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ADULT MED-SURG CHAPTER 4

RADIOGRAPHIC EXAM

NO PREG WOMEN DONE TO LOOK AT THE JOINTS CAN REVIEL FLUID, IRREGULARITY OF JOINTS WITH SPUR FORMATION CHANGES IN SIZE OF THE JOINT CONTOUR AND FRACTURES

BONE SCAN

USED TO DIAGNOSE METASTATIC INFLAMMATORY BONE DISEASE

BONE SCAN PREP

IV ADMIN OF NUCLIDES 2-3 HOURS BEFORE TEST ENCOURAGE FLUIDS TO AID IN RENAL CLEARANCE OF ISOTOPE, AFTER PT HAS VOIDED CAMERA REVEALS DEGREE OF UPTAKE AREAS OF UPTAKE REPRESENT TUMOR AND OTHER ABNORMALITIES

BONE SCAN TEST

TAKES 30-60 MIN PT MUST LIE STILL

MYELOGRAM OIL BASED DIE POST CARE

PT MUST LIE FLAT FOR UPT TO 12 HOURS, MUST REPORT TO NURSE HEADACHE STIFF NECK LEG WEAKNESS OR DIFFICULTY URINATING, RARE COMPLICATIONS INCLUDE SEIZURE INFECTION DROWSINESS

MYELOGRAM WATER BASED DIE POST CARE

SEMI-FOWLERS FOR 8 HOURS ENCOURAGE FLUIDS TO HELP ABSORB DIE HEAD ACHE IS COMMON, TAP IS DONE AT THE 4TH OR 5TH LUMBAR BELOW SPINE

EDOSCOPIC SPINAL MICROSURGERY

TREAT SPINAL COLUMN DISORDERS SUCH AS HERNIATED DISK, SPINAL STENOSIS, SPINAL DEFORMITIES, SCOLIOSIS, KYPHOSIS LOCAL ANETHESIA IS USED

EFFECTS OF BED REST ON MINERAL CONTENT IN BONE

IMMOBILIZATION RESULTS IN BONE TISSUE BECOMING LESS DENSE, LONG PERIODS OF BEDREST PUTS PT AT RISK FOR PATHOLOGICAL FRACTURES, PT MAY LOOSE MUSCLE STRENGTH AND CAN RESULT IN GREATER CHANCES FOR FRACTURES

CALCIUM AND PHOSPHORUS BLOOD SERUM

MAY BE ELEVATED IN PTS WITH METASTATIC TUMORS

ESR

INCREASED IN INFLAMMATORY DISEASES

RA

CHRONIC, SYSTEMIC DISEASE, AUTOIMMUNE DISEASE AFFECTING MOST OFTEN WOMEN OF CHILD BEARING AGE SMOKING INCREASES THE RISK FOR RA AS DOES GENETIC PREDISPOSITION

CHARECTERISTICS OF RA

CHRONIC INFLAMMATION OF SYNOVIAL MEMBRANE OR DIATHRODIAL JOINTS CAN AFFECT MANY SYSTEMS SUCH AS LUNGS HEART VESSELS MUSCLES EYES AND SKIN

RA S/S

MORNING STIFFNESS, PERIODS OF REMISSION AND EXACERBATION CAN BE EXACERBATED BY INFECTION WORK STRESS PHYSICAL EXERTION CHILDBIRTH SURGERY EMOTIONAL UPSET

RA DIAGNOSTIC TESTING

INCREASED ESR INCREASED RF ANA TITER AND ELEVATED CRP LATEX AGGLUTINATION TEST

RA TREATMENTS

CONTROL DISEASE ACTIVITY BY USE OF DISEASE MODIFYING AND ANTIINFLAMMATORY DRUGS, PROVIDE PAIN RELIEF JOINT REPLACEMENT MAY BE AN OPTION, ENCOURAGE ADL'S EXERCISE AND WEIGHT MANAGEMENT

RA NURSING CARE

RELIEVE PAIN ENCOURAGE PT TO SLEEP 8-10 HOURS AT NIGHT AND TAKE 2 HOUR NAPS DURING THE DAY EXERCISE, HEAT RELAX AND SOOTHE MUSCLES USE OF HOT PACKS HEAT LAMPS AND HOT PARIFFIN WAX MAY BE USED

ANKYLOSING MODALITIES (AKS)

INVOLVES INFLAMMATION OF THE SPINE WHICH THE LIGAMENT OR TENDON ATTACHES TO THE BONE, IT DOES NOT AFFECT SYNOVIAL MEMBRANES AFFECTS JOINTS IN THE NECK JAW SHOULDERS HIPS KNEES THE LIGMENTS BECOME OSSIFIED CAN CAUSE HEART ELARGEMENT: PERICARDITIS

