MedSurg Test 4 2nd Semester

bleeding into soft tissue as a result of of blunt force

stretching injury to a muscle or a muscle-tendon unit caused by mechanical overload

pain, limited motion, muscle spasm, swelling and possible muscle weakness

• stretch or tear of a ligament surrounding a joint
• *ankle and knee are most common

cant move joint, discoloration, pain, rapid swelling

• Rest
• Ice
• Compression
• Elevation

ends of two connected bones separate as a result from extreme force put on a ligament

pain, swelling, immobility, deformity, warmth, bruising, or redness in injured area

• inflammation of the bursa
• bursa is a tiny fluid-filled sac located adjacent to the tendona near large joints

injury, infection, underlying rheumatic condition, inflammation of bursa from gout crystals

ice, rest, anti-inflammatory and pain meds, aspiration of bursa fluid, cortisone injection

aspiration and culture of fluid to identify organism

• aggressive vancomycin treatment
• may need repeated aspiration of fluid
• surgical drainage and removal of infected bursa sac

the median nerve in the wrist becomes compressed causing pain and numbness

• phalen's maneuver, tinel's sign, numbness, painful tingling, weak pinch, clumsiness and difficulty with fine movements. 
• progresses to muscle weakness

xray, emg, mri, ultrasound

• nsaids, corticosteroid injections
• immobilization of wrist
• surgical nerve decompression

usually a result of twisting the leg when the knee is flexed and foot is on the ground

• pain, swelling and tenderness in the knee
• clicking or snapping sound when the knee is moved

involuntary movement or contraction of muscles without full control

muscle fatigue, dehydration, low Mg or Ca, alcoholism, kidney failure

• antispasmodic muscle relaxants
• nsaids
• opioid analgesics
• steroids
• relaxation techniques

break is across the entire width of the bone, the bone is divided into two distinct sections

the fracture does not divide the bone into two distinct sections, break is through only part of the bone

• compare the injured area with its systemic counterpart
• assess color, temp, movement, sensation, pulse, cap refill, pain

• cover with sterile dressing if open
• immobilize
• do not attempt to clean
• do not reduce

pain, diminished mobility, change in bone alignment, shortening of extremity, swelling, discoloration, crepitation - a grating aound created by bone fragments rubbing together

• acute compartment syndrome secondary to swelling
• dvt secondary to immobility
• infection (osteomyelitis)
• fat embolism syndrome
• delayed union, nonunion and malunion

pressure from edema and hemorrhage

• internal=hemorrhage
• external=casts and constricting dressings

• numbness and tingling (paresthesia)
• pallor of tissue, weak pulse
• weakness of extremity
• pain with passive movement of extremity
• pain that is unrelieved by pain medication

• open fracture
• diminished bloodflow

• delayed wound healing
• osteomyelitis
• tissue death and necrosis

• fat globules lodge in lungs or peripheral circulation
• occur in long bone fractures

• petechiae
• dependent on where that fat has lodged

early stabilization of fracture

• plaster of paris
• fiberglass
• polyester-cotton knit

• infection
• circulatory impairment
• peripheral nerve damage
• complication of immobility

pins are implanted into the bone and held in place ny an external metal frame to prevent bone movement

• affected leg will be shorter
• affected leg will be externally rotated
• edema, stiffness and bruising
• pain in hip or groin
• inability to bear weight on affected extremity
• muscle spasm

hemorrhage and shock

osteoporosis

• nonsurgical management = bedrest, analgesics, and physical therapy
• surgical = vertebroplasty and kyphoplasty in which bone cement is injected

an excess of bone destruction and unorganized bone formation

• unknown
• genetic predisposition in 10% of patients
• slow viral infection may trigger the disease
• autoimmune dysfunction

vertebrae, skull, pelvis, femur, and tibia

• increase in osteoclasts cause bone reabsorption
• increase in osteoblasts cause bone formation
• result is new bone that is structurally weak and enlarged
• deformities and bony enlargement occur

• none in early stages
• severe and persistent pain that intensifies with weight bearing
• cranial enlargement (headaches, hearing and vision impaired)
• kyphosis, barrel shaped chest, asymmetrical bowing of tibia and femur
• site warm and tender
• slow and incomplete healing of fractures

• adult bone disease
• vitamin d deficiency resulting in decalcification and softening of the bone

• pain
• difficulty walking
• fractures and delayed healing
• height loss
• kyphosis

eggs, low fat milk, fish, vegetables

• porus bone with low bone mass
• structural deterioration of bone tissue
• known as the silent thief

female, increasing age, family hx, white or asian, small stature, early menopause, hx of anorexia or oophorectomy, sedentary lifestyle, insufficient dietary calcium, cigarette smoking, alcoholism

• corticosteroids
• anti-seizure meds
• aluminum-containing antacids
• heparin
• certain cancer treatments

• back pain or spontaneous fracture
• fracture from minimal trauma
• hip, vertebral or wrist fracture
• spinal deformities

sardines, milk, ice cream, cottage cheese, yogurt

alcohol and caffine

bacterial infection of the bone caused by fungus, parasites, and virus

pathogens are carried in the blood to the bone from sites of infection elsewhere in the body

• from a contiguous infection
• vascular insufficiency

• intravenous drug abusers
• hemodialysis patients
• recent trauma
• diabetes mellitus
• spleenectomy

• bone scan
• blood test/culture
• wound culture

• a chronic autoimmune disease that causes hardening of the skin and scarring
• can be limited around  the fingers or in large areas such as limbs

• Calcinosis - calcium deposits in the skin
• Raynauds syndrome 
• Esophageal dysfunction - acid reflux and decrease in motility of the esophagus
• Sclerodactyly - thickening and tightening of the skin on the fingers and hands
• Telangieactasias - dilation of capillaries causing red marks on the surface of the skin

• joint pain (grating pain that diminishes after rest and intensifies after activity)
• joint stiffness after a period of inactivity
• crepitus (grating sound)
• joint enlargement due to bony hypertrophy
• joint is rarely hot or inflamed

• loss of appetite
• low grade fever
• anemia
• fatigue

• muscle and joint aches
• stiffness
• muscle joints are inflamed in a symmetrical pattern
• joints become red, swollen, painful, and tender

• most common type
• results from inborn errors of purine metabolism or a decrease in renal uric acid excretion

involves hyperuricemia caused by another disease process such as renal insufficiency, multiple myeloma, certain carcinomas

• pain, swelling, redness, warmness and stiffness in the affected joint
• inflammation of the tissue around the joint also causes the skin to be swollen, tender and sore

• wound care: stitches or staples will be removed 2 weeks after surgery, avoid getting wet, bandage over incision, observe for bleeding
• may have drain in place: monitor output
• assess for neurovascular compromise: color, temp, pulses, cap refill, movement/sensation, compare to non-operative side
• pain: epidural analgesia, pca

• pt gets out of bed the day after surgery and physical therapy is started
• raised toilet seats and chairs to prevent hyperflexion
• a patient with a cemented implant is allowed immediate partial weight bearing (PWB) or full weight bearing (FWB)
• a patient with a noncemented implant cannot tolerate FWB until bony ingrowth occurs

• similar to THR
• maintain the knee in a neutral position - not internally/externally rotated
• knee brace
• continuous passive motion device