Term
|
Definition
| Coordinated efforts of the musculoskeletal and nervous systems |
|
|
Term
| What is alignment and balance? |
|
Definition
|
|
Term
|
Definition
| Weight force exerted on the body |
|
|
Term
|
Definition
| Force that occurs in a direction opposite to movement |
|
|
Term
| The greater the surface area of the object that is moved, the _______ the friction. Large objects produce greater resistance to movement. This is why nurses need to be aware of the friction that can cause a client’s skin to shear or tear. |
|
Definition
|
|
Term
|
Definition
| Gravity. The force of weight is always downwards. |
|
|
Term
| What does the skeletal system do? |
|
Definition
Provides attachments for muscles and ligaments
Provides leverage for movement |
|
|
Term
| What do the skeletal muscles do? |
|
Definition
| Help movement of bones and joints |
|
|
Term
| What does the nervous system do? |
|
Definition
| Regulates movement and posture |
|
|
Term
| How do postural abnormalities effect mobility? |
|
Definition
Congenital or
Aquired
Affects ROM
Some deformities may affect or limit ROM. See Text for Postural Abnormalities. |
|
|
Term
| How does impaired muscle development effect mobility? |
|
Definition
| Any disease that affects muscles or musculoskeletal function will impair muscle development. Osteoarthritis (OA), Rheumatoid arthritis (RA), Osteoporosis |
|
|
Term
| How does damage to the CNS effect mobility? |
|
Definition
Affects body alignment
Balance
Mobility
affect body alignment, balance, and mobility. Damage can be a result of head trauma, stroke, meningitis, or injury to the cerebral cortex |
|
|
Term
| How does musculoskeletal problems effect mobility? |
|
Definition
Direct trauma
Bruises, contusions sprains, fractures
These can all cause muscle atrophy. |
|
|
Term
|
Definition
| The ability to move about freely |
|
|
Term
|
Definition
| Inability to move about freely |
|
|
Term
|
Definition
| An intervention that restricts clients for therapeutic reasons |
|
|
Term
| How does immobility effect the body's metabolic processes? |
|
Definition
| Endocrine, calcium absorption, and GI function |
|
|
Term
| What effect does immobility have on the lungs? |
|
Definition
| Atelectasis and pneumonia |
|
|
Term
| What effect does immobility have on the cardiovascular system? |
|
Definition
Orthostatic hypotension
Thrombus, increased workload= increased O2 demand
Prolonged bed rest increases the heart’s workload, producing an increase in oxygen demand |
|
|
Term
| How does immobility effect the musculoskeletal system? |
|
Definition
| Loss of endurance and muscle mass and decreased stability and balance |
|
|
Term
| What causes muscular catabolism? |
|
Definition
| When the client is immobile, the body often excretes more nitrogen than it ingests protein, which causes a negative nitrogen balance leading to weight loss, decreased muscle mass, and weakness resulting from tissue breakdown (catabolism). |
|
|
Term
| What effect does mobility have on skeletal system? |
|
Definition
| Impaired calcium absorption |
|
|
Term
| What effect does immobility have on urinary elimination? |
|
Definition
|
|
Term
| What effect does immobility have on the skin? |
|
Definition
|
|
Term
| What are the emotional responses to immobility? |
|
Definition
| Hostility, giddiness, fear, anxiety |
|
|
Term
| What are the sensory alterations effected by immobility? |
|
Definition
|
|
Term
| What are the changes in coping with immobility? |
|
Definition
| Depression, sadness, rejection |
|
|
Term
| Should you do everything for your immobile patient? |
|
Definition
|
|
Term
| How does immobility effect infant-preschool development? |
|
Definition
| Prolonged immobility delays gross motor skills, intellectual development or musculoskeletal development |
|
|
Term
| How does immobility effect adolescents? |
|
Definition
Delayed in gaining independence and in accomplishing skills
Social isolation can occur |
|
|
Term
| How does immobility effect adults? |
|
Definition
Physiological systems are at risk
