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Unit 3B - Mobility and Osteoperosis
Test 2
189
Nursing
Undergraduate 3
06/20/2014

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Term
What are body mechanics?
Definition
Coordinated efforts of the musculoskeletal and nervous systems
Term
What is alignment and balance?
Definition
Posture
Term
What is gravity?
Definition
Weight force exerted on the body
Term
What is friction?
Definition
Force that occurs in a direction opposite to movement
Term
The greater the surface area of the object that is moved, the _______ the friction. Large objects produce greater resistance to movement. This is why nurses need to be aware of the friction that can cause a client’s skin to shear or tear.
Definition
greater
Term
Why do objects fall?
Definition
Gravity. The force of weight is always downwards.
Term
What does the skeletal system do?
Definition
Provides attachments for muscles and ligaments
Provides leverage for movement
Term
What do the skeletal muscles do?
Definition
Help movement of bones and joints
Term
What does the nervous system do?
Definition
Regulates movement and posture
Term
How do postural abnormalities effect mobility?
Definition
Congenital or
Aquired
Affects ROM
Some deformities may affect or limit ROM. See Text for Postural Abnormalities.
Term
How does impaired muscle development effect mobility?
Definition
Any disease that affects muscles or musculoskeletal function will impair muscle development. Osteoarthritis (OA), Rheumatoid arthritis (RA), Osteoporosis
Term
How does damage to the CNS effect mobility?
Definition
Affects body alignment
Balance
Mobility
affect body alignment, balance, and mobility. Damage can be a result of head trauma, stroke, meningitis, or injury to the cerebral cortex
Term
How does musculoskeletal problems effect mobility?
Definition
Direct trauma
Bruises, contusions sprains, fractures
These can all cause muscle atrophy.
Term
What is mobility?
Definition
The ability to move about freely
Term
What is immobility?
Definition
Inability to move about freely
Term
What is bed rest?
Definition
An intervention that restricts clients for therapeutic reasons
Term
How does immobility effect the body's metabolic processes?
Definition
Endocrine, calcium absorption, and GI function
Term
What effect does immobility have on the lungs?
Definition
Atelectasis and pneumonia
Term
What effect does immobility have on the cardiovascular system?
Definition
Orthostatic hypotension
Thrombus, increased workload= increased O2 demand

Prolonged bed rest increases the heart’s workload, producing an increase in oxygen demand
Term
How does immobility effect the musculoskeletal system?
Definition
Loss of endurance and muscle mass and decreased stability and balance
Term
What causes muscular catabolism?
Definition
When the client is immobile, the body often excretes more nitrogen than it ingests protein, which causes a negative nitrogen balance leading to weight loss, decreased muscle mass, and weakness resulting from tissue breakdown (catabolism).
Term
What effect does mobility have on skeletal system?
Definition
Impaired calcium absorption
Term
What effect does immobility have on urinary elimination?
Definition
-Stasis
-Calculi
Term
What effect does immobility have on the skin?
Definition
-Pressure ulcer
-Ischemia
Term
What are the emotional responses to immobility?
Definition
Hostility, giddiness, fear, anxiety
Term
What are the sensory alterations effected by immobility?
Definition
Sleep-wake alterations
Term
What are the changes in coping with immobility?
Definition
Depression, sadness, rejection
Term
Should you do everything for your immobile patient?
Definition
no
Term
How does immobility effect infant-preschool development?
Definition
Prolonged immobility delays gross motor skills, intellectual development or musculoskeletal development
Term
How does immobility effect adolescents?
Definition
Delayed in gaining independence and in accomplishing skills
Social isolation can occur
Term
How does immobility effect adults?
Definition
Physiological systems are at risk
Changes in family and social structures
Term
How does immobility effect older adults?
Definition
Decreased physical activity
Hormonal changes
Bone reabsorption
Term
What is apart of a mobility assessment?
Definition
ROM
Exercise and activity tolerance
Body alignment
-Standing
-Sitting
-Lying
Term
What is a metabolic assessment?
Definition
includes anthropometric measurements and analysis of intake and output to assess for dehydration.
Term
What is a respiratory assessment?
Definition
includes inspecting the chest for wall movement auscultating the lungs for decreased breath sounds, crackles, and wheezes.
