ORTHO

What is necessary for bone mineralization and has increased levels with metabolic disorder, healing fractures, and bone cancer?

Alkaline phosphatase

How many pounds are allowed for skin traction?

5-10

How many ponds are allowed in skeletal traction?

5-45

What are major complications of pts with facial fractures?

Airway obstruction and aspiration of vomit

What is associated with noncontact injuries during sports. Seen following pivots, jumps, or sudden slowing?

ACL injury

Intracapsular fracture involves the neck of the femur and puts pts at an increased risk for what?

AVN because of loss of blood supply to the distal head of the femur

How do you assess the motor function of the ulnar nerve?

Abduct fingers

What does 4/5 muscle strength mean?

Active movement against gravity and some resistance

What does 2/5 muscle strength mean?

Active movement against gravity only and NOT against movement

What does 5/5 muscle strength mean?

Active strength against full resistance without evident fatigue ( normal muscle strength )

What are the nursing considerations of TNF inhibitors?

Administer TB and perform CXR before therapy before starting therapy Monitor for signs of infection STOP drug therapy temporarily and notify HCP if acute infection develops Instruct pts to avoid live vaccination while taking drug Report bruising, bleeding, or persistent fever and other signs of infections

A sudden pop, severe pain and rapid swelling in the knee and loss of ROM a sensation of "giving way" may indicate what?

Anterior cruciate ligament ( ACL ) injury

What is the most specific test in diagnosing systemic lupus erythematous?

Anti-DNA antibody

What may be used with open reduction fractures to prevent infection?

Antibiotic beads

What is useful in diagnosing RA?

Anticyclic citrullinated peptide

What internal visualization of joint with arthroscope?

Arthroscopy

What does 1/5 muscle strength mean?

Barely detectable flicker or trace of contraction with observation or palpation

What is a withdrawal fluid from joint called? It usually occurs at bedside or exam room. Local anesthesia and aseptic is used.

Athrocentesis

What is seen in decreased levels of Ca?

Bone cancer and hyperthyroidism

What kind do methotrexate and hydrochloroquine have in common?

Both teratogenic and should NOT be used during pregnancy

What is an xray that provides a 3D picture and IDs side tissue abnormalities?

CT scan

What provides bone rigidity and is stored in bones?

Calcium

Compression of the median nerve by the tendon over the carpal tunnel what is this?

Carpal tunnel syndrome

What should you monitor with FES?

Check Sat late signs are neuro changes

What kind of fracture has multiple fragments and can be difficult to heal?

Comminuted fracture

What is second to edema leading to venous and arterial occlusions( ischemia death or nerve and muscle cells )?

Compartment syndrome

What are the nursing considerations of arthroscopy?

Cover with sterile dressing Ice Assess for complication Review activity limitations

What measures bone density in hip, spine, and wrist. It is useful to diagnose and determine MBD?

DEXA scan

What kind of pts have an increased incidence of carpal tunnel syndrome?

DM RA PVD Pregnancy

What is the removal or degenerative debris arthroscopically?

Debridement

What are the S/S of compartment syndrome?

Deep throbbing pain ( that is unrelenting ) Intensifies with passive ROM Do NOT raise higher than the heart

What are s/s of joint dislocation?

Deformity Pain Loss of use of affected limb Affected limb shortened and internally rotated Orthopedic emergency d/t vascular injury may result in AVN ( avascular necrosis ) OR compartment syndrome

What is last tx option for with osteoporosis?

Denosumab ( Prolia ) given SQ q 6 months

What is myositis ossificans?

Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

What are the s/s of skin breakdown in cast?

Discoloration Burning pain inside of cast

What are the nursing interventions of T-cell activation inhibitors like abatacept? ( Given SQ and IV )

Do not give with TNF Monitor for infection at infection site

What are the nursing considerations of IL receptor inhibitors like anakinra ( SQ) and tocilizumab ( IV )?

Do not give with TNF inhibitors GI perforation possible

How do you assess the motor function of the peroneal nerve?