Changes in family and social structures |
|
|
Term
| How does immobility effect older adults? |
|
Definition
Decreased physical activity
Hormonal changes
Bone reabsorption |
|
|
Term
| What is apart of a mobility assessment? |
|
Definition
ROM
Exercise and activity tolerance
Body alignment
-Standing
-Sitting
-Lying |
|
|
Term
| What is a metabolic assessment? |
|
Definition
| includes anthropometric measurements and analysis of intake and output to assess for dehydration. |
|
|
Term
| What is a respiratory assessment? |
|
Definition
| includes inspecting the chest for wall movement auscultating the lungs for decreased breath sounds, crackles, and wheezes. |
|
|
Term
| What is a cardiovascular assessment? |
|
Definition
| includes measurement of vital signs, peripheral pulses, apical pulse, orthostatic hypotension, DVT, and edema. |
|
|
Term
| What is a musculoskeletal assessment? |
|
Definition
| includes assessing muscle strength and tone, loss of muscle mass, incidence of contractures, and ROM. |
|
|
Term
| What is a integumentary assessment? |
|
Definition
| assessed for integrity or early changes in skin condition. |
|
|
Term
| What is an elimination assessment? |
|
Definition
| intake and output, bowel sounds, and bowel and bladder habits need to be checked. |
|
|
Term
| What is a psychosocial assessment? |
|
Definition
| focus on the client’s emotional state, behavior, and sleep-wake cycle. |
|
|
Term
| What is a developmental assessment? |
|
Definition
| looks at how immobility affects the normal development of clients across the lifespan. |
|
|
Term
| What are popular nursing diagnoses r/t immobility? |
|
Definition
Activity Intolerance
Impaired Physical Mobility |
|
|
Term
| What diet changes should be made for immobile patients? |
|
Definition
| Provide high-protein, high-caloric diet with vitamin B and C supplements |
|
|
Term
| What respiratory exercises should be done for immobile people? |
|
Definition
Cough and deep breathe every 1 to 2 hours
Chest physiotherapy |
|
|
Term
| What cardiovascular implementations should be done for immbolies? |
|
Definition
Progress from bed to chair to ambulation
SCDs, TED hose, and leg exercises |
|
|
Term
| What should you do for musculoskeletal support for immobile patients? |
|
Definition
|
|
Term
| What should you do for integumentary for immobile? |
|
Definition
Reposition every 1 to 2 hours
Skin care |
|
|
Term
| What should you do for the elimination system for immobile? |
|
Definition
Adequate hydration
Diet rich in fluids, fruits, vegetables, and fiber
Clients need between 2000 to 3000 ml of fluids per day to help prevent renal calculi and UTIs. Monitor intake and output to ensure the fluid balance is maintained. |
|
|
Term
| What are the positioning techniques/ |
|
Definition
Fowler’s
Supine
Prone
Side lying
Sims |
|
|
Term
|
Definition
Chronic metabolic disease, in which bone loss causes decreased density and possible fracture
Unclear etiology |
|
|
Term
|
Definition
|
|
Term
|
Definition
osteoclastic (loss) activity is greater than osteoblastic (building) activity r/t changes in hormone levels and other diseases
Osteoblasts (bone forming cells) have shortened life span or less efficient in osteoporosis patient |
|
|
Term
| Who is at greater risk for osteoporosis? |
|
Definition
|
|
Term
| Why are black people at a risk for osteoporosis? |
|
Definition
| many blacks are lactose intolerant, milk products is a good source of protein, needed to bind calcium for use by body |
|
|
Term
| Who gets primary osteoporosis? |
|
Definition
| postmenopausal women and men in their 60s and 70s. |
|
|
Term
| What is secondary osteoperosis? |
|
Definition
| Caused by an associated medical disorder like hyperparathyroidism, long-term drug therapy, long-term immobility. |
|
|
Term
| What is regional osteoporosis? |
|
Definition
| occurs when a limb is immobilized r/t a fx for 8-12 wks |
|
|
Term
| What teaching should be included in osteoporosis prevention? |
|
Definition
-Women start to lose bone mass at 30
-Ensure adequate calcium intake.
