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What is TCMS?
What type of assessment is this done during?
Temp, color, movement, sensation.
Done Neurovascular status.
What is the importance of calcitonin (thyroid gland), Vit D, Phosphorus, and PTH on bones?
CalcitonIN: lowers serum Ca+ by putting Ca+ & phosphorus back IN (calcitonIN) bone & inhibiting osteoclasts; stops bone resorption; tells kidneys to excrete Ca+ & phosphorus.
Vit D: needed for Ca+ absorption.
Phosphorus: inverse r'ship to Ca+.
PTH: Increases serum Ca+ by taking Ca+ & phosphorus from the bone to the bloodstream.
What meds are given for:
Relief of inflammation
Relief of muscle spasms
Pain: NSAIDs, Opioids
Relief of in: NSAIDs
What can low back pain be caused by?
◦Intervertebral disk problems
◦Unequal leg length
Assessing low back pain.
What should you focus on?
Location, severity, duration, characteristics, radiation, weakness
Work & recreational activities
How patient deals with pain
What are some Management tx for low back pain?
Should Pt be put on bed rest?
- Lumbar support
- NO BED REST!
- Good body mechanics
- Proper posture
- Exercise-conditioning, stretching
- Reduce body weight
What are some Management tx for low back pain?
Opiods-short term only
Tricyclic antidepressants, SNRIs, seizure meds (gabapentin/Neurontin)
Where are the two locations for herniated disks?
What is parasthesia?
Parasthesia: numbness & tingling feeling.
What is an EMG used to do?
What does a myelogram show?
Localize a specific nerve.
Myelogram shows where the "bulge" is (the herniation)
What is the MOST COMMON surgical procedure for a herniated disc?
What is done and what does it do (results in)?
Laminectomy - creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery; it enlarges your spinal canal to relieve pressure on the spinal cord or nerves.
How does stress effect LBP? (a CYCLE)
Give an example.
Increases muscle tension
Worry creates stress = exacerbates back pain.
Pt becomes unnecessarily limited in daily activities --> decrease in activity d/t fear of injury --> limitations in movement & activity lead to muscle weakening --> increases back pain.
What is Scoliosis?
Lateral S or C curvature of the spine.
Explain the degrees and Tx of scoliosis: mild vs moderate vs severe (degrees of curvature)
Mild: <20 degrees of curvature
Tx: exercises to improve posture, muscle tone, flexibility.
Mod: 20-40 degrees of curvature
Tx: bracing - maintain current curvature; wear brace 23 hours/day.
Severe: >40 degrees of curvature.
Tx: Surgery-spinal fusion w/ instrumentation (rods, wires)
Post-op: limited bed rest then up w/ TLSO for months. (thoraco lumbar sacral orthotic)
What age-related diseases makes older adults and children @ risk?
Older adults: osteoporosis
Children: Osteogenesis Imperfecta (brittle bone disease) an inherited disease which causes bones to break easily.
What are the four types of fractures?
- Complete: all the way through bone.
- Incomplete: partially through bone.
- Closed: bone does not come through skin.
- Open: some bone comes through skin.
Hinkle Cheever: p. 1161.
What are most falls usually due to for the elderly?
Osteoporosis of the bones; not fall causing the fracture.
What is the immediate tx (priority) of any fracture?
What should you apply and what is the goal?
Immobolize to prevent further damage.
- Apply traction
- Goal: manage muscle spasms and keep bone in alignment until surgery or healed
What is the difference between a "skin traction" (straight traction) and a "skeletal traction"?
Skin: force applied over a LARGE area of skin and controls muscle spasms.
Skeletal: applies a PULLING force thru placement of pins into the bone (increased risk of infection).
What is IMPORTANT about weights when applied via skin (straight) traction and why?
Where should Pts be positioned on bed?
Wts MUST hang freely b/c it's more comfortable for the Pt & easy to manage.
Pts should be CENTERED.
What is the MOST COMMON type of skin (straight) traction and what must you do?
- immobilize proximal femur fracture
- Foam boot applied to LL.
- Free-hanging wt attached to boot.
What is the advantage of a "balanced suspension" traction?
It allows for INCREASED MOBILITY w/o compromising joint stability.
What are the surgical tx of (hip) fractures?
What is the purpose?
ORIF: open reduction internal fixation; w/ hip fractures; reduce fracture by correcting the alignment and apply hardware to hold bone in place; fracture heals.
What is External Fixation?
Frame connected to pins that are inserted into bone.
What are the 5 P's?
pain, pulse, palor, paralysis, parasthesia.
Complications of fracture: What is "compartment syndrome"?
In what time frame does it usually occur post-op?
A compartment usually contains a group of muscles, nerves, and BVs held together by a FASCIA.
When the compartment's pressure is increased, it may block BVs to tissues in the compartment causing acidosis & necrosis. The fascia is also unable to expand to meet the swelling of the compartment.
Usually 48h post op.
What is done for surgical tx of "compartment syndrome"?
@ risk for?
Fasciotomy to reduce swelling and fluid & relieve pressure.
@ risk for infection.
Primary concern for Fat embolism of systems is which system?
Explain phys of (fat) embolism.
(usually within 12-72h of fracture)
Respiratory: d/t embolism causing occlusion.
- Bone marrow has fat cells—w/ injury to long bone (femur, tibia, etc.), fat cells are released from bone
- marrow—enter venous compartment and combine with platelets—form clots—move throughout body—occludes small BVs that supply the lungs, brain, kidneys, and other organs.
What are the 3 factors that produce DVT?
What do tx include?
Venous stasis (not moving)
Injury to BV wall (inflammation)
Altered blood coagulation
Tx: Compression stocking/device to promote venous return; anticoagulants to prevent clot formation.
What may be a complication of DVT?
Blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism).
What 3 conditions may happen post surgery and what are the s/sx?
FE, DVT, compartment syndrome
s/sx: SOB, chest pain on inhalation, dizziness, rapid pulse, coughing up blood.
What is it a fracture of?
What is the difference between intracapsular and extracapsular?
Fracture of the femur @ the head, neck or trochanteric area of the bone.
- Intra: Head or neck of femur; Inside
- the acetabulum—poorer blood supply.
- Extra: Trochanteric
- area; Outside the acetabulum—better blood supply—covered by periosteum
What is the tx (#1 priority)?
ASAP: Surgery: ORIF/CRIF
Total joint replacement (arthroplasty)
- Replace the head with a metal cap or ball and line acetabulum with metal or
- polyethylene liner