MODULE 22 P2

A muscle tear that is microscopic and due to overuse is called a...

Strain

The femur fracture that commonly leads to avascular necrosis or nonunion due to an abundant
supply of blood vessels in the area is a fracture of the...

Femur neck

Patients with open fractures risk which three major complications?

-osteomyelitis
-tetanus
-gas gangrene

The _________________ is the most common fracture of the distal radius.

Colles fracture

The most common complication of hip fractures in the elderly is _______________________?

Deep vein thrombosis

Common pulmonary complications for the elderly following a hip fracture include
__________________ and ___________________.

atelectasis and pneumonia

Three range of motion activities are avoided for a patient with a lower extremity amputation:
___________________
__________________
__________________

-abduction
-external rotation
-flexion

The residual limb should never be placed on a pillow to avoid ____________________.

flexion contraction of the hip

Patients who experience a fracture of the humeral neck are advised that healing will take an
average of ______________ weeks, with restricted vigorous activity for an additional
__________ weeks.
10
4

The longest immobilization time necessary for fracture union occurs with a fracture of the
_______________________.

tibial shaft

Nursing care for sprains and strains include____________.

Rest
Ice
Compression
Elevation

Joint dislocation can lead to avascular necrosis if it is not treated. What is avascular necrosis?

Avascular necrosis (AVN) is tissue death due to anoxia and diminished blood supply.

The nurse feels a grating sensation in a patient's extremity. What is this sensation caused by?
How would the nurse document this sensation?

The sensation is caused by the rubbing of bone fragments against each other; the nurse would
document it as crepitus.

Name three early and three delayed complications of fractures.

Early complications: shock, fat embolism, compartment syndrome, deep vein thrombosis,
thromboembolism, DIC, infection.

Delayed complications: delayed union and nonunion, avascular necrosis of bone, reaction to
internal fixation devices, complex regional pain syndrome, heterotrophic ossification.

A break occurs across the entire section of the bone is called ________________.

complete

A fragment of the bone is pulled off by a ligament or tendon is called _______________.

avulsion

Bone is splintered into several fragments is called _______________.

comminuted

One side of a bone is broken and the other side is bent is called _______________.

greenstick
A fracture that occurs through the epiphysis is called ___________.

epiphyseal

What immediate nursing and medical management techniques are used for an open fracture?

With an open fracture, the wound is covered with a sterile dressing to prevent contamination of
deeper tissues. No attempt is made to reduce the fracture, even if one of the bone fragments is
protruding through the wound. Splints are applied for immobilization.

Describe the difference between open and closed reduction as management techniques for
fractures.

Closed reduction is performed without a surgical incision and can be done when there is a
dislocation of a fracture. Cast may be applied after the procedure.
Open reduction is usually performed with plate and screws to provide immobilization of the
bone, especially if there is displacement of the fracture.

List five factors that can enhance fracture healing.

-immobilization
-maximum bone contact
-sufficient blood supply
-proper nutrition
-exercise (weight bearing for long bones)
-Hormones (growth hormone, thyroid, calcitonin, Vit D, anabolic steroids)
-electrical potential across fracture

List five factors that can inhibit fracture healing.

-Extensive local trauma

-Bone loss
-Weight bearing prior to approval
-Malalignment of the fracture fragments
-Inadequate immobilization
-Space or tissue between bone fragments
-infection
-local malignancy
-metabolic bone disease such as pagets
-Irradiated bone
-avascular necrosis
-intra-articular fracture
-age > 40
-corticosteriods, NSAIDS
-Smoking
-Diabetes
A fracture occurs at an angle across the bone is called_______.

Oblique

Fragments are driven inward is called _______.

Depressed

The fractured bone is compressed by another bone is called _______.

Compressed

The fracture extends through the skin is called __________.

Open

A fracture occurring through an area of diseased bone is called _______.

Pathologic

The major consequence of osteoporosis is __________.

bone fracture

Primary osteoporosis in women usually begins between the ages of ____ and ____.

