What type of fracture accounts for 10-15% of all childhood injuries?
Why do children's bones heal faster than adults?
Higher metabolic rate and growth plate is still open.
What is a pathological fracture?
Fracture in a bone weakened by disease. Ex: osteoporosis, primary/secondary cancer. Occurs with normal ADL's with minimal force.
What are some risk factors of fractures?
Osteoporosis, cigarette smoking, falls, and metastatic cancer bone defects.
Who has the highest incedence of fractures?
Males 15-24 and elderly women over 65.
What 2 basic mechanisms cause a fracture?
Direct force and indirect force.
Give an example of direct force.
Hitting your ankle hard on pavement resulting in ankle fracture, or hitting your elbow and fracturing it, or hip, etc.
Give an example of indirect force.
Hitting your ankle hard on the pavement, and the force travels up your leg to a weaker area s/a your femur, and fracturing that.
What is closed fracture?
aka simple, skin is intact still. uncomplicated.
What is an open fracture?
aka: complicated. skin is broken over fracture site. potential for infection.
What are some manifestations of fractures?
Edema, swelling, pain, tenderness, muscle spasms, deformity, ecchymosis, loss of function, crepitation.
If someone on the street has a fall and injures their knee, what are some actions you would take immediately?
Immobilize fracture, maintian tissue perfusion, prevent infection, apply direct pressure over artery if open bleeding.
What is fracture reduction?
restoration of the fracture fragments to anatomic alignment and positioning.
How is closed reduction achieved?
Bringing the bone fragments into anatomic alignment through manipulation and manual traction. Apply splint, cast, etc. Anesthesia used.
How is open reduction performed?
Through surgical approach, fracture fragments are aligned. Apply internal fixation devices. Direct visualization of a fracture.
Why do we do reduction of fractures?
To restore alignment, alleviate compression, stretch out nerves and vessels.
This method is used to reduce and immobilize a fracture. Use of screws/pins/wires to immobilize the fracture during healing. Treatment of choice for open fractures, widely seperated fragments, femur fractions, or fractured joint. What is this called?
Open Reduction Internal Fixation (ORIF)
What arterial damage can occur d/t a fracture?
Arteries can be severed, contused, thrombosed, under pressure from swelling/bleeding. May be extrenally constricted d/t casts.
Increased pressure within a limited space compromises the circulation viability and function of the tissue. Numbness, tingling, change in sensation, and loss of motion are all symptoms of neurological impairment d/t this condition. Pain on passive stretch/ROM is also a big sign!
A pt. exhibits the following symptoms: increased HR and RR, decreased BP, pallor, cool, clammy, restless, following a femur fracture. What condition would you expect they would have?
A pt. complains of pain in their R lower calf, you see swelling, feel it is warm to the touch, and a positive homans sign. What do you suspect?
Deep vein thrombosis. (DVT) blood clot forms along intima or lining of a vein as a result of venous stasis and immobility.
What are some prevenative measures of a DVT?
leg elevation, AV pumps, AES, leg exercises, Lovenox/Heparin/Coumadin therapy.
Describe a PE.
Pulmonary embolism. When a clot breaks loose into circulation and travels to the lungs, blocking pulmonary circulation.
Prevention methods of PE include:
Early ambulation, leg elevation, AES, anticoag/antiplt replacement, leg exercises.
What are some manifestations to watch for with PE?
What are some modifiable risk factors of osteoporosis?
Calcium deficiancy, estrogen deficiancy, smoking, high alcohol intake, sedentary life style, medications.
What meds put you at risk for osteoporosis?
corticosteroids, anti seizure meds, heparin, thyroid hormone.
Describe the pathophysiology of osteoporosis.
bone resorption exceeds bone formation. Imbalance between osteoblasts and osteoclasts. Bone diameter decreases.
Your pt A.R. states that he's noticed a decrease in his own hieght and a hump starting to form in the upper part of his spine. What condition would you expect?
Kyphosis. also called dowager hump, in the thoracic spine.
Conventional x ray does not pick up osteoporosis until it is how far along?
What test dx osteoporosis?