ANKYLOSING MODALITIES ASSESSMENT

COMPLAINTS OF LOW BACK PAIN STIFFNESS ALTERNATING OR BILAT SCIATICA PAIN PAIN WORSENS WHEN IN AN ERECT POSITION INACTIVITY EXACERBATES PAIN, EXERCISE GIVE RELIEF, WEIGHT LOSS, AB DISTENTION, VISUAL PROBLEMS, FATIGUE, VITAL SIGNS HIGH TEMP, TACHYCARDIA,, HYPERPNEA *IF COSTOVERTEBRAL JOINTS ARE EFFECTED, KYPHOSIS CAN OCCUR AND ALTER RESP*

ANKYLOSING NURSING CARE

MAINTAIN ALIGNMENT OF THE SPINE ENCOURAGE PT TO LIE ON ABDOMEN FOR 15-30MIN FOUR TIMES A DAY TO HELP EXTEND THE SPINE REPOSITION PT EVERY 2 HOURS TO PREVENT SORES,

ANKYLOSING PT TEACHING

POSTURAL EXERCISES, METHODS OF APPLYING HEAT TO BACK AND HIPS, PREVENT COMPLICATIONS, SLEEP ON A FIRM MATRESS WITHOUT A PILLOW AND DO RESP EXERCISES

OSTEOARTHRITIS

KNOWN AS DJD NONSYSTEMIC, NONINFLAMMATORY, DOES PROGRESSIVELY CAUSE BONE AND JOINT DEGENERATION **ALMOST EVERYONE OVER THE AGE OF 40 HAS CHANGES IN THE JOINTS IT IS AN INEVITABLE CONSEQUENCE OF AGING AND IS A MAJOR CASE OF CHRONIC DISABILITY**

OSTEOARTHRITIS FACTS

AFFECTS JOINTS OF HANDS KNEES HIP AND CERVIAL AND LUMBAR VERTEBRAE UNKOWN CAUSE USUALLY AFFECTS THE HANDS OF WOMEN AND THE HIPS OF MEN PEOPLE WHO ARE OBESE SUFFER MORE WITH OSTEOARTHRITIS AND IT AFFECTS THEIR KNEES AND JOINTS

OSTEOARTHRITIS ASSESSMENT

PAIN AND STIFFNESS USUALLY RELIEVED BY REST IN THE EARLY STAGES PTS MAY DEVELOP HEBERDENS NODES LOCATED AT THE SIDES OF DISTAL JOINTS OF FINGERS (FARTHEST AWAY FROM THE HEART) BOUCHARDS NODES HARD BONY CARTILAGINOUS ENLARGEMENTS (CLOSER TO THE HEART)

OSTEOARTHRITIS TX

EXERCISE WITH BALANCED REST PERIODS, PHYSICAL THERAPY WITH HEAT THERAPY GAIT ENHANCERS MAY BE USED TO HELP WITH DISCOMFORT WHILE USING WEIGHT BEARING JOINTS

OSTEOARTHRITIS NURSING CARE

MIANTIAN ADL'S AND HELP PT ADAPT TO LIMITS, ALTERNATE SITTING, WALKING, STANDING, WITH PERIODS OF REST, OLDER PTS MAY BE CAPABLE OF TURNING AND MOVING IN BED BUT MAY FORGET TO DO SO REMIND THEM TO TURN FROM SIDE TO SIDE EVERY TWO HOURS

GOUT

METABLIC DISEASE RESULTING FROM ACCUMULATION OF URIC ACID IN THE BLOOD AFFECTS BIG TOE AND OTHER JOINTS

TOPHI

CALCULI CONTAINING SODUM URATE DEPOSITS THAT DEVELOP IN PERIARTICULAR FIBROUS TISSUE TYPICALLY IN PTS WITH GOUT RESULTS IN INFLAMMATION OF THE JOINT CAUSE IS UNKNOWN

GOUT SIGNS AND SYMPTOMS

NITIME EXCRUCIATING PAIN EDEMA INFLAMMATION IN THE AFFECTED JOINT

GOUT ASSESSMENT

CAN BE EXACERBATED BY INTAKE OF ALCOHOL FOODS HIGH IN PUINES SUCH AS ORGAN MEAT, ANCHOVIES, HERRING, MACKEREL, SCALLOPS JOINTS MAYBE DISCOLORED WARM TO THE TOUCH AND HAVE LIMITED MOVEMENT

GOUT DX

INCREASED URIC ACID IN SERUM BLOOD TEST

GOUT TX

TREATED WITH COLCHOCINE, ANTI INFLAMMATORIES, ALLOPUINOL TO DECREASE URIC ACID

GOUT CARE

ENCOURAGE PT TO DRINK 2000ML/D AVOID ALCOHOL AND FOODS HIGH IN PURINES PT MAY NEED BEDREST AND JOINT IMMOBILIZATION WHILE SYMPTOMATIC INSTRUCT PT TO TAKE MEDICATIONS AS DIRECTED

