms |
| Rheumatoid Arthritis: Diagnosis pt 2 | ANA: Autoimmune reaction/activity, not diagnostic of RA ESR, CRP: General indicators of active inflammation Tissue biopsy: Confirm early inflammatory changes Bone imaging |
| Rheumatoid Arthritis: Manifestations | Inflammation, tenderness, stiffness of joints Moderate to severe pain with morning stiffness Lasting longer than 30 minutes Pain increases with movement but is not necessarily related to inflammation Joint deformities, muscle atrophy, tendon destroy |
| Rheumatoid Arthritis: Manifestations systemic | Low-grade temperature, fatigue, weakness Anorexia, weight loss, anemia |
| Rheumatoid Arthritis: Extraarticular Manifestations | Can affect every body system Atherosclerosis Chronic inflammation that damages endothelial cells within blood vessels-can lead to MI or stroke Higher formation of cholesterol plaques Inflammation Lead to MI or CVA when broken loose |
| Rheumatoid Arthritis: Typical Deformities | A: Ulnar drift B: Boutonnière deformity C: Hallux valgus D: Swan neck deformity |
| Rheumatoid Arthritis: Rheumatoid Nodules | Develop in about 50% of RA patient population Firm, nontender masses Found on bony areas exposed to pressure Mostly on fingers and elbows Treatment not usually needed |
| Rheumatoid Arthritis meds | NSAIDs DMARDs: Treat pain, slow disease progression, suppress overactive immune response Cornerstone of RA treatment Glucocorticoids |
| Rheumatoid Arthritis mobility | Preserve joint function ROM exercises & muscle strengthening Physical Therapy Avoid weight-bearing on inflamed joints Balance rest & activity Splints during acute inflammation Heat & cold therapy |
| Rheumatoid Arthritis: Nursing Care | Body alignment during rest Firm mattress or bed board Encourage positions of extension Avoid flexion positions Puts stress on already unstable joints No pillows under knees Increase risk for joint contracture. flat pillow under head & shoulders |
| Gout | Systemic disease Urate crystals deposit in joints & other body tissues Abnormal amounts of uric acid in the body Triggers: Trauma, surgery, alcohol, or systemic infection Primary: Disorder of purine metabolism Purines: Compounds found in food |
| Gout: Phases 1-2 | Asymptomatic: No symptoms, but serum uric acid level is elevated Acute: Excruciating pain and inflammation of one or more small joints Especially the great toe (podagra) [Hallmark sign] Cooler temperature + poorer blood circulation. |
| Gout: Phases 3-4 | Intermittent: Intermittent periods without symptoms between acute attacks Chronic: Repeated episodes of acute gout Results in deposits of urate crystals under the skin & within organs such as the kidneys…leading to dysfunction |
| Gout: Assessment & Diagnosis | Uric acid levels Serum values may be normal during an acute attack High levels not diagnostic of gout 24-hour urine for uric acid Shows how well kidneys are excreting uric acid |
| Synovial Fluid Aspiration gout | Gold Standard Direct visualization of uric acid crystals under microscope Clinical symptoms may be sufficient to determine diagnosis |
| Gout: Manifestations | Night symptom onset Decreased body temperature, decreased circulation Sudden swelling & inflammation of the joints: Excruciating pain lasting days to weeks followed by long asymptomatic periods Tophi: Hard, irregularly shaped, sodium uratedeposit |
| gout diet | Low Purine Diet: Avoid organ meats, wines, aged cheese, shellfish, high fructose drinks High fluid intake: 2,000 mL/day to prevent kidney stones Weight reduction diet |
| Gout: Nursing Care | Protect the affected joint from excessive movement or direct contact with sheets or blankets Heat or cold treatment Whichever is best tolerated |
| gout meds | Colchicine Acute attacks NSAIDs, corticosteroids Allopurinol Maintenance-all the time |
| Lyme Disease | Borrelia burgdorferi infection transmitted by deer tick bite Most common vector-borne disease in U.S. Summertime Peak transmission Reinfection common |
| Lyme Disease prevent | Avoid tick-infested areas Cover exposed skin Insect repellent with DEET Inspect skin after exposure Remove as much of the tick with tweezers as possible Within 24 hours no vaccine |
