Fractures, Strains, and Skin Conditions: Exam 2 Review, Exams of Nursing

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Correct Solutions

What is an open fracture? - Correct Answer ✅bone breaks through the skin and is exposed What is a closed fracture? - Correct Answer ✅bone does not break through the skin What is a complete fracture? - Correct Answer ✅the bone is broken into two pieces What is an incomplete fracture? - Correct Answer ✅bone remains in one piece What does directionality tell us about fractures? - Correct Answer ✅tells us which way the fracture line goes What is a transverse fracture? - Correct Answer ✅the line goes straight through the bone What is a linear fracture? - Correct Answer ✅the line is parallel to the long axis of the bone

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What is an oblique fracture? - Correct Answer ✅the line is slanted across the bone shaft What is a spiral fracture? - Correct Answer ✅the line goes around and encircles the bone What is a stress fracture? - Correct Answer ✅repeated force to the same area over time that is common in athletes What if a pathologic fracture? - Correct Answer ✅weakening of bone due to disease (ex. Tumors, infections, osteoporosis) What are the different types of bone fracture treatments? - Correct Answer ✅reduction, traction, fixation Explain reduction treatment - Correct Answer ✅realignment of bone fragments; may be internal vs external and open vs closed

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Explain traction treatment? - Correct Answer ✅closed external reduction using weights, typically used preoperatively -used to maintain reduction of fracture Traction stretches and fatigued muscles that pull the bone fragments out of place, allowing the distal fragment to align with the proximal fragment -ex. use of weights to rescue bone fractures into proper alignment. Typically only used for a short time if the patient is delayed to go to surgery due to medical reasons Explain fixation treatment? - Correct Answer ✅immobilization of bone; can be via splints, casts, or other devices -some form of hardware, such as a screw, plate, nail, or wire, is used to maintain the reduction (internal fixation) -external fixation is a procedure used to reduce and immobilize significantly displaced open fractures

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What are the phases of bone fracture repair? - Correct Answer ✅hematoma formation, pro callus formation, callus formation, replacement, remodeling Explain hematoma formation - Correct Answer ✅fibrin and platelets form a framework for healing Explain procallus formation - Correct Answer ✅fibroblasts and osteoblasts create a granulation tissue called procallus Explain callus formation - Correct Answer ✅procallus is hardened by increasing phosphate and calcium deposition Explain replacement - Correct Answer ✅callus is replaced with lamellar or trabecular bone Explain remodeling - Correct Answer ✅bone remodeled to shape and size prior to injury What are the functions of a tendon? - Correct Answer ✅tissue connecting muscle to bone

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What are the functions of a ligament? - Correct Answer ✅tissue connecting bone to bone What injuries occur to tendons? - Correct Answer ✅strain: injury or tear to tendon (muscle-bone) -ex. person is lifting excessive weight or forced dorsiflexion of the foot What injuries occur to ligaments? - Correct Answer ✅sprain: injury or tear to ligament (bone-bone) -ex. there is sudden force to the joint due to range of motion which is often seen in young athletes, like running What are clinical manifestations of strains and sprains? - Correct Answer ✅-pain, functional limitations and weakness, swelling, discoloration -healing tendon and ligament lacks the strength to withstand a strong pull for 4-5 weeks

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What are the treatments for strains and sprains? - Correct Answer ✅depends on severity- protect involved structures via immobilization, early rehabilitation when safe, may need surgery if complete rupture What is rhabdomyolysis? - Correct Answer ✅trauma caused to striated muscles which then leads to cell lysis (death of cell). This can be life threatening and is seen in severe trauma cases like crush injuries, prolonged fall, and compartment syndrome. What is the pathophysiology behind rhabdomyolysis? - Correct Answer ✅striated muscle cells are broken down and release myoglobin which is able to store oxygen for strenuous exercise. This can travel to the kidneys if it enters the bloodstream and causes acute kidney injury. What are the clinical manifestations of rhabdomyolysis? - Correct Answer ✅pain, weakness, and dark-colored urine (due to iron released from myoglobin in the kidney)

