Musculoskeletal

epidural steroid injections

decreases inflammation of nerve root

Buck's traction

decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture

phalen's sign

done by pushing back of your hands together for one minute, positive when it causes the same symptoms of carpel tunnel

carpal tunnel

entrapment neuropathy of median nerve in wrist

check distal circulation capillary refill CMS stabilize IV, pain meds Tetanus shot

for a angulated fracture nursing measures would include

dialysis

for patients with CHF this is another option for treating rhabdo

reactive phase

fracture and inflammation phase, hematoma, granulation tissue formation, painful

compound fracture

fracture in which damage also involves the skin or mucous membranes with the risk of infection great

immobilize nero-vascular assessment CMS full body assessment 5 P's

fracture managment

colles fracture

fracture of the lower end of the radius with displacement of the distal fragment dorsally- falling with outstretched arms on the ground

salter harris fracture

fracture through a growth plate (pediatric)

nondisplaced fracture

fragments in close approximation to each other

depressed fracture

fragments of bone are driven inward from blunt trauma

L4-5 & L5-S1

greatest mechanical stress and greatest degenerative changes

malunion

growth of the fragments of a fractured bone in a faulty position, forming an imperfect union

pain

hallmark sign of compartment syndrome

pain intensifies with PASSIVE ROM

hallmark sign of compartment syndrome

loss of function

hallmark sign of fracture

CRPS

hyperesthesia stiffness fluctuating extremity temperature

compartment syndrome

inability to perform active movement and pain with passive movement.

CPK, myglobin, K+

lab testing for rhabdo will show an elevated

osteomyelitis delayed union malunion, nonunion complex regional pain syndrome hetertopic ossification

late fracture complications

pulselessness

late sign of compartment syndrome

most distal point that will heal successfully

level of amputation is determined by

fat embolism

life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury

sprain

ligament and tendon injury

obesity stress depression

low back pain is aggravated by

sciatica

lumbar(lower back) through the hips and buttocks down one side of body

hypovolemic shock

more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments

end of long bones

more vascular area that heals quicker

CRPS

most common in upper extremities, women, stressed personalities

bucks traction

most common skin traction

radiculopathy

nerve foot involvement

heat/cold therapies avoid twisting, lifting limit sitting to 20-50 mins encourage ADLS lumbar flexion for comfort in bed

nonpharmacological treatments for low back pain

place limb at level of the heart may need to bivalve cast

nursing intervention for patient with compartment syndrome, what are you as the nurse going to do after contacting PCP

pain management wound care-bleeding infection prevention compression dressings contracture prevention- extension prone transfer techniques support

nursing management for amputation

oblique fracture

occurs at an angle across the bone but does not protrude through the skin

subluxation

partial separation or dislocation of joint surfaces

hemorrhagic shock

patients with pelvic fractures are at an increased risk for

VS- CMS (distal to proximal) pain management DVT prophylaxis call doctor for sore throat, hoarseness, dysphagia call doctor if you asses halo sign HA donor site logroll Q2 hours (lumbar supine 24-48 hrs)

post op assessment for cervical disecectomy

hetertopic ossification

presence of bone in soft tissues where bone normally does no exist

strain

pulled muscle or tendon

repetitive movements, OA, trauma, diabetes mellitus exposure to cold, vibration

risk factors for carpal tunnel

crush injuries electrocution heatstroke seziures trauma elderly falls overdose of drugs statins burns 3rd degree

risk factors for rhabdo

hetertopic ossificaton

seen in trauma, spinal cord injuries, total hip replacements, and traumatic brain injuries

closed fracture

skin intact

NV checks q15min/1-2hrs, q30 min RICE heat after 48 hours immobilization

soft tissue injury management

weight bearing

stimulates of stabilized fractures

lower leg

the most common area for compartment syndrome to occur

nonunion

the patient complains of persistent discomfort and movement at the fracture site

remodeling phase

to original bone contour

NSAID- indomethacin local radiation therapy surgical resection to prevent joint mobility

tx for hetertopic ossification

Blood C&S IV antibiotics for 3-6 weeks- PICC oral for next three months bone debridment wound care

tx for osteomyelitis

soft dressing

used for amputation with large amount of drainage or frequent inspection is needed

avascular necrosis

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect?

