exam 3 - musculoskeletal

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exam 3 - musculoskeletal
2011-04-03 18:24:36

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  1. fx of the proximal end of femur
    hip fx
  2. main cause of hip fx
  3. may degenerative disease may predispose one to hip fx
    • osteoporosis
    • osteoarthritis
    • rheumatoid arthritis
  4. pathophysiology of hip fx
    • femoral neck fracture (intracapsular)
    • intertrochanteric or subtrochanteric (extracapsular - located below the femoral neck)
  5. hip fx:
    why can a femoral neck fx be more serious?
    arterial blood supply is usually disrupted --> high risk for avacular necrosis of femoral head
  6. what's the difference between a femoral neck fx vs inter- or subtrochanteric fx?
    • femoral neck fx - blood supply usually disrupted (may be displaced, comminuted, compacted)
    • inter- or subtrochanteric fx - severe and difficult to fixate but blood supply usually is NOT disrupted (almost always comminuted)
  7. hip fx:
    • pain
    • bruising
    • immobility
    • leg shortened on injured side and may be externally rotated
  8. hip fx
    dx test:
    • x rays
    • routine screening lab work
  9. hip fx:
    collaborative management
    • bucks traction before surgery - maintain alignment and decrease musc spasm
    • surgery
    • prothetic implant
    • total hip replacement
    • hemiarthroplasty
  10. complications of hip fx
    • hemorrhage; SHOCK!
    • delayed healing
    • avascular necrosis of femoral head
    • dvt/pe
    • dislocation or loosening of prosthesis, secondary arthritis, infection, confusion, uti , pressure ulcers
  11. what is the most potentially life threating complication of post hip or knee replacement surgery?
    DVT/ PE!!!!

    *need to give lovenox, SCDs, TEDs
  12. nurse management post op hip replacement
    • monitor/prevent complications:
    • blood loss/ anemia
    • infection
    • confusion
    • complications of immobility
    • dvt prevention
    • atelectasis/pneumonia
  13. other nurse interventions post hip surgery
    • monitor neurovascular compromise
    • position and moblity
    • rehabilitation
    • pain management
  14. what are some post-prosthetic implant restriction
    • avoid hip flexion >45-90%
    • avoidance of adduction of affected leg past midline (abduction pillow used)
    • avoidance of internal or external hip rotation
    • partial weight-bearing
  15. what is the purpose of a total knee replacement
    increase stability and function on knee joint w/c has been damaged (usually r/t osteo or rheumatoid arthritis etc)
  16. knee replacement surgery:
    post-operative management
    emphasis on mobilization of the joint (CPM, early ambulation w/ partial weight bearing w/t crutches and knee immobilizing brace)
  17. complications of post knee surgery
    • hemorrhage/SHOCK
    • DVT/ PE
    • infection
  18. name 4 degenerative diseases of the spine
    • 1. herniated nucleus pulposus (bulging disc)
    • 2. osteophyte (bone spurs from osteoarthritis)
    • 3. spinal stenosis (narrowing of intervertebral foramina)
    • 4. degenerative/rheumatoid involvement (pain/limited motion)
  19. pathophysiology of degenerative disease of the spine
    degeneration of vertabrae or intervertebral disks as a result of defect, infection, trauma, herniated, disc, arthritis, or aging
  20. clinical manifestation:
    neurological changes of degenerative diseases of the spine depends on what?
    level of nerve root involved
  21. neuro changes involved with degen dz of spine may include:
    • numbess/tingling/paresthesia/pain
    • weakness of one or more extremities
    • muscle wasting
    • depression of deep tendon reflexes
    • partial or complete loss of bowel/bladder control (lumbar/sacral)
  22. what tests are done to dx degen dz of spine?
    • x ray
    • CT or MRI
    • myelography
    • EMG
  23. collaborative management of spinal surgery
    • conservative
    • bed rest
    • supportive corsets
    • heat
    • analgesics/anti-inflammatory meds
    • traction
    • back strengthening exercise/ PT
    • epidural steroid infections
    • Williams position
    • compl and alternative tx
  24. surgical management of degen spinal dz
    • minimally invasive surgery:
    • percutaneous lumbar diskectomy
    • microdiskectomy

    • convetional open surgery:
    • laminectomy
    • diskectomy
    • spinal fusion
  25. nursing management - conservative tx for spinal issues
    • teaching:
    • activity restriction and proper body mechanics

    • promote comfort:
    • slightly elevate HOB
    • flex knees

    pain management:
  26. nusre management of post-surgical pt (spinal surgery)
    • neuro function (motion, strength, sensory abnormalities)
    • airway patency and swallow (cervical)
    • assess dressing for CSF leakage or bleeding
  27. what position should one be post cervical (spinal) surgery?
    elevate HOB 30-45

    *w/ soft-rigid cervical collar
  28. what position should one be post lumbar/sacral surgery
    • HOB FLAT, or slightly elevated
    • spine streight w/t hips/knees flexed
    • log roll
  29. how would be promote comfort post spinal surgery?
    • analgesics
    • firm mattress
    • brace for suport/comfort
    • lumbar: fx pan
    • cervical: ice chips, progress diet slowly
  30. promoting mobility for lumbar/sacral surgery
    • OOB 1st post op day for simple laminectomy
    • log roll side to side
    • if surgery more extensive: maintain spine in straight position w/o bending or twisting
  31. promote mobility for cervical
    • make sure neck brace is on
    • OOB 1st post op day or next am
  32. complications post spinal surgery
    • bleeding/hematoma
    • airway
    • progressive neurodysfunction
    • CSF leak (HA, clear drainage, about 1 wk after surgery)
    • urinary retention (common lumbar/sacral)
    • impaired bowel functino/constipation
    • DVT infection
    • laryngeal nerve damage w/ cervical surgery (loss of voice or persistent hoarseness)
  33. discharge teaching post spinal surgery (cervical)
    • wear brace
    • no driving while wearing brace
  34. discharge teaching post spinal injury (lumbar/sacral)
    • don't lift/carry objects >5lbs
    • avoid twisting trunk
    • bneding over knees w/ back straight
    • no prolonged sitting