adults exam 1: set 2

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adults exam 1: set 2
2014-02-03 14:01:28
adults ortho

adults ortho and
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  1. 4 steps to bone healing with Fx's
    • Bone injury: hematoma
    • Fibrocartilaginous Callus Formation
    • Bony Callus formation
    • Remoldeling
  2. Fibrocartilaginous Callus Formation
    • starts w/n 48 hours
    • granulation replaces hematoma
    • osteoblasts build web of collagen
  3. Bony Callus formation
    • starts in 3-4 weeks
    • new bone
    • osteoclasts invade: reabsorb excess callus as it is replaced by mature bone
  4. remodeling stage
    • 2-4 months for full repair
    • plates/bars are laid down
    • repaired along lines of stress
  5. factors in bone healing
    • Ca
    • Vit D
    • Alkaline Phosphatase= bld work for bone disease shows Inc Alk Phosph
    • Decrease circulation (diabetes)
    • No osteoporosis or infections
  6. myelogram

    nrsing focus pre- and post-test
    Dx test done to look at problems with spinal cord/column

    pre= drug allergies to shelfish (dye)

    • post=bedrest, HOB elevated
    •  =fluids
    •  =site checks Q1hr of the lumbar puncture
  7. hallmark sign of CSF leak?
    halo on bandage
  8. Dislocation

    D= loss of articulation of the bone ends in the joint cap

    S= partial dislocation where bone ends still partially touch
  9. Nursing care (Dx) for joint trauma
    • Risk for injury - Neurovascular compromise
    • Acute pain - ice/heat, splint, NSAIDS
    • Impaired Physical Mobility
  10. Bursitis


    repetition injurys

    B= inflammation of the bursa

    • Epi= inflamm of tendon at point of origin to bone
    •  = tennis elbow

    • CTS= carpal tunnel
    •  = compression of median nerve and inflamm of synovial sheath
    •  = Phalen test used to Dx
  11. types of fractures:

    complete vs incomplete
    with vs w/o displacement
    simple vs compound
    • c= total segment vs partial
    • w= unstable vs stable
    • s= closed vs open
  12. goal of reduction (fx)
    • approxiate segments
    • restore to nl position
  13. goal of immobiliazation
    fixation/alignment of segments
  14. internal fixation

    adv. and disadv.
    pins, rods, etc.

    • a=fast ambulation
    • d=surgery required

  15. external fix

    adv and disadv.
    cast, splint

    • a= may not need surgery, may allow for more movement
    •  = external fix (think Penny) may allow for more movement

    • d= casts means slow ambulation
    •  = ext. fix require surgery
  16. cast care
    • elevation
    • rotation while drying
    • pad skin edges
    • pain control
    • window or bivalve to relieve pressure
    • nuerovasc changes (monito 5 p's)
    • hotspots and draignage
    • cool air to relieve itching
  17. skin traction
    • short term
    • low weight
    • immoblize and align
    • prevent ms spasms

    do not use if they have a fracture
  18. Buck Traction
    used for a hip fracture prior to surgery to prevent ms spasms
  19. skeletal traction
    • long term
    • infection risk
    • more weight

    • never remove weights
    • provide surgery site care
  20. auotgraft


    sites used for donation
    auto= from pt

    allo= from donor

    sites= illiac crest or tibia

    These are bone grafting terms
  21. delayed union


    healing complications

    d= abnl time but still <6 months

    n= no heal w/n 6-9 months

    m= growth of frag. of bone in a faulty position
  22. Sx and care of osteomyelitis
    Sx= high fever and chills, redness to ulceration and drainage

    Tx= hygeine and aseptic practices, antibiotics
  23. fat embolism occurs when?
    w/n a few hours or up to one week
  24. fat released
    fat breaks into f. acids, attracting platelets
    sm vessel occlusion
    • fat released
    • fat breaks into f. acids, attracting platelets
    • sm vessel occlusion
    • ischemia
  25. S & Sx of fat embolism
    • Resp failure: hypoxia
    •  = tachycardia, tachypnea, fever

    LOC changes, seizures

    • Petechiae; chest, upper arms, axilla
    •   **Hallmark sign***
  26. care of fat embolism
    • recognize s & sx
    • O2, ABG's
    • corticosteroids for anti-inflamm
  27. what and when can cause compartment syndrome?
    • poor fitting casts
    • edema
    • hemorrhage

    w/n 1st 48 hours
  28. comp. synd
    inc. pressure traps nerves and vessels
    causes hypoxia, capilarry dilitation, edema, and necrosis
    • comp. synd
    • inc. pressure traps nerves and vessels
    • causes hypoxia, capilarry dilitation, edema, and necrosis
  29. Sx of comp. synd.
    • severe pain
    • cyanosis
    • weakness
    • parestesia (numbing)
  30. Tx of comp synd
    • decompress fasciotomy
    • antibiotics
    • pain management
  31. hip fracture location
    • proximal 1/3 of femur
    •  -head, neck, trochanter region

    • intercapsular
    • vs
    • extracapsular
  32. intracapsular
    • w/n joint
    • head or neck of femur

    Tx= Arthroplasty
  33. extracapsular
    • outside the joint
    • trochanter region

    Tx= ORIF
  34. nursing care of hip fracture
    • Turn to UNAFFECTED side
    • ambulate w/n 1st 24 hours
    • no flexion >90 degrees (raised toilet seat)
  35. size and placement of TKR incision
    what is cut through?
    • 8-12 inches on front of joint
    • cut thru quadriceps and tendons
  36. What is some priorities for a spinal fracture?
    • Cord Decompression - 1
    • and Airway stability
  37. spinal injuries:
    @ or above C-8
    @ of below T-1
    C-1 - C-3
    C3 - C5
    • C8= tetraplegia (quad)
    • T1= paraplegia
    • C1-3= cardio and resp. collapse
    • C3-5= resp paralysis
  38. Spinal shock: cervical or high thoracic injuries
    • cause: massive vasodilation
    • flaccid paralysis below injury
    • Body temp at room temp
    • BP-HypoTN, Pulse-Bradycardia
  39. Autonomic dysflexia
    • SCI's at or above C-6
    • triggered by stimulant that causes abd. discomfort, like a full bladder
    • Neurologic Emergency
    • BP- Sever HTN, Pulse- Bradycardia