| Lyme Disease: Assessment & Diagnosis | Based on manifestations & history of exposure CDC recommends 2-step testing Enzyme immunoassay (EIA) Screening Western Blot Test Confirming Both positive confirms Lyme disease |
| Lyme Disease CNS | CSF Examination Confirms nervous system involvement |
| Lyme Disease: Assessment & Diagnosis skin | Erythema Migrans: Bull’s Eye Rash occurs in 80% Appears within 1 month of exposure Central red macule or papule Expands to outer red ring Up to 12 inches Warm to touch Not itchy or painful |
| Lyme Disease: Manifestations | Acute flu-like symptoms: Low-grade fever, headache, neck stiffness, fatigue, loss of appetite, & muscle pain Without treatment can spread to heart, joints, and CNS: Arthritis: 2nd most common symptom arthritic knee pain, palpitation, pericarditis |
| Lyme Disease: Nursing Care | Oral antibiotics Early treatment and prevention of progression Preferred: 10 to 14 days Doxycycline Some need extended antibiotic treatment Risks of untreated Lyme outweigh those of long-term antibiotic therapy |
| Septic Arthritis | Infectious or bacterial arthritis Microorganism invades joint cavity Can destroy the joint if not treated Most common pathogen: Staphylococcus aureus |
| Septic Arthritis risks | Diseases with decreased host resistance Decreased immune system Corticosteroid or immunosuppressant therapy Debilitating chronic illness Joint trauma, artificial joint Skin conditions IV drug use |
| Septic Arthritis: Diagnosis | Diagnosis: Arthrocentesis (Joint Aspiration) Cornerstone of Treatment! EMERGENT… Want to avoid irreversible joint damage Synovial fluid culture WBC count Blood cultures |
| Septic Arthritis most affected and symtpoms | Most affected joints: Knee and Hip Symptoms: Severe pain, redness, and swelling; fever, shaking chills |
| Ankylosing Spondylitis [AS] | Chronic inflammatory disease that primarily affects axial skeleton Ankylosis: “Abnormal fusion of” Also called Axial Spondyloarthritis Axial = Head / Neck / Torso Main axis of the body Involves the sacroiliac joints + intervertebral disc space |
| Ankylosing Spondylitis: Assessment & Diagnosis | Late Sign X-Ray: Bamboo Spine calcifications Looks like a bamboo stalk due to vertebral fusion Rigid, straight spine MRI & CT scan Elevated ESR Genetic Marker HLA-B27 |
| Ankylosing Spondylitis: Manifestations | Inflammatory spine pain is first sign Inflammation of joints & tissue: leads to joint fusion Inflammation affects: Eyes, heart, kidneys, lungs, and PNS Low back pain-limit of motion Worse in morning and night Improve wt activity, postural changes |
| Ankylosing Spondylitis: Complications | Postural abnormalities & deformities can cause disability Impaired spinal ROM & fusion raises concerns about safe ambulation Risk for aortic insufficiency, pulmonary fibrosis Remember: inflammation isn’t limited to spine! Cauda equina syndrome |
| Ankylosing Spondylitis risk for | spinal fracture from osteoporosis |
| Ankylosing Spondylitis: Nursing Care | Maintain skeletal mobility, positioning & posture Decrease pain and inflammation Heat NSAIDs; DMARDs; corticosteroid injections Biologic Response Modifiers (BRMs): Alter body’s immune response to reduce inflammation |
| Ankylosing Spondylitis: Nursing Care DRUGS | Anti-Tumor Necrosis Factor Drugs (TNF): Type of BRM that blocks tumor necrosis factor (TNF) TNF: Chemical that causes inflammation TB Skin test before: Can wake up latent TB! Physical therapy focused on ROM & exercise, assess chest expansion |
| Ankylosing Spondylitis: Nursing Care surgery | Spinal osteotomy & total joint replacement Surgery reserved for structural complications |
| Psoriatic Arthritis (PsA) | Progressive inflammatory disorder Affects about 1/3 of people with psoriasis Psoriasis: Common, benign, inflammatory skin disorder with red, irritated, and scaly patches |
| Psoriatic Arthritis: Assessment & Diagnosis | X-ray DIP joints, “pencil in cup” deformity Cartilage loss and erosion similar to RA Elevated ESR Treatment: Control inflammation |
| Reactive Arthritis | Reiter’s Syndrome” Symptom complex of urethritis, conjunctivitis, and mucocutaneous lesions Inflammatory arthritis after an infection Cause unknown Believed to be triggered by specific GU or GI infections, especially STIs Chlamydia trachomatis |
