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Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last ________ seconds and are __________ minutes apart.
While monitoring the fetus, _______ ________ predicts a well-oxygenated fetus with normal acid-base balance at the time.
Fetal tachycardia is HR above 160 bpm for at least 10 minutes.What is this typically caused by?
Variable decelerations are a result of what?
Woman in labor frequently hyperventilates if she is breathing too fast (respiratory alkalosis). What sorts of symptoms would you see?
This is the beginning of the postpartum period.
The McRoberts Maneuver - sharply flex the thigh onto the maternal abdomen to straighten the sacrum.
Woman is at risk for postpartum hemorrhage and the fetus is at risk for hypoxia and CNS depression from the rapid birth.
There is the 15-20 min window.
Blood flow and increased heart rate, NOT by BLOOD PRESSURE. Pregnant women have an increase in blood/fluid volume so if they are hemorrhaging you will not see a change in blood pressure and/or vital signs right away.
"Liquid gold” - it is full of immunoglobulins, immunities from the mother, and nutrients.
It is uncontrollable shaking caused by adrenaline used during pushing. Apply warm blankets and reassure client that this is normal.
Acrocyanosis is the blueness in the hands and feet. This is normal due to immature circulatory system. Central Cyanosis is the blueness at the trunk or face and is never normal.
Brickdust is when the infant may pass urate crystal. It is common until the fluid intake is greater.
To prevent blindness caused by gonorrhea and chlamydia present in vagina.
Commitment, attachment, and preparation for an infant during pregnancy.
Acquaintance with & ↑ attachment to the infant, learning how to care for the infant and physical restoration during weeks after birth.
Achievement of a maternal identity around 4 months.
Bonding is defined as the emotional feelings that begin during pregnancy or shortly after birth between the parent and the newborn. Bonding is unidirectional from parent to newborn.
Attachment is defined as an emotional connection that forms between infant and parents. Attachment is bidirectional from parent to infant and infant to parent. Attachment has a lifelong impact on the developing individual. Quality of the attachment influences the person’s physical and emotional development and is the foundation for future relationships.
___ are common injuries from abnormal stretching or twisting forces that may occur during vigorous activities.
These injuries tend to occur around joints and in the spinal musculature.
is partial disruption of the involved tissue with more swelling and tenderness
is complete tearing of the ligament in association with moderate to severe swelling.
A gap in the muscle may be apparent or palpated through the skin if the muscle is torn.
Because areas around joints are rich in nerve endings, the injury can be extremely painful.
A __ is an excessive stretching of a muscle, its fascial sheath, or a tendon.
where does this usually occur?
Most strains occur in the large muscle groups, including the lower back, calf, and hamstrings.
a severe injury of the ligamentous structures that surround a joint. results in the complete displacement or separation of the articular surfaces of the joint. characteristically result from forces transmitted to the joint that disrupt the soft tissue support structures surrounding it
a partial or incomplete displacement of the joint surface.
The clinical manifestations of a subluxation are similar to those of a dislocation but are less severe.
terms used to describe injuries resulting from prolonged force or repetitive movements and awkward postures.
Repeated movements strain the tendons, ligaments, and muscles, causing tiny tears that become inflamed. The exact cause of these disorders is unknown.
an incision is made in the wrist and then the carpal ligament is cut to enlarge the carpal tunnel
the supraspinatus, infraspinatus, teres minor, and subscapularis muscles.
These muscles act to stabilize the humeral head in the glenoid fossa while assisting with the ROM of the shoulder joint and rotation of the humerus.
a gradual, degenerative process resulting from aging, ; sudden adduction forces applied to the cuff while the arm is held in abduction. In sports, repetitive overhead motions
. Other causes include (1) falling onto an outstretched arm and hand, (2) a blow to the upper arm, (3) heavy lifting, or (4) repetitive work motions.
crescent-shaped pieces of fibrocartilage in the knee.
also found in other joints.
injuries are closely associated with ligament sprains common among athletes in sports such as basketball, football, soccer, and hockey.
Examination of the knee with an ACL tear may produce a positive ___This test is performed by flexing the knee 15 to 30 degrees and pulling the tibia forward while the femur is stabilized. The test is considered positive for an ACL tear if there is forward motion of the tibia with the feeling of a soft or indistinct endpoint. MRI is often used to diagnose coexisting conditions, including a fracture, meniscus tearing, and collateral ligament injuries.
closed sacs that are lined with synovial membrane and contain a small amount of synovial fluid.
hey are located at sites of friction, such as between tendons and bones and near the joints
a disruption or break in the continuity of the structure of bone.
the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis.