-Avoid sedentary lifestyle.
-Continue program of weight-bearing exercises.
-Avoid excessive caffeine, carbonated drinks, alcohol and tobacco
-Maintain balanced diet
-Avoid excessive weight loss and dieting/ eating disorders (insufficient calorie intake) |
|
|
Term
| What are you looking for when assessing for osteoporosis? |
|
Definition
| Vertebral column (dowager’s hump), gotten shorter, back pain (worse with activity, relieved with rest), fractures of wrist and hip |
|
|
Term
| What are you looking for when assessing psychosocial for osteoporosis? |
|
Definition
| Body image (kyphotic), avoid socials, fear of fx |
|
|
Term
| What labs are important to note when diagnosing osteoporosis? |
|
Definition
-Biochemical markers
-Imaging assessments
+DXA – dual x-ray absorptiometry – hip/spine; baseline age 40’s- best tool currently for definite diagnosis; T-score is calculated
+OCT - measures bone density of the spinal column, expensive
+QUS - heel, predict risk of hip fx |
|
|
Term
| What are the risk factors for primary osteoporosis? |
|
Definition
All women age 65 and older
Men 75 years and older
Family history
History of low trauma fracture after age 50
Caucasian or Asian
Low body weight, thin build
Chronic low calcium intake
Estrogen or androgen deficiency
Women with other risk factors
Smoking
High alcohol intake
Lack of physical activity/ prolong immobility |
|
|
Term
| What nutrition changes should be made for osteoporosis patients? |
|
Definition
Adeq amts protein, Mg, vit K, Calcium, vit D
Avoid excessive alcohol/caffeine
If fx: protein, vitamin C, and iron to promote healing
Diet: fruits/veg, low-fat dairy, protein, fiber |
|
|
Term
| What exercise should be included with osteoporosis? |
|
Definition
Stengthen abd/back muscles to improve posture/spine
Active ROM, weight bearing
Swimming, walking 30min/3x/week |
|
|
Term
| What other lifestyle changes should be made with osteoporosis? |
|
Definition
Avoid tobacco
Prevent falls/hazard free environment |
|
|
Term
| What are the s/e of calcium and vitamin D supplements? |
|
Definition
| not a treatment but important prevention to promote bone health, take with food and 6-8 ounces of water, vit D is needed for Calcium absorption |
|
|
Term
| What are the s/e of estrogen or progesterone therapy Premarin? |
|
Definition
| therapy hx of prevention therapy; risk of long-term use: cardiovascular disease, breast cancer, venous thromboembolism. Should be used in low doses and for short periods; benefits must outweigh risk. |
|
|
Term
| What are the s/e of parathyroid hormone, Forteo? |
|
Definition
| Forteo, for use in postmentopausal women with high risk for fracture, daily sub-q, stimulates bone growth |
|
|
Term
| What are the s/e of biophosphonates? |
|
Definition
Boniva, Fosamax, Actonel; associated with esophagitis, ensure tablet is completely swallowed, take in am with 8 oz water in an upright position for 30 min. before eating. Do not take if poor renal function, GERD, hypocalcemia.