OSTEOPOROSIS

REDUCTION OF BONE MASS, WOMEN 55-65 SMALL FRAMED MENOPAUSAL WHITE OR ASIAN WOMEN ARE AT GREATER RISK

OSTEOPOROSIS RISK FACTORS

STERIODS, ANTICONVULSANTS, HEPARIN LOW CALCIUM DIETS THROUGHOUT LIFE, EXCESSIVE CAFFEINE, ALCOHOL AND TO MUCH PROTIEN IN DIET

OSTEOPOROSIS SIGNS AND SYMPTOMS

DEVELOPS SLOWLY USUALLY STARTS WITH BACKACHES AS DISEASE PROGRESSES BONES BECOME POROUS AND BRITTLE DUE TO LACK OF CALCIUM

OSTEOPOROSIS ASSESSMENT

PAIN IN LOW THORACIC AND LUMBAR WORSENS WITH STANDING SITTING COUGHING SNEEZING AND STRAINING. DOWAGERS HUMP (SPINAL DEFORMITY AND HEIGHT LOSS THAT RESULTS FROM REPEATED SPINAL VERTEBRAL FRACTURES) INCREASED LORDOSIS, SCOLIOSIS, AND KYPHOSIS INABILITY TO MAINTIAN ERECT POSTURE

OSTEOPOROSIS DX

BONE DENSITY TESTING

OSTEOPOROSIS TX

CALCIUM SUPPLEMENTS 1500MG/D VIT D 50,000U ONCE OR TWICE PER WEEK, WEIGHT BEARING EXERCISES TO IMPROVE TONE ESTROGEN, FOSOMAX SLOWS BONE LOSS, EVISTA PREVENTS BONE LOSS

OSTEOPOROSIS SURGICAL INTERVENTIONS

VEREBROPLASTY AND KYPHOPLAST 90% SUCESSFULL IN RELEAVING PAIN FROM COMPRESSION FRACTURES

VEREBROPLASTY

HIGH PRESSURE INJECTION OF CEMENT INTO THE SPINE WHICH PUSHES VERTEBRAE APART

KYPHOPLASTY

DOWAGERS HUMP SURGERY INSERT A BALLOON INTO CENTER OF COLLAPSED VERTEBRAE AND CREATES A SPACE FOR INJECTION OF CEMENT POROUS BONE IS PACKED AROUND OUTSIDE EDGE, LESS RISK; PT MUST LIE FLAT IN BED FOR AT LEAST 4 HOURS AND THEN AMBULATE AS TOLERATED ANTIBIOTICS/STEROIDS ARE ADMINISTERED FOR 3 DOSES POST OP

OSTEOPOROSIS DIETARY NEEDS

CALCIUM SLOWS BONE LOSS DECREASES FRACTURES. 1500MG/D IS NEEDED IN DIET GOOD CALCIUM SOURCES ARE MILK PRODUCTS GREEN LEAFY VEG ORANGE JUICE AND SOY MILK, YOGURT TURNIP GREENS COTTAGE CHEESE ICE CREAM SARDINES AND SPINICH ARE EXAMPLES OF HIGH CALCIUM FOODS
VIT D ASSIST WITH CALCIUM ABSORPTION AND STIMULATES BONE FORMATION DIETS SHOULD ALSO BE LOW SODIUM, AVOIDING ANIMAL PROTEIN AND CAFFIENE

OSTEOPOROSIS PROGNOSIS

CHRONIC BUT VIT D AND CALCIUM CAN SLOW THE RATE OF BONE LOSS ESTROGEN THERAPY DECREASES RATE OF BONE ABSORPTION BUT DOES NOT INCREASE BONE FORMATION

PAGETS DISEASE

INFLAMMATORY DISEASE OF BONE WHERE BONE FORMATION AND BONE RESORPTION ARE NOT OCCURING AT SAME RATE

PAGETS SIGNS AND SYMPTOMS

BONE PAIN, SKULL ENLARGEMENT, BOWING OF TIBIA AND REDUCTION IN HEIGHT CAN CAUSE HEARING PROBLEMS AND PT IS IN CONSTANT PAIN

PAGETS DX

ALKALINE PHOSPHATASE IS ELEVATED BONE DENSITY IS ABNORMAL

PAGETS TX

PAIN CONTROL CACITONIN AND POSSIBLY SURGERY

OSTEOMYELITIS

INFECTION OF BONE AND BONE MARROW

OSTOEMYELITIS CAUSES

BACTERIA CAN ENTER THROUGH TRAMA SUCH AS COMPOUND FRACTURE OR SURGERY

OSTEOMYELITIS SIGNS AND SYMPTOMS

PERSISTENT SEVERE AND INCREASING BONE PAIN AND TENDERNESS WOUND DRAINAGE VITAL SIGNS FOR INFECTION INCREASED TEMP TACHYCARDIA AND TACHYPNEA

OSTEOMYELITIS TX

IV ANTIBIOTICS OVER A LONG PERIOD OF TIME BEDREST SURGERY TO REMOVE A FRAGMENT OF NECROTIC BONE THAT IS PARTIALLY OR ENTIRELY DETACHED FROM THE SURROUNDING OR ADJACENT TO HEALTHY BONE (SEQUESTRUM)