Term
What is a cardiovascular assessment?
Definition
includes measurement of vital signs, peripheral pulses, apical pulse, orthostatic hypotension, DVT, and edema.
Term
What is a musculoskeletal assessment?
Definition
includes assessing muscle strength and tone, loss of muscle mass, incidence of contractures, and ROM.
Term
What is a integumentary assessment?
Definition
assessed for integrity or early changes in skin condition.
Term
What is an elimination assessment?
Definition
intake and output, bowel sounds, and bowel and bladder habits need to be checked.
Term
What is a psychosocial assessment?
Definition
focus on the client’s emotional state, behavior, and sleep-wake cycle.
Term
What is a developmental assessment?
Definition
looks at how immobility affects the normal development of clients across the lifespan.
Term
What are popular nursing diagnoses r/t immobility?
Definition
Activity Intolerance
Impaired Physical Mobility
Term
What diet changes should be made for immobile patients?
Definition
Provide high-protein, high-caloric diet with vitamin B and C supplements
Term
What respiratory exercises should be done for immobile people?
Definition
Cough and deep breathe every 1 to 2 hours
Chest physiotherapy
Term
What cardiovascular implementations should be done for immbolies?
Definition
Progress from bed to chair to ambulation
SCDs, TED hose, and leg exercises
Term
What should you do for musculoskeletal support for immobile patients?
Definition
Passive ROM
CPM
Active ROM
Term
What should you do for integumentary for immobile?
Definition
Reposition every 1 to 2 hours
Skin care
Term
What should you do for the elimination system for immobile?
Definition
Adequate hydration
Diet rich in fluids, fruits, vegetables, and fiber



Clients need between 2000 to 3000 ml of fluids per day to help prevent renal calculi and UTIs. Monitor intake and output to ensure the fluid balance is maintained.
Term
What are the positioning techniques/
Definition
Fowler’s
Supine
Prone
Side lying
Sims
Term
What is osteoporosis?
Definition
Chronic metabolic disease, in which bone loss causes decreased density and possible fracture
Unclear etiology
Term
What is ostoepenia?
Definition
Low bone mass
Term
What causes osteopenia?
Definition
osteoclastic (loss) activity is greater than osteoblastic (building) activity r/t changes in hormone levels and other diseases
Osteoblasts (bone forming cells) have shortened life span or less efficient in osteoporosis patient
Term
Who is at greater risk for osteoporosis?
Definition
Women, thin, asian
Term
Why are black people at a risk for osteoporosis?
Definition
many blacks are lactose intolerant, milk products is a good source of protein, needed to bind calcium for use by body
Term
Who gets primary osteoporosis?
Definition
postmenopausal women and men in their 60s and 70s.
Term
What is secondary osteoperosis?
Definition
Caused by an associated medical disorder like hyperparathyroidism, long-term drug therapy, long-term immobility.
Term
What is regional osteoporosis?
Definition
occurs when a limb is immobilized r/t a fx for 8-12 wks
Term
What teaching should be included in osteoporosis prevention?
Definition
-Women start to lose bone mass at 30
-Ensure adequate calcium intake.
-Avoid sedentary lifestyle.
-Continue program of weight-bearing exercises.
-Avoid excessive caffeine, carbonated drinks, alcohol and tobacco
-Maintain balanced diet
-Avoid excessive weight loss and dieting/ eating disorders (insufficient calorie intake)
Term
What are you looking for when assessing for osteoporosis?
Definition
Vertebral column (dowager’s hump), gotten shorter, back pain (worse with activity, relieved with rest), fractures of wrist and hip
Term
What are you looking for when assessing psychosocial for osteoporosis?
Definition
Body image (kyphotic), avoid socials, fear of fx
Term
What labs are important to note when diagnosing osteoporosis?
Definition
-Biochemical markers
-Imaging assessments
+DXA – dual x-ray absorptiometry – hip/spine; baseline age 40’s- best tool currently for definite diagnosis; T-score is calculated
+OCT - measures bone density of the spinal column, expensive
+QUS - heel, predict risk of hip fx
Term
What are the risk factors for primary osteoporosis?
