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AHI > Care of Patients with Musculoskeletal Trauma > Flashcards

Care of Patients with Musculoskeletal Trauma Flashcards

1
Q

break or disruption in continuity of a bone that often affects mobility and sensory perception

A

Fracture

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2
Q

Break is across the entire width of the bone; bone is divided into two distinct sections

A

Classified by extent of the break: Complete

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3
Q

Break is only through part of the bone

A

Classified by extent of the break: Incomplete

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4
Q

skin surface over the broken bone is disrupted and causes an external wound

A

Classified by the extent of associated soft-tissue damage: Open or compound

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5
Q

does not extend through the skin and therefore has no visible wound

A

Classified by the extent of associated soft-tissue damage: Closed or simple

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6
Q

Occurs after minimal trauma to a bone that has been weakened by disease
Not sig amount trauma causes break

A

Classified by the cause of fractures: Pathologic (spontaneous)

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7
Q

Results from excessive strain and stress on the bone

A

Classified by the cause of fractures: Fatigue (stress)

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8
Q

Produced by a loading force applied to the long axis of cancellous bone
Commonly occur in the vertebrae of older patients with osteoporosis
Compresses vertebrae with all the pressure

A

Classified by the cause of fractures: Compression

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9
Q

24 to 72 hours after the injury
Hematoma forms at the site of the fracture because bone is extremely vascular
Stop bleeding

A

Stage 1 - 5 Stages of bone healing

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10
Q

3 days to 2 weeks after injury
Granulation tissue begins to invade the hematoma
Beginning Formation of fibrocartilage - bone; Foundation for bone healing

A

Stage 2 - 5 Stages of bone healing

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11
Q

3-6 weeks
Fracture site is surrounded by new vascular tissue known as a callus
Callus formation is the beginning of a non-bony union occurs
Result of vascular and cellular proliferation

A

Stage 3 - 5 Stages of bone healing

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12
Q

3-8 weeks
Callus is gradually resorbed/disappears and transformed into bone

A

Stage 4 - 5 Stages of bone healing

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13
Q

From 4-6 weeks up to 1 year
Bone remodeling
Length of time depends on the severity of the injury and the age and health of the patient and interventions needed
In young, healthy adult bone, healing takes about 4 to 6 weeks
Healing time is lengthened in older adults: 3 months or longer

A

Stage 5 - 5 Stages of bone healing

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14
Q

Increased pressure within one or more compartments reduces circulation to the area - pressure cannot be released
Pressure can be from an external or internal
Complication:
Early signs of acute compartment syndrome
Late signs
Release pressure

A

Acute compartment syndrome - Complications of fractures

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15
Q

tight, bulky dressings and casts - muscle around damaged

A

External - Acute compartment syndrome

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16
Q

blood or fluid accumulation - kills tissue

A

Internal - Acute compartment syndrome

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17
Q

Infection
Persistent motor weakness
Contracture
Myoglobinuric renal - muscles break down releases myoglobin and causes a build up
Amputation in extreme cases

A

Complication: - Acute compartment syndrome

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18
Q

pressure, paresthesia (abnorm sensations), pallor, paralysis
Better outcomes

A

Early signs of acute compartment syndrome - Acute compartment syndrome

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19
Q

pain, cyanosis, decreased pulses, pulselessness (rare), necrosis

A

Late signs - Acute compartment syndrome

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20
Q

Systemic complication: Results from severe or prolonged pressure, hemorrhage and edema after a severe fracture or crush injury
Causes severe damage to kidneys
Myoglobin is released into circulation, where it can occlude the distal renal tubules and result in kidney failure
Rhabdomyolysis: Release myoglobulin in the bloodstream
Identify and prevent renal failure
Priority of care is to prevent Acute Tubular Necrosis

A

Crush syndrome - Complications of fractures

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21
Q

From blood loss of trauma

A

Hypovolemic shock - Complications of fractures

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22
Q

DVT and PE

A

Venous thromboembolism - Complications of fractures

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23
Q

Fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury or illness
Early signs
Petechiae is a classic manifestation, but is usually the last sign to develop - want catch early signs
Can result in respiratory failure or death, often from pulmonary edema

A

Fat embolism syndrome - Complications of fractures

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24
Q

Globules clog small blood vessels that supply vital organs and impair organ perfusion

