ch. 44 continued &study guide

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1

colle's fracture

fracture of the distal portion of the radius within 1 inch of the wrist joint.

2

when does a colle's fracture occur?

when a person attempts to break a fall by putting the hands down

3

potts fracture

distal end of the fibula and is characterized by chipping off of a piece of the medial malleolus with a displacement of the foot outward

4

what does it mean when we say "bone is vascular"

  • bleeding occurs when fracture occurs
  • bleeding at the site of the fracture and in the surrounding tissue
5

what is the first phase of bone healing post fracture?

  • bleeding
  • clot formation
6

in bone healing where do clots form ?

at the ends of fractured bones

7

second phase in bone healing

  • inflammation occurs
  • white blood cell formation
  • leukocytes involved
8

what is the role of osteoblasts in the 3rd phase of bone healing?

  • enters fibrous area to hold the union firm
  • continue to lay the network for bone build up
  • "create new bone"
9

what is the role of osteoclasts during the 3rd phase of bone healing ?

destroy dead bone

10

what is the role of collagen in the 3rd phase of bone healing ?

  • incorparate calcium deposits resulting in callus
  • strengthens and continues to incorporate calcium deposits
11

what is the role of a callus in the 3rd phas of bone healing?

  • form between and around the broken ends of a fractured bone during healing
  • forms when osteob builds up and osteoc breaks down
12

what happens during the 4th phase of bone healing ?

  • remodeling
  • excess callus reabsorbed and trabecular bone is laid down along the lines of stress
13

what does the sign and symptoms of a fracture involve?

clinical manifestations of fractures

  • location and function
  • strength of muscle attachment
  • type of fracture
  • amount of related damage
14

clinical manifestions of bone fractures

  • pain and warmth may not come for several days
  • deformity or loss of normal function
  • incapable of voluntary movement
  • change of curvature or length of bone
  • loss of sensation or paralysis distal to injury
  • crepitus
  • shock related to tissue injury, blood loss and severe pain
15

what does a loss of sensation or paralysis distal to injury indicate in a bone fracture?

nerve constricture

16

what do you do if you suspect crepitus ?

do not attempt to verify sign because it can cause damage and increase pain

17

what is crepitus?

grating sound heard if the limb is gently moved

(fracture)

18

assessment of a bone fracture

7 P's to establish

  • muscular function
  • bone integrity
  • distal circulation
  • sensation
19

subjective data assessment for bone fracture ?

  • pain at the site
  • loss of sensation or movement
  • cause of injury
20

objective data assessment for bone fracture ?

  • warmth
  • edema
  • ecchymosis
  • deformity
  • loss of normal function
  • systemic shock
  • circulatory, motor or sensory impairment
21

diagnostic tests for bone fracture?

  • radiographic examination
  • fluoroscopy
22

what do you do immediately for a bone fracture ?

medical management

  • splinting
  • elevation to prevent edema
  • body alignment
  • cold packs during first 24
  • administer analgesics
  • observe the injured part for change in color, sensation or temp.
  • observe for signs of shock
23

what does applying a cold pack within the first 24 hours on a bone fracture do for the fracture?

reduces :

  • hemmorrhage
  • edema
  • pain
24

what is the secondary managment for a closed fracture?

  • reduction
  • replace bone fragments
  • closed reduction
  • traction
  • ORIF
  • mobilization
25

what is closed reduction?

manualling manipulating bones

  1. moving bony fragments into positon and applying traction and presssure to distal fragments
26

what is open reduction with internal fixation?

surgical procedure allowing fracture alignment under direct visualization while using various internal fixation devices applied to the bone

27

how can immobilization be achieved ?

medical managament of bone fracture

  • external fixation with cast or splint
  • traction
  • internal fixation devices
28

what are some internal fixation devices

  • pins
  • plates
  • screws
  • wires
  • prosthese
29

medical management for an open fracture?

  • surgical debridement
  • date of last tetanus
  • expired status must have the shot
  • wound culture
  • prophylactic antibiotic therapy
  • observe for :osteomyelitis, tetanus or gangrene
  • observe for and treat any complications
30

when does closure of an open wound take place?

  • when there is no sign of infection
  • reduction and immobilization also takes place
31

nursing interventions for patients with fractures

  • balanced diet :proteins, calcium and vitamins
  • fluids
  • exercise of the unaffected joints
  • muscle setting exercise
  • skin care
  • elimination
  • anticipate and prevent the complications that result from immobility
32

protein riched foods good for bone fracture healing

  • lean meats
  • eggs
  • nuts
  • beans
33

good sources of calcium for bone fracture healing

  • dark leafy green veggies
  • low fat dairy products
  • soy milk
34

good sources of vitamin d for bone fracture healing

  • tofu
  • seafoood
  • fortified cerals
35

patient teaching for bone fractures

  • how to move comfortably in bed
  • how to transfer safely in and out of bed
  • weight bearing restrictions and activity limitations
  • proper use of ambulatory assistive devices
  • how to avoid edema
  • proper elevation
  • how to control pain and discomfort
  • exercise to perform and maintain strength of cleansing pins using surgical asepsis
36

prognosis of bone fracture

  • depends on patients age and health
  • nutrition
  • presence of other systemic diseases complicates healing process
37

what type injury results in fractures of the vertebrae?