Dorsiflex foot

What is the last tx option for people with chronic low back pain?

Epidural corticosteroids

What are examples of TNF inhibitors?

Etanercept Infliximab ( IV ) Adalimumab Certolizumab Golimumab

What are the nursing interventions of CT?

Evaluate renal function Assess allergies to shellfish NPO 4 hrs before Hold metformin day of test

What may be needed for a pt who has compartment syndrome?

Fasciotomy - it relieves the pressure caused by compartment syndrome may be left open for several days to allow adequate soft tissue decompression

What is occurs within 24-48 hrs of injury, chest pain, dyspnea, hypoxemia, neuro compromise, petechial over neck, chest wall, axilla, buccal membranes and conjunctiva?

Fat Embolism Syndrome - most common in long bones, crush injuries and pelvic fractures

How do you assess the motor function of the radial nerve?

Flex and extend the wrist

What is nonunion?

Fracture does not heal despite tx. No xray evidence of callus formation

What is delayed union?

Fracture healing progresses more slowly than expected. Healing eventually occurs.

What is angulation?

Fracture heals in abnormal position in relation to midline of structure (type of malunion)

What is malunion?

Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction.

What are the treatments of repetitive strain injury?

Good ergonomic workspaces Pain management Identify precipitating activity Heat/cold NSAIDs PT Lifestyle changes Modify equipment

What is the nonoperative tx included for humeral shaft?

Hanging arm cast which helps realign the bones back into alignment

What are the nursing interventions for Myelogram?

Have pt empty bladder Give sedation as ordered Post procedure lie flat 1-2 hrs and encourage fluids Monitor neuro SE

What is the tx of rhabdomyolysis?

Increase fluids sometimes need IV fluids

Describe a bone scan

Injection of radioisotope > uptake osteomyelitis and cancer and < with avascular necrosis

What are some ways to prevent DVTs?

LWMH ( enoxaparin ) or other anticoagulants like aspirin and Coumadin TED SCD ROM Early ambulation

What are the nursing considerations of arthrocentesis?

Label at bedside and send samples to lab Apply compression dressing and ice Observe for complications and review activity limitations Assess the NV status below and the site and assess for infection

What is done by flexing the knee 15-30 degrees and pulling the tibia forward while stabilizing the femur. It is positive if forward motion of the tibia occurs with the feeling of a soft indistinct endpoint?

Lachman's test which indicates ACL tear

What are clinical manifestations of osteoporosis?

Loss of height Kyphosis Back pain

Radio waves, and magnetic fields are used to view soft tissue. Very useful in detecting AVN, disc disease, tumors, osteomyelitis, Cartlidge, and ligament tears. Patient is inside a scanning chamber for extending time may use oral or IV contrast. What is this?

MRI

How are meniscus injuries diagnosed?

MRI Arthroscopy

What should you do before a pt's leaves for hip surgery?

Mark pedal pulses

What are the nursing considerations of sulfasalazine?

May cause orange to yellow discoloration of skin or urine Space doses evenly around the clock taking the drug after food with 8 oz of water Monitor CBC sunscreen d/t photosensitivity

Pain with flexion and internal rotation then extension is called what?

McMurray's test - used for meniscus injuries

Positive McMurray test, clicks and pops in knee, locks, and traumatic arthritis. What is this?

Meniscus injury

What occurs when the body cast is to tight which compresses the superior mesenteric artery against the duodenum causing pain, nausea, and vomiting.

Mesenteric syndrome Usually leave window around umbilicus for a pt in a body cast to auscultate bowel sounds

What is seen in increased levels of Ca?

Metabolic bone diseases and hypothyroidism

What is the gold standard for early RA tx?

Methotrexate

How do you prevent FES?

Minimal fracture manipulation Maintain F&E balance Respiratory support

What are the nursing considerations for penicillamine?

Monitor CBC Platelets UA Take 1 hr before or two hours after meals and an hour before or after other meds

What are the nursing considerations of hydrochloroquine?