A

Fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury or illness - Fat embolism syndrome

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25
Q

Altered mental status (earliest sign)
Increased respirations, pulse, and temperature
Chest pain
Dyspnea
Crackles
Low arterial oxygen level

A

Early signs - Fat embolism syndrome

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26
Q

Superficial skin wound infections
Deep wound abscesses
Bone infection (osteomyelitis) - SEVERE
Clostridial infections can lead to gas gangrene or tetanus and may result in a loss of an extremity - keep open fracture as clean as possible to prevent infection

A

Infection - Complications of fractures

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27
Q

Cutting off/From loss of blood supply to the bone

A

Chronic complications: Ischemic necrosis - Complications of fractures

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28
Q

Fracture that has not healed within 6 months of injury

A

Chronic complications: Delayed union - Complications of fractures

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29
Q

History
Clinical manifestations
Lab
Imaging

A

Assessment

30
Q

Mechanism of injury - clues what eval; fracture tells injury
Medical history
Drug history

A

History

31
Q

Hx of DM, osteoporosis, CKD, diabetes

A

Medical history

32
Q

including substance abuse

A

Drug history

33
Q

Depends on the specific traumatic event
Moderate to severe pain - common
Edema
Ecchymosis (bruising)
Check for neurovascular compromise - changes in all

A

Clinical manifestations

34
Q

could be rapid and result in neurovascular compromise
IR - neurovascular checks imp

A

Edema

35
Q

Bleeding into the underlying soft tissues

A

Ecchymosis (bruising)

36
Q

Skin color and temperature – distal to the injury
Movement
Sensation – any numbness or tingling (paresthesia)
Pulses - distal to the fracture site
Capillary refill (least reliable)
Pain
Imp to look at

A

Check for neurovascular compromise - changes in all

37
Q

No special laboratory tests are available for assessment of fractures
Hemoglobin and hematocrit
Erythrocyte sedimentation rate (ESR) may be elevated
Increased WBC
Elevated serum calcium and phosphorus

A

Lab

38
Q

Low because of bleeding caused by the injury
Lot bleeding

A

Hemoglobin and hematocrit

39
Q

Indicates inflammatory response - lot inflammation

A

Erythrocyte sedimentation rate (ESR) may be elevated

40
Q

Indicates bone infection

A

Increased WBC

41
Q

During healing, bone releases these elements into the blood

A

Elevated serum calcium and phosphorus

42
Q

X-rays - BIG and gold oe
CT
MRI

A

Imaging

43
Q

Useful for fractures of complex structures, e.g., joints, spine, pelvis; not get something on x-ray

A

CT

44
Q

Useful in determining the amount of soft tissue injury

A

MRI

45
Q

Acute pain related to one or more fractures, soft-tissue damage, muscle spasm, and edema
Risk for neurovascular compromise related to tissue edema and/or bleeding
Risk for infection related to a wound caused by an open fracture
Impaired physical mobility related to need for bone healing and/or pain

A

Priority N diagnoses and collaborative probs

46
Q

Assess ABC’s and perform a quick head-to-toe assessment
Remove clothing from the fracture site - swelling/edema least amount of pressure further cause issues
Remove jewelry on the affected extremity
Apply direct pressure on the area if there is bleeding
Keep the patient warm and in a supine position
Check the neurovascular status of the area distal to the fracture- imp
Immobilize the extremity
Cover any open areas with a dressing

A

Emergency care of the patient with an extremity fracture

47
Q

temperature, color, sensation, movement, and capillary refill
compare the affected and unaffected limbs; see if any changes

A

Check the neurovascular status of the area distal to the fracture- imp

48
Q

preferably sterile - infection prevention imp

A

Cover any open areas with a dressing

49
Q

Closed reduction and immobilization with a bandage, splint, cast, or traction
Cast care
Prevent neurovascular dysfunction or compromise - with cast care
Elevate extremity higher than the heart - immbolize
Ice for the first 24 to 48 hours - decrease IR
Drug therapy
Improve physical mobility and prevent complications of impaired mobility
Prevent infection

A

Nonsurgical management

50
Q

For small, closed incomplete bone fractures in the hand or foot, reduction is not required
Realign bones and immobilize
Not for open or small fractures

A

Closed reduction and immobilization with a bandage, splint, cast, or traction

51
Q

Four primary groups of casts
Arms, legs, braces, and body or spica casts.