  • diving
  • blows to the head
  • mortocylce accidents (men, 16-30)
38

what type patients are at risk for vertebrae fractures ?

  • osteoporosis pt.
  • metastatic cancers
39

clinical manifestions of vertabral fractures

  • pain at the site of injury
  • partial or complete loss of mobility or sensation below the level of the injury
  • evidence of fracture
  • fracture dislocation
40

subjective data for vertebrae fracture ?

  • pain
  • numbness
  • tingling
  • inability to move extremities
41

objective data for vertabrae fracture

  • neuro function ?
  • fecal and urinary retention
  • signs of hemmorrahge
42

what would you include in the neuro function assessment for a vertabral fracture ?

  • pupillary reaction to light
  • hand grip
  • ability to move extremities
  • level of oriention
  • vital signs
  • reaction to painful stimuli
43

what are some signs of hemorrhage in a vertebral fracture patient?

  • hypotension
  • tachycardia
  • tachypnea
  • decreased renal functioning
44

diagnostic test for vertbrae fractures ?

  • x ray
  • spinal tap
45

why are x rays done for vertbrae fractures?

to determine if the vertebral bodies are compressed

46

what is a spinal tap test used for?

to evaluate the fluid

  • if suspected of fracture or dislocation of a vertebra
47

what color is spinal fluid normally?

  • clear
48

what does the presence of blood indicate in a spinal tap?

trauma

49

medical management for vertabrae stable injury fractures ?

  • pain medication
  • muscle relaxants
  • anticoagulant therapy
  • maintaing erect posture
  • ambulation with assistance
50

medical managgement for vertabrae unstable fractures that involve displacement

  • fraction reduction
  • postural positioning and traction
51

when is cranial skeletal traction used?

for cervical spine fractures

52

when is pelvic traction used ?

for lumbar spinal fractures

53

nursing interventions for vertebrae fracture?

  • logrolling patient for -position changes
  • elevating the head of the bed no more than 30 degrees
  • using stabliziation devices for the head and back
  • assess the coninuity of traction
  • asses skin integrity
54

patient teaching for vertebrae fracture

  • how to support the back
  • use firm mattress
  • sitting in straight firm chairs for no longer than 20 to 30 minutes
  • use proper lifting techniques (legs not the back)
  • doing back exercises to stregthen spinal extensor muscles
55

prognoisis of vertbrae fractures

stable :full recovery

unstable :guarded when spinal cord injury is involved

56

fractures of the pelvis

  • forceful trauma
  • falls at extreme heights
  • car accidents
  • crushing accidents
  • cab result in extensive blood loss
  • can cause damage to other organs in that area
57

clincal manifestations for pelvis fracture

  • unable to bear weight without discomfort
  • local tenderness and edema
  • hematuria
  • hemorrhage :most life threatening
58

hematuria

blood in the urine

59

subjective data for pelvic fracture

complaints of :

  • pelvic pain
  • tenderness
  • backache
  • restlessness
  • anxiety
  • progressive disorientation may be signs of shock
60

objective data for pelvic fracture

  • muscle spasm
  • ecchymoses over the pelvis, perineum, groin , or suprapubic area
  • inability to raise the legs when supine
  • shortening, external foot rotation
  • vital signs :shock
  • observe for fat emobolism
  • assess bowel sounds
  • asses color and amount of urinary output
61

diagnostic tests for pelvic fracture

  • abdominal xray in supine and lateral positions
  • ct : evaluation of the bony pelvis and intraabdominal contents
  • intravenous pyelogram :to determine kidney damage
62

medical managment for pelvis fractures

  • remains on bed rest for three weeks
  • walks on crutches for 6 weeks after
63

medical man. for symphasis pubis fracture and iliac fractor on the same side

  • surgery
  • skeletal traction for 6 weeks
  • ambulate without bearing weight for 3 months
64

medical management for bilateral fracture of the pelvis

  • pelvic sling
65

nursing interventions for fracture of the pelvis?

  • monitor the patient for signs of shock
  • measure abdominal girth every 8 hours for signs of increased abdominal pressure
  • monitor i&o
66

what are the signs of shock ?

  • hypotension
  • tachycardia
  • tachypnea
  • decreased urinary output
67

patient teaching for pelvis fracture

  • reinforce immobility and not bearing full weight
  • dealing with acute pain
  • changes in medication
  • pain decreases
  • explain turning and moving techniques
68

prognosis for pelvis fractures

  • hemorrhage
  • depends on the severity , age and presence of other systemic disorders
69

what are the complications of fractures ?

  • compartment syndrome
  • shock
  • fat embolism
  • gas gangrene
  • thromboembolus
  • delayed fracture healing
70

compartment syndrome

pathologic condition caused by the progressive develoopment of arterial vessel compression and reduced blood supply to one of the body's compartment typically in an extremity

71

how can a patient achieve compartment syndrome ?

  • expansion or inflammation of a compartments contents
  • compression of blood vessls from swelling
  • too tight of a cast or dressing resulting in ischemia
72

what is ischemia ?