Report c/o esophageal irritation to MD and d/c the drug. Instruct dentist that patient is taking BP due to possible jaw osteonecrosis. |
|
|
Term
| What are the s/e of selective estrogen receptors? |
|
Definition
| mimic estrogen in some parts and block in others; used for prevention and treatment; reduces bon resorption (loss), increases bone mineral density, reduces the incident of vertebral fx. |
|
|
Term
| What are the s/e of calcitonin? |
|
Definition
| inhibits osteoclastic activity, decreasing bone loss, used for treatment, also has an analgesic effect after vertebral fracture promoting early recovery |
|
|
Term
|
Definition
| Androgens decrease bone resorption and increase bone growth, may decrease bone resorption in men, in women- may cause masculine traits and liver disease. |
|
|
Term
|
Definition
Used to tx vertebral body compression
Injection of bone cement into the vertebral body to reduce a fx or fill the space created by osteoporosis |
|
|
Term
|
Definition
| Use of a balloon in the verterbral body to contain the bone cement |
|
|
Term
| What are the care settings for osteoporosis? |
|
Definition
|
|
Term
| What interventions should be made with the different settings? |
|
Definition
-Assess for risk factors and provide teaching
-Collaborate with case managers or discharge planner
-Osteoporosis Society of Canada (www.osteoporosis.ca)
-Refer to special clinics and support groups |
|
|
Term
|
Definition
| a break or disruption in the continuity of a bone. |
|
|
Term
| What is a complete fracture? |
|
Definition
| Across entire width of bone |
|
|
Term
| What is an incomplete fracture? |
|
Definition
| break only through portion of bone |
|
|
Term
| What is an open/compound fracture? |
|
Definition
| Skin surface over the broken bone is disrupted causing an external wound |
|
|
Term
| What is a closed/simple fracture? |
|
Definition
| does not extend thru skin, no wound |
|
|
Term
| What are the pathologic or spontaneous causes of fracture? |
|
Definition
| occurs after minimal trauma to a bone weakened by dz – ex. osteoporosis |
|
|
Term
| How does fatigue/stress cause fractions? |
|
Definition
| results from excessive strain & stress on bone – athletic injury |
|
|
Term
| How does compression cause fractures? |
|
Definition
| produced by a loading force applied to the long axis of a bone – vertebra of pts w/osteoporosis – very painful |
|
|
Term
| What are the stages of bone healing? |
|
Definition
1.) Hematoma forms w/in 48-72 hrs
2.) Granulation begins
3.) Callus forms
4.) Osteoblastic proliferation
5.) Bone remodeling
6.) Bone healing completed within 6 weeks for a young person, up to 6 mo. for an old person |
|
|
Term
| What considerations should be made for older adults w/ fractures? |
|
Definition
Healing can be affected by the aging process
Adequate nutrition
Calcium phosphorous, vitamin D and Protein are needed for new bone
Menopause women=loss of estrogen=decreased ability to form new bone
Chronic disease: PVD, Arteriosclerosis reduce circulation to bone=less O2 and nutrients for healing |
|
|
Term
| What are the complications of a fracture? |
|
Definition
Acute compartment syndrome
Crush syndrome
Hypovolemic shock
Fat embolism syndrome
Venous thromboembolism (VTE)
Infection
Chronic complications: ischemic necrosis or delayed union |
|
|
Term
| What is acute compartment syndrome? |
|
Definition
| Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area |
|
|
Term
| Where does acute compartment syndrome happen? |
|
Definition
|
|
Term
| How does acute compartment syndrome occur? |
|
Definition
| capillaries in muscle dilate, becoming more permeable, plasma proteins leak into the interstitial space causing edema, edema increases pressure causing pain, blood flow to area is reduced causing ischemia, sensory deficits or paresthesia appears, color pales, pulses weaken |
|
|
Term
| What happens if acute compartment syndrome is not treated? |
|
Definition
| cyanosis, tingling, numbness, paresis, & severe pain occur |
|
|
Term
| What are the 6 p's of compartment syndrome? |