Definition
All women age 65 and older
Men 75 years and older
Family history
History of low trauma fracture after age 50
Caucasian or Asian
Low body weight, thin build
Chronic low calcium intake
Estrogen or androgen deficiency
Women with other risk factors
Smoking
High alcohol intake
Lack of physical activity/ prolong immobility
Term
What nutrition changes should be made for osteoporosis patients?
Definition
Adeq amts protein, Mg, vit K, Calcium, vit D
Avoid excessive alcohol/caffeine
If fx: protein, vitamin C, and iron to promote healing
Diet: fruits/veg, low-fat dairy, protein, fiber
Term
What exercise should be included with osteoporosis?
Definition
Stengthen abd/back muscles to improve posture/spine
Active ROM, weight bearing
Swimming, walking 30min/3x/week
Term
What other lifestyle changes should be made with osteoporosis?
Definition
Avoid tobacco
Prevent falls/hazard free environment
Term
What are the s/e of calcium and vitamin D supplements?
Definition
not a treatment but important prevention to promote bone health, take with food and 6-8 ounces of water, vit D is needed for Calcium absorption
Term
What are the s/e of estrogen or progesterone therapy Premarin?
Definition
therapy hx of prevention therapy; risk of long-term use: cardiovascular disease, breast cancer, venous thromboembolism. Should be used in low doses and for short periods; benefits must outweigh risk.
Term
What are the s/e of parathyroid hormone, Forteo?
Definition
Forteo, for use in postmentopausal women with high risk for fracture, daily sub-q, stimulates bone growth
Term
What are the s/e of biophosphonates?
Definition
Boniva, Fosamax, Actonel; associated with esophagitis, ensure tablet is completely swallowed, take in am with 8 oz water in an upright position for 30 min. before eating. Do not take if poor renal function, GERD, hypocalcemia.


Report c/o esophageal irritation to MD and d/c the drug. Instruct dentist that patient is taking BP due to possible jaw osteonecrosis.
Term
What are the s/e of selective estrogen receptors?
Definition
mimic estrogen in some parts and block in others; used for prevention and treatment; reduces bon resorption (loss), increases bone mineral density, reduces the incident of vertebral fx.
Term
What are the s/e of calcitonin?
Definition
inhibits osteoclastic activity, decreasing bone loss, used for treatment, also has an analgesic effect after vertebral fracture promoting early recovery
Term
What do androgens do?
Definition
Androgens decrease bone resorption and increase bone growth, may decrease bone resorption in men, in women- may cause masculine traits and liver disease.
Term
What is vertebroplasty?
Definition
Used to tx vertebral body compression
Injection of bone cement into the vertebral body to reduce a fx or fill the space created by osteoporosis
Term
What is kyphoplasty?
Definition
Use of a balloon in the verterbral body to contain the bone cement
Term
What are the care settings for osteoporosis?
Definition
hospital, long-term care
Term
What interventions should be made with the different settings?
Definition
-Assess for risk factors and provide teaching
-Collaborate with case managers or discharge planner
-Osteoporosis Society of Canada (www.osteoporosis.ca)
-Refer to special clinics and support groups
Term
What is a fracture?
Definition
a break or disruption in the continuity of a bone.
Term
What is a complete fracture?
Definition
Across entire width of bone
Term
What is an incomplete fracture?
Definition
break only through portion of bone
Term
What is an open/compound fracture?
Definition
Skin surface over the broken bone is disrupted causing an external wound
Term
What is a closed/simple fracture?
Definition
does not extend thru skin, no wound
Term
What are the pathologic or spontaneous causes of fracture?
Definition
occurs after minimal trauma to a bone weakened by dz – ex. osteoporosis
Term
How does fatigue/stress cause fractions?
Definition
results from excessive strain & stress on bone – athletic injury
Term
How does compression cause fractures?
Definition
produced by a loading force applied to the long axis of a bone – vertebra of pts w/osteoporosis – very painful
Term
What are the stages of bone healing?
Definition
1.) Hematoma forms w/in 48-72 hrs
2.) Granulation begins
3.) Callus forms
4.) Osteoblastic proliferation
5.) Bone remodeling
6.) Bone healing completed within 6 weeks for a young person, up to 6 mo. for an old person
Term
What considerations should be made for older adults w/ fractures?