| Reactive Arthritis tip | immune system “keeps reacting” even after infection is gone , Can’t pee (Urethritis) Can’t see (Conjunctivitis) Can’t climb a tree (Arthritis) |
| Reactive Arthritis: Assessment, Diagnosis & Nursing Care | Elevated ESR Urethritis develops 1 to 2 weeks post sexual contact or GI infection Followed by low-grade fever, conjunctivitis, and arthritis Arthritis: last symptom to appear Lesions involving the skin and mucous membranes |
| Reactive Arthritis treat | Treatment based on symptoms: Doxycycline for patient + sexual partners Ophthalmic corticosteroids for uveitis NSAIDs and DMARDs for joint symptoms PT for arthritis |
| Systemic Lupus Erythematosus: [SLE; Lupus] | Chronic, systemic, autoimmune inflammatory disease Immune system attacks the body’s own tissues Affects connective (collagen) tissue Can involve multiple major organs Skin, joints, kidneys, heart, CNS No cure |
| Systemic Lupus Erythematosus: Causes | Abnormal immune response Autoantibody production Type III hypersensitivity response Overaggressive autoimmune responses Most probable causes: Genetic influence: High prevalence Hormones: Menses, oral contraceptives, pregnancy |
| Systemic Lupus Erythematosus: Causes pt 2 | Infections: Epstein Barr Virus Environment factors: Sun, UV light, stress, chemicals, toxins Drugs: Long-term use of causative drugs |
| Systemic Lupus Erythematosus: Diagnosis | Blood & urine test Manifestations Physical exam Patient symptoms + Antinuclear Antibody (ANA) Screening test for autoimmune disease Not specific to SLE ↑ ESR & CRP. Lupus specific antibodies Anti-DNA |
| Systemic Lupus Erythematosus: Manifestations | Erythema of the face Butterfly rash Dry, scaly, raised discoid rash on face, head, or upper body Painless oral & nasal lesions Fever Photosensitivity Joint pain Weight loss |
| Systemic Lupus Erythematosus: Nursing Care | Manage active disease vs. prevent complications of treatment Prognosis improved with Early diagnosis Flares can happen Avoid fatigue, sun exposure, emotional stress, infection, drugs, surgery |
| lupus treat | Antimalarials (prevent flare-ups) Corticosteroids DMARDs + Biologics (suppress immune response) |
| Scleroderma [Systemic Sclerosis] | Chronic connective tissue disease: Similar to SLE Characterized by inflammation, fibrosis [scar tissue], and sclerosis [hardening] Overproduction of collagen causes: Progressive tissue fibrosis Blood vessel occlusion |
| Scleroderma [Systemic Sclerosis) causes what | Causes fibrotic changes involving the skin, synovial membranes, esophagus, heart, lungs, kidneys, GI tract Unknown cause Aim for slowing disease process |
| Scleroderma: Assessment, Diagnosis | Serum muscle enzymes Numerous antibodies related to scleroderma CREST syndrome X-rays SQ calcification, esophageal hypomotility, pulmonary fibrosis |
| Scleroderma manifestations | Pain Taut, shinny skin Expressionless face Muscle weakness / stiffness Dysphagia Joint contractures Inability to perform ADLs Pericarditis Kidney disease Dyspnea Lung disease leading cause of death |
| Scleroderma: CREST Syndrome | Calcinosis: Painful deposits of calcium in skin of fingers, forearms, pressure points Raynaud’s Phenomenon: Intermittent vasospasm of fingertips in response to cold or stress Esophageal Dysfunction: Difficulty swallowing due to internal scarring |
| Scleroderma: CREST Syndrome (ST) | Sclerodactyly: Tightening of skin on fingers and toes Telangiectasia: Red spots on hands, forearms, palms, face, and lips from capillary dilation THINK: Scleroderma is the “big” disease Inside that “big” disease are different forms |
| Raynaud’s Phenomenon | first sign with CREST. Sudden vasospasm of digits leading to Blanching or white phase Decreased blood flow to fingers & toes when exposed to cold Blue phase Cyanosis as hemoglobin releases O2 to tissues Red phase Rewarming |
| Scleroderma: Nursing Care | Supportive therapy for major organs affected Maintain a constant room temperature Avoid changes in extreme temperatures Avoid smoking Vasoconstricting effect Small, frequent meals Sit up after meals Medications: Treat symptoms |
| Sjögren’s Syndrome | Autoimmune disease often triggered by viral or bacterial infection Targets moisture-producing gland |
