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Med Surg > 62 - Muscoloskeletal Trauma and Orthopedic Surgery > Flashcards

62 - Muscoloskeletal Trauma and Orthopedic Surgery Flashcards

1
Q

sprain

A

injury to LIGAMENTS surrounding joints

-caused by wrenching or twisting

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2
Q

most sprain soccur in…

A

ankle, wrist, + knee joints

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3
Q

1st degree sprain

A

tears of a few fibers w mild tenderness + swelling

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4
Q

2nd degree sprain

A

partial tear/disruption of tissue w more swelling + tenderness

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5
Q

3rd degree sprain

A

complete tear of ligament w mod-severe swelling + tenderness

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6
Q

strain

A

excessive stretching of MUSCLE, FASCIA, + TENDONS

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7
Q

if injury occurs, the immediate focus is on….

A 
1 rest (stop activity + limit mvmt)
2 ice 
3 compress
4 elevate
5 pain control (analgesia)
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8
Q

RICEM is for…… during…..

A

decr local inflammation + pain

acute phase 24-28 hrs

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9
Q

cryotherapy

A
  • cold cause vasoconstriction

- reduce transmission+ perception of nerve pain impulse

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10
Q

cryotherapy is most useful when_____

A

applied immediate after injury

  • w/in 24-28 hrs
  • apply no more than 20-30 min at a time
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11
Q

compression helps …

A
  • prevent edema + encourage fluid return

- pain

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12
Q

compression

how to

A
  • wrap starting distally towards trunk
  • leave on 30 min + off 15 min
  • too tight if there is numbness , tingling, to swelling beyond
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13
Q

how long for elevation

A

24-48 hr

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14
Q

HEAT

A
  • after acute phase 24-28hr
  • warm + moist heat reduce swelling + provide comfort
  • dont exceed 20-30 min
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15
Q

should patient use their limb that is protected by cast, brace, splint, or taping?

A

yes

  • joint mvmt maintains nutrition to cartilage
  • muscle contraction improves circulation + helps resolve bruising + swelling
  • helps prevent contracture of tendons + ligaments
  • exercise + wt bearing helps strengthen + prevent reinjury
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16
Q

contracture

A

stiffening

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17
Q

dislocation

A

complete displacement or separation of articular surfaces of joint

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18
Q

subluxation

A

partial or incomplete displacement of joint surface

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19
Q

prophylaxis for injury

A
  • tetanus for open fracture

- abx for open fracture, large tissues defects, or mangled extremity injury

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20
Q

common causes of dislocation/subluxation

A
  • injury + laxity
  • forces on the joint that disrupt supporting tissues
  • weak/atrophied muscles>chronic joint instability
  • sm tears to fribrocartilage>recurrent + chronic dislocation/subluxation
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21
Q

the shoulder often dislocates ANTERIORLY. when does POSTERIOR dislocation typically occur?

A

electrocution + seizure

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22
Q

most obvious sign of dislocation is…

A

DEFORMITY

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23
Q

intraarticular fractures

A

w/in join

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24
Q

avascular necrosis

A

bone cell death fr blood supply

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25
Q

major complications of dislocation

A
  • open joint injury
  • intraarticular fraction
  • avascular necrosis
  • damage to adjacent nerves + bld vessesl
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26
Q

dislocation is considered a ____ emergency bc ____

A

orthopedic emergency bc assoc w significant vascular injury

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27
Q

the longer a joint is dislocated, the greater the risk for ___

A

avascular necrosis

—femoral head of hip joint is especially susceptible

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28
Q

first goal of mgmt vs nursing mgmt of dislocation

A

realign the dislocated part of the joint to its original anatomic position

nursing: pain mgmt + support + protect injured joint

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29
Q

Repetitive Strain Injury

A

injuries resulting fr prolonged force or repetitive mvmt + awkward positions

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30
Q

fracture

A

disruption or break in the continuity of bone

-commonly caused by trauma but may also be due to cancer or osteoporosis

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31
Q

osteoporosis is a type of ___ fracture

A

pathologic

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32
Q

way to classify fractures

A
  • open vs closed
  • complete vs incomplete
  • displaced vs nondisplaced
  • direction of fracture line (linear, oblique, transverse, spiral, longitudinal)
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33
Q

an INCOMPLETE Fx is often a result of…

A

bending or crushing forces applied to the bone

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34
Q

displaced fracture

A

2 ends of the broken bone are separated fr each other

-often COMMINUTED or OBLIQUE

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35
Q

nondisplaced fracture

A

bone fragments stay in alignment

-usually TRANSVERSE, SPIRAL, or GREENSTICK

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36
Q

7 manifestations of a fracture

A 
1 bruising
2 crepitation
3 deformity
4 edema + swell
5 loss of function
6 muscle spasm
7 pain + tenderness
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37
Q

bruising

A

discoloration of skin from extravasation of blood in subq tissues
-may appear immediately after injury