Definition
Healing can be affected by the aging process
Adequate nutrition
Calcium phosphorous, vitamin D and Protein are needed for new bone
Menopause women=loss of estrogen=decreased ability to form new bone
Chronic disease: PVD, Arteriosclerosis reduce circulation to bone=less O2 and nutrients for healing
Term
What are the complications of a fracture?
Definition
Acute compartment syndrome
Crush syndrome
Hypovolemic shock
Fat embolism syndrome
Venous thromboembolism (VTE)
Infection
Chronic complications: ischemic necrosis or delayed union
Term
What is acute compartment syndrome?
Definition
Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area
Term
Where does acute compartment syndrome happen?
Definition
lower leg & forearm
Term
How does acute compartment syndrome occur?
Definition
capillaries in muscle dilate, becoming more permeable, plasma proteins leak into the interstitial space causing edema, edema increases pressure causing pain, blood flow to area is reduced causing ischemia, sensory deficits or paresthesia appears, color pales, pulses weaken
Term
What happens if acute compartment syndrome is not treated?
Definition
cyanosis, tingling, numbness, paresis, & severe pain occur
Term
What are the 6 p's of compartment syndrome?
Definition
Pain
Pressure
Paralysis
Paresthesia
Pallor
Pulselessness (late sign)
Term
What is the onset of neuromuscular irreversible damage?
Definition
Within 4 to 6 hr
Term
What relieves the pressure of ACS?
Definition
Fasciotomy
Term
What do you do after a fasciotomy?
Definition
Pack and dress the wound after fasciotomy (4-5 days)until secondary closure occurs
Wound may be debrided & skin graft applied to promote healing
Term
What are the complications of ACS?
Definition
-Infection
-Motor weakness
-Volkmann's Contractures
-Myoglobinuric renal failure (RAHBOMYOLYSIS)
-Crush Syndrome
Term
What is rhabidomyolysis?
Definition
occurs when lg or multiple compartments are involved. Injured muscles release myoglobulin which clogs renal tubules & has a toxic affect on kidney leading to acute renal failure.
Term
What should you monitor for rhabdomyolysis?
Definition
Potassium
Term
What is crush syndrome?
Definition
External crush injury that compresses 1 or more compartments in the leg, arm, or pelvis
Term
What causes crush syndrome?
Definition
hemorrhage & edema after a severe fx injury
Term
What is a result of crush syndrome?
Definition
As muscle becomes ischemic & necrotic from pressure with in the compartment, myoglobin is released into circulation & occludes distal renal tubual causing kidney failure
Term
What are possible causes of Crush Syndrome?
Definition
Twisting-type injuries
Natural disasters, such as earthquakes
Work-related injuries, ex. trapped under heavy equipment
Drug/Alcohol overdose, 1 or more limbs compressed by body weight for prolonged time
Older adults who fall are unable to get up & live for prolonged time
Term
What are the indicators of Crush Syndrome?
Definition
Acute compartment syndrome
Hypovolemia
Hyperkalemia
Rhabdomyolysis
Acute tubular necrosis (r/t hypovolemia & rhabdomyolysis)
Dark brown urine
Muscle weakness/pain
Term
How do you treat crush syndrome?
Definition
IVFs
Diuretics
Low dose Dopamine
Kayexalate
Dialysis
Term
What is kayexalate?
Definition
to reduce K
Term
Why is dialysis used for crush syndrome?
Definition
if K levels remain high or kidney failure occurs
Term
What are the other serious complications of fractures?
Definition
Shock
Fat embolism syndrome
Venous thromboembolism
Infection
Chronic complications—ischemic necrosis (avascular necrosis [AVN] or osteonecrosis), delayed bone healing
Term
What is a fat embolism syndrome?
Definition
Fat globules are released from yellow bone marrow into bloodstream clogging small vessels that supply organs; lungs
Usually in long bone fractures (hips) & total joint replacements, occurs within 48 hours
Older adults 70-80 are at greater risk
Term
What is the 1st sign of altered mental status?
Definition
Altered mental status (1st sign)
LOC, drowsiness, sleepiness
Term
What are the other signs of fat embolism?
