Critical care Mus-skel

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Author:
Emilybillet
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294906
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Critical care Mus-skel
Updated:
2015-02-04 22:18:54
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critical care exam 1 mus-skeletal
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  1. 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
  2. What does a bunionectomy involve?
    removal of the bony growth and realignment with pins
  3. What are the effects of high heels?
    • misalignment of the spine
    • bunions
    • shortening of the Achilles tendon
    • hammer toes
    • hallus vagus
    • Morton's neuroma
  4. 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
  5. 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
  6. 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
  7. 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)
  8. What are complications of a fracture?
    • Compartment syndrome
    • Fasciotomy 
    • Fat Embolism syndrome
    • Infection
    • Delayed union
  9. 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;
  10. What is a fasciotomy?
    an incision into the skin and fascia to release pressure; vessels are no longer compressed' capillaries are functional
  11. 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
  12. What is considered a delayed union?
    fracture has not healed in six months.
  13. 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
    • CMS
    • Splint and dressing
  14. *What is closed reduction?
    • manual traction applied to fracture 
    • general anesthesia 
    • X-ray, AnteroPosterior and Lateral
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. *What are common amputation sites? the usual cause?
    • usually caused by DM 
    • common sites: toes, Chopart???? syme??? BKA, AKA, HIp disarticulation
  24. What is the preop care for amputations? post op risks?
    • pre: grieving for anticipated loss of limb
    • ABX
    • R/f systemic infection 
    • Routine preop procedures
    • post: hemorrhage, infections, phantom limb pain

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