Med/Surg Unit 3
Card Set Information
Med/Surg Unit 3
Most common sites for arthritic involvment
Drugs used to decrease the risk of DVT
low-dose unfractionated heparin (UFH)
low-molecular-weight heparin (LMWH)
slower to reach blood but less expesive and easier to pt to take after discharge
Surgical management of hip OA
Osteotomy-cut across a bone w/ resection of a bone fragment to correct a deformityor alter stress on a joint-
performed on clients in 40's
performed on active clients <55
Total Hip Arthroplasty/ Replacement- persormed to restore joint motion by replacing arthritic bone with metal and plastic components
What is Homan's sign?
dorsiflexion of the foot causes discomfort in upper calf present in fewer than 1/3 of symptomatic client’s with DVT
nonspecific indicator to assess for thrombophlebitis
Client may have thrombophlebitis but have a negative Homan's sign
Positive sign can result from shin splints
Early manifestations of DVT
unilateral calf or thigh pain that results from venous
inflammation or obstruction
red vein track
Bone Healing Stages
Stage I Hematoma or Inflammatory stage-warmth, vasodilation, edema, loss of function, bruising,
: 1-3 days
Stage II Fibrocartilage formation (cellular proliferation) -
: 3 days-2 weeks
Stage III Callus Formation
: 2-6 weeks
Stage IV Ossification-new bone
: 3 weeks- 6 months
Stage V Consolidation and Remodeling-comes back together
: 6 weeks to 1 year
Factors affecting wound healing
Proper fragment immobilization
Presence of systemic or bone diseases
Age and general health of pt
Type of fractureTreatment
If a client is taking warfarin what should the nurse reinforce?
The importance of consistent intake of foods that contain Vit K (ex green, leafy veggies)
What is used in for the diagnosis of DVT
Doppler ultrasound of the leg
what is warfarin used for?
long term home use to prevent clot recurrence
Disorders that alter bony equilibrium and affect bony turnover
parathyroid gland abnormalities
low bone mineral density compared with that expected for the person's age and gender
caused by steroid use or Cushing's Syndrome
Categories for Osteporosis
low bone mass (osteopenia)
severe (established osteoporosis)
Tissue Damage Grading
Grade I The wound is smaller than 1cm; contamination is minimal
Grade II The wound is larger than 1 cm; contamination is moderate
Grade III The wound exceeds 6-8 cm; extensive damage to soft tissue, nerve, and tendon; high degree of contamination
: intact skin over site of injury
: break in skin over the bone injury
**serious because once the skin is broken, infection in both the wound and bone can occur
Describe Reducing Fractures
the manipulation of bone to restore alignment, position, and length by bringing the bony fragments into close approximation.
also called bone setting
alleviates compression or stretching of nerves and blood vessels.
Osteprorsis can result from underlying medical conditions such as....
long-term use of meds such as thyroid hormone, anticonvulsants, furosemide and corticosteroids
Major risk factors for Osteoporosis
personal history of fracture as an adult
Hx of fragility (low trauma) fracture in a first degree relative
Low body weight (less than 128 lbs)
Current cig smoking
Use of oral corticosteroid therapy for more than 3 months
Describe Skin Traction
involves the application of a pulling force directly to the skin through the use of skin strips, boots, or foam splints. Do not move extremity out of alignment, rarely used
a. Bears a low longitudinal force load (5-7lbs)
b. Only used temporarily due to risk of skin breakdown
Describe Skeletal Traction
uses pins or wires to apply force to the bone. A direct force can be applied after the physician inserts stainless-steel pins through the bone itself.
a.Most common sites are
: the distal femur, the proximal tibia, and the proximal ulna
b. Can be tolerated for longer periods than can skin traction
c. Weights over 10 lbs are commonly used
Major Types of Traction
most common form-a foam boot is applied to the clients’ affected extremity and attached to a weight that is suspended off the foot of the bed, form of skin traction
modification of Buck’s, short-term
collar with weights, being used to treat sprain or strain or cervical fracture. Can cause damage to spinal cord
put device around pelvis, ropes pull hip off bed
Two principal functions of bone remodeling
Replaces old bone with new so that the biomechanical properties of the skeleton are not compromised by continuous use
Plays a role in mineral homeostasis by transferring calcium and other ions into and out of the skeletal reservoir
Descrine Compartment Syndrome
Cast in place, due to prolonged compression swelling occurs and there is increased pressure.
Condition of compromised circulation related to progressively increased pressure in a confined space.
Irreversible after 24 hours, after 4-6 muscle damage will occur, nerve damage 12-24 hours if swelling is left untreated
what is Paget's Disease?
an idiopathic bone disorder characterized by abnormal and accelerated bone resorption and formation in one or more bones
normal bone is replaced by abnormal, structurally weaker bone that is prone to fractures
most frequently produces deformities of the femur, tibia, lower spine, pelvis and cranium
cause is unkown
rarely seen in people under 40
Most common presenting complaints of Paget's Disease
deep, aching bone pain
skeletal deformity such as barrel shaped chest, bowing of tibia or femur, or kyphosis
changes in skin temp
pathological fractures through diseased bone
manifestations related to nerve compression
What is Volkmann’s Contracture?
untreated compartment syndrome
What is Fat Embolism syndrome?
similar to PE but fat not blood, released atsite of fracture, released into blood and travels. Pt is apprehensive, anxious, confused
Where does Osteomyelitis most frequently occur?
other chronic open wounds
What is Osteomyelitis?
- severe pyogenic infection of bone and surrounding tissues
-generally bacterial but can be caused by a fungus or virus
-Staphylococcus aureus-most common infecting organism
What meds/therapies can be used to control pain associated with Paget's Disease?
NSAIDS such as ibuprofen
Long Term Complications of Fractures
Joint stiffness or Traumatic arthritis- can happen years later
Avascular necrosis- most frequently seen in femur
Complex Regional Pain Syndrome
Manifestaions of cast Syndrome
abdominal pressure and vague abdominal pain
feelings of bloating or tightness
inability to take a deep breath.
What is gout?
a metabolic bone disorder in which purine (protein) metabolism is altered and the by-product, uric acid, accumulates.
Classifications of gout
Primary- caused by inherited defect of purine metabolism, leading to increased renal excretion
Secondary- acquired condition that occurs following hematopoetic or renal disorders