pelvic and lower extremity fractures

Elderly clients who fall are most at risk for

nonunion

Failure of fragments of a fractured bone to heal together

300 ml/ hr

Patient being treated for rhabdo should have a urine output of

pressure necrosis compartment syndrome thermal injury can lose reduction

complications of casts/splints

Fe damages renal tubule cells myoglobin obstructs tubules DIC RISK

complications of rhabdo

loss of bone matrix and fractures IE: bedrest

continued bone resorption during times of stress can lead to

open fracture

continuity between wound and fracture

impacted fracture

a bone fragment is driven into another bone fragment

dorsalis pedis pulse

a patient with a pelvic fracture the nurse would want to assess the

urinary tract trauma

all pelvic fractures have this unless proven otherwise

Prevent internal rotation of the affected leg.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

prevent internal rotation of affected leg

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Elevating the leg might lead to a flexion contracture

A patient asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

tendons

attach muscle to bone

dislocation or fracture nonunion or malunion glandular diseases alcohol abuse long term use of corticosteroids sickle cell anemia

avascular necrosis can be caused by

CRPS

avoid BP, venipuncture in the effected arm with

fiberglass casts

best for simple fractures of upper and lower extremities

immediate immobilization

best prevention for fat embolism to occur

cauda equina syndrome

bilateral leg pain and weakness urinary retention bowel and bladder incontinence

ligaments

bind bone to bone

TENS

blocks nerve impulses that are interpreted by the brain as pain by increasing blood flow and circulation

contusion

blunt force trauma

communited fracture

bone has broken into a number of pieces due to large force or crush injury

avascular necrosis

bone loses blood supply and dies

incomplete fracture

break through only part of the cross-section of the bone

rhabdomyolysis

breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) in the bloodstream occuring 12-24 hours post injury

reparative phase

callus formation, lamellar bone deposition, 3-4 week to months

elderly

communited fractures can occur more frequently with the

promote extension of hip prone position for 20-30 mins several times per day PT

contracture prevention

rigid dressing

controls edema and assists with residual limb shaping after an amputation

shock compartment syndrome rhabdomyolysis fat embolism DVT/PE

early fracture complications

dexamethasone( Decadron) triamcinolone (Kenalog) Soul-medrol

epidural steroid injections

12-24 hrs but up to 10 days

fat embolism can occur within

long bones or pelvic bone fractures due to crush injuries

fat embolisms usually occur in

osteomyelitis

fever leukocytosis increased ESR malaise

skin traction

limited force, no greater than 10lbs

angulated fracture

loss of anatomical position due to direct or lateral force

bone necrosis

occurs when the bone is deprived of blood

greenstick fracture

one side of the bone is broken and the other side is bent; it does not protrude through the skin

lower extremity (tibia)

open fracture most often occurs in the

risk for osteomyelitis

open fractures increase your risk for

phantom limb pain

originates in the spinal cord and brain

complex regional pain syndrome

painful SNS problem with burning pain and edma

deep, throbbing pain increasing pain eve with opiods pain intensifies with passive ROM

s/s of compartment syndrome

AMS tachypnea, tachycardia petechiae- buccal, chest, eyelid fever > 103 ABG PaO2 <60

s/s of fat embolism

altered mental status fever tachypnea tachycardia hypoxemia petechiae

s/s of fat embolism

pain- muscle spasms 20 minutes loss of function deformity shortening crepitus

s/s of fracture

dark reddish urine myalgia elevated CPK, myglobin, K+

s/s of rhabdo

tinel's sign

tapping the median nerve along its course in wrist, positive test will cause worsening of tingling in first finger thru third digits

communited fracture

the bone has splintered into several fragments

sterile dressing

the first thing the nurse should for a patient with an open fracture is to apply a

intra-articular injections of methylprednisolone wrist splints surgery

treatment for carpel tunnel syndrome includes

TCA (Elavil) SNRI (duloxetine)

treatment for chronic back pain

electric bone stimulation

treatment for delayed union

vent support with PEEP corticosteroids vassopressors for obstructive shock

treatment for fat embolism

internal fixation, bone grafting

treatment for nonunion

gabapentin before or within 24 hours of amputation

treatment for phantom limb pain

AGGRESSIVE HYDRATION

treatment for rhabdo

spiral fracture

twists around the shaft of the bone but does not protrude through the skin.

acetaminophen NSAIDS cyclobenzeprine (Flexeril)-muscle relaxant

tx for acute back pain

bucks traction

used in preop hip fractures to decrease spasms and increase comfort

administer analgesics provide comfort measures encourage participation in ADLS promoting physical mobility preventing infections maintaining skin integrity preparing patient for self-care

what nursing interventions are appropriate for a patient with a closed reduction extremity fracture?

lay prone 20-30 minutes at a time

with a patient with an amputation, you will want to prevent contracture prevention by having your patient