Term
|
Definition
any break in the continuity of the bone
closed: skin remains intact
open (compound): skin integrity is interrupted |
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Term
| Classification of Fractures |
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Definition
Oblique: at an angle to the bone
Spiral: curves around the bone
Avulsed: pulls bone and tissue away from point of attachement
compressed: bone is crushed
impacted: broken bone ends are forced into each other
depressed: broken bone is forced inward |
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Term
|
Definition
Inflammatory phase
Reparative phase
Remodeling phase |
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Term
| Inflammatory phase of Fracture Healing |
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Definition
bleeding and inflammation that develop at the site of the fracture
-lymphocites and monocytes wall of the area of injury |
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Term
| Reparative phase of Fracture Healing |
|
Definition
Calcium is deposited and a callus forms
Osteoblasts promote the formation of new bone |
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Term
| Remodeling Phase of Fracture Healing |
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Definition
| Excessive calcium is removed and new bone is laid down along the fracture line |
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Term
| Risks associated with Falls/Fractures |
|
Definition
Lower extremity weakness
Hx of falls
Gait problems
Use of Assistive device
Visual Impairment
taking 4+ meds or and anticonvulsant/benzodiazapine
Dementia/Cognitive impairment
Osteoporosis
Fear of Falling |
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Term
| Common Hip fracture sites? |
|
Definition
femoral neck fracture--intracapsular (most common)
Intertrochanteric Fracture--extracapsular |
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Term
| Symptoms of Extracapsular Hip Fracture |
|
Definition
severe pain in the groin and hip-increases with movement, muscle spasm
Affected hip may be externally rotated and shortened |
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Term
| Symptoms of Intracapsular Hip Fracture |
|
Definition
Moderate discomfort
may have movement
May or may not be able to bear weight
May not be shortened or rotated |
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Term
| Hip Replacement Postop Precautions |
|
Definition
-most not allow internal rotation: use abduction pillow between legs
-Do not allow hip to flex >90 degrees
-Do not cross legs
-Do not put on own socks/shoes for up to 8 weeks |
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Term
| Complications of Fractures |
|
Definition
Fat Embolism Syndrome: confusion, resp. distress, petichiae rash on the chest
Compartment Syndrome
Infection |
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Term
|
Definition
large amounts of pressure in a limited space causes vessels to be constricted-affects BVs and neurons
r/t trauma, infiltration of IV, burns, tight casts
TX fasciotomy-open skin to relieve pressure |
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Term
| 5 P's of Compartment Syndrome |
|
Definition
Pain (early)
Paresthesia (early)
Pallor (late)
Pulselessness (late)
Paralysis (irreversible damage) |
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Term
|
Definition
metabolic disease:
osteoclasts break down bone faster than osteoblasts can deposit more
--porous bones |
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Term
| Risk Factors R/t Osteoporosis |
|
Definition
W>M
Aging
small thin body type
sedentary lifestyle
excessive alcohol
smoking
low calcium
medications: aluminum containing antacids, anticonvulsants, PPIs, heparin, corticosteriods |
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|
Term
| Conditions Associated with Osteoporosis |
|
Definition
Endocrine (DM)
Renal failure
Rheumatoid arthritis
Advanced alcoholism
Liver cirrhosis
Chronic eating disorder |
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Term
|
Definition
"silent disease"
Loss of height
dorsal kyphosis and cervical lordosis (curving of the spine--hunch back/Dowager's hump)
fractures/pain associated with fractures |
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Term
| Prevention of Osteoporosis |
|
Definition
begin as children!