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What is the treatment for rhabdomyolysis? - Correct Answer ✅immediate hydration to prevent damage to the kidney or even dialysis What is osteoporosis? - Correct Answer ✅when there is low bone mineral density which leads to impaired structural integrity, decreased bone strength, and an increased risk of fracture What are the causes of osteoporosis? - Correct Answer ✅low calcium intake, eating disorders, estrogen deficient, inactive lifestyle, cigarette smoking What are the signs/symptoms of osteoporosis? - Correct Answer ✅pain, bone deformities, diminishing height, kyphosis (curving of spine), and fractures What is osteoarthritis? - Correct Answer ✅degenerative joint disease. This is a disease that means there is a local loss of articular cartilage, sclerosis of underlying bone, and bone spurs form in the joint that is affected. This is a common disorder and is caused by aging of synovial joints or overuse.

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What are the causes of osteoarthritis? - Correct Answer ✅middle aged/older ages, no specific cause, mechanical issues, joint overuse, obesity, injury What are the signs/symptoms of osteoarthritis? - Correct Answer ✅joint swelling (Herberden and Bouchard nodes), stiffness, and limited mobility of the joint that is affected What is rheumatoid arthritis? - Correct Answer ✅type of autoimmune destruction that occurs throughout the body in synovial membranes and joints. The joints begin to fill with exudate. The cause is due to an autoimmune disease. What are the causes of rheumatoid arthritis? - Correct Answer ✅old age, environmental/genetic factors, female, smoking (and early life exposure), low socioeconomic status, and obesity

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What are the signs/symptoms of rheumatoid arthritis? - Correct Answer ✅painful/stiff joints, symmetrical joint swelling, and severe joint deformities What are the stages of a pressure injury/ulcer? - Correct Answer ✅1. skin is still intact but has non-blanchable erythema (pressing your finger on their skin does not make it turn white; it remains red).

2. some thickness of the skin is lost, including the epidermis or the dermis.
3. complete loss of the thickness of the skin causing damage or loss of subcutaneous tissue.
4. there is complete loss of skin thickness causing damage to muscle, bone, or it's surrounding structures. What are primary skin lesions? - Correct Answer ✅result from the disease process What are secondary skin lesions? - Correct Answer ✅result from primary lesions/patient activities such as itching/scratching (irritates areas and turns into a rash)

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What are examples of primary skin lesions? - Correct Answer ✅macule, papule, patch, nodule, vesicle, pustule, cyst, bulla, wheal, tumor, telangiectasia What are examples of secondary skin lesions? - Correct Answer ✅scale, lichenification, excoriation, keloid, ulcer What are 2 types of hair disorders? - Correct Answer ✅alopecia, hirsutism What is alopecia? - Correct Answer ✅loss of hair from head or body. Occurs when there is a distraction in the growth phase of hair follicle. Can be associated with systemic disorders (hypothyroidism and iron deficiency) What is hirsutism? - Correct Answer ✅abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in 5-10% of women. Due to secreting hormones associated with ovarian or adrenal disease.

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What are the symptoms of alopecia - Correct Answer ✅small bald patches, redness of fingernails and toenails, more hair loss in cold weather, bald spots What are the symptoms of hirsutism? - Correct Answer ✅thick, coarse, dark hair grows in areas that are usually thin What are the 2 types of nail disorders? - Correct Answer ✅paronychia, onychomycosis What is paronychia? - Correct Answer ✅acute or chronic infection of cuticle -one or more fingers may be involved -lots of exposure to moisture -caused by staphylococcus, streptococcus, or -candida -rapid onset of painful inflammation of cuticle -pus and redness -nail plate is not affected

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What is onychomycosis? - Correct Answer ✅fungal or dermatophyte infection of nail unit -nail plate turns yellow or white (infection develops under dorsal surface) and becomes elevated What is squamous cell carcinoma? - Correct Answer ✅- second most common type of cancer -tumor of epidermis due to overgrowth of keratinocytes -fat reddish and scaly patches -metastasis is rare since it does not invade into blood vessels -invasion into surrounding tissue is rare but it will grow rapidly when it does occur What is basal cell carcinoma? - Correct Answer ✅-most common cancer in the world -surface epithelial tumor of undifferentiated basal cells -pearly or ivory in appearance and slightly elevated (as depressed centers and rolled borders as it grows)