In a __fracture the two ends of the broken bone are separated from one another and out of their normal positions. usually comminuted (more than two fragments) or oblique .
In a ___ fracture the periosteum is intact across the fracture and the bone is still in alignment. usually transverse, spiral, or greenstick
describe fracture hematoma
When a fracture occurs, bleeding creates a hematoma, which surrounds the ends of the fragments. The hematoma is extravasated blood that changes from a liquid to a semisolid clot. This occurs in the initial 72 hours after injury.
active phagocytosis absorbs the products of local necrosis. The hematoma converts to granulation tissue. Granulation tissue (consisting of new blood vessels, fibroblasts, and osteoblasts) produces the basis for new bone substance called osteoid during days 3 to 14 postinjury.
As minerals (calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is primarily composed of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified by x-ray.
Ossification of the callus occurs from 3 weeks to 6 months after the fracture and continues until the fracture has healed. Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed. However, the fracture is still evident on x-ray. During this stage of clinical union, the patient may be allowed limited mobility or the cast may be removed.
As callus continues to develop, the distance between bone fragments diminishes and eventually closes. During this stage ossification continues. It can be equated with radiologic union, which occurs when there is x-ray evidence of complete bony union. This phase can occur up to 1 year after injury.
Excess bone tissue is resorbed in the final stage of bone healing, and union is complete. Gradual return of the injured bone to its preinjury structural strength and shape occurs. remodels in response to physical loading stress or Wolf's law. Initially, stress is provided through exercise. Weight bearing is gradually introduced. New bone is deposited in sites subjected to stress and resorbed at areas where there is little stress.
Fracture healing progresses more slowly than expected. Healing eventually occurs.
Fracture fails to heal despite treatment. No x-ray evidence of callus formation.
Fracture heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction.
Fracture heals in abnormal position in relation to midline of structure (type of malunion).
type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at site.
New fracture occurs at original fracture site.
Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury.
Bone is classified according to structure as ____ (compact and dense) or ____(spongy).
In cortical bone, cylindric structural units called ____ fit closely together, creating a dense bone structure .
Within the systems, the Haversian canals run parallel to the bone's long axis and contain _____.
Surrounding each osteon are concentric rings known as ____, which characterize mature bone.
Smaller canals ____ extend from the Haversian canals to the _____ where mature bone cells are embedded.
lacks the organized structure of cortical bone.
The lamellae are not arranged in concentric rings but rather along the lines of maximum stress placed on the bone.
Cancellous bone tissue is filled with red or yellow marrow, and blood reaches the bone cells by passing through spaces in the marrow.
synthesize organic bone matrix (collagen) and are the basic bone-forming cells
____ are the mature bone cells
_____ participate in bone remodeling by assisting in the breakdown of bone tissue.
Bone remodeling is the removal of old bone by ______ (resorption) and the deposition of new bone by ______ (ossification).
changes in aging
increased bone ____ and decreased bone ____ cause a loss of bone density, contributing to the development of osteopenia and osteoporosis
The inner layer of bone is composed primarily of ____ with a few ____
Each long bone consists of the ___
know what these are, if the epiphyseal plate is damaged, the bone may __
The ______ is composed of fibrous connective tissue that covers the bone.
- Tiny blood vessels penetrate the it to provide nutrition to underlying bone.
-Doesn’t exist on the articular surfaces of long bones. These bone ends are covered by articular cartilage
____anchor to the outer layer of the periosteum.
-The inner layer is attached to the bone by bundles of collagen.
· characterized by a central shaft(diaphysis) and 2 widened ends (epiphyses)
o Fermur, humerus, tibua
composed of cancellous bone covered by a thin layer of compact bone.
Examples include the carpals in the hand and the tarsals in the foot; cubical
have two layers of compact bone separated by a layer of cancellous bone.
·Cylindrical synovial structures found where tendons cross joints; Decrease friction by forming a fluid-filled cushion through which the
tendon can slide
-without this, the tendon cant move.
A ____is a place where the ends of two bones are in proximity and move in relation to each other.
classified by the degree of movement that they allow
the most common type of cartilage, contains a moderate amount of collagen fibers.
It is found in the trachea, bronchi, nose, epiphyseal plate, and articular surfaces of bones.