The DEXA scan. measures bone density. osteoporosis- >2.5 sd below mean. osteopenia- 1-2.5 sd below mean.
How much exercise is recommended to decrease risk of and treat osteoporosis?
20-30 mins, wieght bearing, 3 times/ week.
What is important to know about giving calcium suppliments?
Give with food in divided doses w/ 6-8 oz of water. May cause GI upset. Check for kidney stones.
How does Fosamax and Acetonel work?
reduces spine and hip fractures by increasing bone mass and decreasing bone loss by stopping osteoclast function. approved for prevention and treatment of corticosteroid induced osteoporosis. Need adequate calcium and Vit D intake for maximum effect.
This drug is an oral preparation given monthly. Used for both treatment and prevention of post menopausal osteoporosis. What is it?
This drug is given as an IV infusion yearly. It increases bone mass and decreases bone loss by inhibiting osteoclast function. Cost effective. What is it?
This hormone reduces bone loss and increases bone density. Given by nasal spray, sq, or IM. Should not be prescribed for pt's with seafood allergies. What is it?
Selective estrogen receptor modulator (SERM). Mimics estrogens effects on bone density. Reduces risk of osteoporosis. Contraindicated in women with a hx of DVT's.
Synthetic parathyroid hormone. Administered 1/day SQ. Stimulates osteoblasts to build bone matrix and facilitates overall calcium absorption.
Hormone replacement therapy. reduces bone loss. increases bone density in spine and hip. reduces risk of fracture in postmenopausal women.
What are some primary prevention methods of osteoporosis?
weight-bearing exercises, intake of calcium suppliment, avoidance of smoking, high caffiene, high protein diets, and high alcohol intake. DEXA screening every 1-2 years. Outdoor sunlight.
This is an uncommon metabolic disorder of adult bone associated with vitamin D deficiency resulting in decalcification and bone softening, causing pain, tenderness to touch, bowing of bones and pathological fractures. Inadequate mineralization of calcium and phosphorus resulting in weak bones. Same as rickets in children.
What disorders can cause malabsorption of calium/vitamin D?
Celiacs disease, hepatic disease, chronic pancreatitis, gastrostomy, disorders of GI.
increases phophate excretion in the urine.
Also called osteitis deformans, this disease is a progressive metabolic skeletal disorder in which there is a rapid bone turnover. Most commonly involves sternum, vertebrae, femur, skull, sternum, and pelvis. higher occurance in men than women.
Describe the pathophysiology of Paget's diease.
Proliferation of osteoclasts which cause bone resorption. then increase in osteoblastic activity that replaces the bone. bone turnover continues, disorganized pattern of bone develops, which is diseased, very vascularly and stucturally weak, leading to fractures. Bone never stops growing, always alive, always regenerating.
What are some manifestations of
bone/ join pain worse when walking. low back and sciatic nerve pain. loss of normal spinal curvature. enlarged thick skull.
Loss of teeth, hearing loss, vision loss, osteoarthritis, fractures, and heart failure are all complications of what disease?
This is a systemic disease in which urate crystals deposit in the joints and other body tissues causing inflammation. Uric acid production exceeds excretion by kidneys, causing sodium urate to deposit in synovium and other tissues. inherited as an x-linked trait.
Describe primary gout.
most common type: results from one of several inborn errors of purine metabolism.
Describe secondary gout.
involves hyperuricemia caused by another disease/condition s/a renal insufficiency, diuretic therapy, certain chemotherapeutic agents.
Describe the pathophysiology of gout.
attacks r/t sudden increases and decreases of serum uric acid levels. urate crystals build up within a joint, inflammatory response occurs.
What are some nursing care actions for someone with gout?
stop attack with anti-inflammatorys, prevent future attacks w/ drugs, weight reduction, avoid alcohol and high protein diet, drugs to reduce serum urate.
What 3 ways can someone develop osteomylitis?
Extension of sodt tissue infection, direct bone contamination frm surgery/open fracture of traumatic injury, or spread of blood pathogen frm another site of infection.
Describe acute osteomyelitis.
infection lasts less than 4 weeks. Higher rate in adults w/ diabetes or PVD. May result whn infection frm another part of body invades bone or direct infection frm trauma.
