Med/Surg Unit 3

• 1st- hip
• 2nd- spine
• 3rd- knee

• low-dose unfractionated heparin (UFH)
• low-molecular-weight heparin (LMWH)
• fondaparinux (Atrixta)
• warfarin sodium-slower to reach blood but less expesive and easier to pt to take after discharge

• Osteotomy-cut across a bone w/ resection of a bone fragment to correct a deformityor alter stress on a joint-performed on clients in 40's
• Arthrodesis-Joint fusion-performed on active clients <55
• Total Hip Arthroplasty/ Replacement- persormed to restore joint motion by replacing arthritic bone with metal and plastic components

• dorsiflexion of the foot causes discomfort in upper calf present in fewer than 1/3 of symptomatic client’s with DVT
• nonspecific indicator to assess for thrombophlebitis
• Client may have thrombophlebitis but have a negative Homan's sign
• Positive sign can result from shin splints

• unilateral calf or thigh pain that results from venous
• inflammation or obstruction
• redness
• edema
• red vein track

• Stage I Hematoma or Inflammatory stage-warmth, vasodilation, edema, loss of function, bruising, Time: 1-3 days
• Stage II Fibrocartilage formation (cellular proliferation) -Time: 3 days-2 weeks
• Stage III Callus Formation Time: 2-6 weeks
• Stage IV Ossification-new bone Time: 3 weeks- 6 months
• Stage V Consolidation and Remodeling-comes back together Time: 6 weeks to 1 year

• Adequate circulation
• Proper fragment immobilization
• Presence of systemic or bone diseases
• Age and general health of pt
• Type of fractureTreatment

The importance of consistent intake of foods that contain Vit K (ex green, leafy veggies)

• Venography
• Doppler ultrasound of the leg

long term home use to prevent clot recurrence

• estrogen deficiency
• parathyroid gland abnormalities
• vitamin deficiency
• malabsorption
• physical activity

• low bone mineral density compared with that expected for the person's age and gender
• caused by steroid use or Cushing's Syndrome

• normal
• low bone mass (osteopenia)
• osteoporosis
• severe (established osteoporosis)

• Grade I The wound is smaller than 1cm; contamination is minimal
• Grade II The wound is larger than 1 cm; contamination is moderate
• Grade III The wound exceeds 6-8 cm; extensive damage to soft tissue, nerve, and tendon; high degree of contamination

• Closed: intact skin over site of injury
• Open: break in skin over the bone injury **serious because once the skin is broken, infection in both the wound and bone can occur

the manipulation of bone to restore alignment, position, and length by bringing the bony fragments into close approximation.

• also called bone setting
• alleviates compression or stretching of nerves and blood vessels.

• Cushing's syndrome
• hyperparathyroidism
• thyrotoxicosis
• anorexia nervosa
• long-term use of meds such as thyroid hormone, anticonvulsants, furosemide and corticosteroids

• personal history of fracture as an adult
• Hx of fragility (low trauma) fracture in a first degree relative
• Low body weight (less than 128 lbs)
• Current cig smoking
• Use of oral corticosteroid therapy for more than 3 months

• involves the application of a pulling force directly to the skin through the use of skin strips, boots, or foam splints. Do not move extremity out of alignment, rarely used
• a. Bears a low longitudinal force load (5-7lbs)
• b. Only used temporarily due to risk of skin breakdown

• uses pins or wires to apply force to the bone. A direct force can be applied after the physician inserts stainless-steel pins through the bone itself.
• a.Most common sites are: the distal femur, the proximal tibia, and the proximal ulna
• b. Can be tolerated for longer periods than can skin traction
• c. Weights over 10 lbs are commonly used

• a. Buck’s traction: most common form-a foam boot is applied to the clients’ affected extremity and attached to a weight that is suspended off the foot of the bed, form of skin traction
• b. Russell’s traction: modification of Buck’s, short-term
• c. Cervical traction: collar with weights, being used to treat sprain or strain or cervical fracture. Can cause damage to spinal cord
• d. Pelvic traction: put device around pelvis, ropes pull hip off bed

• Replaces old bone with new so that the biomechanical properties of the skeleton are not compromised by continuous use
• Plays a role in mineral homeostasis by transferring calcium and other ions into and out of the skeletal reservoir

• Cast in place, due to prolonged compression swelling occurs and there is increased pressure.
• Condition of compromised circulation related to progressively increased pressure in a confined space.
• Irreversible after 24 hours, after 4-6 muscle damage will occur, nerve damage 12-24 hours if swelling is left untreated

• an idiopathic bone disorder characterized by abnormal and accelerated bone resorption and formation in one or more bones
• normal bone is replaced by abnormal, structurally weaker bone that is prone to fractures
• most frequently produces deformities of the femur, tibia, lower spine, pelvis and cranium
• cause is unkown
• rarely seen in people under 40

• deep, aching bone pain
• skeletal deformity such as barrel shaped chest, bowing of tibia or femur, or kyphosis
• changes in skin temp
• pathological fractures through diseased bone
• manifestations related to nerve compression

untreated compartment syndrome

similar to PE but fat not blood, released atsite of fracture, released into blood and travels. Pt is apprehensive, anxious, confused

• femur
• tibia
• sacrum
• heels
• pressure ulcers
• other chronic open wounds

• - severe pyogenic infection of bone and surrounding tissues
• -generally bacterial but can be caused by a fungus or virus
• -Staphylococcus aureus-most common infecting organism

• NSAIDS such as ibuprofen
• heat therapy
• massage
• bracing

• Joint stiffness or Traumatic arthritis- can happen years later
• Avascular necrosis- most frequently seen in femur
• Nonfunctional union
• Malunion
• Delayed Union
• Non-union
• Fibrous Union
• Complex Regional Pain Syndrome

• nausea
• abdominal pressure and vague abdominal pain
• feelings of bloating or tightness
• inability to take a deep breath.

a metabolic bone disorder in which purine (protein) metabolism is altered and the by-product, uric acid, accumulates.

• Primary- caused by inherited defect of purine metabolism, leading to increased renal excretion
• Secondary- acquired condition that occurs following hematopoetic or renal disorders