Monitor CBC, liver function Response may take up to 6 months to work Report visual changes or hearing changes

What are the nursing considerations of methotrexate?

Monitor CBC, liver, and renal function Keep hydrated Stay on BC during and 3 months after Report signs of anemia ( fatigue and weakness )

What are the nursing considerations of ASA?

Monitor blood salicylic if doses > 3600 mg day- Monitor for signs of toxicity

What are the nursing considerations of B-cell activation inhibitors like rituximab ( IV )?

Monitor for infection and bleeding No live vaccines Monitor BP especially if on antihypertensive med

What are the nursing considerations of leflunomide?

Monitor liver function Avoid pregnancy ( use 2 methods of BC )

What are some occupations that are prone to getting repetitive strain injury?

Musicians Dancers Butchers Grocery clerks Vibratory tool workers People who frequently use keyboard and mouse

Radiographic contrast is injected in the nerve root sac. CT scan may be used to show how bone is affecting the nerve root. Very sensitive for nerve impingement, can detect subtle lesions and injuries but see on MRI and CT scans?

Myelogram

Can topical NSAIDs be used with topical steroids?

NO - ex diclofenac gel with ibuprofen 4 x per day

Redness in skin and serous crust around insertion site in a pt with external fixations are considered what?

NORMAL

What are used in conjunction with DMARDs have an increased risk for blood clots, heart attack, and stroke?

NSAIDs

What should you assess before and after assessing a pt with a splint?

NV status

What is refracture?

New fracture occurs at original fracture site

Can you cover a cast while it is drying?

No

Can you rest a cast that is still drying on a hard surface or sharp edge?

No

What does 0/5 muscle strength mean?

No detection of muscular contraction

Arm cast have increased risk of developing pressure ulcers inside the cast at what sites?

Olecranon Radial styloid Ulna styloid

If a pt has a Cole's fracture is usually managed with what?

Open reduction and internal or external fixation

How do you assess the motor function of median nerve?

Oppose thumb and little finger

What is the management of joint dislocation and subluxation?

Orthopedic emergency d/t vascular injury may result in AVN or compartment syndrome

Removing a wedge or slice of bone to restore alignment and shift weight bearing is called what?

Osteotomy

What means bone spurs?

Ostophytes

What are the s/s of repetitive strain injuries?

Pain Weakness Numbness Impaired motor function

What are common areas of Paget's disease?

Pelvis Long bones Spine Ribs Cranium

What sign is positive if a pt drops their wrist ( hyperflexes ) and maintains the position for longer than 60 seconds and feels a sensation of tingling and numbness?

Phalen sign

What are signs of infection in external fixation devices?

Pins loose and purulent drainage

What is a precautionary measure for pts with facial fractures?

Place in c collar

What is used to diagnose an ACL injury?

Positive Lachlan's test MRI

What is the management of meniscus injuries?

Prevention Ice NSAIDs Surgery

what is the tx of carpal tunnel syndrome?

Prevention Wrist splints to help maintain wrist in neutral position to help control pain PT Steroids directly into tendon Surgery - open or laparoscopic

How do you assess the sensation of the radial nerve?

Prick skin between thumb and index

How do you assess the sensation of the median nerve?

Prick the distal pad of the index finger

How do you assess the sensation of the ulnar nerve?

Prick the pad of the little finger

How do you assess the sensation of the peroneal nerve?

Prick webbing between the great and second toe

What is the biggest concern for a pt with Paget's disease?

Safety

What must be assessed in pts who have Colles' fracture?

Radial, Median, Ulnar nerves

What are the nursing interventions of Bone Scan?

Radioisotope administered 2 hrs before ( no harm from isotopes ) Must lie completely still during scan Increase fluids after scan

What is the goal of joint dislocation and subluxation?

Realign and immobilize And utilize exercise program

What means the realignment of affected bone?

Reduction

What are the nursing considerations for MRI?

