Adult Health - Module 11

Question 1

Soft-tissue injury

Answer 1

Sprains (injury to ligament by twisting) and Strains (excessive stretching of a muscle)

Assessment: Edema, Pain, Decreased function/ROM, and Ecchymosis

Treatment: Rule out fracture. RICE - Rest, Ice (First 24-48 hours. AFTER 48 hours, use heat), Compression, and Elevation. NSAIDS for inflammation/pain (0-6), Opioids (7-10)

Question 2

Carpal Tunnel

Answer 2

Compression of median nerve (under carpal ligament), caused by repetitive motion of the wrist.

Assessment: Phalen’s sign (Bending wrists weirdly and check for numbness, tingling, or pain), Tinel’s sign (tap the median nerve and check for numbness, pain, or tingling)

Treatment: Prevention. Stop repetitive actions, Wrist splints/Keyboard pads -> NSAIDs -> PO steroids -> IM steroids -> Surgical decompression (cutting away the compression)

Question 3

Fracture Types

Answer 3

Trauamatic - Related to injury, Pathologic - Related to disease, Stable - Tranverse, green stick, and spiral. Unstable - Commuted or oblique fractures (Require OR), Open (fractures pierces through the skin outside), Closed (Skin intact).

Question 4

Fracture

Answer 4

Assessment - Pain, edema, deformity, decreased function, crepitus, discoloration.

Diagnostics - Xray

Treatment - Immobilize (cast/splint), Reduce/Realign it (not a nursing action), Elevate, Ice for 20-30 mins, Check for 5 P’s (Pain, pulse, pallor, parasthesia, or paralysis). IF OPEN FRACTURE, OR is necessary.

Meds - Muscle Relaxants, NSAIDS, Tylenol, and Opioids

Question 5

Closed Reduction

Answer 5

Manually pressing (so not invasive, no consent), and patients should be on MAC or medicated.

Question 6

Open Reduction

Answer 6

Surgery to reduce the fractture by using rods, nails, and pins. PREVENT POSTOP COMPLICATIONS

Question 7

Tractions

Answer 7

Skin: Reduce pain and reduce fracture by using a pulling force.
Skeletal: Pins are put straight through the bone (OR and invasive). High risk of infection.
Monitor 6 P’s

Question 8

Fixation

Answer 8

Immobilizing the bones in place with hardware.

Internal: OR, External - temporary

Question 9

Compartment syndrome

Answer 9

Increased pressure/swelling and decreased circulation to an extremity (like a rubberband wrapped tightly around your finger).
Monitor 6 P’s (Pain, parasthesia, pallor, paralysis, pulselessness, and Poikilothermia(coolness).

Treatment: NO HOT OR COLD Remove the cause. If a cast, notify the physician

Question 10

Fat Emboli

Answer 10

Fat Globules released after trauma. After a break in bone, fat sneaks out into the circulatory system and acts as a PE EMBOLI.

Question 11

Fat Emboli prevention

Answer 11

Immobilize broken bone or use traction. Use trapeze to limit movement of affected bone.

Question 12

Fat Emboli Treatment

Answer 12

Treat the symptoms. Administer O2, high fowlers, possible intubate, and Isotonic IVF (if hypovolemic shock occurs).

Question 13

Hip Fracture

Answer 13

Assessment: Pain, Swelling, Bruising, SHORTER LEG on the broken hip side, Muscle spasm (body trying to realign the bone).
Treatment: Immobilize the hip, Buck’s traction (also prevents fat emboli, and DO NOT REMOVE until patient sent to OR), pain management, muscle relaxants for muscle spasms, and surgery

Question 14

Hip Fracture Preop

Answer 14

Bed rest, usually foley cath, skin assessment, Reposition (to side of fracture) q 2 hours.

Question 15

ORIF

Answer 15

Open Reduction Internal Fixation

Question 16

Hip Fracture Postop (acronym)

Answer 16

H - Hydration
I - Incision Care (monitor wbc, h/h, swelling)
P - Pain management (On-Q pump - constant numbness given)
F - Fiber
R - Respiratory care (TCDB)/Pulmonary toilet (to remove secretions from lungs)
A - Abductor pillow to keep hip in an abducted patient.
C - Circulation checks (6P’s bilaterally for compartment syndrome)
T - Temperature (infection)
U - Urine output (I/O)
R - Review dislocation precautions (do not bend more than 90 degrees)
E - Evalutate labs (CBC, WBC, BUN/Cr)

Even though they have a hip fracture, consult with PT to get them ambulating as soon as possible.

Question 17

BKA/AKA

Answer 17

Below the knee and Above the knee.

Reasons: DIABETES, PVD, Trauma, tumors, infection, necrosis, and frostbite.

Question 18

Amputation surgeries

Answer 18

Closed or Flap: No infection present, tissue from anterior side is flapped over to cover the hole.
Open: Bring tissue together and insert drains (if infection is present).

Question 19

Amputation Postop care

Answer 19

A: Assess for hemorrhage/infection
M : Monitor H/H
P - Prevent hip flexion contracture (by elevating 24-48 hours and have patient lay prone 3-4 times a day).
U - U have pain (phantom pain, treat just like normal pain)
T - Tighten and reinforce dressing compression
A - Assess swelling
T - Teach patient and family limb care and appropriate activity (DO NOT ELEVATE LIMB AFTER 48 hours, and lay prone 30 mins 3-4 times a day.
E - Evaluate psychological wellbeing

Question 20

Osteoporosis

Answer 20

Weak bones leading to fractures.

Question 21

Paget’s disease

Answer 21

Bone Destruction

Question 22

Osteoporosis and Paget’s disease meds (bones)

Answer 22

Hormone therapy estrogen (inhibit osteoclasts causing decreased bone breakdown),
Biphosphonates (Keep Ca in the bone),
Calcitonin (Pulls Ca into the bone),
Raloxifene (Decreases bone resorption),
Parathyroid Hromone (stimulates new bone production)