____ cartilage , which contains both collagen and elastic fibers, is more flexible than hyaline cartilage
. It is found in the ear, epiglottis, and larynx.
____cartilage consists mostly of collagen fibers and is a tough tissue that often functions as a shock absorber.
It is found between the vertebral discs and also forms a protective cushion between the bones of the pelvic girdle, knee, and shoulder.
dense connective tissue-- throughout the musculoskeletal system; limited nerve & blood supply (external ear).
Small sacs lined with synovial membrane filled with synovial fluid; cushion between structures
_____allow posture maintenance, body movement, and facial expressions.
increase the tension within a muscle but do not produce movement.
Repeated ____ make muscles grow larger and stronger
Most contractions are a combination of tension generation (____) and shortening (____)
support prolonged muscle activity such as marathon running.
Because they also support the body against gravity, they assist in posture maintenance
_______ are used for rapid muscle contraction required for activities such as blinking the eye, jumping, or sprinting.
Fast-twitch fibers tend to tire more quickly than slow-twitch fibers.
skeletal muscle fibers require a nerve impulse to contract.
A nerve fiber and the skeletal muscle fibers it stimulates are called a motor endplate.
The junction between the axon of the nerve cell and the adjacent muscle cell is called the _____
Almost 30% of muscle mass is lost by age ___.
changes with aging
Tendons and ligaments become ____, and movement becomes ___
changes with aging
A loss of motor neurons can cause additional problems with ___
Decreased number and diameter of muscle cells. Replacement of muscle cells by fibrous connective tissue.
Decreased muscle strength and mass. Abdominal protrusion. Flabby muscles.
Loss of elasticity in ligaments, tendons, and cartilage.
Increased rigidity in neck, shoulders, back, hips, and knees.
Reduced ability to store glycogen. Decreased ability to release glycogen as quick energy during stress
Decreased fine motor dexterity, decreased agility.
•Decreased basal metabolic rate.
Slowed reaction times and reflexes as a result of slowing of impulse conduction along motor units. Earlier fatigue with activity.
Increased risk for cartilage erosion that contributes to direct contact between bone ends and overgrowth of bone around joint margins.
Joint stiffness, decreased mobility, limited ROM, possible crepitation on movement. Pain with motion and/or weight bearing.
Loss of water from discs between vertebrae, decreased height of intervertebral spaces.
Loss of height and shortening of trunk from disc compression. Posture change.
Decreased bone density and strength, brittleness.
•Loss of height and deformity such as dowager's hump (kyphosis) from vertebral compression and degeneration.
•Slowed remodeling process.
•Back pain, stiffness.
•Bony prominences more pronounced.
•Increased risk of osteopenia and osteoporosis.
The most common symptoms of musculoskeletal impairment include ____
Ask the patient about changes in sensation or in the size of a muscle.
Question the patient who has taken antiinflammatory drugs about ___
Ask about the patient's health practices related to the musculoskeletal system, such as __
An adequate intake ___,___ ,___ & ___is essential for a healthy, intact musculoskeletal system.
Abnormal nutritional patterns can predispose individuals to problems such as ___
Movement of part away from midline of body
movement of part toward midline of body
Combination of flexion, extension, abduction, and adduction resulting in circular motion of a body part
Flexion of the ankle and toes toward the shin
Turning of sole outward away from midline of body
Straightening of joint that increases angle between two bones
Movement along longitudinal axis away from midline of body
Movement along longitudinal axis toward midline of body
Bending of joint as a result of muscle contraction that results in decreased angle between two bones
Extension in which angle exceeds 180 degrees
Turning of sole inward toward midline of body
Moving the first and fifth metacarpals anteriorly from a flattened palm (“cupping position”); makes it possible to hold objects between the thumb and fingers
Flexion of the ankle and toes toward the plantar surface of the foot (“toes pointed”)
Turning of palm downward
Turning of palm upward
No detection of muscular contraction
A barely detectable flicker or trace of contraction with observation or palpation
Active movement of body part with elimination of gravity
Active movement against gravity only and not against resistance
Active movement against full resistance without evident fatigue (normal muscle strength)
why do x-rays not penetrate them bones? .
Dense areas show as ___on the standard x-ray.
Pain in posterior leg, initially when running or walking. Can progress to pain at rest.
Cumulative stress on Achilles tendon resulting in inflammation.
Stiffness and fixation of a joint.
