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Musculoskeletal 4of4

abnormal osteoblast or myeloblast that exhibits rapid and uncontrolled growth malignant bone tumor
_____________ bone cancer is very rare primary
Primary tumors include: osteosarcoma, Ewing's sarcoma, chondrosarcoma and fibrosarcoma
osteosarcoma cancer of osteoblasts
Ewing's sarcoma cancer of soft tissue of bone
chondrosarcoma cancer of the cartilage
fibrosarcoma cancer of fibrous connective tissue
Malignant bone tumors are usually found around the ____________ in the _______________ or ______________ with a few found in the _______________. knee; distal femur or proximal fibula; proximal humerous
As a malignant bone tumor expands, it lifts the ____________, much the same was as in osteomyelitis. periosteum
Metastasis is when the cancer spreads through the circulatory or lymphatic system. The most common site it moves to is the _________. lungs
S/S of malignant bone tumor: pathological fracture; persistent pain, swelling and difficulty moving the involved extremity; limp or abnormal gait; decrease in serum calcium level in blood
Medical treatment for malignant bone tumor: surgical removal by amputation or wide local resection; radiation and chemotherapy; amputation
Amputation of limbs or parts of limbs may be related to: trauma (most common with upper extremeties); disease; disability
Amputation is classified as: AKA (above knee amputation); BKA (below knee amputation); AE (above elbow); BE (below elbow)
Amputations are mostly done for __________ disease. vascular
Post-op complications after amputation (immediate): hematoma; hemorrhage; inflammation; pain
Post-op complications after amputation (later complications): chronic osteomyelitis; causalgia - buring pain; phantom limb; phantom pain
Phantom limb/phantom pain sensations dexcribed as pain, tingling, burning or itching; gets better with time
Nursing Management for amputation: education and support prior to surgery; referral to amputee groups; elevate stump (but prevent hip flexion contractures); physical therapy; diet; avoid injury to stump; education after surgery (make home safe, teach about post-op complications)
Break in bone from direct or indirect trauma fracture
fracture that runs along a slant to the length of bone oblique
fracture that is splintered into fragments comminuted
fracture that breaks coils around the bone spiral
fracture that is incomplete fracture, common in children greenstick
fracture where one bone fragment is forcibly wedged against another bone fragment impacted
fracture that remains contained, does not break the skin simple
fracture in which damage also involves the skin or mucus membranes compound
fracture in which bone has been compressed as seen in vertebral fractures compression
a pulling away of a fragment of bone by a ligament or tendon and its attachments avulsion
a fracture in which fragments are driven inward as seen in skull and facial bone fractures depressed
fracture that occurs through an area of diseased bone, can occur without trauma or a fall pathologic
S/S of fractures: pain (especially when attempts are made to move or put pressure over the affected area); loss of function (muscle becomes flacid - usually 10-40 min after break); deformity; false motion; crepitus (grating sound); edema; spasm; may be bruising
Stage 1 of fracture healing: bleeding occurs immediately after fracture, along with edema; in 48-72 hours a hematoma forms between the two broken ends of bone
Stage 2 of fracture healing: Hematoma does not reabsorb. Other cells enter the clot and granulation (healing) tissue forms, gradually becoming firm and making a bridge between the two broken ends
Stage 3 of fracture healing: (by the end of the 1st week) granulation tissue turns into callus which is made up from cartilage, osteoblast, calcium and phosphorus; the callus is larger than the diameter of bone and acts as a splint
Stage 4 of fracture healing: Within 2-3 weeks, woven bone forms; ends of the broken bone begin to knit
Stage 5 of fracture healing: Excess bone is naturally chiseled away by stress to the affected part from motion, exercise and weight bearing; bone takes on its original shape and size
Bone is back to its original forma after about: 1 year
Short term complications of fractures: shock; fat embolism; deep vein thrombosis; compartment syndrome; risk of excessive blood loss
Loss of blood after a fracture can cause: hypovolemic shock
S/S of shock: hypotension, tachycardia, tachypnea, restlessness; diaphoresis (excessive sweating)
Factors that interfere with bone formation: starvation, immobility, corticosteroid, Heparin (blood thinner)
condition in which fat globules are released from the marrow of the broken bone into the blood stream; lodges in capillaries of the lung and obstruct blood flow fat embolism
Fat particles break down into __________ which inflame the pulmonary blood vessel, leading to ___________________. fatty acids; pulmonary edema
Fat embolism is most commonly associated with: long bone fractuers, multiple fractures, and severe trauma
Fat embolism usually occur: 24-48 hours after injury
People at highest risk for fat embolism: older pt with a hip fracture
first sign of fat embolism respiratory distress, followed by tachycardia, tachypnea, fever, confusion and decreased level of consciousness
Treatment of fat embolism: bedrest, gentle handling, oxygen, ventilatory support and fluid restrictions and diuretics for pulmonary edema
Complications of fat embolism: pulmonary embolism; sudden and severe chest pain and shortness of breath; stroke; weakness, slurred speech, confusion; myocardial infarction (MI); severe chest pain, hypotension, irregular pulse, confusion
Venous stasis, vessel damage, and altered clotting mechanisms may all contribute to the formation of blood clots, or: DVTs (deep vein thrombosis)
venous stasis, vessel damage, and altered clotting mechanisms are called: Virchow's Triad
Prevention of DVTs include: anti-embolism stockings, compression devises, early ambulation
serious complication that results from internal or external pressure on the affected area compartment syndrome
Muscles compartment areas are composed of: enclosed spaces made up of muscle, bone, nerves and blood vessels wrapped in a fibrous membrane (fascia)
Internal pressure can be caused by: bleeding or edema into a compartment
External pressure can be caused by: a cast or tight dressing
When there is bleeding or edema into a compartment, there is _____________. nowhere for the drainage to go because it is trapped in the space.