45 and 55, and after menopause

The primary deficit in osteomalacia is ___________, which promotes calcium absorption from
the GI tract.

a deficiency in activated vit. D (calcitrol)

Three medications used to treat Paget's Disease are?

calcitonin
bisphosphonates,
plicamycin

The intervertebral disks that are subject to the greatest mechanical stress and greatest
degenerative changes are?

L4
L5
S1

Osteomyelitis with vascular insufficiency, which most commonly affects the feet, is seen most
often among patients with ______ and _______.

diabetes
PVD
Recommended adequate intake (RAI) level of calcium for all individuals is _____ to ____ mg
daily.

1,000-1,500

Bone formation is enhanced by ______, _______, and _______.

calcium intake
muscular activity
weight bearing

Identify at least five musculoskeletal problems that can cause acute low back pain.

Acute lumbosacral strain

unstable lumbosacral ligaments
weak lumbosacral muscles
osteoarthritis of the spine
spinal stenosis
intervertebral disk problems
unequal leg length

Describe the clinical manifestations associated with septic arthritis.

A warm, painful, swollen joint with decreased ROM. Systematic chills, fever, and leukocytosis
are sometimes present. Although any joint may be infected, 50% of cases involve a knee.

A bone scan is used for ______.

Disclosing infections, tumors, and bone marrow abnormalities.

What does a myelogram do?

Permits visualization of segments of the spinal cord that may have herniated or may be
compressed. This test is not frequently performed. Usually only when an MRI is contraindicated.

The most effective cleansing solution for care of a pin site is

chlorhexidine solution

A nursing goal for a patient with skeletal traction is to avoid infection and the development of
_______ at the site of pin insertion.

osteomyelitis

The nurse knows to assess a patient for DVT by assessing the lower extremities for _______,
________, _______, and _________.

-Unilateral calf tenderness

-warmth
-Redness
-Swelling (increased calf circumference)

The nurse assess for perineal nerve injury by checking the patient's casted leg for the primary
symptoms of _________, ________, and ________.

-burning
-numbness
-tingling

The nurse expects that ________ of weight can be used for a patient in skeletal traction.

25 pounds

An artificial joint for total hip replacement involves an implant that consists of _____, _______,
and ________.

-An acetabular socket

-a femoral shaft
-a spherical ball

The nurse caring for a postoperative hip replacement patient knows that the patient should not
cross his or her legs at any time for _______ after surgery.

4 months

After a total hip replacement, the patient is usually able to resume daily activities after
________.

3 to 6 months

Unrelieved pain for a patient in a cast must be IMMEDIATELY reported to avoid _________,
_________, _______, and ________.

-necrosis
-impaired tissue perfusion
-pressure ulcer formation
-possible paralysis

What are four purposes for having a cast application?

-reducing a fracture
-correcting a deformity
-applying uniform pressure to underlying soft tissue
-providing support and stability for weak joints

The nurse completes a neurovascular assessment of the fingers or toes of a casted extremity to
determine circulatory status. What expected outcomes does the nurse anticipate will occur?
The toes/fingers should be pink, warm, and easily moved/wiggled. There should be minimal
swelling and discomfort. The blanch test should be done to determine rapid capillary refill.

What are the five "Ps" that should be assessed as part of the neuromuscular check?

pain, pallor, pulselessness, paresthesia, paralysis

List the danger signs of possible circulatory constriction that the nurse should assess for in a
casted extremity.

unrelieved pain
swelling
discoloration
tingling
numbness
inability to move fingers/toes
temperature changes

Name three major complications of an extremity that is casted, braced, or splinted.

Compartment syndrome
pressure ulcers
disuse syndrome

List four reasons for a patient to have traction applied.

-to minimize muscle spasms

-to reduce, align, and immobilize fractures
-to lessen deformities
-to increase space between opposing surfaces within a joint

What potential immobility-related complications may develop when a patient is in skeletal

traction.

-Pressure ulcers
-atelectasis
-pneumonia
-constipation
-anorexia
-urinary stasis and infection
-DVT or PE
Patient teaching for ambulation with canes and walkers include _____.

Cane
Opposite
Affected
Leg

Nursing interventions for caring for a client in traction include______.

TRACTION

Facts about RA include_____.