Describe chronic osteomyelitis.
May be a result of acute osteomyelitis, adults w/ compromised vascular supply are at higher risk, advanced age and concurrent disease may prolong infection.
How is osteomyelitis dx?
With a bone biopsy. wound cultures to determine causative organism. if sequestrium culture- positive. elevated wbc and esr. xray, bone scan, mri.
What is a sequestrectomy?
debridement of necrotic and infected bone
What is the open (guilotine) method of amputation?
used with active infection, allowig the skin to be closed at a later time, ised for pts who have or are at risk for developing an infection. wound stays open, drains exudate.
What is the closed (flap) method of amputation?
most common technique, allowing skin flap to close the site, pulled over bone and sutured in place. one or more drains inserted.
Lisfranc, chopart, & syme procedures are all common for what?
midfoot.foot amputations frm PVD.
higher level amputations are commonly done for what disorders?
bone cancers, osteomyelitis, and traumas.
what devices are used to assess blood flow?
doppler ultrasonography, laser doppler flowmetry, transcultaneous o2 pressure(TcPO2) and angiography which is most commonly used and most accurate.
what post op care methods would u carry out for a amputation pt?
dnt distrb dressing for 2-3 days, surgeon wll change dressing, I & o, VS, hct and hgb, elevate for first 24 hrs, after that stump is supported bt not elevated. position q 2 hrs. encourage c& db.
what interventions would u take to prevent shrinkage?
use stump shrinker sock. use air splint inflated to 20-22 mm Hg for 22-24 hrs/day.
what drug is used for constant, dull burning phantom limb pain?
what drug is used for knivelike pain of plp?
what drug type is used for muscle spasms, cramping pain of plp?
Improper positioning can cause this _____, and what can prevent it?
flexion contracture. prevention methods include ROM, avoid elevation after 24 hrs, have pt lie prone.
A rupture of the cartilage surrounding the intervertebral disk with protrusion of the nucleus with protrusion of the nucleus pulposus.
Herniated intervertebral disk
Describe the pathophysiology of a herniated intervertebral disk.
Nucleous pulposus looses fluid content and disks are less able to absorb shock. protrusion may occur. may be abrupt or gradual. most common in lumbar region, more common in men than women between ages of 30 and 50.
What dx tool is the tool of choice for finding a herniated intervertebral disk?
What is an arthrodesis?
What do you do for care of a pt after they had a Laminectomy?
PCA, AES, kend. pumps, log roll, moniter dressing, elevate HOB 30 degrees for cervical, supine -up for only 15 mins-log roll.
How long will a pt wear their cervical collar?
Describe carpal tunnel syndrome.
chronic condition. causes include excessive hand exercise, edema, hemorhage into the carpal tunnel. thrombosis of median nerve. also can be a comlication of RA or DM.
When is pain most common for a CTS pt?
How is Tinel's test performed?
performed by tapping the median nerve along its course in the wrist. A positive test is found when this causes worsening of the tingling in the fingers when the nerve is tapped.
How is Phalen maneuver performed?
Phalen's test is done by pushing the back of your hands together for one minute. This compresses the carpal tunnel and is also positive when it causes the same symptoms you have been experiencing with your carpal tunnel syndrome.
What med would be used for CTS?
corticosteroids. medrol IV or prednisone po.
What two surgical procedures are used for CTS?
Open nerve tunnel release and endoscopic laser tunnel release.
Slow progressive disease that results in a contracture of the palmar fascia resulting in flexion of the 4th and 5th digits of the hand and middle finger.
Round, cyst like lesions, often overlying a dorsum of the wrist.
Also called a bunion, the great toe deviates laterally at the MTP joint. occurs d/t arthritus and poorly fitted shoes.
Dorsiflexion of any MTP joint with plantar flexion of the adjacent PIP joint. second toe is most often affected.
A small tumor grows in a digital nerve of the foot. pain described as burning on surface of 3rd and 4th toes.
Inflammation of the plantar fascia located in the area of the arch of the foot.
This is the 2nd most common connective tissue disorder, most destructive to joints. chronic, systemic inflammatory process that primarily affects the synovial joints.