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HN 3 Exam 1
Terms in this set (43)
inspection assessments for the musculoskeletal system?
-skin appearance, pallor
palpation assessment for the musculoskeletal system?
-sensation of extremeties (parathesia)
motion assessment for the musculoskeletal system?
-ROM, if crepitus in heard STOP
-flacidity (neuro involvement)
-spasticity (neuro involvement)
measurement assessments for the musculoskeletal system?
-difference in length of limb
-difference in diameter of limb
what are the 3 nerves of the upper extremeties and how are they assessed?
sensation - distal fat pad of pinky finger
motion - abduction of fingers
sensation - distal surface of index finger
motion - opposition of thumb and pinky finger
sensation - web space between thumb and index finger
motion - hyperextension of thumb and wrist
what are the 2 nerves of the lower extremeties and how are they assessed?
sensation - web space between the big and 2nd toe
motion - dorsal flexion
sensatoin - medial and lateral surfaces of sole of foot
motion - plantar flexion
how do you compare limb circulation after a trauma injury?
-side to side
-color of limbs
-warmth of limbs
what assessment will indicate progressive damage in an affected limb first?
sensation is lost first, not circulation, so assessing sensation of nerves should take priority
what is the common name for talipes deformity?
what are the 4 types of talipes deformities?
-equinos (plantar flexion)
-calcaneous (dorsal flexion)
what is the most common (usually combined form) of talipes deformity?
what are the risk factors for talipes?
-boys are 2x as likely as girls
-complications in 1st trimester of pregnancy
what will you see when assessing for talipes?
-achilles tendon shortening (from not being extended)
-subluxation of talonavicular joint (ankle join appears out of place)
-smaller foot affected
tx for talipes deformity?
-correction of deformity then casting, usually every 1-2 weeks due to infants rapid growth
-denis browne splint (maintain the correction until normal muscle balance occurs)
-surgery (last resort)
what is the difference between false talipes and real talipes deformity?
with false talipes the foot can be moved back into correct anatomical alignment, real talipes cannot be moved back
what is the common name for metatarus adductus?
pigeon toe (toes point in)
tx for metatarsus adductus
-shoes on opposite feet (or gentle stretching)
-denis browne splint
-may resolve on its own without therapy
what will you see when assessing for metatarus adductus?
-heels are in good alignment, but the forefoot is turned inward
what is genu valgum and genu varum?
Valgum- knock knees (knees together)
Varum- bowlegs (ankles together)
what age range is genu valgum normal for?
2-7 year olds
tx for genu valgum?
-children may outgrow it
-older children may need orthopedic evaluation
what age range is genu varum normal for?
3 - school age
if genu varum (bowlegs) persists past school age, what disease must be ruled out?
Blount's Disease - retardation of epiphyseal line of medial side of tibia
tx for genu varum?
-may resolve without therapy
-orthopedic evaluation if it persists beyond normal age or gets rapidly worse
what is the purpose of traction?
-maintain correct alignment of a reduced fracture
-lessen muscle spasms and pain from injured or diseased joint
-prevent complications (stretch adhesions and contractures)
how is traction classified?
intermittent - may be removed periodically (soft tissue, skin traction)
continuous - constant pull and patient cannot be removed without injury occuring
skin traction (5-15 lbs)- apply device to skin and pulls on it, temporary (no more than 3 days)
skeletal traction (5-45 lbs) - continuous traction, may have 2-3 months, weights pull on pins, wires, or tongs which have been inserted in bone
what is the most common form of traction used?
Buck's Traction - used temporarily with hip or femur fractures, hip dislocations
-usually used when pts need to be stabilized before surgery can be performed
what are the assessments for a pt in buck's traction? priority assessments?
-peroneal and tibial nerve (priority)
-straps on traction are tight
-weights and rope hanging freely
-boot not digging into bed
-pt positioned correctly in bed
how are pts in buck's traction moved?
rolled to unaffected side, may need a pillow between legs before rolling
what are the cervical skeletal tractions (crutchfield, gardner-wells, halo) used for?
-stabilize the neck
-cervical vertebrae fractures
-spinal cord injuries
how are pts in skull tongs moved?
must be log rolled
what is thomas-pearson traction used for?
assessments for thomas-pearson traction?
-make sure lower leg is placed correctly in pearson cradle
-make sure groin ring is not digging into tissues
-pt in proper body alignment
-ropes and pulleys are correct
-knots tied securely and with no fraying
-weights are correct amount and hanging freely
-peroneal and tibial nerve assessments
how can patients move in thomas-pearson traction?
-ROM of unaffected limbs
-can tip to affected side if needing to roll
-can lift bottom of bed using trapeze bar
what might pain during traction indicate?
the traction is not properly aligned or their meds need reassessing
how often should skin traction bandages be removed?
once per shift, skin needs to be reassessed daily
what assessments are needed for all skeletal tractions?
-pin sites assessed for bleeding/infection
-pin screws are tight
-clean skin at pins daily, but not with betadine because it may cause changes in the metal)
-heel should be off the bed
how can complications from traction be prevented?
-encourage ROM exercises of unaffected extremities
-stool softeners for constipation
-offering activities they are able to perform to keep their minds busy
-coughing, deep breathing, incentive spirometer to avoid pneumonia or atelectisis
what crutch walking technique is best to ensure a pt is non-weight bearing on their affected leg?
what are the advantages and disadvantages of plaster casts?
-easier to mold due to 3 day drying time
-cannot get wet
-takes several days to harden
-heavier (issue for very old and very young)
-potential thermal burn from drying
what are the advantages and disadvantages of fiberglass casts?
-porous (xrays can be taken)
-less irritation to skin due to breath-ability
-can be waterproof
-soft padding under shell is not waterproof
-poor conforming capabilities due to minutes long drying time
-possible allergies to fiberglass
teaching for pts going home with casts?
-do not put weight on it for first 48 hours
-dont get it wet
-ROM exercises in unaffected limbs
-do not stick anything into cast
-elevate leg above heart to reduce swelling
-call if there is change in color or sensation of limb, pain, foul odor, shortness of breath
what are the 5 P's?
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