| Sjögren’s Syndrome symptoms | Xerostomia: Dry mouth Burning, altered taste, trouble swallowing Keratoconjunctivitis sicca: Dry eyes Blurred vision, photosensitivity Other glands in stomach, pancreas, and intestines: Dry skin, rashes, joint + muscle pain, thyroid problems |
| Sjögren’s Syndrome: Diagnosis | Ophthalmologic exams: Schirmer’s test for tear production |
| Sjögren’s Syndrome: treat | Artificial tears or ointment; anti-inflammatory drops Increased fluid intake Dental hygiene Increased humidity Moisten & thin foods |
| Myofascial Pain Syndrome: Diagnosis | Eliminating other conditions through imaging and tests |
| Myofascial Pain Syndrome: treat | Focus on trigger or tender points NSAIDs, lidocaine patch, muscle relaxants, steroids Massage Transcutaneous electronic nerve stimulation [TENs] |
| Myofascial Pain Syndrome | Chronic muscle pain & tenderness Usually confined to 1 area in chest, neck, shoulders, hips, or lower back Trigger Point Pain often within connective tissue (fascia) that worsens with activity or stress Deep, aching pain with burning, stinging, stiff |
| Fibromyalgia | Chronic central pain syndrome Widespread, non-articular musculoskeletal pain & fatigue Multiple tender points Very sensitive to pain Abnormal central processing of nociceptive pain input in CNS |
| Fibromyalgia: Assessment, Diagnosis | Widespread Pain Index (WPI) Pain in 11 of 18 tender points on palpation over a week History of widespread pain for at least 3 months: Widespread pain occurs on both sides of body Symptom Severity Index (SSI) |
| Fibromyalgia manifestations | “Fibro Fog” Overwhelming feeling when dealing with multiple tasks Poor stress management Migraine headaches Depression and anxiety Non-refreshing sleep |
| Fibromyalgia: Nursing Care | Symptomatic treatment Patient needs consistent support for chronicity of disease Encourage active participation Regular, gentle exercise and stretching Drug therapy for chronic widespread pain Antidepressants Anticonvulsants, TCAs, SSRIs |
| Systemic Exertion Intolerance Disease (SEID) | Chronic Fatigue Syndrome” Serious, complex, multisystem disease Physical, emotional, or cognitive exertion impaired and accompanied by profound fatigue Unable to do usual activities, may be bed-confined Can have devastating impact on lives |
| Systemic Exertion Intolerance Disease: Assessment & Diagnosis | Impaired function with profound fatigue >6 months Malaise after exertion Unrefreshing sleep Plus one of the following: Cognitive impairment (“Brain Fog”) OR Orthostatic Intolerance: Lightheadedness, dizziness, imbalance, fainting Severe fatigue |
| Systemic Exertion Intolerance Disease drug therapy | NSAIDs: Headaches, muscle and joint aches, and fever Tricyclic Antidepressants [TCAs] and SSRIs: Mood & sleep Clonazepam [Klonopin]: Sleep disorders & panic disorders |
| Systemic Exertion Intolerance Disease care | Avoid total rest: Creates an image of an invalid Gradual exercise program Well-balanced diet Behavioral therapy: Promote a positive outlook Loss of livelihood and economic security: Cannot work or decreased time working |
| Your healthy bones contain | calcium… so when your bones are sick, they break down, which means the calcium then leaves its normal home inside the bone and is now floating around within the bloodstream. • This leads to elevated serum calcium. |
| Pathologic fractures occur when a | bone breaks due to an underlying disease or condition that WEAKENS the bone…not from a significant trauma or injury. • This means that pathologic fractures can occur during normal daily activitiy |
| calcitonin is a hormone that | stops bone BREAKDOWN and promotes calcium deposition into the bone. |
| osteoblasts | LAST into formation…build new bone |
| osteoclasts | cause bone resorption (breakdown) |
| heat | Vasodilation; reduces spasms and pain |
| cold | Vasoconstriction; reduces inflammation and swelling |
| Bisphosphonates | 30, 30, Full! • Take 30 minutes before meals. • Sit up for 30 minutes after taking. • Take with a full glass of water! |