  • decreased blood supply
  • can cause compartment syndrome
73

what can occur within 6 hours due to the compression of the arteries, nerves and tendons entering the compartment ?

irreversible muscle ischemia

compartment syndrome

74

what is seen within 24 to 48 hours of compartment syndrome ?

  • paralysis
  • sensory loss
  • permanent disability of the extremity
75

subjective data of compartment syndrome

  • sharp pain with passive ROM of hand or foot
  • deep, unrelenting pain
  • pain unrelieved by analgesics or elevation
  • numbness or tingling in the affected extremity
76

objective data assessment of compartment syndrome

  • inability to flex the fingers or toes
  • coolness
  • absence of pulsation
  • pallor or cyanosis
  • slow cap refill
  • vital signs
77

what is the prompt medical managment of compartment syndrome ?

  • avoid per. neuro damage
  • surgical intervention
78

fasciotomy

incision into the fascia to relieve pressure and allow return of normal blood flow to the area

79

how does a fasciotomy heal for compartment syndrome

left open to heal by granulation

80

nursing interventions for compartment syndrome

  • administration of analgesics
  • document relief
  • elevate affected limb NO HIGHER THAN HEART LEVEL to maintain arterial pressure
  • apply cold packs
  • remove any material
  • provide instructions to a patient who have iso prec.
  • encourage patients to express fears
81

what is the most common complication when decompression is delayed (compartment syndrome)

infection as a result of necrosis

82

in compartment syndrome patients what is a sign of infection?

purulent drainage from the dressing

must be reported immediately

83

what can reduce the risk of volkmann's contracture

proper positioning and alignment

84

what is volkmanns contracture

permanent contracture with clawhand, flexion of wrist and fingers and atrophy of the forearm that can occur as a result of compartment syndrome

85

prognosis of compartment syndrome

  • perm, contracture of the hand or foot
  • muscle necrosis
  • infection
86

what are some ways shock is obtained ?

  • bone loss from a fractured bone
  • from severed blood vessels (open fractures)
  • pain and fear
87

subjective data for shock

  • monitor level of consciousness
  • restlessness
  • anxiety
  • weakness
  • lethargy
88

objective data of a shock patient ?

  • vitals
  • hypotension
  • tachycardia
  • tachypnea
  • hypothermia
  • diaphoresis
  • pale, cool, moist skin
  • oliguria
89

what is oliguria ?

diminshed urinary output

90

medical managament for shock ?

  • restore blood volumer to ensure a rapid return of oxygen to the tissues
  • administer oxygen
  • central venous cat
  • shock trousers
91

how can blood volume be achieved for shock patients?

iv fluids :

  • lacted ringers solution in normal saline
  • whole blood
  • plasma
  • plasma subs.
92

why might a central venous cat be inserted for a shock patient ?

for accurate monitoring of vital signs to prevent pulmonary edema

93

what is the purpose of shock trousers?

counterats hypotension associated with internal or external bleeding and hypovolemia

94

nursing interventions for shock ?

  • monitor iv insertion
  • monitor vitals every 15 minutes until stable
  • monitor urinary output every hour
  • remain flat in bed
  • raise the lower extrem. to improve venous return to the major body organs
  • keep patient warm,
  • avoid external heat
  • NPO
  • do not give sedatives, tran. or narcotics
  • provide family with breif explanation of pt. condition
95

what is infiltration?

when the infusion solution is seeping into the tissue surrounding the vein

96

what are the signs of infiltration?

  • edema
  • pain
  • induration (harding of tissue)at the site
97

how is decreased renal perfusion indicated by a shock patient

urinary output less than 30 mL/h

98

what postion should be AVOIDED for shock patients?

trendelenburgs

reduces the effectiveness of other organs

99

prognoisis of shock

  • loss o fconsciousness
  • coma
  • fatal within a few hours of injury
  • imm. attention is required
100

fat embolism

  • embolization of tissue fats with platelts and circulating free fatty acids within the pulmonary capillaries
  • rare but life threatning
101

what can be a result of fat embolism

brain hypoxia

tissue death

102

what are the risk factors of fat embolism ?

  • long bone and pelvic fractures
  • crush injuries
  • hip replacement surgery
103

what is the most serious complication of long bone fractures ?

fat embolism

104

how fast can a fat embolism occur?

within 48 hours of injury

105

subjective data of a fat embolism

  • irritability
  • restlessness
  • disorientation
  • stupor
  • coma
  • chest pain in inspiration
  • muscle weakness
  • spasticity
  • rigidity
106

objective data of a fat embolism

  • tachypnea
  • dyspnea
  • hypoxemia
  • auditory crackles
  • wheeezes in the lungs
  • disturbed ventilation
  • dysrhythmias
  • PETICHIAE
107

what is petichaie

rash of red pinpoint dots in buccal membranes conjuctiival sacs, hard palat, chest and anterior axillary folds

found in fat embolus patients

108

diagnostic tests for fat embolism

  • blood gas - hypoxemia
  • hemoglobin and hematocrit - decreased
  • fat is present in the blood and urine
  • sedimentation rate is increased
  • platelet count in decreased
109

medical managment for fat embolism

  • prevention
  • careful immobilization
  • iv fluids to prevent shock and dilute free fatty acids
  • incentive spirometry
  • oxygen
110