Definition
Increased respirations, pulse, temperature
Chest pain
Dyspnea
Crackles
Decreased SaO2
Petechiae (not seen in DVT)
Term
How do you treat a fat embolism?
Definition
BR
Oxygen
Hydration
Possibly steroid therapy
Fracture immobilization
Term
What is the major difference between FAT EMBOLISM and a DVT?
Definition
FE - has petechiae
Term
What is a VTE?
Definition
Obstruction of the pulmonary artery by a blood clot
Can occur anytimeIncludes DVT and its complication:
Pulmonary embolism
Term
What is the most common complication of lower extremity surgery?
Definition
VTE
Term
What is the most fatal complication of musculoskeletal surgery?
Definition
VTE
Term
Who is at risk for VTE?
Definition
Cancer or chemotherapy
Long surgical procedures (longer than 30 min)
Smoking
Obesity
Heart disease
Immobility
Oral contraceptives or hormones
Older adults (especially with hip fractures)
Term
What are the assessment findings of VTE?
Definition
Same as FES
Except no petechiae
Term
What are the preventative measures for a VTE?
Definition
ambulation, TED stockings, SCD’s
Term
What are the actual treatments of a VTE?
Definition
BR
Anticoagulants/thrombolytics
Possible surgery: pulmonary embolectomy, vena cava umbrella
Term
What is a wound infection?
Definition
the most common resulting form orthopedic trauma
May occur from implanted hardware: pins, plates, rods
Term
What is osteomyelitis?
Definition
bone infection
Occurs in open fractures and after surgical repair of fx
Term
When does your risk for hospital acquired MRSA/infection increase?
Definition
With open wounds
Term
What is avascular necrosis?
Definition
Blood supply to bone is disrupted leading to death of bone tissue
Term
What is avascular necrosis usually affect?
Definition
Complication of hip fractures
Term
What may also cause AVN?
Definition
Surgical repair may also cause AVN r/t hardware interfering with circulation
Term
Who is at high risk for AVN?
Definition
corticosteriod therapy; prednisone
Term
What is delayed union?
Definition
not healed within 6 months
Term
What is nonunion?
Definition
never completely heal
Term
What is malunion?
Definition
heal incorrectly
Term
Who is delayed union common n?
Definition
patients with tibial fx, fractures that involve many techniques, pathologic fx

Older people
Term
What does delayed union lead to?
Definition
Chronic pain and immobility
Term
What are you looking for in a musculoskeletal assessment?
Definition
Change in bone alignment
Alteration in length of extremity
Change in shape of bone
Pain upon movement
Decreased ROM
Crepitus- grating sound
Ecchymotic skin-bruising
Subcutaneous emphysema with bubbles under the skin r/t air trapping
Swelling at the fracture site
NEUROVASCULAR ASSESSMENT
Term
What is a neuromuscular assessment?
Definition
CMS
Skin color
Skin temperature
Movement
Sensation
Pulses
Capillary refill (not reliable, especially elderly)
Pain (pain unrelieved by analgesics= compartment syndrome)
Term
What are the special considerations made for a neuromuscular assessment?
Definition
For fractures of the shoulder and upper arm, assess patient in sitting or standing position.
Support the affected arm to promote comfort.
For distal areas of the arm, assess patient in a supine position.
For fracture of lower extremities and pelvis, patient is in supine position.
Possible internal organ injury= hemorrhage
VS, skin color, LOC for shock
Bloody urine= damage to urinary system
Term
What labs are you looking at in a neuromuscular assessment?
Definition
Elevated Erythrocyte sedimenation rate is expected: indicates inflammatory response. Increases indicate bone infection
Increased in calcium and phosphorus levels-bone releases into the blood
Term
What is a tomogram?
Definition
detect fx of hip & pelvis, compression fx of spine
Term
What is an MRI?
Definition
soft-tissue damage, and visualizing avascular necrosis (AVN)
Term
What are the nursing diagnoses r/t fractures?
Definition
Risk for Peripheral Neurovascular Dysfunction r/t fracture
Acute Pain r/t biologic injury
Risk for infection r/t trauma
Impaired physical Mobility r/t pain
Imbalanced Nutrition r/t increased metabolic demand for healing
Term
What are the nursing diagnoses for collaborative problems?