| SPRAINS VS STRAINS: | Sprains: Stretching / tearing of one or more ligaments surrounding a joint. Remember, ligaments connect bones to bones Strains: Stretching of muscle or muscle – Tendon unit *Remember, education is key! |
| ice injuries | Ice for the first 24-48 hours! Don’t exceed 30 minutes per application. Implement breaks for 10-15 minutes between applications. Never apply directly to skin. We want to decrease pain and swelling, right? So, that’s what ice does… it vasoconstricts |
| ice after acute phase | After the acute phase (24-48 hours is acute phase), we can apply warm, moist heat, because now, we want to increase blood flow back to the site now that we’ve reduced the initial issue |
| compression for injuries | compression limits swelling, and when we decrease swelling, we decrease healing time. We always want to compress distal to proximal, so further away, then towards you. |
| Think about your body… which joints have the most ROM? | Ball-and-socket joints, right? So, shoulders and hips have the highest possibility of dislocations because they have the most opportunity to move |
| AVASCULAR NECROSIS: | occurs when a bone is moved away from its blood supply • Fast forward to later in the lecture when we talked about hip fractures… so remember… Femur is a ball and socket joint right? You can have intracapsular and extracapsular fractures. |
| Intracapsular fractures | (fractures that are inside the joint, involving the head or neck of femur). |
| Extracapsular fractures | (fractures that are outside the joint, involving the neck or trochanteric region). |
| So, if blood supply (vascularity) is started within the joint capsule, and there is an intracapsular fracture, we have now what | cut off ALL blood supply… higher risk of developing avascular necrosis. Whereas, if there is an extracapsular fracture, we have cut off blood supply only partially |
| avascular necrosis goal | Joint that is dislocated/subluxated needs to be realigned as soon as possible to reestablish blood flow and prevent avascular necrosis. BUT, we as nurses never realign. We immobilize how we find the patient until the patient is seen by the Provider. |
| REPETITIVE STRAIN INJURIES: | Who: Those who have repetitive movements, awkward postures, or prolonged force What: These movements / this population leads to a lot of strain. This strain causes tiny, tiny tears. These tiny tears lead to inflammation over time, and thus, a strain |
| REPETITIVE STRAIN INJURIES what to do | Educate, educate, educate! Stretching before exercise and activity, routine exercise, weight management, proper posture and body mechanic |
| Carpal Tunnel Syndrome | Inside this tunnel is your median nerve and flexor tendons; they pass through the wrist and into the hand. Think of it like an actual automotive tunnel. When your tunnel has traffic, it’s suddenly too crowded, (the tunnel is narrow), so it squeezes in |
| Carpal Tunnel Syndrome testing | Testing: Positive Tinel’s. Positive Phalen’s • Tinel’s: Tapping over median nerve • Phalen’s: Inverted Praying: Flexion for 60 second |
| Carpal Tunnel Syndrome treat | We give corticosteroid injections (first) because we want CONSERVATIVE first, right? But… what did we say injections served as? Pretty much like a Band-Aid... just temporary relief. So, if 6 months go by with no relief after injections, surgery |
| Rotator Cuff Injury what to avoid | Avoid long immobilization to prevent frozen shoulder. Physical therapy IS CORNERSTONE OF TREATMENT! |
| Meniscus Injury testing | McMurray’s test: Patient is supine, hold one hand on knee, other under the foot, extend & rotate. Pain elicited with flexion, internal rotation, and then extension of the knee. If pain is present, positive McMurray’s test, which means Meniscus injury |
| Anterior Cruciate Ligament (ACL) Injury test | Lachman’s Test: Flex knee 15-30 degrees and pull tibia forward while the femur is stabilized. If there is movement or a shift of the tibia, positive Lachman’s is noted, which means ACL injury is present |
| ACL treat | Partial tear = Rest, ice, elevation. PT. Conservative treatment. Severe tear = surgery and PT, PT, PT! Recovery takes MONTHS, especially if a meniscus injury is involved! |