medications for fat embolism

  • corticosteriods
111

why is digoxin used for fat embolism

to increase the patients cardiac output

112

why is oxygen administered for a fat embolus

the arterial oxygen pressure is less than 70 mm Hg

113

nursing interventions for fat embolism

  • monitoring arterial blood gases
  • check liter flow of oxygen
  • educate
  • respiratory failure - most common form of death
  • careful stabilization of long bone fractures
  • suppport when turning and positioning
  • accurate record of I&O
  • repositioning as little as possible
  • asses daily weight
114

normal pHvalue for fat embolism

7.35 - 7.45

115

normal PaCO2 value for fat embolism

35 to 45 mm Hg

116

normal Pao2 value for fat embolism

80 to 100 mm Hg

117

normal HCO3 values for fat embolism

21 to 28 mEq/L

118

normal SaO2 value for fat embolism

95%to 100

119

prognosis of fat embolism ?

life threatning

120

gas gangrene

  • severe infection of the skeletal muscle
  • caused by gram positive clostridial bacteria
  • clostridium perfringens
  • open fractures
  • lacerated wounds
  • sudden onset 1-14 days after injury
  • when patient is not handeling wound care properly
121

clostridial bacteria

  • anaerobic
  • spore formers
  • found in soil
  • intestinal tracts
  • multiply and produce toxins
  • cause hemolysis
  • causes vessel thrombosis
  • damages the myocardium, liver, kidneys and brain
  • gas ganggreene
122

subjective data of gas gangrene

  • sudden and severe pain
  • toxic delirium
123

objective data for gas gangrene

  • careful inspection of skin
  • gas bubbles at wound site
  • cellulitis - gas present under the skin
  • crepitation
  • infection :temp, tachycardia, tachypnea and edema
  • necrotic and rupturous skin
  • document patients response to antibiotic therapy
124

what is crepitation

crackling sensation when the skin is touched

125

characteristics of the wound discharge in gas gang grene patients

  • thin
  • watery
  • foul smelling
126

medical management for gas gangrene

  • establish larger wound opening to admit air and promote drainage
  • observe for adverse reactions
  • excisions of gang. tissue
127

medications for gas gangrene

  • penicillin G or cephalothin - IVnurs
128

nursing interventions for gas gangrene

  • wound care
  • strict medical asepsis
  • autoclave equipment
  • drainage and secr. precations to prevent spread
129

gang grene prognosis

  • fatal
  • amputation
130

thromboembolus

  • blood vessels are occluded by an embolus carried into the bloodstream from the site of formation of the clot
  • reduced muscle contraction
  • bed rest
131

what patient is at higher risk for thromboembolus

  • pelvic and hip fracture patients are at higher risk
132

clinical manifestations of thromboembolus

  • tingle
  • numb
  • cold
  • cyanotic - blue
133

thromboembolus in the lungs

  • sudden
  • sharp thoracic or upper abdominal pain
  • dyspnea
  • cough
  • fever
  • hemoptysis
134

subjective data for thromboembolus

  • complaints in the calfs
  • tenderness
  • pain in the thoracic area when in the lungs
135

objective data of thromboembolus

  • assessing consistent signs
  • swelling
  • warm to touch
  • redness
  • different leg sizes
  • dyspnea
  • blood in the sputum
  • bleeding
  • petechiae
  • spistaxis
  • hematuria
  • hematemesis
  • gross blood in the stool
136

diagnositc test for thromboembolus

physcial exam

  • PT:prothrombin time
  • INR
  • D- dimer concentration
  • cbc
137

treatment for thromboembolus

  • administration of anticoagulants
  • thrombectomy
138

medications for thromboembolus

  • heparin
  • enoxaparin
  • warfarin
139

thrombectomy

removal of a thrombus from a blood vessel

140

nursing interventions for thromboembolus

  • bed rest
  • foot of bed elevated to aid in venous return
  • active exercise :dosiflexion , plantar flexion ; several times each hour
  • hot moist compresses
  • antiembolism stockings
  • assess lung sounds every 4 hours
  • closely monitor PT, INR & PTT
141

prognosis of thromboembolus

  • fatal if pulmonary artery is obstructed
  • usually resolves with treatment
142

delayed fracture healing

delayed union

  • fracture that fails to heal within the usual time
  • eventually will repair itself
  • calcification of bone does not happen
143

nonunion

delayed fracture healing

  • ends of fractured bones fail to unit
  • produces stable union after 6 to 9 months
144

causes of union and nonunion delayed fracture healing

  • infection
  • perfusion
145

what can be used to correct delyaed bone healing

  • bone grafting
  • prosthetic implants
  • internal , external fixation
  • electrical stimulation :stimulates bone production
146

delayed bone healing prognosis

  • depends on pt. age and general health
  • other systemic diseases
147

external fixation devices

  • used to hold bone fragments in normal position w
148

examples of external fixation devices

  • casts
  • skeletal and skin traction
  • braces
  • metal pins
149

skeletal pin external fixation

  • pins inserted through the bone
  • attaches to a rigid external metal frame
  • communited open fractures
  • infected non unions
  • infected unstable joints
  • leaving the fracture open
  • performed under general anesthesia
150

what is the purpose of leaving the fracture open with a pin external fixation

visibility of the area and accessibility for the wound

151

nursing interventions for skeletal pin external fixation

  • reassure patient that minimal pain after insertion
  • extremity placed in balance suspension traction for edema
  • document positon of pins and surrounding skin
  • asses for drainage or odor and infection
  • remove dried exudate from around the pins
152

for skeletal pin external fixation when can the patient ambulate ?

when the soft tissue edema is relievd

153

for skeletal pin external fixation when can the patient shower?

when the wounds have healed but must avoid sale or chlorinated water to prevent corrosion

154

casts

  • immobilization devices
  • plaster
  • fiberglass
155

what is typically casted with plaster?