Chronic joint inflammation and destruction (RA)
Shortened stride with as little weight bearing as possible on the affected side.
Staggering, uncoordinated gait often with sway.
Flabby appearance of muscle leading to decreased function and tone.
Muscle denervation, contracture, prolonged disuse as a result of immobilization.
Finger abnormality, flexion of proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint of the fingers (see Fig. 65-4, B).
Typical deformity of rheumatoid and psoriatic arthritis caused by rupture of extensor tendons over the fingers.
Resistance of movement of muscle or joint as a result of fibrosis of supporting soft tissues.
Shortening of muscle or ligaments, tightness of soft tissue, incorrect positioning of immobilized extremity.
Frequent, audible crackling sound with palpable grating that accompanies movement.
Fracture, dislocation, temporomandibular joint dysfunction, osteoarthritis.
Separation of two bones from their normal position within a joint.
Trauma, disorders of surrounding soft tissues.
While walking, neck, trunk, and knees flex while the body is rigid. Delayed start with short, quick, shuffling steps. Speed may increase as if patient is unable to stop (____).
Small fluid-filled bump or mass over a tendon sheath or joint, usually on dorsal surface of wrist or foot.
Inflammation of tissues around a joint, which can increase in size or disappear.
Exaggerated thoracic curvature.
Kyphosis (dowager's hump)
Poor posture, tuberculosis, arthritis, osteoporosis, growth disturbance of vertebral epiphyses.
Dull ache along outer aspect of elbow, worsens with twisting and grasping motions.
lateral epicondylitis (tennis elbow)
Partial tearing of tendon at its insertion on epicondyle.
Joint does not achieve the expected degrees of motion.
Limited range of motion (ROM)
Injury, inflammation, contracture.
Asymmetric scapulae and shoulders, exaggerated lumbar curvature.
Increased muscle tone (rigidity) with sustained muscle contractions (spasms); stiffness or tightness may interfere with gait, movement, speech.
General muscle tenderness and pain.
Numbness and tingling, often described as a “pins and needles” sensation.
Compromised sensory nerves, often due to edema in a closed space such as a cast or bulky dressing. May also result from spinal stenosis.
Abnormal flatness of the sole and arch of the foot.
Pes planus (flatfoot)
Hereditary, muscle paralysis, mild cerebral palsy, early muscular dystrophy, injury to posterior tibial tendon.
- asymmetric elevation of shoulders, scapulae, and iliac crests with lateral spine curvature
Burning, sharp pain of sole of foot worse in AM
A limp, unless corrective footwear used.
Leg length discrepancy of ≥1 in, generally of structural origin (arthritis, fracture).
Short steps with dragging of foot. Jerky, uncoordinated, cross-knee (scissor) movement.
Neurogenic (e.g., cerebral palsy, hemiplegia).
Increased hip and knee flexion to clear the foot from the floor. Footdrop is evident, foot slaps down and along walking surface.
Neurogenic disorders (e.g., peroneal nerve injury, paralyzed dorsiflexor muscles).
Partial dislocation of joint.
Instability of joint capsule and supporting ligaments (e.g., trauma, arthritis).
Hyperextension of the PIP joint with flexion of the metacarpophalangeal (MCP) and DIP joints of the fingers
Enlargement, often of a joint due to fluid collection. Generally leads to pain, stiffness.
Superficial swelling, pain, and tenderness along a tendon sheath.
Inflammation that often occurs with infection, injury, or overuse.
Neck is twisted in unusual position to one side.
Prolonged contraction of neck muscles, congenital or acquired
Meniscus injuries are closely associated with ___ common among athletes in sports such as basketball, football, soccer, and hockey.
These activities produce rotational stress when the knee is in varying degrees of flexion and the foot is planted or fixed.
A ____ can cause the meniscus to be sheared between the femoral condyles and the tibial plateau, resulting in a torn meniscus
The acutely injured knee should be examined within ___ of injury. Initial care of this type of injury involves ___. Most meniscus injuries are treated in an ___ setting. Use of a ___ during the first few days after the injury protects the knee and offers some pain relief. After acute pain has decreased, __ can help the patient regain knee flexion and muscle strength to assist in returning to full function.
In older adults with degenerative meniscus tears,__ may improve neuromuscular function and muscle strength
Surgical repair or excision of part of the meniscus (___) may be necessary. Meniscal surgery is performed by ___. Pain relief may include ___.