OSTEOMYELITIS CARE

PREVENTION USING ASEPTIC TECHNIQUE WOUNDS ARE IRREGATED WITH HYDROGEN PEROXIDE AND COVERED WITH A STERILE DRESSING WOUND VACS MAY BE USED PT SOULD EAT A DIET HIGH IN CALORIES PROTIENS AND VITAMINS THEY SHOULD ALSO LOOK FOR OTHER SIGNS OF INFECTION

FIBROMYALGIA

CHRONIC SYNDROME WITH UNKNOWN CAUSE THAT CAUSES PAIN IN THE MUSCLES BONES OR JOINTS

FIBROMYALGIA SYMPTOMS

CAN CAUSE POOR SLEEP HEADACHES ALTERED THOUGHT PROCESSES AND STIFF ACHEY MUSCLES

ARTHRODESIS SURGICAL INTERVENTIONS FOR TOTAL JOINTS

SURGICAL FUSION OF A JOINT FOR SEVER JOINT DESTRUCTION

ARTHROPLASTY SURGICAL INTERVENTIONS FOR TOTAL JOINTS

USED TO REPAIR OR REFASHIONING ONE OR BOTH SIDES, PARTS OR SPECIFIC TISSUE WITHIN A JOINT REQUIRED ON ELBOW HIP KNEE OR SHOULDER JOINT TO RESTORE OR INCREASE MOBILITY

TOTAL KNEE REPLACEMENT (KNEE ARTHROPLASTY)

DONE TO RESTORE MOTION, RELIEVE PAIN, OR CORRECT DEFORMITY PTS WITH RA OR LUPUS ARE NOT CANDIDATES FOR THIS SURGERY

KNEE ARTHROPLASTY DX

XRAYS SHOW NARROWING ON AFFECTED SIDE OF THE JOINT

KNEE ARTHROPLASTY NURSING CARE

POSITION ELEVATE OPERATIVE LEG ON PILLOWS TO ENHANCE VENOUS RETURN FOR ONLY THE FIRST 24 HOURS. PLACE PILLOWS WITH CAUTION TO AVOID FLEXING THE KNEE

KNEE ARTHROPLASTY WOUND CARE

HEMOVAC DRAINS SHOULD BE MONITORED FOR OUTPUT USUALLY REMOVED AFTER THE FIRST 24 HOURS FOLLOWING SURGERY ASSESS PT FOR BLOOD LOSS HYPOTENSION TACHYCARDIA REINFORCE DRESSING IF THE DRAINAGE IS COMING THROUGH FOR THE FIRST 24 HOURS

KNEE ARTHROPLASTY ACTIVITY

PASSIVE FLEXION USING CPM FOLLOWING CPM USAGE PT SHOULD DO LEG EXTENSIONS BY PLACING A ROLLED UP TOWEL UNDER ANKLE

KNEE ARTHROPLASTY DISCHARGE INSTRUCTIONS

PARTIAL WEIGHT-BEARING RESTRICIONS AND AMBULATORY AID FOR 8 WEEKS CONTINUE FLEXION ACTIVITY AND STRAIGHT LEG RAISING EXERCISES AT HOME

HIP ARTHROPLASTY (TOTAL HIP REPLACEMENT)

PERFORMED WHEN ARTHRITIS INVOLVES THE HEAD OF THE FEMUR AND ACCETABULUM

HIP ARTHROPLASTY ASSESSMENT

PREVENT HYPOSTATIC PNU DEEP BREATHING COUGHING TURNING PT TO UNAFFECTED SIDE EVERY TWO HOURS VS FOR BLEEDING WATCH I&O DECREASED OUTPUT CAN BE A SIGN OF HYPOVOLEMIC SHOCK MONITOR INCISION FOR SIGNS OF INFLAMMATION OR INFECTION

HIP ARTHROPLASTY CARE

ISOMETRIC EXERCISES THIGH HIGH TED HOSE NEURO CHECKS ON AFFECTED EXTREMITY USE ABDUCTION PILLOW

HIP ARTHROPLASTY DISCHARGE CARE

USE AMBULATORY DEVICE TO AIDE IN AMBULATION AVOID ADDUCTION LIMIT HIP FLEXION TO 90 DEGREES FOR THE FIRST 2-3 WEEKS PT WILL NEED LIFE LONG ANTIBIOTICS TO PROTECT PROSTHESIS FROM BACTERIAL INFECTION DURING DENTAL WORK INTRUSIVE PROCEDRUES OR SURGERY

HIP FRACTURES

MOST COMMON TYPE OF FRACTURE ESPECIALLY IN WOMEN WITH OSTEOPOROSIS PTS WHO ARE TAKING ANTACIDSOR OR PPI ARE AT INCREASED RISK FOR HIP FRACTURES DUE TO THE MAL ABSORPTION OF CALCIUM