  • body casts
  • long bones requiring more stabilization
156

fiberglass is usually for . . .

  • used on arm fractures
  • lightweight
157

nursing interventions for casts

  • insepect the distal and proximal edges of the cast
  • inspect for rough peices and skin irritant
  • patient education on infection
  • handle wet casts gently
  • never use spica bar
  • set cast dryer on warm never hot
  • elevate the casted extremity :reduces edema (first 24 - 48 hours)
  • support weight on hands
158

cast brace

alternative appliance to the traditional leg cast

  • provides support and stability of plaster cast
  • femur
  • permits early ambulation and weight bearing
  • used 2 to 6 weeks after fracture reduction
  • helps promote the formation of bone
159

nursing interventions for cast bracing

  • elevate the leg to promote when sitting to promote venous return
160

what is one problem that occurs with cast bracing

edema around the knee

161

nursing assesment for casts

  • neuro ass. cap. refill every 15 to 30 minutes for several hours after casting and every 4 hours the first few hours
  • squeeze nailbeds to produce blanching
  • observe skin at cast edges for erythema and irritation
  • compare skin sides
  • asses ability to move fingers and toes
  • pain and discomfort
  • assess the efectiveness of analgesics
162

cast syndrome

  • superior mesentery artery syndrome that can occur after the application of a spica body cast
  • obstruction of the duedenom
  • place patient in prone to relieve pressure symptoms alert charge nurse
163

patient teaching for casts

  • information about cleaning around the cast site
  • use mild soap
  • synthetic fiberglass:can be flushed with water
  • dry after ward to avoid skin impairment
  • dry fiberglass with blotting of towel and then blow dryer on cool or warm setting in sweeping motion across the cast
  • may take one hour to dry
  • diversion activies when puritius occurs
  • do not stick sharp objects underneath the cast to relieve puritius
164

cast removal

  • electric saw
  • prep patient for skin underneath cast
  • wear masks to avoid respiratory irritation
  • gently wash and apply lotion or cream to dead skin
  • muscle atrophy
  • reassure patient that muscle will increase in strength and size with proper exercise
165

traction p

putting an extremity, bone, or group of muscles under tension by means of weights and pulleys

  • continous or intermitten
  • continous :to stablize a fracture
  • intermitten:cervical or pelvic
166

uses for traction

  • align and stabilize a fracture site
  • relieve pressure on nerves as in the case of herniated disk syndrome
  • maintain correct positioning
  • prevent deformities
  • relieve muscle spasms
167

what are the two types of traction

  • skeletal
  • skin
168

skeletal traction

  • applied directly to the bone
  • used for longer periods
  • wires and pins through the bone distal to fracture
  • local or general anesthesia
  • pins pertrude through skin on both sides
169

what type fracture is skeletal traction used for?

  • femur
  • tibia
  • humerus
  • cervical spine
170

skin traction

  • short term use
  • lighter weights
  • applied directly to the skin
  • weights pull on sponge rubber, moleskn and elestic bandage wha
171

what are two types of skin tractions ?

  • bucks traction
  • russells traction
172

bucks traction

  • temp measure to provide support and comfort to a fractured extremity while waiting for more definitive treatment
  • used for hip fractures BEFORE surgery
  • used for muscle spasms
  • used for minor fractures of the lower spine
173

russells traction

  • set up to bucks traction
  • knee sling supports affected leg
  • allows more movement in bed
  • permits flexion of the knee joint
  • used to treat hip and knee fractures
174

nursing interventions for traction

  • proper body alignment
  • assesment of traction equipment
  • pulleys must remain off the floor for correct alignment
  • assesment of pin sites :skeletal traction
175

pin site care skeletal traction

  • cleansing with prescribed agent
  • sterile cotton tipped applicators
  • antibiotic ointment
176

balkan frame

  • wooden or steel attachment to the hospital bed
  • trapeze bar attached to overhead bar
  • adjustable pulleys
177

bradford frame

  • rectangular steel
  • two peices of canvas
  • space open at the butt for hygiene and toileting
178

circolectric bed

  • vertical turning bed
  • operated by one person
  • placed in a variety of positions
179

microair alternating lateral rotation bed

  • regulates air with a series of valves that open and close
  • bed has customizable turn times ranging from 10 to 60 minutes
180

rotorest bed

  • rock a patient as much as 62 degrees 17 times per hour
  • helps heal pressure ulcers
  • prevents venous thrombosis
  • reduces kidney stone formation
181