|
Definition
Pain
Pressure
Paralysis
Paresthesia
Pallor
Pulselessness (late sign) |
|
|
Term
| What is the onset of neuromuscular irreversible damage? |
|
Definition
|
|
Term
| What relieves the pressure of ACS? |
|
Definition
|
|
Term
| What do you do after a fasciotomy? |
|
Definition
Pack and dress the wound after fasciotomy (4-5 days)until secondary closure occurs
Wound may be debrided & skin graft applied to promote healing |
|
|
Term
| What are the complications of ACS? |
|
Definition
-Infection
-Motor weakness
-Volkmann's Contractures
-Myoglobinuric renal failure (RAHBOMYOLYSIS)
-Crush Syndrome |
|
|
Term
|
Definition
| occurs when lg or multiple compartments are involved. Injured muscles release myoglobulin which clogs renal tubules & has a toxic affect on kidney leading to acute renal failure. |
|
|
Term
| What should you monitor for rhabdomyolysis? |
|
Definition
|
|
Term
|
Definition
| External crush injury that compresses 1 or more compartments in the leg, arm, or pelvis |
|
|
Term
| What causes crush syndrome? |
|
Definition
| hemorrhage & edema after a severe fx injury |
|
|
Term
| What is a result of crush syndrome? |
|
Definition
| As muscle becomes ischemic & necrotic from pressure with in the compartment, myoglobin is released into circulation & occludes distal renal tubual causing kidney failure |
|
|
Term
| What are possible causes of Crush Syndrome? |
|
Definition
Twisting-type injuries
Natural disasters, such as earthquakes
Work-related injuries, ex. trapped under heavy equipment
Drug/Alcohol overdose, 1 or more limbs compressed by body weight for prolonged time
Older adults who fall are unable to get up & live for prolonged time |
|
|
Term
| What are the indicators of Crush Syndrome? |
|
Definition
Acute compartment syndrome
Hypovolemia
Hyperkalemia
Rhabdomyolysis
Acute tubular necrosis (r/t hypovolemia & rhabdomyolysis)
Dark brown urine
Muscle weakness/pain |
|
|
Term
| How do you treat crush syndrome? |
|
Definition
IVFs
Diuretics
Low dose Dopamine
Kayexalate
Dialysis |
|
|
Term
|
Definition
|
|
Term
| Why is dialysis used for crush syndrome? |
|
Definition
| if K levels remain high or kidney failure occurs |
|
|
Term
| What are the other serious complications of fractures? |
|
Definition
Shock
Fat embolism syndrome
Venous thromboembolism
Infection
Chronic complications—ischemic necrosis (avascular necrosis [AVN] or osteonecrosis), delayed bone healing |
|
|
Term
| What is a fat embolism syndrome? |
|
Definition
Fat globules are released from yellow bone marrow into bloodstream clogging small vessels that supply organs; lungs
Usually in long bone fractures (hips) & total joint replacements, occurs within 48 hours
Older adults 70-80 are at greater risk |
|
|
Term
| What is the 1st sign of altered mental status? |
|
Definition
Altered mental status (1st sign)
LOC, drowsiness, sleepiness |
|
|
Term
| What are the other signs of fat embolism? |
|
Definition
Increased respirations, pulse, temperature
Chest pain
Dyspnea
Crackles
Decreased SaO2
Petechiae (not seen in DVT) |
|
|
Term
| How do you treat a fat embolism? |
|
Definition
BR
Oxygen
Hydration
Possibly steroid therapy
Fracture immobilization |
|
|
Term
| What is the major difference between FAT EMBOLISM and a DVT? |
|
Definition
|
|
Term
|
Definition
Obstruction of the pulmonary artery by a blood clot
Can occur anytimeIncludes DVT and its complication:
Pulmonary embolism |
|
|
Term
| What is the most common complication of lower extremity surgery? |
|
Definition
|
|
Term
| What is the most fatal complication of musculoskeletal surgery? |
|
Definition
|
|
Term
|
Definition
Cancer or chemotherapy
Long surgical procedures (longer than 30 min)
Smoking
Obesity
Heart disease
Immobility
Oral contraceptives or hormones
Older adults (especially with hip fractures) |
|
|
Term
| What are the assessment findings of VTE? |
|
Definition
Same as FES
Except no petechiae |
|
|
Term
| What are the preventative measures for a VTE? |
|
Definition
| ambulation, TED stockings, SCD’s |
|
|
Term
| What are the actual treatments of a VTE? |