| if a fracture is suspected…. | IMMOBILIZE. Do we reset the bone ourselves? No, Meredith Grey. We immobilize it in whatever position we found it in! ** WHY? Because if we reposition, we could potentially cause a closed fracture to become an open fracture |
| Cephalosporins: | Antibiotics that penetrate bone. • Do they need a tetanus shot? • How was the fracture obtained? • Check vaccine history • Closed Reduction: Closed = not open skin. So, not invasive. Manual realignment. |
| Synthetic Material casting | Favorable. Material activated in cool or tepid water. Lightweight. Stronger. Earlier weight bearing. • Petal Edges: Avoid skin irritation from rough edges. Several strips (petals) of tape are placed over rough edges for smoothness. |
| If cast itches | can use a hair dryer on cool setting. Assess 6 P’s! * |
| Fascia | Muscles, nerves, & vessels of extremities are enclosed in this fibrous membrane. |
| compartment syndrome can lead to | Limb loss. Sepsis. Nerve damage. Acute Renal Failure. Why? Muscles that are destroyed activate the release of myoglobin. Myoglobin is toxic to the kidneys. Thus, resulting in renal failure. • Ischemia can occur quickly. ASSESS |
| Volkmann’s Contracture: | Your elbow makes a “V” shape… Volkmann’s contracture is just compartment syndrome of an elbow fracture. |
| OSTEOMYELITIS diagnosis | Early diagnosis is crucial: If caught late, what’s more likely to happen? Probably amputation, depending on severity…because if the actual BONE is infected…instead of just skin / tissue, then that means that blood supply has been cut off, |
| Particular Tumors Love Killing Bone: | prostate • Thyroid • Lungs • Kidney • Breast |
| Tumor size and Location | If the tumor is too big, it could start to cut off blood supply to the bone that it’s surrounding, right? Which means what? If the blood supply is reduced/cut off completely, avascular (no blood) necrosis (death) could occur. |
| Cervical Herniation | Treat with a C-Collar! Watch for skin breakdown underneath. Watch airway |
| Cauda Equina Syndrome: | Medical Emergency! • Saddle Anesthesia • Starts as severe low back pain. That low back pain then creates compression at a nerve root, and if that nerve root is compressed enough, then everything below it will have problems |
| Cauda Equina Syndrome treat | Have to decompress the spinal cord. If not, permanent paralysis. |
| The nurse is reviewing the health care record of a client with a new diagnosis of rheumatoid arthritis (RA). The nurse understands that which is an early clinical manifestation of RA? | anorexia |
| The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? | The nurse needs to monitor for signs of infection, such as inflammation, purulent drainage, and pain at the pin site |
| Signs of infection under a casted area include | odor or purulent drainage from the cast or the presence of "hot spots |
| The nurse determines that the client understands the information if the client states that they would report which early symptom of compartment syndrome? | numbness and tingling in fingers |
| The nurse is developing a plan of care for a client in Buck's traction. The plan of care would include assessing the client for which finding indicating a complication associated with the use of this type of traction? | weak pedal pulses |
| A comminuted fracture is a | complete fracture across the shaft of a bone, with splintering of the bone into fragments. |
| Clients who experience fractures of the femur, pelvis, thorax, and spine are at risk for | hypovolemic shock. Bone fragments can damage blood vessels, leading to hemorrhage into the abdominal cavity and the thigh. This can occur with closed fractures as well as open fractures. Signs of hypovolemic shock include tachycardia and hypotension. |
| The nurse is caring for a client diagnosed with a rotator cuff lesion. The nurse assesses the client knowing that the client most likely has which structure affected? | tendon |
| The nurse determines that heat application to the area has been effective if which has occurred? | reabsorption of blood at injured site |
| The nurse is caring for a client on postoperative day 1 following left above-knee amputation. Which is the priority nursing action at this time? | elevate foot of bed |
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