Remove all metal objects ( inquire surgical hx: staples, plates, dental bridges, metal appliances ) Assess for pregnancy Remove foil lines patches Must lie still for procedures ( may need antianxiety meds ) Assess for allergy and renal function ( BUN and Creatinine )

What are the nursing considerations X-ray?

Remove radiopaque objects

What are the nursing interventions for DEXA scan?

Remove radiopaque objects Explain procedure to the pt

What is the tx for ACL injury?

Rest Ice Elevation NSAIDS Ambulation as tolerated with crutches Knee immobilizer PT Surgery- in severe cases

What is the tx for rotator cuff injury?

Rest Hold/cold compress NSAIDS Steroids Surgery ( in extreme cases )

What is the nursing care for strains?

Rest Ice Compression Elevation

What is caused by the breakdown of skeletal muscles which release myoglobin into the blood that can obstruct renal tubules leading to AKI?

Rhabdomyolysis - assess urine output

What are the nursing considerations of JAK ( Janus Kinas Inhibitors ) end in nib?

Risk for infection Monitor for infection and tx early

The arm is abducted 90 degrees and the pt is asked to slowly lower the arm to the side. If the arm falls suddenly what is suspected and what test is this?

Rotator Cuff Injury & Positive drop arm test

What are the s/s of shoulder weakness, pain, and Decreased ROM?

Rotator Cuff injury

What is seen in pts who repetitively use overhead motion like painters OR pts who have a direct injury ( sports related )?

Rotator cuff injury

When someone tears one of the 4 muscles in the shoulder it is called what?

Rotator cuff injury

Antinuclear antibodies ( ANA ) are positive in 95% of what pts?

SLE

What are the most common sites of joint dislocation?

Shoulders and hips

Onset of bladder of bowel incontinence in a pt with a vertebral fracture could indicate what?

Spinal cord injury

What is an injury to ligaments surrounding a joint and is usually caused by wrenching or twisting motion?

Sprain - usually occurs in ankle, wrist, or knee Classified by ligament damage and ranges between 1-3 1 being small tear while 3 being complete tear of ligament

When a pt is lying prone and the examiner passively raises the pt's leg to < 60 degrees and the pt reports pain? What is this?

Straight leg raise test which is used to assess sciatic compromise d/t lumbosacral root irritation

What is the excessive straining of the muscle its fascial sheath and/or tendon?

Strain - usually occurs in large muscle groups like the lower back, calf, and hamstring

How do you assess the sensation of the tibial nerve?

Stroke the plantar aspect of the foot

The removal of inflamed synovial membrane is called what?

Synovectomy

What are the nursing considerations of Cox 2 inhibitors?

Take with food, milk, or antiacids

How do you assess the motor function of the tibial nerve?

The ability to plantar flex ankle and toes

Where are common sites of pressure ulcers in the lower extremities?

Tibial tuberosity Lateral malleolus

What sign is positive if you lightly tap over the median nerve and the pt experiences numbness and tingling among the median nerve? This is used to assess for carpal tunnel syndrome

Tinel's sign

What is used to diagnose carpal tunnel syndrome?

Tinel's sign Phalen's sign

What are s/s of a pt with phantom limb pain?

Tingling Muscle cramps Heavy feeling

What may cause carpal tunnel syndrome?

Trauma or edema Cancer soft tissue masses RA Thickening of tendon shaft from overuse

What is a pseudoarthrosis?

Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at site.

How should you teach a pts with external fixators to perform pin care?

Usually use chlorhexidine with sterile applicators then rinse with saline and dry with sterile applicators Usually done twice a day

What are the nursing considerations of capsaicin cream?

Wash hands after use Avoid local heat while using

How should your handle a cast while it is drying?

With palms

What is used to determine bone integrity and density, joint alignment and erosion?

X-rays

Can compartment syndrome occur without an external force ( cast and braces )?

Yes

What do DMARDS stand for?

disease modifying anti-rheumatic drugs

What are the 6P's of compartment syndrome?

pain Pressure increasing pallor paresthesia ( coolness and loss ) paralysis pulselessness ( decreased or absent )