TYPES OF HIP FRACTURES

INTRACAPSULAR FRACTURE-FEMUR IS BROKEN INSIDE THE JOINT FRACTURES OF FEMORAL HEAD OR NECK EXTRACAPUSULAR FRACTURE MOST COMMON OCCURS OUTSIDE THE HIP JOINT CAPSULE INTERTROCHANTERIC FRACTURE USUALLY SEEN IN YOUNG PEOPLE DUE TO TRAMA

HIP FRACTURE ASSESSMENT

SEVERE PAIN AND TENDERNESS IN REGION OF THE FACTURE SITE INABILITY TO MOVE LEG VOLUNTARILY AND SHORTENING OR EXTERNAL ROTATION OF THE LEG PT MAY HAVE HEARD A POP OR SNAP AT TIME OF INJURY USUALLY NUTRITIONAL STATUS IS EITHER THIN OR OBESE AND ARE AT RISK FOR SKIN BREAKDOWN IF BED REST IS ORDERED

HIP FRACTURE COMPLICATIONS

MOST COMMON CAUSE OF DEATH IN PTS WHO ARE OLDER THAN 75 COMPLICATIONS FROM DM CARDIAC PROBLEMS, AND NEURO DISORDERS HIGH RISK FOR DVT PNEUMONIA, FAT EMOLUS IMPAIRED SKIN URINARY RETENTION CONSTIPATION MENTAL DISORIENTATION DERPESSION

HIP FRACTURE CONTRIBITING FACTORS

PROPENSITY FOR FALLS, INABILLITY TO CORRECT A POSTURAL IMBALANCE INADEQUACY OR LOCAL TISSUE SHOCK ABSORBERS AND UNDERLYING SKELETAL WEAKNESS

FACTORS CAUSING FALLS

GIAT/BALANCE PROBLEMS DECREASED VISION DECREASED HEARING DEMINISHED REFLEXES ORTHOSTATIC HYPOTENSION AND MEDICATIONS RUGS AND SLIPPERY UNEVEN SURFACES MANY FALLS ARE ASSOCIATED WITH GETTING OUT OF A CHAIR OR BED

OTHER FRACTURES

TRAUMATIC INJURY TO BONE IN WHICH THE CONTINUITY OF TISSUE OF THE BONE IS BROKEN

PATHOLOGICAL FRACTURES

OCCUR WITHOUT TRAUMA CAUSED BY A WEAKENING OF THE BONE

FRACTURES RESULT FROM

DIRECT FORCE TORSION

CLOSED FRACTURE

BONE DOES NOT PROTRUDE THROUGH SKIN

OPEN FRACTURE

BEONE PROTRUDES THROUGH SKIN AND INFECTION IS A BIG COMPLICATION

COLLES FRACTURE

DISTAL PORTION OF RADIUS WITHIN 1 INCH OF WRIST JOINT USUALLY OCCURS WHEN PERSON IS TRYING TO BREAK A FALL

PTSS FRACTURE

DISTAL END OF THE FIBULA CHARECTERIZED BY CHIPPIN OFF A PEICE OF THE MEDIAL MELLEOUSL WITH DISPLACEMENT OF TEH FOOT OUTWARD

CALLUS

BONY DEPOSITS FORMED BETWEEN AND AROUND THE BROKEN ENDS OF A FRACTRED BONE DURING HEALING FORMS WHEN OSTEOBLAST CONTINUE TO LAY THE NETWORK FOR BONE BUILDUP AND OSTEOCLASTS DESTROY DEAD BONE

7 P'S OF ASSESSMENT

PAIN PALLOR PARESTHESIA PARALYSIS POLAR TEMP PUFFINESS PULSELESSNESS

FRACTURE TX

IMMEDIATELY SPLINT AND ELEVATE TO PREVENT EDEMA APPLY COLD DURING FIRST 24 HOURS TO REDUCE BLEEDING EDEMA AND PAIN

ORIF SURGERY

FRACTURE ALIGNMENT UNDER DIRECT VISULAIZATION WHILE USING VARIOUS INTERNAL FIXATION DEVICES APPLIED TO THE BONE

PELVIC FRACTURES

WHEN TRAUMA IS SEVER ENOUGH TO BREAK THE PELVIS, VITAL ORGANS MAY ALSO BE INVOLVED, BIG RISK FOR HEMMORRHAGE ORGANS INVOLVED BLADDER VAGINA UTERUS LIVER SPLEEN INTESTINE KIDNEYS INCREASED RISK FOR LARGE BOWEL AND RECTAL LACERATIONS AND BLADDER LACERATIONS

COMPARTMENT SYNDROME

CAUSED BY PROGRESSIVE DEVELOPMENT OF ARTERIAL VESSEL COMPRESSION AND REDUCED BLOOD SUPPLY TO AN EXTREMITY USUALLY SEEN IN FRACTURES OF FOREARM OR TIBIA USUALLY PRECEDE ONSET OF MUSCLE EDEMA WITHIN THE FASCIAE IRREVERSIBLE MUSCLE ISCHEMIA CAN OCCUR WITHIN 6 HOURS WITH CONTRACURE AND PERMANENT DISABILITY OCCURING WITHIN 24-48 IF UNTREATED

