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What is TCMS?
What type of assessment is this done during?
Temp, color, movement, sensation.
Done Neurovascular status.
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What is the importance of calcitonin (thyroid gland), Vit D, Phosphorus, and PTH on bones?
CalcitonIN: lowers serum Ca+ by putting Ca+ & phosphorus back IN (calcitonIN) bone & inhibiting osteoclasts; stops bone resorption; tells kidneys to excrete Ca+ & phosphorus.
Vit D: needed for Ca+ absorption.
Phosphorus: inverse r'ship to Ca+.
PTH: Increases serum Ca+ by taking Ca+ & phosphorus from the bone to the bloodstream.
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What meds are given for:
Pain relief
Relief of inflammation
Relief of muscle spasms
Pain: NSAIDs, Opioids
Relief of in: NSAIDs
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What can low back pain be caused by?
◦Lumbosacral strain
◦Unstable ligaments
◦Weak muscles
◦Intervertebral disk problems
◦Unequal leg length
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Assessing low back pain.
What should you focus on?
Location, severity, duration, characteristics, radiation, weakness
Work & recreational activities
How patient deals with pain
Physical Exam
Diagnostic Procedures
Chart 42-1
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What are some Management tx for low back pain?
Non-pharm
Should Pt be put on bed rest?
- Heat/cold
- Chiropractor
- Lumbar support
- PT
- Massage
- Acupuncture
- Yoga
- NO BED REST!
- Good body mechanics
- Proper posture
- Exercise-conditioning, stretching
- Reduce body weight
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What are some Management tx for low back pain?
Pharm
Acetaminophen
NSAIDs
Muscle relaxants
Opiods-short term only
Tricyclic antidepressants, SNRIs, seizure meds (gabapentin/Neurontin)
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Where are the two locations for herniated disks?
What is parasthesia?
Parasthesia: numbness & tingling feeling.
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What is an EMG used to do?
(electromyogram)
What does a myelogram show?
Localize a specific nerve.
Myelogram shows where the "bulge" is (the herniation)
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What is the MOST COMMON surgical procedure for a herniated disc?
What is done and what does it do (results in)?
Laminectomy - creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery; it enlarges your spinal canal to relieve pressure on the spinal cord or nerves.
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How does stress effect LBP? (a CYCLE)
Give an example.
Increases muscle tension
Worry creates stress = exacerbates back pain.
Pt becomes unnecessarily limited in daily activities --> decrease in activity d/t fear of injury --> limitations in movement & activity lead to muscle weakening --> increases back pain.
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What is Scoliosis?
Lateral S or C curvature of the spine.
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Explain the degrees and Tx of scoliosis: mild vs moderate vs severe (degrees of curvature)
Mild: <20 degrees of curvature
Tx: exercises to improve posture, muscle tone, flexibility.
Mod: 20-40 degrees of curvature
Tx: bracing - maintain current curvature; wear brace 23 hours/day.
Severe: >40 degrees of curvature.
Tx: Surgery-spinal fusion w/ instrumentation (rods, wires)
Post-op: limited bed rest then up w/ TLSO for months. (thoraco lumbar sacral orthotic)
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Fractures.
What age-related diseases makes older adults and children @ risk?
Older adults: osteoporosis
Children: Osteogenesis Imperfecta (brittle bone disease) an inherited disease which causes bones to break easily.
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What are the four types of fractures?
- Complete: all the way through bone.
- Incomplete: partially through bone.
- Closed: bone does not come through skin.
- Open: some bone comes through skin.
Hinkle Cheever: p. 1161.
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What are most falls usually due to for the elderly?
Osteoporosis of the bones; not fall causing the fracture.
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What is the immediate tx (priority) of any fracture?
What should you apply and what is the goal?
Immobolize to prevent further damage.
- Apply traction
- Goal: manage muscle spasms and keep bone in alignment until surgery or healed
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What is the difference between a "skin traction" (straight traction) and a "skeletal traction"?
Skin: force applied over a LARGE area of skin and controls muscle spasms.
Skeletal: applies a PULLING force thru placement of pins into the bone (increased risk of infection).
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What is IMPORTANT about weights when applied via skin (straight) traction and why?
Where should Pts be positioned on bed?
Wts MUST hang freely b/c it's more comfortable for the Pt & easy to manage.
Pts should be CENTERED.
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What is the MOST COMMON type of skin (straight) traction and what must you do?
Buck's traction:
- immobilize proximal femur fracture
- Foam boot applied to LL.
- Free-hanging wt attached to boot.
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What is the advantage of a "balanced suspension" traction?
It allows for INCREASED MOBILITY w/o compromising joint stability.
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What are the surgical tx of (hip) fractures?
What is the purpose?
ORIF: open reduction internal fixation; w/ hip fractures; reduce fracture by correcting the alignment and apply hardware to hold bone in place; fracture heals.
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What is External Fixation?
Frame connected to pins that are inserted into bone.
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Neurovascular assessment:
What are the 5 P's?
pain, pulse, palor, paralysis, parasthesia.
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Complications of fracture: What is "compartment syndrome"?
In what time frame does it usually occur post-op?
(usually calf)
A compartment usually contains a group of muscles, nerves, and BVs held together by a FASCIA.
When the compartment's pressure is increased, it may block BVs to tissues in the compartment causing acidosis & necrosis. The fascia is also unable to expand to meet the swelling of the compartment.
Usually 48h post op.
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What is done for surgical tx of "compartment syndrome"?
@ risk for?
Fasciotomy to reduce swelling and fluid & relieve pressure.
@ risk for infection.
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Primary concern for Fat embolism of systems is which system?
Explain phys of (fat) embolism.
(usually within 12-72h of fracture)
Respiratory: d/t embolism causing occlusion.
- Bone marrow has fat cells—w/ injury to long bone (femur, tibia, etc.), fat cells are released from bone
- marrow—enter venous compartment and combine with platelets—form clots—move throughout body—occludes small BVs that supply the lungs, brain, kidneys, and other organs.
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DVT.
What are the 3 factors that produce DVT?
What do tx include?
Venous stasis (not moving)
Injury to BV wall (inflammation)
Altered blood coagulation
Tx: Compression stocking/device to promote venous return; anticoagulants to prevent clot formation.
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What may be a complication of DVT?
Blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism).
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What 3 conditions may happen post surgery and what are the s/sx?
FE, DVT, compartment syndrome
s/sx: SOB, chest pain on inhalation, dizziness, rapid pulse, coughing up blood.
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Hip Fracture.
What is it a fracture of?
What is the difference between intracapsular and extracapsular?
Fracture of the femur @ the head, neck or trochanteric area of the bone.
- Intra: Head or neck of femur; Inside
- the acetabulum—poorer blood supply.
- Extra: Trochanteric
- area; Outside the acetabulum—better blood supply—covered by periosteum
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Hip Fracture.
What is the tx (#1 priority)?
Immobilization
ASAP: Surgery: ORIF/CRIF
Total joint replacement (arthroplasty)
- Replace the head with a metal cap or ball and line acetabulum with metal or
- polyethylene liner
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