Rehabilitation after meniscal surgery starts
__ including quadriceps and hamstring strengthening exercises and ROM.
When the patient's strength is back to its preinjury level, normal activities may be resumed
Because meniscus injuries are commonly caused by sports-related activity, teach athletes to
do warm-up exercises.
ACL injuries are usually noncontact injuries that occur when ___. Patients often report coming down on the knee, twisting, and hearing a pop, followed by ___. Athletes usually cannot continue playing, and the knee may feel unstable.
Conservative treatment for an intact ACL injury includes___. If there is a tight, painful effusion, ___.A ___ or ___ may be helpful in supporting the knee. ___often assists the patient in maintaining knee joint motion and muscle tone.
1) anatomic realignment of bone fragments (reduction), (2) immobilization to maintain realignment, and
(3) restoration of normal or near-normal function of the injured part.
nonsurgical, manual realignment of bone fragments to their previous anatomic position.
-usually performed while pt is under local or general anesthesia.
If open reduction with internal fixation (ORIF) is used for intraarticular fractures, ___ is indicated
the application of a pulling force to an injured or diseased part of the body or an extremity
Tape, boots, or splints are applied directly to the skin to maintain alignment, assist in reduction, and help diminish muscle spasms in the injured extremity.
- wt limit?
A ___- boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms
what is it most commonly used for?
__ used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia. It provides a long-term pull that keeps the injured bones and joints aligned.
A __is a temporary circumferential immobilization device. a common treatment following closed reduction. It allows the patient to perform many normal activities of daily living while providing sufficient immobilization to ensure stability. generally incorporates the joints above and below the fracture.. why?
The __is typically used for acute wrist injuries or injuries that may result in significant swelling.
- accommodates postinjury swelling in the fractured extremity.
The ___ is often used for the treatment of stable wrist or metacarpal fractures. An aluminum finger splint can be incorporated for concurrent treatment of phalangeal injuries. circular cast extending from the distal palmar crease to the proximal forearm. This cast provides wrist immobilization and permits unrestricted elbow motion.
The __ is commonly used for stable forearm or elbow fractures and unstable wrist fractures; extends to the proximal humerus, restricting motion at the wrist and elbow. supporting the extremity and reducing the effects of edema by elevating the extremity with a sling. when a hanging arm cast is used for a proximal humerus fracture, this is contraindicated b/c hanging provides traction & maintains fracture alignment.
The usual indications for applying a long leg cast are an ___. The cast usually extends from the base of the toes to the groin and gluteal crease.
The short leg cast can be used for a variety of conditions, but primarily for __.
a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals. I
simple fractures, complex fractures with extensive soft tissue damage, correction of bony defects (congenital), nonunion or malunion, and limb lengthening.
-often used in an attempt to salvage extremities that otherwise might require amputation
used to facilitate the healing process for certain types of fractures, especially those with nonunion or delayed healing. The mechanism of action may include (1) increasing the calcium uptake of bone, (2) activating intracellular calcium stores, and (3) increasing the production of bone growth factors (e.g., bone morphogenic protein).
Central and peripheral muscle relaxants, such as ____, may be prescribed for relief of pain associated with muscle spasms
In an open fracture the threat of tetanus can be reduced with ___ for the patient who has not been previously immunized
Bone-penetrating antibiotics, such as a ___ are used prophylactically before surgery.
The patient's dietary requirements must include adequate ___ to ensure optimal soft tissue and bone healing.
well-balanced meals should be supplemented by a fluid intake of ___/day to promote optimal bladder and bowel function.
If immobilized in bed with skeletal traction or in a body jacket brace, the patient should ___ to avoid overeating and thus abdominal pressure and cramping.
Pallor or a cool to cold extremity below the injury could indicate __
A warm, cyanotic extremity could indicate __
poor venous return.
A diminished or absent pulse distal to the injury can indicate__
vascular dysfunction and insufficiency.
Evaluate the ulnar, median, and radial nerves by assessing __
In the lower extremity, dorsiflexion and plantar flexion indicate __. Sensory innervation is evaluated for the peroneal nerve on the dorsal part of the foot between the web space of the great and second toes. Tibial nerve assessment is performed by stroking the plantar surface (sole) of the foot. Contralateral evaluation is critical.
The overall goals are that the patient with a fracture will (
1) have healing with no associated complications, (2) obtain satisfactory pain relief, and (3) achieve maximal rehabilitation potential.
