Critical care Mus-skel
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What are bunions?
bony enlargement of a joint of the foot, caused by ill fitting shoes; joint enlarges due to body weight on ball of foot; enlargement leads to hallux valgus
What does a bunionectomy involve?
removal of the bony growth and realignment with pins
What are the effects of high heels?
- misalignment of the spine
- shortening of the Achilles tendon
- hammer toes
- hallus vagus
- Morton's neuroma
What is a complete fracture?
an incomplete fracture?
- a fracture is classified by the extent of the break-
- Complete: the break is across the entire width of the bone in such a way that the bone is divided in two sections
- incomplete fracture: does not divide the bone in two; the break is only through one part of the bone
What is an open fracture? a closed fracture?
- Open and closed describe the extent of soft tissue damage
- Open (compound): the skin surface over the bone is disrupted; causes an external wound
- Closed (simple): does not extend through the skin; no visible wound
What is a pathological fracture? compression fracture?
- fractures are also classified by their cause
- Pathological (spontaneous): occurs after minimal trauma to the bone that has been weakened by disease (osteoporosis/bone cancer)
- fatigue (stress) fracture: excessive strain and stress on bone ( recreational sports)
- compression fractures: a loading force applied to the long axis of cancellous bone. Commonly occur in the vertebrae of elderly patients and are extremely painful
What is a displaced fracture?
What is non-displaced fracture?
What is a Comminuted fracture?
What is an oblique fracture?
What is a spiral fracture?
What is an impacted fracture?
What is a greenstick fracture?
- displaced: The two ends of the bone do not line up
- nondisplaced: bone remains aligned
- Comminuted: fragmented, broken, splintered crushed in many pieces
- Oblique: slanted fractures that occur when a force is applied at any angle other than a right angle to the bone
- Spiral: occurring when torque (a rotating force) is applied along the axis of a bone
- Impacted: is one whose ends are driven into each other. This is commonly seen in arm fractures in children
- Greenstick: occurring typically in children, in which one side of the bone is broken and the other only bent (like a live stick/branch)
What are complications of a fracture?
- Compartment syndrome
- Fat Embolism syndrome
- Delayed union
What is compartment syndrome? Where is it most common? What is it caused by? What does it cause? Nursing Interventions?
- The nerves and vessels are compressed within the fascia (a thin sheath of fibrous tissue enclosing a muscle or other organ);
- most often in lower leg and/or arm
- caused by: hemorrhage, edema, tight cast
- Causes: pain, edema, decreased circulation, pallor, cyanosis, tingling, numbness, then severe pain, paralysis, necrosis, permanent damage
- NI: Assess- circulation, sensory( numbness, tingling, pain, sensation, pain, motor( movement, toe/finger wiggles , skin color, temp of extrem., cap refill, pulses distal to site;
What is a fasciotomy?
an incision into the skin and fascia to release pressure; vessels are no longer compressed' capillaries are functional
What is a fat embolism?
- Fat globules are released into the circulating volume usually within 2 days after an injury or on long bone surgery (fx, femur, hip)
- altered mental status R/T low 02 levels
- dyspnea and CP
- petechiae on upper trunk
What is considered a delayed union?
fracture has not healed in six months.
What is the emergency care of a fracture?
- CAB, 911
- quick assessment, look for other injuries
- assess affected area
- apply direct pressure
- remove clothing and jewelry
- Splint and dressing
*What is closed reduction?
- manual traction applied to fracture
- general anesthesia
- X-ray, AnteroPosterior and Lateral
What does casting do? What can be done to avoid/treat compartment syndrome?
- permanently immobilizes bone ends post reduction;
- CompartSyn: CMS checks, bivalve casts (cut in half to relieve pressure held with plastic wrap to splint); elevate cast above heart; apply ice to cast for first 24-48 hours
How long does it take plaster casts to dry? how should you handle it until it dries?
- takes 24-72 hours
- do not cover-allow to air dry
- use palms to handle cast when wet
What is Bucks traction?
- pulling applied to fracture to align bone ends prior to surgery
- may be used for patients who are not surgical candidates as treatment for fracture
- add 5-10llb/ make sure weights are hanging
What is Open reduction internal fixation?
- an open surgery to reduce fracture and apply plates and screws to fix it
- plates/screws can later be removed when fracture heals (most often removed in the ankles
- one or more incisions are made; usual post-op care for incisions
What are external fixation devices?
- developed by Dr. Ilizarov, circular fixation devices were used to lengthen limbs in people of small stature
- pins go through the skin directly into bone or fixation
- done under gen. anesthesia
- "EX Fix" to limbs and pelvis
- frame can be externally adjusted PRN by MD
- Allows for direct visualization of skin, pin sites
- clear drainage for first 3 days
- pain management starts in PACU
What is bone grafting? What is it used for?
- Cadaveric bone used or auto graft from pelvis
- used to supplement bone ends, add length, replace comminuted bone
- graft is wired or internally fixated to surrounding bone
What are hip fractures usually caused by? how are they classified? how are they fixed? and its risk factors?
- usually caused by falls
- classified by location (intracapsular- capital, subcapital, femoral neck; extracapsular- intertrochanteric, subtrochanteric)
- tx: surgical- ORIF/ bedrest(allows fx to heal on its own)
- Risk factors: vision, hearing, poor lighting, uneven surfaces, weakened gait, balance, muscle strength, *osteoporosis, loose carpets, throw rugs, polypharmacy
What are the signs and symptoms of hip fractures? how are they diagnosed?
- pain over outer upper thigh or groin
- affected leg shorter than unaffected side
- external rotation of affected leg
- Dx is made by XRAY
*What are common amputation sites? the usual cause?
- usually caused by DM
- common sites: toes, Chopart???? syme??? BKA, AKA, HIp disarticulation
What is the preop care for amputations? post op risks?
- pre: grieving for anticipated loss of limb
- R/f systemic infection
- Routine preop procedures
- post: hemorrhage, infections, phantom limb pain
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