Definition
Activity intolerance r/t pain and impaired mobility
Constipation r/t opioids, immobility
Ineffective coping
Self-care deficit
Disturbed body image
Fear r/t possible nursing home placement
Impaired skin integrity
Term
What are the potential problems r/t severe fractures?
Definition
Acute Compartment Syndrome
Hypovolemic shock
Fat Embolism Syndrome
Venous Thromboembolism
Ischemic Necrosis
Delayed healing, malunion, nonunion
Term
What emergency care interventions may be needed?
Definition
assess for respiratory distress, bleeding, and head injury
Term
What nonsurgical care interventions may be needed?
Definition
closed reduction and immobilization with a bandage, splint, cast, or traction
Term
What is the primary nursing concern with fractureS?
Definition
assessment and prevention of Neurovascular dysfunction or compromise
Term
When should you perform a vascular assessment?
Definition
q1 hour/24 hours
Term
What reduces edema?
Definition
Apply ice for first 24 hours
Term
What is a cast?
Definition
Rigid device that immobilizes the affected body part while allowing other body parts to move
Term
What are casts made of?
Definition
plaster, fiberglass, polyester-cotton
Term
What are the cast complications?
Definition
infection, circulation impairment, peripheral nerve damage, complications of immobility
Term
What is important in cast care?
Definition
Monitor neurovascular status
Should be able to insert a finger between cast and skin
Ice
Document drainage & immediately report increases to MD
Term
What is a cast infection?
Definition
t skin breakdown under cast
Warmer in infected area (hot spot), odor, fever
Term
What is a circulation issue with casts?
Definition
impairment and peripheral nerve damage
Teach assess circulation daily: distal mobility, numbness, increased pain
Term
What are the long term complications of casts?
Definition
skin breakdown, pneumonia, atelectasis, thromboembolism, constipation, osteoporosis, osteoarthritis, muscle atrophy
Term
What is traction?
Definition
Application of a pulling force to the body to provide reduction, alignment, and rest at that site
Term
What is skin traction?
Definition
– requires boot, belt, etc. secured around effected leg, purpose is to decrease muscle spasm, 5 – 10 lbs. hip fractures
Term
What is skeletal traction?
Definition
requires pins, wires, etc. surgically inserted into bone, purpose is to aid in bone realignment, 15 – 30 lbs. Pin care to prevent infection!
Term
What is plaster traction?
Definition
combines skeletal traction & a plaster cast
Term
What is brace traction?
Definition
exerts a pull for correction of alignment deformities
Term
What is circular traction?
Definition
belt around body, ex. pelvic traction for low back problems
Term
What is important to note in traction care?
Definition
Maintain correct balance between traction pull and countertraction force and proper weight
Care of weights: should not be lifted or rest on floor, must hang freely @ all times, remove only with prescription
Skin inspection q 8 hours
Pin care
Assessment of neurovascular status q1 hour/24
Report pain
Term
What is open reduction with internal fixation?
Definition
Permits early mobilization
Preferred for older adults
Term
What is external fiction?
Definition
Pins or wires inserted through skin & bone, then connected to an external frame
Pin site care q 8hrs! Infection= osteomyelitis
Monitor for drainage, color odor, severe redness
Postop: clear fluid drainage/weeping is expected 48-72hrs
Term
What is postoperative care for fractures and casts?
Definition
similar to that for any surgery; certain complications specific to fractures and musculoskeletal surgery include prevention for fat embolism and venous thromboembolism
Term
What interventions are done with acute pain r/t fracture?
Definition
Reduction and immobilization of fracture
Assessment of pain
Drug therapy—opioid and non-opioid drugs, anti-inflammatory, muscle relaxants
PCA-morphine
Constipation (older adults)
Encourage stool softeners, flds, activity
Complementary and alternative therapies—ice, heat, elevation of body part, massage, baths, back rub, therapeutic touch, distraction, imagery, music therapy, relaxation techniques
Term
What are the interventions for infection?
Definition
Apply strict aseptic technique for dressing changes and wound irrigations.
Assess for local inflammation.
Report purulent drainage immediately to health care provider.
