Care of Patients with Musculoskeletal Trauma

Question 1

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

Answer 1

Fracture

Question 2

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

Answer 2

Classified by extent of the break: Complete

Question 3

Break is only through part of the bone

Answer 3

Classified by extent of the break: Incomplete

Question 4

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

Answer 4

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

Question 5

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

Answer 5

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

Question 6

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

Answer 6

Classified by the cause of fractures: Pathologic (spontaneous)

Question 7

Results from excessive strain and stress on the bone

Answer 7

Classified by the cause of fractures: Fatigue (stress)

Question 8

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

Answer 8

Classified by the cause of fractures: Compression

Question 9

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

Answer 9

Stage 1 - 5 Stages of bone healing

Question 10

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

Answer 10

Stage 2 - 5 Stages of bone healing

Question 11

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

Answer 11

Stage 3 - 5 Stages of bone healing

Question 12

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

Answer 12

Stage 4 - 5 Stages of bone healing

Question 13

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

Answer 13

Stage 5 - 5 Stages of bone healing

Question 14

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

Answer 14

Acute compartment syndrome - Complications of fractures

Question 15

tight, bulky dressings and casts - muscle around damaged

Answer 15

External - Acute compartment syndrome

Question 16

blood or fluid accumulation - kills tissue

Answer 16

Internal - Acute compartment syndrome

Question 17

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

Answer 17

Complication: - Acute compartment syndrome

Question 18

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

Answer 18

Early signs of acute compartment syndrome - Acute compartment syndrome

Question 19

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

Answer 19

Late signs - Acute compartment syndrome

Question 20

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

Answer 20

Crush syndrome - Complications of fractures

Question 21

From blood loss of trauma

Answer 21

Hypovolemic shock - Complications of fractures

Question 22

DVT and PE

Answer 22

Venous thromboembolism - Complications of fractures

Question 23

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

Answer 23

Fat embolism syndrome - Complications of fractures

Question 24

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

Answer 24

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

Question 25

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

Answer 25

Early signs - Fat embolism syndrome

Question 26

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

Answer 26

Infection - Complications of fractures

Question 27

Cutting off/From loss of blood supply to the bone

Answer 27

Chronic complications: Ischemic necrosis - Complications of fractures

Question 28

Fracture that has not healed within 6 months of injury

Answer 28

Chronic complications: Delayed union - Complications of fractures

Question 29

History Clinical manifestations Lab Imaging

Answer 29

Assessment

Question 30

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

Answer 30

History

Question 31

Hx of DM, osteoporosis, CKD, diabetes

Answer 31

Medical history

Question 32

including substance abuse

Answer 32

Drug history

Question 33

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

Answer 33

Clinical manifestations

Question 34

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

Answer 34

Edema

Question 35

Bleeding into the underlying soft tissues

Answer 35

Ecchymosis (bruising)

Question 36

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

Answer 36

Check for neurovascular compromise - changes in all

Question 37

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

Answer 37

Lab

Question 38

Low because of bleeding caused by the injury Lot bleeding

Answer 38

Hemoglobin and hematocrit

Question 39

Indicates inflammatory response - lot inflammation

Answer 39

Erythrocyte sedimentation rate (ESR) may be elevated

Question 40

Indicates bone infection

Answer 40

Increased WBC

Question 41

During healing, bone releases these elements into the blood

Answer 41

Elevated serum calcium and phosphorus

Question 42

X-rays - BIG and gold oe CT MRI

Answer 42

Imaging

Question 43

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

Answer 43

CT

Question 44

Useful in determining the amount of soft tissue injury

Answer 44

MRI

Question 45

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

Answer 45

Priority N diagnoses and collaborative probs

Question 46

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

Answer 46

Emergency care of the patient with an extremity fracture

Question 47

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

Answer 47

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

Question 48

preferably sterile - infection prevention imp

Answer 48

Cover any open areas with a dressing

Question 49

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

Answer 49

Nonsurgical management

Question 50

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

Answer 50

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

Question 51

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

Answer 51

Cast care

Question 52

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

Answer 52

Prevent neurovascular dysfunction or compromise - with cast care

Question 53

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

Answer 53

Drug therapy

Question 54

Collab with PT/OT

Answer 54

Improve physical mobility and prevent complications of impaired mobility

Question 55

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

Answer 55

Prevent infection

Question 56

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

Answer 56

Surgical management

Question 57

If closed but sig Open reduction Internal fixation External fixation

Answer 57

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

Question 58

Allows the surgeon to directly view the fracture site

Answer 58

Open reduction

Question 59

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

Answer 59

Internal fixation

Question 60

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

Answer 60

External fixation

Question 61

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

Answer 61

Amputations: Types: Elective

Question 62

often result of accidents

Answer 62

Amputations: Types: Traumatic

Question 63

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

Answer 63

Amputations: Levels of amputation for lower extremities

Question 64

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

Answer 64

Comps of amputations

Question 65

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

Answer 65

Phantom limb pain

Question 66

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

Answer 66

Neuroma

Question 67

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

Answer 67

Flexion contractures

Question 68

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

Answer 68

Interventions

Question 69

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

Answer 69

Emergency care for traumatic amputations

Question 70

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

Answer 70

Assess tissue perfusion

Question 71

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

Answer 71

Manage pain

Question 72

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

Answer 72

Health promotion and maintenance