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-metastasis is rare since it does not invade into blood vessel or lymph nodes but will destroy surrounding tissues if not treated What is capos sarcoma? - Correct Answer ✅-vascular malignancy caused by Human Herpes Virus type 8 -associated with immunodeficiency states such as post- transplantation and HIV/AIDs -clinical manifestations: purplish-brown macules that evolve into nodules and plaques -(rapidly progressive form: involved with mucous membranes/organs such as in the oral cavity; classic form: lesions over lower legs of older men; Africa endemic form) What are the signs/symtpoms of cold injuries? - Correct Answer ✅-skin injury from exposure to extreme cold temperatures -most commonly affects fingers, toes, ears, nose, cheeks -burning reaction is caused by alternating vasoconstriction and vasodilation

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-inflammation and reperfusion are part of the pathophysiology -skin becomes white or yellowish, waxy, and firm to the touch What are treatments for cold injuries? - Correct Answer ✅immersion in a warm water bath until frozen tissue is thawed (avoid rubbing or massaging tissue) What is cerebral palsy? - Correct Answer ✅an issue in children that has to do with posture disorders or nonprogressive movement What are the causes of cerebral palsy? - Correct Answer ✅injury or issues with the formation of the central nervous system (neurons of the brain or spinal cord). This injury disrupts movement and feeling in some parts of the body. What are the signs/symptoms of cerebral palsy? - Correct Answer ✅spastic gait (unusual and stuffness while walking) and hemiplegia/diplegia/quadriplegia (weakness on side of body)

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What is the sympathetic nervous system? (part of autonomic nervous system) - Correct Answer ✅fight or flight: release of epinephrine and norepinephrine to vasodilate vessels to muscles and vasoconstrict vessels to viscera What is the parasympathetic nervous system? (part of autonomic nervous system) - Correct Answer ✅rest and digest: reduced heart rate and blood pressure (increased digestion and visceral function) What are the 4 phases of nociception (pain)? - Correct Answer ✅transduction, transmission, perception, modulation Explain transduction - Correct Answer ✅the tissue gets exposed to chemical (ex. bradykinin or histamine), mechanical (ex. fingercut; lots of pressure or stretching), or thermal (high/low temperatures) harmful stimuli that causes damage and converts the stimuli to electrophysiology activity. Nociceptors are activated.

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Explain transmission - Correct Answer ✅pain impulses are transmitted and sent into the dorsal horn (spinal cord), then to the reticular formation, hypothalamus, thalamus, and lastly the limbic system (involved in behavioral and emotional response) Explain perception - Correct Answer ✅processing and being aware/conscious of the pain Explain modulation - Correct Answer ✅transmission of the pain signals is being increased or decreased throughout the nervous system and can occur before, during, or after the pain is processed/recognized What are the mechanisms of heat loss? - Correct Answer ✅evaporation, convection, voluntary mechanisms, radiation, vasodilation, decreased muscle tone, increased pulmonary ventilation Explain evaporation - Correct Answer ✅major source of heat loss because it produces sweat that helps cool off the body.

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Water from the body evaporates leaving the skin and mucous membranes. This occurs through the sweat glands. Explain convection - Correct Answer ✅heat is transferred through gases/liquids and the cooler air is being exchanged for the body's hotter air. This can be done with the help of fans or the wind. Explain voluntary mechanisms - Correct Answer ✅the body can slow down or stretch which increases the body's surface area to allow for more heat loss. This can also mean dressing in lighter clothes that allow for more air or cooling. Explain radiation - Correct Answer ✅electromagnetic waves emerges from surfaces that are higher in temperature in comparison to the air then the body can lose heat Explain vasodilation - Correct Answer ✅diverts core-warmed blood to surface of body, with heat transferred by conduction to skin surface and from there to surrounding environment; occurs in response to autonomic stimulation under control of hypothalamus

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Explain decreased muscle tone - Correct Answer ✅exhausted feeling caused by moderately reduced muscle tone and curtailed voluntary muscle activity Explain increased pulmonary ventilation - Correct Answer ✅air is exchanged with environment through normal process; minimal effect