weight bearing and resistance exercise
Avoid Alcohol, caffeine, tobacco
increase calcium and vitamin D in youth
Bone density scans |
|
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Term
| Pharmacological TX of Osteoporosis |
|
Definition
Antiresorptive Therapies-inhibit bone resorption
-Estrogen replacement therapy
2. Biphosphonates-potent inhibitors of bone resorption and increase bone density in vertebrae and hip
-Fosamax
-Actonel
-Prolia
Selective Estrogen Replacement Modulators: Evista, Tamofen
Calcitonin: hormone used with calcium supplement
Anabolic therapy: stimulates bone growth |
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Term
|
Definition
Application of pulling force to an injured or diseased part of the body
-reduce, realign and promote healing of fracture bone
-decreases muscle spasm and pain
-immobilization
-corrects/prevents deformity
-rests joint |
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Term
|
Definition
tx: hip fracture or femoral fracture
pulley system doubles applied weight
--examine pts. position |
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Term
|
Definition
Pulling force applied directly through pins inserted into the bone
-allows more weight to be applied
-risk for infection |
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Term
| Glycemic Goals for Diabetics |
|
Definition
Before meals: 90-130
After meals: <180
A1C: <7% |
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Term
| Diabetic Ketoacidosis (DKA) |
|
Definition
Type 1 DM--insulin deficiency leads to
acidosis and ketosis
hyperglycemia
dehydration
electrolyte imbalance |
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Term
|
Definition
increased caloric intake
inadequate insulin dosage
physical/emotional stress
surgery, infection, illness
undiagnosed type 1 diabetes |
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Term
|
Definition
BG >300
Dehydration:
polyuria initially
dry skin/mucous membranes
sunken eyes
tachycardia
Hypotension
Thirst
Hypovolemic shock
electrolyte imbalance
renal failure
coma, death
Ketosis: ketones in blood and urein
breath has sweet, fruity odor
Metabolic Acidosis: N/V, restlessness, confusion, lethargy
Kussmauls Respirations |
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Term
|
Definition
Insulin
Fluids:
first .9%NS
second: 45%NS
third: Dextrose
Potassium Replacement: prevent cardiac dysrhythmias |
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|
Term
| Hyperosmolar Hyperglycemic State (HHS) |
|
Definition
type 2 DM (non insulin dependent)
severe hyperglycemia
elevated plasma osmolarity
osmotic diuresis
severe fluid depletion/dehydration |
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Term
|
Definition
hyperglycemia causes fluid to move from intracellular to extracellular spaces to dilute blood
cells become dehydrated leading to neurologic abnormalities and Altered LOC |
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Term
|
Definition
Infection--most common
Acute illness- burns, stroke, MI, GI bleed, UTI, pancreatitis
Chronic Illness- renal or cardiac disease, hx of stroke
Therapeutic agents: diuretics, glucocorticoids
Therapeutic procedures: dialysis, surgery |
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Term
|
Definition
extreme hyperglycemia >600
increased plasma osmolarity
dry, parched mouth, extreme thirst, altered LOC, warm dry skin with out sweating
Sever dehydration- leading to neuro issues like seizure, hyperthermiea, positive Babinski's somnolence, coma, hypotension and shock
No Acidosis or Ketones |
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Term
|
Definition
Fluid and electrolyte replacement
0.9NS then 0.45NS then Dextrose
--need more fluids than DKA
-insulin is not administered until fluid replacement has begun--first bolus then continuous IV |
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Term
| Sick Day management for DM pts. |
|
Definition
Continue Insulin/antidiabetic meds as prescribed
more frequent glucose testing, report >300
encourage fluids and food, report N/V/D |
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Term
|
Definition
| excessive thyroid hormone (T3 and T4) not enough TSH |
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Term
|
Definition
| Autoimmune disease- antibodies attach to TSH receptors on the thyroid gland which stimulate excess release of T3 and T4 |
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Term
| Symptoms of Hyperthyroidism |
|
Definition
Heat intolerance
Excessive sweating, warm, most skin
Increased appetite with weight loss
thin sparse hair
fine hand tremors
hyperactivity: tachycardia
shortened attention span
diarrhea
Exophathalmos: bug eyes
Dermopathy (like an orange peel)
Goiter |
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Term
| Diagnosis of Hyperthyroidism |
|
Definition
H&P
Thyroid antibodies (TA)
T3 uptake test
Thyroid suppression test
radioactive iodine test |
|
|
Term
|
Definition
Propylthioruil (PTU)
Methimazole (tapazole)
Radioactive Iodine
Thyroidectomy |
|
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Term
|
Definition
| Tachycardia, increased systolic BP, N/V/D, abd. pain, restlessness, delirium, seizures, confusion, hyperthermia, psychosis, coma, fever |
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Term
|
Definition
| Too little T3 and T4, too much TSH |
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Term
|
Definition
-occurs often long standing untreated hypothyroidism
puffiness
periorbital edema
masklike look
-can lead to severe metabolic disorders, hypothermia, cardiovascular collapse, impaired cognition, coma |
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Term
| Diagnosis of Hypothyroidism |
|
Definition
H&P
Serum blood levels of T3, T4 and TSH
Thyroid Radioactive uptake
Thyroid antibodies |
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Term
|
Definition
lifelong medication
-synthroid |
|
|
Term
| Symptoms of Hypothyroidism |
|
Definition
| dry brittle hair, puffy face, goiter, slow HR, cold intolerance, dry skin, fatigue, heavy menstrual period, weight gain, constipation |
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