|
Definition
BR
Anticoagulants/thrombolytics
Possible surgery: pulmonary embolectomy, vena cava umbrella |
|
|
Term
| What is a wound infection? |
|
Definition
the most common resulting form orthopedic trauma
May occur from implanted hardware: pins, plates, rods |
|
|
Term
|
Definition
bone infection
Occurs in open fractures and after surgical repair of fx |
|
|
Term
| When does your risk for hospital acquired MRSA/infection increase? |
|
Definition
|
|
Term
| What is avascular necrosis? |
|
Definition
| Blood supply to bone is disrupted leading to death of bone tissue |
|
|
Term
| What is avascular necrosis usually affect? |
|
Definition
| Complication of hip fractures |
|
|
Term
|
Definition
| Surgical repair may also cause AVN r/t hardware interfering with circulation |
|
|
Term
| Who is at high risk for AVN? |
|
Definition
| corticosteriod therapy; prednisone |
|
|
Term
|
Definition
| not healed within 6 months |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Who is delayed union common n? |
|
Definition
patients with tibial fx, fractures that involve many techniques, pathologic fx
Older people |
|
|
Term
| What does delayed union lead to? |
|
Definition
| Chronic pain and immobility |
|
|
Term
| What are you looking for in a musculoskeletal assessment? |
|
Definition
Change in bone alignment
Alteration in length of extremity
Change in shape of bone
Pain upon movement
Decreased ROM
Crepitus- grating sound
Ecchymotic skin-bruising
Subcutaneous emphysema with bubbles under the skin r/t air trapping
Swelling at the fracture site
NEUROVASCULAR ASSESSMENT |
|
|
Term
| What is a neuromuscular assessment? |
|
Definition
CMS
Skin color
Skin temperature
Movement
Sensation
Pulses
Capillary refill (not reliable, especially elderly)
Pain (pain unrelieved by analgesics= compartment syndrome) |
|
|
Term
| What are the special considerations made for a neuromuscular assessment? |
|
Definition
For fractures of the shoulder and upper arm, assess patient in sitting or standing position.
Support the affected arm to promote comfort.
For distal areas of the arm, assess patient in a supine position.
For fracture of lower extremities and pelvis, patient is in supine position.
Possible internal organ injury= hemorrhage
VS, skin color, LOC for shock
Bloody urine= damage to urinary system |
|
|
Term
| What labs are you looking at in a neuromuscular assessment? |
|
Definition
Elevated Erythrocyte sedimenation rate is expected: indicates inflammatory response. Increases indicate bone infection
Increased in calcium and phosphorus levels-bone releases into the blood |
|
|
Term
|
Definition
| detect fx of hip & pelvis, compression fx of spine |
|
|
Term
|
Definition
| soft-tissue damage, and visualizing avascular necrosis (AVN) |
|
|
Term
| What are the nursing diagnoses r/t fractures? |
|
Definition
Risk for Peripheral Neurovascular Dysfunction r/t fracture
Acute Pain r/t biologic injury
Risk for infection r/t trauma
Impaired physical Mobility r/t pain
Imbalanced Nutrition r/t increased metabolic demand for healing |
|
|
Term
| What are the nursing diagnoses for collaborative problems? |
|
Definition
Activity intolerance r/t pain and impaired mobility
Constipation r/t opioids, immobility
Ineffective coping
Self-care deficit
Disturbed body image
Fear r/t possible nursing home placement
Impaired skin integrity |
|
|
Term
| What are the potential problems r/t severe fractures? |
|
Definition
Acute Compartment Syndrome
Hypovolemic shock
Fat Embolism Syndrome
Venous Thromboembolism
Ischemic Necrosis
Delayed healing, malunion, nonunion |
|
|
Term
| What emergency care interventions may be needed? |
|
Definition
| assess for respiratory distress, bleeding, and head injury |
|
|
Term
| What nonsurgical care interventions may be needed? |
|
Definition
| closed reduction and immobilization with a bandage, splint, cast, or traction |
|
|
Term
| What is the primary nursing concern with fractureS? |
|
Definition
| assessment and prevention of Neurovascular dysfunction or compromise |
|
|
Term