The hypercalcemia from demineralization causes a rise in urine pH and stone formation from the precipitation of calcium. Unless contraindicated, a fluid intake of 2500 mL/day is recommended
Rapid deconditioning of the cardiopulmonary system can occur as a result of prolonged bed rest, resulting in orthostatic hypotension and decreased lung capacity. Unless contraindicated, these effects can be diminished by ___
External rotation of the hip can occur when skin traction is used on the lower extremity. Correct this position by ___
Generally, the patient should be in the center of the bed in a supine position. Incorrect alignment can result in increased pain and nonunion or malunion.
Decreased muscle mass normally occurs as a result of disuse after prolonged immobilization.
•Loss of nerve innervation can precipitate muscle atrophy.
what are the nursing considerations?
Isometric muscle-strengthening exercise regimen within confines of immobilization device assists in reducing amount of atrophy.
•Muscle atrophy interferes with and prolongs rehabilitation process.
Abnormal condition of joint characterized by flexion and fixation.
•Caused by atrophy and shortening of muscle fibers or by loss of normal elasticity of skin over joint.
Can be prevented by frequent position change, correct body alignment, and active-passive range-of-motion exercises several times a day.
•Intervention requires gradual and progressive stretching of muscles or ligaments in region of joint.
Plantar-flexed position of the foot (____) occurs when Achilles tendon in ankle shortens because it has been allowed to assume an unsupported position.
•Peroneal nerve palsy (a compression neuropathy) can cause it and spinal nerve compression.
Management of patient with long-term injuries must include preventive measures by supporting foot in neutral position.
•Once footdrop has developed, ambulation and gait training may be significantly hindered.
•May require splint to keep foot (feet) in neutral position.
•High-top athletic shoes may also help.
Caused by involuntary muscle contraction after fracture, muscle strain, or nerve injury and may last several weeks.
•Measures to reduce the intensity of the muscle spasms are similar to corrective actions for pain control.
•Do not massage muscle spasms because it may stimulate muscle tissue contraction that increases spasm and pain.
•Thermotherapy, especially heat, may reduce muscle spasm.
The patient with lower extremity dysfunction usually starts mobility training when ___
able to sit in bed and dangle the feet over the side.
Although most musculoskeletal injuries are not life threatening, __ are medical emergencies requiring immediate attention.
a condition in which swelling and increased pressure within a limited space (a compartment) press on and compromise the function of blood vessels, nerves, and/or tendons that run through that compartment. causes capillary perfusion to be reduced below a level necessary for tissue viability. usually involves the leg, but can also occur in the arm, shoulder, and buttock.
1) decreased compartment size resulting
from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia; and (2) increased compartment contents related to bleeding, inflammation, edema, or IV infiltration.
-usually associated with trauma, fractures (especially of long bones), extensive soft tissue damage & crush injury
Myoglobin released from damaged muscle cells precipitates and causes obstruction in renal tubules. This condition results in acute tubular necrosis and acute kidney injury. Common signs are
The veins of the lower extremities and the pelvis are highly susceptible to thrombus formation after a fracture, especially a hip fracture.
- may also occur after total hip or total knee replacement surgery.
In patients with limited mobility, venous stasis is aggravated by inactivity of the muscles that normally assist in the pumping action of venous blood returning to the extremities.
characterized by systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury; a contributory factor in mortality associated with fractures.
removal of a body extremity by trauma or surgery
effects of PVD, atherosclerosis, vascular changes r/t DM
Most due to PVD(esp. Older w/ DM) – peripheral neuropathy that progresses to trophic ulcers & subsequent gangrene.
-trauma and thermal injuries
Vascular tests such as __provide info about circulatory status of extremity
The goal of amputation surgery is to __
preserve extremity length and function while removing all infected, pathologic, or ischemic tissue
A ___ is performed to create a weight-bearing residual limb (or stump). An anterior skin flap with dissected soft tissue padding covers the bony part of the residual limb. The skin flap is sutured posteriorly so that the suture line will not be positioned in a weight-bearing area. Special care is necessary to prevent accumulation of drainage, which can produce pressure and harbor bacteria that may cause infection.
is an amputation performed through a joint.
A ____ is a form of disarticulation at the ankle.
Assess any preexisting illnesses because most amputations are performed as a result of __
The overall goals are that the patient with an amputation will__
Control of causative illnesses such as __can eliminate or delay the need for amputation
reinforce information that the patient and caregiver have received about the reasons for the amputation, proposed prosthesis, and mobility-training program. Instruct the patient in the performance of upper extremity exercises such as push-ups in bed or the wheelchair to promote arm strength. . Discuss general postoperative nursing care, including positioning, support, and residual limb care.