COMPARTMENT SYNDROME ASSESSMENT

SHARP PAIN THAT INCREASES WITH PASSIVE MOVEMENT DEEP UNRELENTING PROGRESSIVE AND POORLY LOCALIZED PAIN UNRELIEVED BY ANALGESIC OR ELEVATION OF EXTREMITY INABILITY TO FLEX THE FINGERS OR TOES, COOLNESS OF THE EXTREMITY AND ABSENCE OF PULSATION IN THE AFFECTED EXTREMITY PALLOR CYANOSIS OR POOR CAP REFILL

FASCIOTOMY

TREATMENT FOR COMPARTMENT SYNDROME INCISION INTO THE FASCIA TO RELIEVE PRESSURE AND ALLOW RETURN OF NORMAL BLOOD FLOW TO THE AREA DONE IMMEDIATELY WITHIN 30 MIN INCISION IS LEFT OPEN TO HEAL BY GRANULATION

COMPARTMENT SYNDROME CARE

ELEVATE AFFECTED LIMB NO HIGHER THAN HEART LEVEL TO MAINTAIN ARTERIAL PRESSURE APPLY COLD FOR VASOCONSTRICTION

COMPLICATIONS FOLLOWING FASCIOTOMY

DELAYED INFECTION AS A RESULT OF TISSUE NECROSIS PURULENT DRAINAGE IS A SIGN OF INFECTION VOLKMANNS CONTRACTURE PROPER POSITIONING AND ALIGNMENT CAN REDUCE RISK OF THIS COMPLICATION

VOLKMANNS CONTRACTURE

CLAWHAND FLEXION OF WRIST/FINGERS AND ATROPY OF FOREARM RESULTS FROM UNTREATED COMPARTMENT SYNDROME PROPER POSITIONING AND ALIGNMENT CAN REDUCE THE RISK OF THIS COMPLICATION

COMPARTMENT SYNDROME NUSING CARE

ALWAYS ASSESS ECCHYMOSIS OVER PELVIS, PERINEUM, VS EVERY 15 MIN FOR SHOCK UNTIL STABLE INSERT FOLEY IF NEEDED AND MONITOR I & O

SHOCK

RESULT OF BLOOD LOSS FROM A FRACTURED BONE OR FROM SEVERED BLOOD VESSELS ESPECIALLY IN OPEN FRACTURES, PAIN AND FEAR CAN ALSO CAUSE SHOCK

SHOCK ASSESSMENT

LOC RESTLESS OR ANXIETY WEAKNESS LETHARGY OLIGURIA HYPOTENSION TACHYCARDIA TACHYPNEA HYPOTHERMIA PALE COOL MOIST SKIN

SHOCK TX

RESTORE BLOOD VOLUME TO ENSURE RAPID RETURN OF OXYGEN TO THE TISSUES WITH IV FLUIDS ADMINISTER OXYGEN CENTRAL LINE FOR ACCURATE VS MONITORING TO PREVENT PULOMANRY EDEMA

SHOCK CARE

INFLITRATION ERYTHEMA EDEMA PAIN AND INDURATION (HARDENING OF TISSUE) MONITOR VS EVERY 15 MIN UNTIL STABLE I & O EVERY HOUR AND WATCHFOR URINE OUTPUT LESS THAN 30ML PER HOUR LIE FLAT IN BED KEEP TP WARM NPO AVOID SEDATIVES TRANQUILIZERS AND NARCOTICS CAN MASK SYMPTOMS CAN BE FATAL IF IMMEDIATE ACTION IS NOT TAKEN

FAT EMBOLI

EMBOLIZATION OF TISSUE FAT WITH PLATELETS AND CIRCULATING FREE FATTY ACIDS WITHIN PULMONARY CAPILLARIES IT IS RARE BUT CAN BE LIFE THREATENING, FAT DROPLETS CAN OCCLUDE CAPILLARIES CAUSING BRAIN HYPOXIA AND TISSUE DEATH MOST SERIOUS COMPLICATON OF LONG BONE FRACTURES

FAT EMBOLI ASSESSMENT

IRRITABILITY RESTLESSNESS DISORIENTATION STUPOR AND COMA RESULT FROM SEVERE HYPOXEMIA CHEST PAIN ESP ON INSPIRATON AND LOCALIZED MUSCLE WEAKNESS SPASTICITY AND RIGIDITY TACHYPNEA DYSPNEA HYPOXEMIA AUDITORY CRACKLES AND WHEEZES IN LUNG FIELD PETECHIAE CAUSED BY OCCLUSION OF CAPILLARIES SEEN ON THE CONJUNCTIVA OF EYE NECK CHEST AXILLARY AND CAN BY A SIGN OF FAT EMBOLISM

