MSII_15_Musculoskeletal

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Author:
vanwin
ID:
272993
Filename:
MSII_15_Musculoskeletal
Updated:
2014-05-03 16:19:32
Tags:
MedsurgII nursing MSII
Folders:
MSII
Description:
UT Tyler level 3 nursing
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  1. Sprain vs strain
    • sprain: twisting of muscles
    • strain: pulling/ excessive stretching of muscles
  2. Avulsion fracture
    severe sprain -> torn ligament pulls bown loose from joint
  3. sprain/strain manifestation
    localized pain & edema

    mild sprain/strain = self limitting, heals within 3 - 6 wks
  4. Contusion
    localized swelling, discoloration & pain

    no skin break
  5. Acute sprain & strain management
    • Rest
    • Ice; 20-30 on, 10 - 15 off
    • Compressio
    • Elevation; above heart
    • NSAIDs
    • heat after 24 - 48hrs
  6. subluxation vs dislocation
    • sublux: incomplete joint dislocation
    • dislocate: fully out
  7. subluxation & dislocation management
    identify & realign
  8. subluxation & dislocation increases risks of
    avascular necrosis
  9. carpal tunnel syndrome patho & incidence
    patho: occulsion of median nerve in harnd

    incidence: women, DM, hypothyroidism, activities requiring continuous wrist movements
  10. Tinel's vs Phalen's sign
    Tinel's: tapping of median nerve on hand; positive = tingling sensation

    Phalen's
  11. Fracture classifications (6)
    • transverse
    • oblique
    • spiral
    • greenstick
    • comminute
    • pathologic
  12. initian fracture treatment
    immobilize position
  13. emergencies with fractures priorities
    • ABC's
    • immobilize
    • stabilize bleeding
    • elevate
  14. cephalosporin nursing considerations
    *nephrotoxic - monitor BUN (10-30) & creatine (.8 - 1.2)
  15. Neurovascular & neurologic assessment
    • pulse
    • temperature
    • cap refill
    • sensation
    • color
    • pain
  16. goals of fracture treatment
    • mobility
    • anatomical alignment
    • restoration
  17. ORIF adv & disadvantages
    adv: promotes healing, early ambulation

    disadv: open surgery, risk of infections
  18. External fixation
    • follows open reduction
    • *pin care
  19. Traction
    apply pulling force on a fractured extremity & counter traction pulls it in the opposite direction
  20. Types of traction
    • Skin: temporary; temporary stabilization until open reduction
    • Skeletal: pin care!
  21. patient with cast teaching
    Do not: wet cast, scratch beneath, bear weight first 24 - 72 hrs, handle with palms first three days, cover for prolonged time

    Do: raise above heart level, ice but do not get wet, move extremeties & report signs of infection
  22. compartment syndrome manifestation
    • Pain
    • Pallor
    • Pulselessness
    • Pressure
    • Parasthesia
    • Paralysis
  23. Compartment Syndrome complications (3)
    • ATN & AKI
    • volkman's contracture (claw hand)
    • necrosis
  24. Compartment Syndrome Treatment (4)
    • Do not: elevate, ice, put in dependent position
    • remove cast
    • loosen bandage
    • surgical decompression
  25. fasciotomy
    surgical decompression for compartment syndrome; cut through skin into fascia

    *risk of infection, transparent dressing
  26. Venous thrombosis prophylaxis
    • Meds: coumadin/warfarin, arixtra, lovenox, aspirin ( adult dose)
    • SCD
    • Compression stockings
    • teach to flex extremities
  27. fat embolism syndrome manifestations as compared to DVT's
    petechiae of neck, axilae & conjunctiva

    change in LOC
  28. Colle's fracture
    of wrist when patient attempts to break fall with hand
  29. Colle's fracture treatment
    closed reduction with splint/cast

    severe: Open reduction
  30. Pelvic fracture manifestation (3)
    • pain
    • abnormal movement of hip
    • abd bruising
  31. Hip fracture manifestation (4)
    • external rotation
    • shorten extremity
    • muscle spasm
    • pain & tenderness
  32. Hip fracture treatment
    • buck's traction until stabilized
    • surgery asap
  33. Hip fracture post op patient teaching
    • do not flex hip
    • - sit down on low seat/comode
    • - bend over
    • - cross legs
    • - weight bearing on affected side
  34. Mandibular fracture post op care
    • airway
    • pain
    • communication
    • oral hygiene
    • nutrition
  35. Mandibular fracture post op nutrition & oral hygiene
    • fluids
    • flush with warm water, NS, non acidic mouthwash after meal
    • inspect mouth for residue & remove
    • *suction & scissors @ bedside
    • *scissors with pt at all times
  36. Amputation post op care
    • do not flex hip - risk of contracture
    • - do not sit with raised leg for longer than 1hr
    • - do not elevate with more than 1 pillow
    • lay on abd 30mins 3-4x a day
  37. osteomyelitis
    infection of bone, bone marrow, & surrounding soft tissue
  38. Acute osteomyelitis manifestations
    • < month
    • fever >101*F
    • night sweats
    • chills
    • pain
    • malaise
  39. Chronic osteomyelitis manifestations
    • longer than 1 month
    • skin ulceration
    • sinus formation under ulceration
    • possible drainage
    • increased pain
  40. acute osteomyelitis treatment
    IV antibiotics 4 - 6 wks or 3-6 months

    • *mycin - nephrotoxic & ototoxic
    • check peak & trough levels
    • *hydrate patient
  41. Chronic Osteomyelitis Treatment
    • Cipro oral 6-8wks
    • Remove necrotic tissue
    • implanted antibiotic beads
    • hyperbaric O2 chamber
    • remove implanted ortho hardware

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