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Musculoskeletal 4of4
| Question | Answer |
|---|---|
| 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
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