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38
Q

crepitation

A

grating or crunching of bony fragments

-may incr chance of nonunion if bone ends are allowed to move excessively

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39
Q

micromvmt of postfracture fragments _____

A

helps w osteogenesis

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40
Q

deformity

A

abnormal position of extremity or part fr of forces of injury

  • classic sign of fracture
  • if uncorrected, may cause problems w boy union + restoration of function
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41
Q

edema + swelling

A

disruption or penetration of skin or soft tissue by bone fragments
or
bleeding into surrounding tissues
-may occlude blood vessels + damage nerves + incr risk of compartmnt syndr

42
Q

muscle spasm

A

irritation of tissues + protective responsive to injury + fracture
-may displace nondisplaced fractures or prevent it fr reducing spontaneously

43
Q

stages of fracture healing

A 
1 hematoma (bleed to semi-clot)
2 granulation (forms osteoid)
3 callus
4 ossification
5 consolidation
6 remodeling
44
Q

osteoid

A

basis of new bone substance in granulation phase

45
Q

granulation phase

A

new bld vessels, fibroblast, osteoblast, + osteoid

46
Q

callus formation

A

mostly cartilage, osteoblast, Ca + P
minerals like Ca, P, Mg
new bone matrix

47
Q

closed reduction

A

nonsurgical manual realignment of bone fragments to their anatomic position

  • may use local or general anesthesia
  • traction, casting, splints, orthoses/braces
48
Q

open reduction

A

correction of bone alignment w incision

-usually internal fixation w wired, screws, pins, plates etc

49
Q

pros + cons of open reduction

A

PRO: early ambulation
CON: risk of infection, complication w anesthesia, + effects of preexisting conditions

50
Q

traction

A

application of pulling force to an injured or diseased body part or extremity

51
Q

Why is traction used?

A 
1 prevent/reduce pain +spasms
2 immobilize
3 reduce fracture/dislocation
4 treat pathologic joint condtn
5 prevent soft tissue damage
6 promote active/passive exercise
7 expand a joint space during procedure/reconstructions
52
Q

skin traction

A
  • usually for short term treatmt (48-72hr) until skeletal traction or surgery is available
  • tapes, boots, splints, buck’s,
53
Q

skin traction weights

A

5-10 lb

54
Q

assess key pressure points in skin traction every ___

A

2-4 hr

55
Q

skeletal traction

A

used to align injured bones + joints or to treat joint contractures + congenital hip dysplasia
-HCP inserts pins + wires into bones

56
Q

weight for skeletal traction

A

5-45 lbs

57
Q

major complications of skeletal tractions

A
  • infection are pin sites

- effects of prolonged immobility

58
Q

balanced suspension is a common type of ____

A

skeletal traction

59
Q

fracture immobilization is achieved w

A

casts brace, splints, immobilizers

60
Q

cast

A

temporary immobilizer often applied after closed reduction

  • to ensure stability
  • restricts tendon + ligament mvmt
61
Q

casts made from fiberglass or other synth material (NOT plaster of paris) is activated by….

A

submerging in cool or repid water

62
Q

should you cover a fresh plaster cast?

A

NO, must be allowed to air dry.

if covered, it will retain moist heat
-carry gently w palm to not make any dents

63
Q

reduce the edema of cast by….

A

elevating the extremity w a sling

or if its a lower body cast, then elevate on pillow during first 24 hr

64
Q

cephalosporin (cefazolin)

A

bone penetrating abx

-used prophylactically

65
Q

drugs for pain meds

A

carisoprodol (Soma)
cyclobenzaprine
methocarbamol (Robaxin)