Stryker wedge turning frame /foster bed

  • changes pt. position from supine to prone
  • may be apprehensive
182

splints crutches and braces are used for

to immobilize and assist with ambulaton

183

3 paint gait

  • 2 crutches one foot touching the floor
184

swing to swing gait

patient swings the body up to or beyond the two points of the crutch tips

185

cane walking

  • instruct the patients to hold cane in the opp hand of the affeected extremity
  • advance cane at the same time the affected leg moves forward
186

roll about walker

gait enhancer designed for patients who have an injury below the knee

  • fractured tibia
  • fibula
  • ankle
  • foot

pt . distributes weight evenly

places injured knee on knee [ad

187

contusions (traumatic injury)

  • most common soft tissue injury
  • blow or blunt force trauma
  • local bleeding under the skin
  • severity depends on part of body affected
  • can cause cellulitis
188

contusion treatment

  • ice bags
  • cold compress for 15 to 20 minutes ovr 12 to 36 hours for the vasoconstrictive effects of cold
  • elevate to reduce edema and suppress pain
189

prognosis of contusions

excellent

190

sprains

  • wrenching or hyperextension of a joint
  • tearing the capsule ligaments
  • can involve hemarthrosis
  • sudden twist or injury
  • medical man. similar to contusion
191

what is hemarthrosis

bleeding into a joint

192

common sites for sprains

  • knee
  • ankle
  • cervical spine (whiplash)
193

treatment for sprain

  • rest
  • ice
  • compression
  • elevation
194

prognosis of sprain

excellent

195

whiplash

  • injury at cervical spine
  • typical cervical disk syndrome
  • compression of one or more cervical nerves
196

how does whiplash occur ?

  • sudden accelaration and deceleratin
  • rear end car collisions
  • back and fourth movements of head and neck
  • cervical fractures
197

symptoms of whiplash

  • pain
  • may not be obvious for days or weeks after injury
198

subjective data of whiplash

  • pain felt in the cervical area and moves down the arm to the fingers and increase with cervical motion
  • coughing
  • sneezing
  • radical movement
  • ^ paid increase
  • parastesia
  • headache
  • blurred vision
  • decreased skeletal function
  • weakened hand grip
199

what is parasthesia

numbness or tingling

200

objective data for whiplash

  • edema in the cervical spine
  • tightening of the muscles
  • report and document abnormal vitals
  • perform neuor every 15-30 minutes to rule out increased ICP
201

diagnostic test for whiplash

physical exam

radiographic studies aka x ray

202

medical management for whiplash

  • analgesics
  • muscle relaxants
  • intermittent cervical traction
  • surgery
  • special exercises
  • heat therapy
  • administration of mild analgesics
  • neck brace color - limits head movement
203

nursing interventions for whiplash

  • restricted activity to immobilize
  • decrease irritation
  • rest for trauma area
  • cervical traction
  • inspect the skin around the neck and chin for signs of excoriation
204

prognosis of whiplash

  • depnds on extent of neuro involement
  • excellent with minor trauma
  • extensive injury - profound disability
205

ankle sprrains

  • "twisted ankle"
  • wrenching or twisting of the foot and ankle
206

clinical manifestations of ankle sprains

  • edematous
  • spasms of the muscle
  • pain on passive movement
207

subjective data of ankle sprain

  • pain
  • tenderness
  • intesifies with movement
208

objective data for ankle sprain

  • assesment of traumatized ankle for :
  • edema
  • limited movement and function of the joint
  • ecchymosis of soft tissue around the ankle
209

dignostics for ankle sprains

x ray

210

medical management for ankle sprains

  • surgery if severe
  • small whole in the medial malleoulous
211

nursing interventions for ankle sprains

  • elevate and keep at rest
  • apply ice for 15 to 20 minutes intermittently for 12 to 36 hours after 24 hours of mild heat application for 15 to 30 minutes four times daily :promotes absorption of blood and fluid from the area
  • compressive dressings
  • splinting
  • neuro assessment
212

prognosis of a ankle sprain

generally excellent

213

strains

  • microscopic muscle tears
  • over stretching muscles and tendons
  • forceful movement
  • vigours exercise
  • repeated muscle overuse
214

subjective data for sprains

  • sudden and severe pain away from joint
  • pain increases with activity
  • pain may not appear for several hours
  • sorness
  • stiffness
  • tenderness
215

objective data for strains

stiffness

ecchymosis

slight edema w

216

what are the most common sites for strains ?

  • calf muscles
  • hamstrings
  • quadriceps
  • lumbosacral area
  • edema can occur rapidly in the muscle and tendon area
217

diagnostic for strains

x ray

218

medical managment for strains

  • surgery if muscle rupture
  • analgesics and muscle relaxants
  • exercise program if in lumbosacral region
219

nursing interventions for strain

  • ice
  • heat
  • avoid strenous activity
  • use a firm chair with rigid back support
  • avoid wearing high heels
  • use a firm mattress for sleep
  • never sleep on the abdomen
  • leg exercises
220

what is the most common strain

back strain

221

prognosis for strains

favorable

222

dislocation

  • tearing of the joint capsule
  • temp displacements of bones
  • congenital
  • caused by disease
  • caused by trauma
  • stretching and tearing of ligaments
  • may rupture blood vessels
223

subluxations

partial or incomplete dislocations

joints involved are particially separated

224

clincial manifestations of dislocations

  • length changes
  • pain and loss of function
  • immobilizes a joint
225

what are the common dislocation sites?