FAT EMBOLI TX

PREVENTATIVE CAREFUL IMMOBILIZATION OF LONG BONE FRACTURE IS MOST IMPORTANT FACTOR IN PREVENTION OXYGEN IF PO2 IS LESS THAN 70 IS TO IMPROVE LUNG EXPANSION AND OXYGENATION

NORMAL pH

7.35-7.45

NORMAL PaCO2

35-45

NORMAL PaO2

80-100

NORMAL HCO3

21-28

NORMAL SaO2

95-100

CAST CARE

IMMOBILIZATON DEVICE MADE OF PLASTER OF PARIS FIBERGLASS OR PLASTIC ROLLER BANDAGES

LONG LEG CAST

UPPER THIGH TO BASE OF THE TOES

SPICA CAST

COVERS TRUNK AND ONE OR BOTH EXTREMITIES

BIVALVE CAST

SPLIT CAST DOWN BOTH SIDES AND SECURE PIECES SO EXTREMITY IS SUPPORTED

CAST ASSESSMENT

NEUOR WITH CAP REFILL EVERY 15 TO 30 MIN FOR SEVERAL HOURS AFTER CASTING CAP REFILL SHOUILD BE 2-3 SECONDS OBSERVE SKIN FOR ERYTHEMA OR IRRITATION AND SIGNS OF INFECTION HANDLE A NEW OR WET CAST WITH THE FLAT OF THE HAND ON PILLOW TO AVOID INDENTATIONS

CAST CARE

ELEVATE EXTREMITYTO REDUCE EDEMA FOR THE FIRST 24-48 HOURS AFTER CASTING CLEAN AROUND CAST WITH MILD SOAP AND RINSE SO THE SKIN IS NOT IMPAIRED

CAST SYNDROME

ACUTE OBSTRUCTION OF DUODENUM CAN BE CAUSED BY SPICA CAST

SYNTHETIC CAST CARE

FLUSH WITH WATER IF SOILED AND THEN DRY WITH TOWEL OR BLOW DRYER ON LOW SETTING USING A SWEEPING MOTION

TRACTION

PUTTING EXTREMITY BONE OR GROUP OF MUSCLES UNDER TENSION BY MEANS OF WEIGHTS OR PULLYS

TRACTION USE

ALIGN AND STABILIZE FRACTURE SITE BY REDUCING THE FRACTURED PART
MAINTIANING CORRECT POSITIONING PREVENT DEFORMITIES RELIEVE MUSCLE SPASMS

SKELETAL TRACTION

DIRECTLY TO BONE USED FOR FEMUR TIBIA HUMERUS AND CERVICAL SPINE

SKIN TRACTION

WEIGHT PULLS ON MATERIAL ATTACHED TO SKIN BUCK'S RUSSELL'S BRYANT'S TRACTION

BUCKS SKIN TRACTION

SUPPORTS AND COMFORTS FRACTURED EXTREMITY WHILE WAITING FOR TREATMENT USED TO MAINTAIN THE REDUCTION OF A HIP FRACTURE BEFORE SURGERY USED TO TREAT MUSCLE SPASMS AND FINE FRACTURES OF THE LOWER SPINE

RUSSELL'S TRACTION

KNEE SLING SUPPORTS AFFECTED LEG ALLOWS MORE MOVEMENT IN BED AND PERMITS FLEXION OF THE KNEE JOINT TREATS HIP AND KNEE FRACTURES

CARE DURING TRACTION

MAINTAIN BODY IN PROPER ALIGHNMENT AND CAREFUL ASSESSMENT OF TRACTION EQUIPMENT ENSURE WEIGHTS HANG FREELY FROM BED AND ARE NEVER REMOVED WITHOUT ORDERS OBSERVE CONDITION OF CORDS

CONTUSIONS

MOST COMMON SOFT TISSUE INJURY

CONTUSION CARE

APPLY ICE OR COLD COMPRESSES FOR 15-20 MIN OVER 12-35 HOURS FOR VASOCONSTRICTING EFFECTS ELEVATE TO REDUCE EDEMA AND SUPPRESS PAIN "RICE"REST ICE COMPRESSION ELEVATION

CARPAL TUNNEL

PAINFUL DISORDER OF WRIST AND HAND CAUSED BY INFLAMMATIN AND EDEMA OF THE SYNOVIAL LINING OF THE TENDON SHEATHS IN THE CARPAL TUNNEL OF THE WRIST

CARPAL TUNNEL

BURNING PAIN OR TINGLING IN HADS RELIEVED BY SHAKING OR EXERCISING THE HANDS PAIN MORE INTENSE AT NIGHT

CARPAL TUNNEL DX

ELECTROMYLOGRAM SHOWS WEAKENED MUSCLE RESPONSE TO STIMULATION

CARPAL TUNNEL TX

SPLINT MAY HELP HYDROCORTISONE ACETAT SUSPENSION INJECTED INTO THE CARPAL TUNNEL CAN RELIEVE MILD SYMPTOMS SURGERY FOR SEVERE SYMPTOMS WITH MUSCLE ATROPHY