66
Q

nutritional therapy

A
  • protein (1g/kg)
  • vit B, C, D, Ca, P, Mg
  • fluid (2k-3k mL/day)
  • 6 small meals a day
  • high in bulk + roughage
67
Q

a thorough ___ assessment should be done following a fracture

A

neurovascular assessment of affected area + distal to the fracture site

68
Q

peripheral vascular assessment

A
  • color
  • temp
  • periph pulse
  • edema
69
Q

peripheral neurologic assessment

A
  • sensation
  • motor function
  • pain
70
Q

pallor or cool colot can indicate

A

arterial insufficiency

71
Q

warm cyanotic extermity can indicate

A

poor venous return

72
Q

slow cap refill can indicate

A

arterial insufficiency

73
Q

late signs of neurovasc damage

A
  • paresthesia (abnorm sensatn like tingling numbness)
  • hypersensation/hyperesthesia
  • paresis (partial loss of sensatn)
  • paralysis (total loss of sensatn)
74
Q

rapid deconditioning of cardiopulmo system can occur from prolonged bed rest resulting in ____

A

orthostatic hypotension + decr lung capacity

75
Q

we always encourage patients to elevate their cast unless ______ is suspected

A

compartment syndrome

76
Q

nursing dx for fracture

A
  • impaired phys combility
  • risk for infection
  • acute pain
77
Q

bone breakage causes a release of Ca in the blood which puts patient at high risk for

A

renal calculi

-drink lots of water

78
Q

if cast is itchy…

A

patient can place a cool hair dryer under the cast

79
Q

DIRECT complications of fractures

A

bone infection, bone union, avascular necrosis

80
Q

INDIRECT complications of fractures

A

compartment syndrome, VTE, fat embolism syndrome, rhabdomyolysis, hypovol shock

81
Q

rhabdomyolysis

A

breakdown of skeletal muscle cells

  • causes release of myoglobin into bloodstream
  • —-precipitates + cause obstruction in renal tubules
  • —may lead to acute kidney injury
82
Q

compartment syndrome

A

swelling causes incr pressure w/in limited space

  • cont swelling can compromise the function of bld vessels + nerves
  • cap perfusion is reduced
83
Q

2 basic causes of compartment syndrome

A

1 decr compartment size (restrictive dressing, splints, casts, excessive traction premature closing of fascia

2 incr compartment contents due to bleeding, inflammation, edema, or IV infiltration

84
Q

compartment syndrome is usually assoc w…

A
  • fractures of long bone
  • extensive soft tissue damage
  • crush injury

*distal humerus + proximal tibia are msot common

85
Q

ischemia can occur w/in ____ after the onset of compartment syndrom

A

4-8 hrs

86
Q

paresthesia

A

abnormal sensation

numbness + tingling

87
Q

early signs of compartment syndrome

A

pain + paresthesia

88
Q

later signs of compartment syndrome

A

pulselessness + paralysis

89
Q

with compartment syndrome do not _______ + _______

A

elevate or ice

90
Q

high risk for VTE

A
  • lower extremities + hip after a fracture
  • limited mobility
  • inactivity
91
Q

prophylactic meds for VTE

A

anticoagulants for 10-14 days

like warfarin, heparin, aspirin

92
Q

preventative measures for VTE

A
  • anticoag
  • compression stockings
  • pneumatic compression device
  • dorsiflex/plantarflex against resistance
  • ROM exercise unaffected leg
93
Q

fat embolism syndrome

A

fat globules entering circ system fr fractures

-collect in areas w abundant bld vessels like lungs + brain

94
Q

fat embolism syndrome is commonly assoc w fractures of

A
  • long bone
  • ribs
  • tibia
  • pelvis
95
Q

FES can occur after

A
  • total joint replacement
  • spinal fusion
  • lipo
  • crush injuries
  • bone marrow transplant
96
Q

fat emboli in the LUNGS

A 
hemorrhagic interstitial pneumonitis
s/s: acute resp distress syndrome
-PETECHIAE IN NECK, CHEST, AXILLA, BUCCAL, + CONJUCTIVA in eye
-chest pain
-tachypnea
-cyanosis
-dyspnea
-tachycardia
-hypoxemia
97
Q

fat embolism syndrome in lab test

A
  • fat cells in blood, urine, or sputum
  • decr PaO2 <60mmHg
  • decr platelet + hematocrit
  • ST + T wave change son ECG
98
Q

with FES, chest x ray may show…

A

bilateral pulmonary infiltrates

99
Q

FES

management

A
  • dont move/reposition patient
  • administer O2
  • fluid administration (prevent hypovol shock)
  • dobutamine + nitrous oxide
100
Q

rhabdomyolysis

common s/s

A

dark reddish brown urine + symptoms of AKI

101
Q

soft tissue injuries include

A

sprain
strain
subluxation
dislocation

Med Surg (18 decks)

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