Assess for pneumonia and UTI
VS q4 to 8 hrs (older adults may not have a temp even with severe infection)
Administer broad-spectrum antibiotics prophylactically.
Term
What are the interventions for impaired physical mobility?
Definition
Use of crutches to promote mobility (not older adults)
Use of walkers and canes to promote mobility, PT
Prevention for:
Pressure ulcers
Constipation
Urinary retention
Contracted joints
Pneumonia
Venous Thromboembolism(VTE)
Term
What are the interventions of imbalanced nutrition (less than)?
Definition
Diet high in protein, calories, and calcium; supplemental vitamins B and C
Frequent, small feedings and supplements of high-protein liquids: shakes=protein, calories and calcium
Intake of foods high in iron (less weight bearing on long bones can cause anemia)
Term
What are the upper extremity fractures?
Definition
Clavicle-self healing
Scapula-uncommon
Humerus-common in older adults
Olecranon- adults
Radius and ulna
Wrist and hand
Term
What are the most common fractures of older adutls?
Definition
Hips
Term
Is there a high mortality rate w/ hip fractures?
Definition
Yes because of complications and long term immobility
Term
What are hip fractures at risk for?
Definition
osteoporosis- weakens the upper femur (hip), breaks, and causes fall
Term
What are the risk factors for falls?
Definition
Physiologic aging changes
Visual acuity and diminished hearing; changes in gait, balance, muscle strength; joint stiffness
Disease process
Osteoporosis, foot disorders, changes in cardiac function
Drugs increase risk for fall
Diuretics, antihypertensives, antidepression, sedatives, opioids, alcohol, (Use of three drugs at the same time)
Environmental hazards
Rugs, loose carpet, poor lighting, uneven walking surfaces/ stairs, pets
Term
What is a intracapsular fracture?
Definition
within the joint capsule, upper 1/3 of the femur
Term
What is an extra capsular fracture?
Definition
outside the joint capsule
Term
What is a femoral neck fracture?
Definition
concerned with disruption of blood flow to the femoral head= avascular necrosis (AVN)
Term
How is a femoral neck fracture treated?
Definition
surgical repair, when possible, to allow the older patient to get out of bed
Term
What are some interventions for these fractures?
Definition
-PCA
-Ambulation
-Prevent hip dislocation
Term
How do you prevent hip dislocation?
Definition
Prevent hip adduction and rotation
Keep leg in proper alignment; pillows or abduction device
Check skin for pressure
Neurovascular assessment for arterial circulation & peripheral nerve conduction
Keep heels off bed at all times, inspect q8 hrs
Turn q1-2 hours
Term
Is there a cast with femur breaks?
Definition
No
Term
What is a complication of femur break/
Definition
Hemorrhage/shock
Term
How is a femur break treated?
Definition
-ORIF
-RODS
-COMPRESSION SCREWS
Term
What is the risk associated / rib/sternum break?
Definition
Potential puncture of lungs, heart, arteries
Assess ABC first
Risk: pneumonia
Term
What is the risk associated w/ pelvis breaks?
Definition
very vascular, close to major organs and vessels
Major focus on damage to organs
Falls are common cause in older adults
Major concern: venous oozing/arterial bleeding= hypovolemic shock
Term
What is the assessment w/ pelvis breaks?
Definition
Check blood in stool and urine
Abdomen: ridged or swelling
CT scan, ultrasound
Term
What is a non-weight bearing fracture of the pelvis?
Definition
pelvis
Pubic rami or iliac crest
Tx: BR, firm mattress or bed board
Heals in 2 months
Term
What is a weight-bearing fracture of the pelvis?
Definition
Multi fractures, fractured acetabulum
Tx: external fixation or ORIF
Weight bearing depends on stability of fx after fixation
Term
What are spine breaks associated w/?
Definition
Associated with osteoporosis, metastatic bone cancer, & multiple myeloma
Term
What results from a spine break?
Definition
Result when vertebra weakens and causes vertebral body to collapse
Term
What is nonsurgical management of spine breaks?
Definition
Nonsurgical management includes bedrest, analgesics, and physical therapy.
Term
What are the minimally invasive surgery that treats spine breaks?
Definition
vertebroplasty and kyphoplasty, in which bone cement is injected.
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