shoulder

hip

knee

226

subjective data of a dislocation

  • pain
  • dsesation loss and paresthesia (shoulder dislocation)
227

objective data of dislocation

  • erythema
  • discoloration
  • edema
  • pain
  • tenderness
  • limited movement
  • deformity or shortening of the extremity
  • (shoulder):absent radial pulse , hypothermia of the hand and wrist drop
228

diagnostic test for dislocations

physical assessment

discomfort

x ray

229

medical managment of a dislocation

  • closed reduction : manipulation of the extremitiy
  • surgical intervention
230

nursing interventions for dislocations

  • reduction of edema and discomfort
  • immobilization of the injured part to promote healing
  • patient education
  • ice for first 24
  • heat after ice
  • elevate with pillows
  • elastic bandages relieve edema
  • air cast or air splint
  • neuro checks
  • administer analgesics
  • rate pain from 0 to 10
  • opioiod
  • positioning and repositioning
  • promote accident free environment
231

medication ordered for extreme dislocation pain

morphine

232

medication administered for mild to moderate dislocation pain

  • ibuprofen
  • acetaminophen (tylenol)
233

promotion of accident free enviornments for dislocation patients

  • grab bars in bathroom
  • removing throw rugs
  • gait enhancers
  • side rails
  • safe ladder
  • wearing protective clothing
234

prognosis of dislocations

generally excellent

235

airbag injuries

  • chemical burns
  • ocular trauma
  • cervical injury
  • soft tissue injury
  • upper extremities
  • chest trauma
  • can be life threatning
236

orthopedic injuries include ?

  • upper extremities
  • wrist
  • hand
  • elbow
237

who are at an increased risk for airbag injuries

very yound small children

older adults

238

treatment for airbag injuries

cleaning

application of ice to inflammed areas

analgesic therapies

239

carpal tunnel syndrome

  • disorder of the wrist and hand
  • inflammation and edema of the synovial lining of the tendon sheaths in the carpal tunnel of the wrist
  • hypoesthesia
  • paraesthesia
240

who is more at risk for carpal tunnel

  • obese middle aged women
  • occupations involving repetitious motions of the fingers and hangs
  • increase computer usage
  • pregnant women develop during last trimester :fluid retention and edema
241

what can pedispose a patient to carpal tunnel

edema of the tendon sheaths caused by RA

242

clinical manifestions of carpal tunnel?

  • gradual to increased numbness and tingling in the thumb index and middle finger
  • altered ability to grab
  • atrophy of the thenar eminence
243
  • subjective data of carpal tunnel
  • discomfort
  • burning or tingling in the hands
  • pain may be intermittient or constant
  • more intense at night
  • numbness of the thumb, index and ring fingers
  • inability to grasp or hold small objects
244

objective data of carpal tunnel

  • assessmment of the hand , wrist , fingers for edema
  • muscle atrophy
  • depressed appearance of the soft tissue
245

diagnostics for carpal tunnel

  • physcial exam
  • increased tingling with a gentle tap of the tendon
  • edema
  • have patient hold wrist against each other in forced palmar flexion for 1 minute
  • electromyogram
  • mri
  • elctroneuormeter
246

medical managment of for carpal tunnel

  • splint
  • PTand yoga
  • surgery
  • decompression of median nerve
  • endoscopic technique or open surgery
247

medication for carpal tunnnel

hydrocortisone acetate injection into the carpal

248

nursing interventions for carpal tunnel

  • education
  • changes and stretching of the hands and fingers
  • immobilizer
  • cock up splint
  • elevation
  • ROM
249

post op interventions for carpal tunnel

  • elevate the hand and arm for 24 hours
  • active thumb and finger motion within limits imposed by the dressing
  • administer analgesics
  • monitor vitals
  • check for circulation, sensation and movement every 1-2 hours for 24 hours
  • use had 2-3 days after surgery
250

prognosis of carpal tunnel

excellent

if pregnant symptoms relieved after delivery

251

herina

  • rupture of the fibrocartilage surrounding intervertebral disk
  • pressure of the nerve roots
  • can occur suddenly or gradually
252

lumbar spine hernia affects

25-45 year olds c

253

cervical herniations usually occur

45 years and older

254

who are more prone to herniation of intervertebral disk

men

255

clinical manifestations of herniated disks

  • low back pain
  • over the butt and down the leg
  • sciatic nerve pathway
  • numbness and tingling
  • activity intolerance and alteration in bowle and bladder elimination
  • neck pain
  • headache
  • neck rigidity
  • pain and tingling down both arms
  • loss of strength
256

subjective data of herniated disks

  • paint
  • measures used for relief
  • altered bowel nd bladder function
257

objective data for herniated disks

  • limited spinal flexibility
  • gait alteration
  • ineffective breathing [attern
  • bowel and bladder elimination
  • maintenance of traction equipment
258

diagnostic tests for herniated disk

physical exam

xray

MRI

CT

myelography

electromyelography - nerve involement

259

medical managament for herniated disks

  • local heat or ice
  • ultrasound
  • massage
  • TENS
  • surgical procedure
260

medicines for herniated disks ?