| When should you perform a vascular assessment? |
|
Definition
|
|
Term
|
Definition
| Apply ice for first 24 hours |
|
|
Term
|
Definition
| Rigid device that immobilizes the affected body part while allowing other body parts to move |
|
|
Term
|
Definition
| plaster, fiberglass, polyester-cotton |
|
|
Term
| What are the cast complications? |
|
Definition
| infection, circulation impairment, peripheral nerve damage, complications of immobility |
|
|
Term
| What is important in cast care? |
|
Definition
Monitor neurovascular status
Should be able to insert a finger between cast and skin
Ice
Document drainage & immediately report increases to MD |
|
|
Term
| What is a cast infection? |
|
Definition
t skin breakdown under cast
Warmer in infected area (hot spot), odor, fever |
|
|
Term
| What is a circulation issue with casts? |
|
Definition
impairment and peripheral nerve damage
Teach assess circulation daily: distal mobility, numbness, increased pain |
|
|
Term
| What are the long term complications of casts? |
|
Definition
| skin breakdown, pneumonia, atelectasis, thromboembolism, constipation, osteoporosis, osteoarthritis, muscle atrophy |
|
|
Term
|
Definition
| Application of a pulling force to the body to provide reduction, alignment, and rest at that site |
|
|
Term
|
Definition
| – requires boot, belt, etc. secured around effected leg, purpose is to decrease muscle spasm, 5 – 10 lbs. hip fractures |
|
|
Term
| What is skeletal traction? |
|
Definition
| requires pins, wires, etc. surgically inserted into bone, purpose is to aid in bone realignment, 15 – 30 lbs. Pin care to prevent infection! |
|
|
Term
| What is plaster traction? |
|
Definition
| combines skeletal traction & a plaster cast |
|
|
Term
|
Definition
| exerts a pull for correction of alignment deformities |
|
|
Term
| What is circular traction? |
|
Definition
| belt around body, ex. pelvic traction for low back problems |
|
|
Term
| What is important to note in traction care? |
|
Definition
Maintain correct balance between traction pull and countertraction force and proper weight
Care of weights: should not be lifted or rest on floor, must hang freely @ all times, remove only with prescription
Skin inspection q 8 hours
Pin care
Assessment of neurovascular status q1 hour/24
Report pain |
|
|
Term
| What is open reduction with internal fixation? |
|
Definition
Permits early mobilization
Preferred for older adults |
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Term
| What is external fiction? |
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Definition
Pins or wires inserted through skin & bone, then connected to an external frame
Pin site care q 8hrs! Infection= osteomyelitis
Monitor for drainage, color odor, severe redness
Postop: clear fluid drainage/weeping is expected 48-72hrs |
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Term
| What is postoperative care for fractures and casts? |
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Definition
| similar to that for any surgery; certain complications specific to fractures and musculoskeletal surgery include prevention for fat embolism and venous thromboembolism |
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Term
| What interventions are done with acute pain r/t fracture? |
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Definition
Reduction and immobilization of fracture
Assessment of pain
Drug therapy—opioid and non-opioid drugs, anti-inflammatory, muscle relaxants
PCA-morphine
Constipation (older adults)
Encourage stool softeners, flds, activity
Complementary and alternative therapies—ice, heat, elevation of body part, massage, baths, back rub, therapeutic touch, distraction, imagery, music therapy, relaxation techniques |
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Term
| What are the interventions for infection? |
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Definition
Apply strict aseptic technique for dressing changes and wound irrigations.
Assess for local inflammation.
Report purulent drainage immediately to health care provider.