CARPAL TUNNEL CARE

ERGONOMIC TRAINING IS IMPORTANT SPECIAL EQUIPMENT CAN BE USED SUCH AS KEYBOARDS AND MOUSE TO PREVENT PRESSURE ON MEDIAN NERVE WRIST COCKUP SPLINT TO RELIEVE PRESSURE AND TO LESSEN WRIST FLEXION ELEVATION TO RELIEVE EDEMA AND ROM TO LESSEN SENSE OF CLUMSINESS AND RESTRICTION OF TWISTING AND TURNING

CARPAL TUNNEL POST OP CARE

ELEVATE HAND AND ARM FOR 24 HOURS CHECK FINGERS FOR CIRCULATION USUALLY CAN USE AFFECTED HAND WITHIN 2-3 DAYS POST OP

LAMINECTOMY

SURGICAL REMOVAL OF BONY ARCHES OR ONE OR MORE VERTEBRA PERFORMED TO RELIEVE COMPRESSION OF THE SPINAL CORD CAUSED BY BONE DISPLACEMENT FROM INJURY OR DEGENERATION OF A DISK OR TO REMOVE A DISPLACED VERTEBAL DISK PT SHOULD HAVE A DIET HIGH IN PROTIEN TO PROMOTE HEALING

AMPUTATION

NECESSARY FOR TUMORS, INJURIES IMPAIRED CIRCULATION CONGENITAL DEFORMITIES AND INFECTIONS

TRAUMATIC AMPUTATION

CAN BE REVERSED BY REPLANTION IF THE SEVERED LIMB IS KEPT STERILE AND MOIST PLACED IN BAG FILLED WITH ICE WATER PROTECT THE LIMB FROM DIRECT CONTACT WITH ICE

AMPUTATION TX

RESTORE BLOOD VOLUME CONTROL PAIN PREVENT INFECTION SURGERY TO REPAIR SITE TO FACILITATE USE OF PROSTHESIS AND MAINTAIN OUTPUT

PHANTOM PAIN FOLLOWING AMPUTATION

OCCURS BECAUSE NERVE TRACKS THAT REGISTER PAIN IN THE AMPUTATED AREA CONTINUE TO SEND A MSG TO BRAIN IT IS NORMAL

PHANTOM PAIN ASSESSMENT

PT MAY FEEL BURNING TINGLING THROBBING ITCHING AND MAY LAST FOR MONTHS

PHANTOM PAIN TX

RUB EXTREMITY OR TAKE ANALGESICS FOR PAIN

PERSISTANT PHANTOM PAIN TX

STUMP REVISION WITH REAMPUTATION AT HIGHER LEVEL LOCAL INFILTRATION OF SUMP WITH PROCAINE MECHANICAL PERCUSSION BY STRIKING THE SENSITIVE DIGITAL STUMP AGAINST A SOLID OBJECT ( BELIEVED TO SHRINK SMALL TUMORS THAT FORM IN THE SCAR TISSUE OF STUMP) SYMPATHETIC NERVE BLOCK

AMPUTATION TEACHING

EDUCATE PT AND FAMILY ON HOW TO APPLY ELASTIC WRAPS TO SHRINK AND RESHAPE RESIDULE ESTREMITY INTO A CONE TO FACILITAE THE PROPER FIT AND USE OF PROTHESIS

OSTEOPOROSIS DIET

ESTROGEN CALCIUM VIT D FOSOMAX AND EVISTA CAN BE USED

SPINAL STENOSIS

PAIN IN LUMBAR AREA

POLYMYALGIA RHEUMATICA

SYMPTOMS OF RA BUT LAST ONLY 4 WEEKS

FUNCTIONS OF BONES

SUPPORT PROTECT MOVEMENT MINERAL STORAGE HEMATOPOIESIS

TYPES OF BONES

LONG (ARMS AND LEGS) SHORT (HANDS AND FEET) FLAT(SKULL STERNUM) IRREGULAR (VERTEBRAE)

JOINTS

POINT OF CONTACT BETWEEN BONE ALLOWS MOVEMENT AND FLEXION 3 TYPES SYNARTHROSIS(NO MOVEMENT) AMPIATHROSIS(SLIGHT MOVEMENT) DIATHROSIS(FREE MOVEMENT)

SKELETON

AXIAL (SKULL, HYOID, VERTIBRAL COLUMN, THORAX) APPENDICUALR (EXTREMITIES, SHOULDER GIRDLE, PELVIC GIRDLE)

ABDUCTION

AWAY FROM THE BODY

ADDUCTION

TOWARDS THE BODY

SUPINATION

PALM FACE UPWARD AND FORWARD

PRONATION

PALM FACE DOWN OR BACKWARD

DORISFELXION

TOP OF FOOT ELEVATED AND TILTS UPWARD TOWARD BODY

PLANTAR FLEXTION

BOTTON OF FOOT DOWN

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