  • nsaids
  • muscle relaxants
  • corticosteriod epidural injection
261

tinel sign

burning or tingling in the hands

may be intermitten or constant

seen in carpal tunnel

262

artificial disk replacement

  • replacement of damaged intervertebral disk with an artificial disk
  • metal or plastic
  • return of natural movement of the spine
  • for herniated disks
263

chemonucleolysis

  • pts with no nerve involvement
  • local anesthetic
  • needle into nucleus
  • for herniated disks
264

what is chymopapain ?

a drug for herniated disks that dissolves the nucleus pulposus

265

diskectomy

  • removal of the extruded disk material
  • local anesthesia
  • used for herniated disks
266

endoscopic spinal microsurgery

  • used for herniated disk
  • local anesthesia
  • removal of herniated disks with minimal damage
267

laminectomy

  • surgery for herniated disks
  • removal of bony arches
268

spinal fusion

  • surgery for herniated disks
  • removal of the lamina and several jermoated mice;o
269

post op laminectomy care

(herniated disk surgery)

  • assessing the incision site for signs of infection : drainage edema , odor and temp
  • use of surgical asepsis
270

pot op care for chemonucleolysis

(herniated disk surgery)

assess for allergic reactions to chymopapain :

  • urticaria
  • respiratory difficulties
271

nursing interventions for herniated disks

  • give info on procedure & hospital protocol
  • administer meds on schedule
  • document effectivenes
  • heat or ice
  • position every 2 hours
  • high protein , iron and vitamin diet
  • apply antiembolism
  • document i&o
  • ensure voided into first 8 hours
  • sit in straight firm chair for no long than 30 minutes a one time
  • monitor for respiratory distress and oaralytic ileus
  • begin activity out of bed 1 day after a simple laminectomy or 2 to 4 days after
  • braces or coresettes before the patient gets out of bed
  • do not lift or carry anything heavier than 5-10 lbs for 8 weeks
  • do not drive until permitted
  • avoid twisting the trunk
272

herniated disk prognosis

  • relief of symptoms
  • sugery
  • usually favorable
273

tumors of the bone

  • cause is not always known
274

osteogenic tumors

(tumor of the bone)

malignant bone tumors that occurs most often in younr people

275

osteogenic sarcoma

(tumor of the bone)

  • fast
  • agressive
  • affect the long bones of the body : distal femur, proximal tibia, proximal humerus
  • mastasizes via the blood stream
  • males between 10-25
276

osteochondroma

(tumor of the bone)

  • most common
  • benign
  • highest in males 10-30
  • single or multiple
  • humerus, tibia, and femur
277

clinical manifestations of tumors of the bone ?

  • metastasizes and invade other bones and lung tissue
  • benign can grow large enough to put pressure on blood vessels and nerves
278

subjective data of tumors of the bone ?

  • pain in the affected bone site
  • pain with weight bearing
  • spontaneous fracture pain
  • tenderness of the affected site
279

objective data of tumors of the bone ?

  • edema
  • discoloration of the skin
280

diagnostic tests for tumors of the bone ?

  • x ray
  • bone scan
  • bone biopsy
  • CBC (bone marrow involvement
  • Serum protein levels (elevated)
  • serum alkaline phosphatase leve )elevated in osteogenic sarcoma
281

medical management for tumors of the bone that are large and symptomatically benign or malignant

  • surgery
  • wide excision
  • resection
  • bone curettage
  • leg, arm amputation
282

medical managment for tumors of the bone

  • destroying or removing the malignant lesion
  • amputation
  • radiation and chemo before surgery
  • limb salvage surgical procedures
283

why is radiation and chemo used before surgery

to decrease tumore size or tissue involvement

284

what is chemo for ?

  1. destroying cancer cells at primary and metastic sites
  2. usually recieve in 3 or 4 week cycles
285

radiation therapy?

  • for tumors of the bone
  • may be given internally or externally
286

nursing interventions for tumors of the bone ?

  • give information
  • performing a neurovascular assessment
  • monitor vital signs
  • administer analgesics and evaluating effectiveness
  • provide cast car or dressing changes
  • PT and OT therapists to promote ADL's
287

prognosis of tumors of the bone

osteogenic sarcoma = 50 percent at 5 years

288

why might amputation be necessarry?

  • malignant tumors
  • injuries
  • impaired circulation (diabetes or arteriosclerosis)
  • congenital deformities
  • infections
289

amputation of long bones can result in what?

post op anemia

290

preop subjective data assessment for amputation

  • question patient about understanding of the injury
  • assess complaints of pain and symptoms of neurovascular impairment
  • asses orientation
291

objective prop assessment for amputation

  • vital signs
  • arterial blood flow
  • would drainage for color, amount, and presence of odor
  • evaluate upper body muscle strength
  • nutritional status
292

how to assess arterial blood flow in an amputation patient

palpation of the bilateral pedal pulses

293

diagnostic tests for amputation

  • cbc : to determine blood dyscrasias
  • BUN
  • potassium levels
  • routine urinalyusis
  • ECG : to detect cardiac dysrhthmias e