Assess for pneumonia and UTI
VS q4 to 8 hrs (older adults may not have a temp even with severe infection)
Administer broad-spectrum antibiotics prophylactically. |
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Term
| What are the interventions for impaired physical mobility? |
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Definition
Use of crutches to promote mobility (not older adults)
Use of walkers and canes to promote mobility, PT
Prevention for:
Pressure ulcers
Constipation
Urinary retention
Contracted joints
Pneumonia
Venous Thromboembolism(VTE) |
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Term
| What are the interventions of imbalanced nutrition (less than)? |
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Definition
Diet high in protein, calories, and calcium; supplemental vitamins B and C
Frequent, small feedings and supplements of high-protein liquids: shakes=protein, calories and calcium
Intake of foods high in iron (less weight bearing on long bones can cause anemia) |
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Term
| What are the upper extremity fractures? |
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Definition
Clavicle-self healing
Scapula-uncommon
Humerus-common in older adults
Olecranon- adults
Radius and ulna
Wrist and hand |
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Term
| What are the most common fractures of older adutls? |
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Definition
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Term
| Is there a high mortality rate w/ hip fractures? |
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Definition
| Yes because of complications and long term immobility |
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Term
| What are hip fractures at risk for? |
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Definition
| osteoporosis- weakens the upper femur (hip), breaks, and causes fall |
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Term
| What are the risk factors for falls? |
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Definition
Physiologic aging changes
Visual acuity and diminished hearing; changes in gait, balance, muscle strength; joint stiffness
Disease process
Osteoporosis, foot disorders, changes in cardiac function
Drugs increase risk for fall
Diuretics, antihypertensives, antidepression, sedatives, opioids, alcohol, (Use of three drugs at the same time)
Environmental hazards
Rugs, loose carpet, poor lighting, uneven walking surfaces/ stairs, pets |
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Term
| What is a intracapsular fracture? |
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Definition
| within the joint capsule, upper 1/3 of the femur |
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Term
| What is an extra capsular fracture? |
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Definition
| outside the joint capsule |
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Term
| What is a femoral neck fracture? |
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Definition
| concerned with disruption of blood flow to the femoral head= avascular necrosis (AVN) |
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Term
| How is a femoral neck fracture treated? |
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Definition
| surgical repair, when possible, to allow the older patient to get out of bed |
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Term
| What are some interventions for these fractures? |
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Definition
-PCA
-Ambulation
-Prevent hip dislocation |
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Term
| How do you prevent hip dislocation? |
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Definition
Prevent hip adduction and rotation
Keep leg in proper alignment; pillows or abduction device
Check skin for pressure
Neurovascular assessment for arterial circulation & peripheral nerve conduction
Keep heels off bed at all times, inspect q8 hrs
Turn q1-2 hours |
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Term
| Is there a cast with femur breaks? |
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Definition
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Term
| What is a complication of femur break/ |
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Definition
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Term
| How is a femur break treated? |
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Definition
-ORIF
-RODS
-COMPRESSION SCREWS |
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Term
| What is the risk associated / rib/sternum break? |
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Definition
Potential puncture of lungs, heart, arteries
Assess ABC first
Risk: pneumonia |
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Term
| What is the risk associated w/ pelvis breaks? |
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Definition
very vascular, close to major organs and vessels
Major focus on damage to organs
Falls are common cause in older adults
Major concern: venous oozing/arterial bleeding= hypovolemic shock |
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Term
| What is the assessment w/ pelvis breaks? |
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Definition
Check blood in stool and urine
Abdomen: ridged or swelling
CT scan, ultrasound |
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Term
| What is a non-weight bearing fracture of the pelvis? |
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Definition
pelvis
Pubic rami or iliac crest
Tx: BR, firm mattress or bed board
Heals in 2 months |
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Term
| What is a weight-bearing fracture of the pelvis? |
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Definition
Multi fractures, fractured acetabulum
Tx: external fixation or ORIF
Weight bearing depends on stability of fx after fixation |
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Term
| What are spine breaks associated w/? |
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Definition
| Associated with osteoporosis, metastatic bone cancer, & multiple myeloma |
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Term
| What results from a spine break? |
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Definition
| Result when vertebra weakens and causes vertebral body to collapse |
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Term
| What is nonsurgical management of spine breaks? |
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Definition
| Nonsurgical management includes bedrest, analgesics, and physical therapy. |
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Term
| What are the minimally invasive surgery that treats spine breaks? |
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Definition
| vertebroplasty and kyphoplasty, in which bone cement is injected. |
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