A

Cast care

52
Q

Primary nursing concern
Assess the neurovascular status every hour for the first 24 hours and then every 1-4 hours; esp if have a cast

A

Prevent neurovascular dysfunction or compromise - with cast care

53
Q

Opioid and non-opioid analgesics, anti-inflammatory drugs, muscle relaxants (muscles tense with fracture) - pain control imp
Meperidine (Demerol) should never be used for older adults because it has toxic metabolites that can cause seizures and other complications; many AE

A

Drug therapy

54
Q

Collab with PT/OT

A

Improve physical mobility and prevent complications of impaired mobility

55
Q

Proper wound care - sterile technique
IV antibiotics
Wound vacuum-assisted closure system - VAC; sig abscess use this

A

Prevent infection

56
Q

If needed to realign the bone for the healing process
Open reduction with internal fixation (ORIF) most common method of reducing and immobilizing a fracture

A

Surgical management

57
Q

If closed but sig
Open reduction
Internal fixation
External fixation

A

Open reduction with internal fixation (ORIF) most common method of reducing and immobilizing a fracture

58
Q

Allows the surgeon to directly view the fracture site

A

Open reduction

59
Q

Uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing
After the bone achieves union, the metal hardware may be removed, depending on the location and type of fracture

A

Internal fixation

60
Q

Pins or wires are inserted through the skin and affected bone and then connected to a rigid external frame
Stablize them
increased risk for pin site infection
Have for long-period time so make sure keep clean

A

External fixation

61
Q

related to complications of peripheral vascular disease, arteriosclerosis, DM
Least amount required goal

A

Amputations: Types: Elective

62
Q

often result of accidents

A

Amputations: Types: Traumatic

63
Q

Toe
Mid-foot
Syme: most of the foot is removed, but the ankle remains
Below-knee
Above-knee

A

Amputations: Levels of amputation for lower extremities

64
Q

Hemorrhage - traumatic
Infection - traumatic
Phantom limb pain
Neuroma
Flexion contractures

A

Comps of amputations

65
Q

More common in patients who had chronic limb pain before surgery and less common in those who have traumatic amputations
Sensation is felt in the amputated part immediately after surgery and usually diminishes over time
If sensation persists and is unpleasant or painful, it is referred to as phantom limb pain
Painful and addressed as if is present

A

Phantom limb pain

66
Q

Sensitive tumor consisting of damaged nerve cells
more common in upper extremity amputations

A

Neuroma

67
Q

Hip or knee flexion contractures are seen in patients with amputations of the lower extremity
Careful to ensure moving joints

A

Flexion contractures

68
Q

Emergency care for traumatic amputations
Assess tissue perfusion
Manage pain
Prevent infection
Promote mobility and preparation for prosthesis - as mobile as possible; collab with team
Promote body image and lifestyle adaptation

A

Interventions

69
Q

Stop the bleeding, stabilize the patient, ABCs
Wrap the amputated part (finger, hand, toe) in a clean or sterile cloth - try save it
Place it in a water tight sealed plastic bag
Place the bag in ice water – but never directly on ice - tissue damage
Clean, cold
Avoid contact between the body part and the water to prevent tissue damage

A

Emergency care for traumatic amputations

70
Q

After surgical closure, the skin flap at the end of the remaining limb should be pink in a light-skinned person and not discolored in a dark-skinned patient
Tissue should be warm, but not hot

A

Assess tissue perfusion

71
Q

Pain medications per HCP
IV infusions of calcitonin (Miacalcin, Calcimar) during the week after amputation can reduce phantom limb pain
Massage
Heat
TENS unit - PT
Ultrasound therapy per PT

A

Manage pain

72
Q

Health teaching should focus on:
Airbags and seatbelts
Osteoporosis screening and self-management - risk for compression fractures; focus on educating young women
Fall prevention
Home safety assessment and modification, if needed
Dangers of drinking and driving
Drug safety (prescribed, OTC, illicit)
Older adults and driving
Helmet use when riding bicycles, motorcycles, all-terrain vehicles (ATVs), and skateboards

A

Health promotion and maintenance

AHI (77 decks)

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