The __ prosthetic fitting may be the best choice for patients who have had amputations above the knee or below the elbow, older adults, debilitated individuals, and those with infection
Barring any problems, patients can bear full weight on permanent prostheses approximately __ months after amputation.
The seriously ill or debilitated patient
may not have the upper body strength and energy required to use a lower extremity prosthesis.
Mobility with a wheelchair may be the most realistic goal for these patients.
Flexion contractures may delay the rehabilitation process. The most common and debilitating contracture is ___; __contracture is rare.
how could you prevent flexion contractures?
residual limb care, ambulation, prevention of contractures, recognition of complications, exercise, and follow-up care
- clean the prosthesis socket daily with a mild soap and rinse thoroughly to remove irritants.
-Leather and metal parts of the prosthesis should not get wet.
-Encourage the patient to have regular maintenance of the prosthesis.
-Consideration of the condition of the shoe is also necessary. A badly worn shoe alters the gait and may damage the prosthesis.
Because most upper extremity amputations result from __, the patient has had little time to adjust psychologically to an amputation or to participate in the decision-making process.
After an amputation, include the following instructions when teaching the patient and caregiver.
Inspect daily for signs of skin irritation, especially erythema, excoriation, and odor;D/C use of the prosthesis if irritation develops;3.Wash the residual limb thoroughly each night with warm water and a bacteriostatic soap. Rinse thoroughly and dry gently. Expose the residual limb to air for 20 min.;Do not use any substance such as lotions, alcohol, powders, or oil on residual limb unless rx by the HCP;
After an amputation, include the following instructions when teaching the patient and caregiver.
Surgery is aimed at ___
relieving chronic pain, improving joint motion, correcting deformity and malalignment, and removing intraarticular erosion.
Limitation of motion at the joint can be demonstrated on physical examination and by__
is used as a prophylactic measure and as a palliative treatment of (RA). Removal of the synovial membrane, thought to be the location of the basic pathologic changes in joint destruction, helps prevent further progression of joint damage
-WHAT ARE THE COMMON SITES FOR THIS?
An __involves removing a wedge or slice of bone to change alignment (joint and vertebral) and to shift weight bearing, thereby correcting deformity and relieving pain.
Cervical osteotomy may be used to correct deformity in some patients with ___. Halo vests and body jacket braces are worn until fusion occurs (3 to 4 months). Subtrochanteric or femoral osteotomy may provide some relief of pain and improve motion in selected patients with hip osteoarthritis (OA). . Osteotomy of the knee (tibia) provides relief of pain in selected patients, but advanced joint destruction is usually corrected by joint replacement surgery.
An alternative to hip replacement is __, which allows the femoral head to be preserved and reshaped rather than replaced. (In contrast, in a THA the prosthesis replaces the femoral head.)
is a severe infection of the bone, bone marrow, and surrounding soft tissue. Although Staphylococcus aureus is a common cause of infection, a variety of microorganisms may cause it
boys younger than 12 years old, and is associated with their higher incidence of blunt trauma. Adults with vascular insufficiency disorders (e.g., diabetes mellitus) and genitourinary and respiratory tract infections are at higher risk for a primary infection to spread via the blood to the bone. The pelvis, tibia, and vertebrae, which are vascular-rich sites of bone, are the most common sites of infection.
___ osteomyelitis can occur at any age when there is an open wound (e.g., penetrating wounds, fractures) and microorganisms gain entry to the body. Osteomyelitis may also occur in the presence of a foreign body such as an implant or orthopedic prosthetic device
Local manifestations include constant bone pain unrelieved by rest that worsens with activity; swelling, tenderness, and warmth at the infection site; and restricted movement of the affected part
Systemic manifestations include fever, night sweats, chills, restlessness, nausea, and malaise. Later signs include drainage from cutaneous sinus tracts or the fracture site.
Systemic signs may be diminished, with local signs of infection more common, including constant bone pain and swelling and warmth at the infection site. Over time, granulation tissue turns to scar tissue. This avascular scar tissue provides an ideal site for continued microorganism growth that cannot be penetrated by antibiotics.
Long-term and mostly rare complications of osteomyelitis include ___
septicemia, septic arthritis, pathologic fractures, and amyloidosis.