Increased fluid in compartment syndrom puts pressure on the tissues, nerves and blood vessels so that ____________. blood flow is decreased, resulting in pain and tissue damage.
Irreversible muscle damage from compartment syndrome can occur within: 4-6 hours
Partial paralysis caused by compartment syndrome can occur in: 24 hours
Complete paralysis caused by compartment syndrome can occur within: 24-48 hours
Primary symptom of compartment syndrome is: pain, especially with touch or movement, that is not relieved by opioid analgesia; edema; pallor; weak or unequal pulses; cyanosis, tingling numbness and decreased movement
once bone cells are deprived of oxygen and nutrients, they die and the cells walls collapse. This is called: avascular necrosis
S/S of avascular necrosis: pain, instability, and decreased function in the affected area
Treatment of avascular necrosis: relieving the weight bearing and removal of part of the bone. If that fails, joint replacement may be necessary.
improper alignment of the bone ends resulting in external deformity malunion
fracture never heals nonunion
failure of the fracture to heal in the expected time delayed union
Delayed union can be treated by: electrical stimulation; bone grafts; synthetic material that stimulates bone growth
process of bringing the ends of the broken one into proper alignment reduction
nonsurgical realignment of the bones that is usually done with some form of anesthesia and a cast is usually applied afterwards closed reduction
surgical procedure where the bones are realigned; usually done for commuted or open fractures open reduction
an attempt to attach the fragments of the bone together when reduction alone is not feasible because of the type and extent of the break fixation
fixation that includes the use of rods, pins, nails, screws, or metal plates to align the bone fragments and keep them in place for healing internal fixation
fixation similar to internal fixation but the pins in the bones are attached to an external frame external fixation
types of casts: plaster of paris; fiberglass; thermopastic resins; thermolabile plastic; polyester-cotton knit impregnanted with polyurethane
lease expensive case; it is initially hot, then becomes damp and cool; dries in 24-72 hours; should lift cast only with palms during drying time to prevent pressure areas Plaster of Paris
________ may be cut in casts to check on surgical incisions. cast windows
Type of cast that may be applied to upper extremeties: "sugar tong" cast
Cast that is used with swollen arm or limb; when being weaned from a cast; when sharp radiograph is needed; as a splint bivalve cast
Cast used for fracture of the foot, ankle, or distal tibia or fibula short-leg cast
Cast used for fracture of the distal femur, knee, or lower leg long leg cast
cast used for fractures of the femur, acetabulum, or pelvis hip spica cast
cast used for fracture of the wrist or hand short arm cast
cast used for fracture of the forearm, elbow or humerus long arm cast
What should be reported to the doctor when casts are used? numbness, tingling, pain not relieved by opioids (may be compartment syndrome)
________ is normal when putting on a cast. Heat
Lift a cast with your ________ while it is drying to avoid pressure-spots from fingers. palms
Hot spots under cast could signal ___________. infection
If ___________ under cast or dressing,draw a circle around it to measure for growth. drainage
Keep cast __________ when lying down and as much as possible. elevated
______________ will help skin get back to normal after casting. Lotions and soaking
Exerts a pulling force on a fractured extremity to provide alignment of the broken bone fragments; decreases muscle spasms; aids with pain relief traction
Two types of traction: skin traction and skeletal traction
Traction applied directly to skin with weights of 5-10 pounds skin traction
Weights used in traction will stay on until: ordered to come off by doctor
skin traction used in hip and knee fractures Buck's traction
skin traction that elevates knee Russell's traction
Other types of traction: head halter traction, pelvic traction
When using traction, check for _______ (on both extremeties, not only the one in traction. 6 P's
traction that rovides a strong steady pull and can be used for longer periods of time; pulleys are attached to bone skeletal traction
Types of skeletal traction: Gardner-Wells, Crutchfield, Vinke tongs and halo vest.
What to look for in skeletal traction: bowing of bolt, tenting of skin on bolt, redness, drainage, pus, temperature
Important points when using traction: weights must hang freely; maintain good body alignment; use padding; assess affected extermity for temp, pain, sensation, cap refill, and pulses; assess pin sites for redness, drainage, odor; care for pins well - use one applicator at a time
Most hip fractures are in the _________ and __________ regions. femoral neck and intertrochanteric
Most common cause of hip fracture: fall; however, may have a fracture then a fall
Hip fractures can result from ____________. decreased bone mass or brittle bones associated with osteoporosis
S/S of hip fracture: severe pain in affected region; affected leg is shorter than the unaffected leg; hip on affected side rotates externally; tenderness and edema in the area of fracture
Medical treatment for hip fracture: traction; surgical repair (ORIF - open reduction internal fixation); total hip replacement
Post op, pts may begin PT the day of surgery or the next day to prevent __________. DVTs
Fracture that is a break in the distal radius - usually occurs when an outstretched hand is used to break a fall - most common in elderly women (because of osteporosis) Colles' fracture
Pelvic fractures are caused mostly by motor vehicle accidents in _____________. young adults
Pelvic fractures are caused mostly by falls in _________. older adults
Pelvic fractures typically heal within 6-8 weeks
Pelvic fractures may require: pelvic sling; skeletal traction; double hip spica cast; external fixation (OREF)
Created by: akgalyean