Chapter 63: Med Surg Flashcards
sprain
injury to a ligamentous structure surrounding a joint, usually caused by wrenching or twisting motion
first degree sprain
mild; involves tears in only a few fibers resulting in mild tenderness and minimal swelling, self-limiting with full fx returning within 3-6 weeks
second degree sprain
moderate; involves partial disruption of the involved tissue with more swelling and tenderness
third degree sprain
complete tearing of a ligament in association with moderate to severe swelling, a gap in the muscle may be apparent, may require surgical repair if it involves the fascia or tendons
strain
excessive stretching of a muscle and its fascial sheath usually involving the tendon, mostly occur in large muscle groups
why does edema develop in an injured area?
tiny hemorrhages within the disrupted tissues occur along with the local inflammatory response
acute intervention of strains and sprains
stopping the activity and limiting movement, applying ice, compressing, elevating, and providing analgesia
compression
limits swelling, wrapped starting distally and progressing proximally to encourage fluid return, bandage left in place for 30 minutes and removed for 15 minutes
dislocation
severe injury of the ligamentous structures that surround joint evidence by obvious deformity and local pain, tenderness, loss of fx of injured part, and swelling
tx for dislocation
prompt attention! must be realigned and immobilized, nurses need to reduce pain and protect injury
subluxation
partial or incomplete displacement of the joint surface, less severe than dislocation, may require less healing time
repetitive strain injury
cumulative traumatic disorder resulting from repetitive movements, awkward postures, or sustained force causing tiny tears that become inflammed
s/s of repetitive strain injury
pain, weakness, numbness, impairment of motor fx
tx of repetitive strain injury
precipitating activity, modification of activity, pain management with heat/cold, rest, to type: keep the hips and knees flexed to 90 degrees and feet flat with the wrists kept straight
carpal tunnel syndrome
caused by compression of the median nerve caused by pressure from trauma or edema caused by inflammation of tendon
s/s of carpal tunnel
weakness especially in thumb, burning pain, tingling, numbness, and + phalen’s test
predisposed to carpal tunnel
diabetes, hypothyroidism, women
tinel’s sign
tapping over the median nerve as it passes through the carpal tunnel in the wrist and positive response is sensation of tingling
phalen’s sign
allow wrists to fall freely into maximum flexion and maintain position for longer than 60 seconds, positive sign is sense of tingling over median nerve
tx of carpal tunnel
in acute cases, stop the aggravating motion and let wrist rest with wrist splint, injection of corticosteroid directly into carpal tunnel may relieve, avoid extreme temps, carpal tunnel release
release surgery
indicated if symptoms persistent for more than 6 months, open release enlarges carpal tunnel and endoscopic is faster and causes less pain
rotator cuff injury
occurs gradually from aging, repetitive stress, or injury from falling, can tear as sudden force of adduction occurs when limb is in abduction, confirmed with MRI
s/s rotator cuff injury
shoulder weakness, severe pain when the arm is abducted 60-120 degrees, decreased ROM, drop arm test
drop arm test
arm falls suddenly after is has been abducted 90 degrees is a sign of rotator cuff injury
tx rotator cuff injury
rest, ice, heat, NSAIDs, corticosteroid injections to joint, physical therapy, surgery indicated when complete tear or no improvement with conservative therapy (arthroscope surgery)
meniscus injury
associated with ligament sprains that commonly occur in athletes (basketball, football, rugby, soccer, hockey) exhibited by rotational stress when the knee is in varying degrees of flexion and foot is planted; MRI diagnose
s/s of meniscus injury
pain with flexion, internal rotation, and knee extension, no significant edema, localized tenderness, knee clicks or pops, quadricep atrophy is injury has not been tx
tx meniscus injury
ice, immobilization, weight bearing as tolerated, knee brace, physical therapy, surgery may be indicated and done with arthroscopy
anterior cruciate ligament (ACL) injury
usually occurs from noncontact when the athlete pivots, lands from a jump, or slows down when running, x rays and MRI diagnostic
lachman’s test
flex the knee 15-30 degrees and pull tibia forward while femur is stabilized, considered positive for ACL injury if there is forward motion of the tibia with the feeling of a soft or indistinct endpoint
tx for ACL injury
if intact: rest, ice, NSAIDs, elevation, ambulation, knee brace; if severe ligament and meniscus injury: surgery, recovery within 6-8 months
bursitis
results from repeated or excessive trauma or friction in bursae (synovial fluid)
s/s bursitis
warmth, pain, swelling, limited ROM
tx bursitis
rest is often the only tx needed
greenstick fracture
incomplete fracture with one side splintered and other side bent, nondisplaced fracture
comminuted
more than two fragments, common in osteoporosis pt, displaced fracture
fracture healing
called union; fracture hematoma, granulation tissue, callus formation, ossification, consolidation, remodeling effected by age, blood supply, infection, hormones, immobilization, and site of fracture
s/s of fracture
edema, pain, tenderness, muscle spasm, deformity, ecchymosis, loss of fx, crepitation
edema
can occlude circulation and damage nerves
pain and tenderness cause
splinting of muscle around fracture with reduction in motion of injured area
muscle spasm causes
displacement or prevents it from reducing spontaneously
crepitation
increases the chance for nonunion
electrical stimulation
can be used in some cases to stimulate bone healing with nonunion or delayed union and causes bone remodeling, electrodes placed on pt while sleeping for 10-12 hours
closed reduction
nonsurgical, manual realignment of bone, tx following is traction, casts, splints, braces
open reduction
correction of bone alignment through surgery, wires, screws, or pins placed internally or externally
traction
prevents or reduces pain and muscle spasms, immobilizes effected limb, reduces a fraction or dislocation, prevents soft tissue damage, promotes active and passive exercise, expands a joint before surgery
skin traction
used for short term management (48-72 hours), weights are usually 5-10 lbs, nurses do not change weights, but can observe and report when weight is touching ground or different from order
skeletal traction
in place longer than skin traction, weights are usually 5-45 lbs
plaster cast
immobilizes above and below injury, bony prominences padded, sets in 15 minutes, strong enough for weight bearing at 24-72 hours, don’t cover while fresh
synthetic casts
being used more because lightweight, stronger, relatively waterproof, and provide earlier weight bearing
short arm cast vs long arm cast
short arm used for treatment of stable fractures or metacarpal fractures and long arm casts are for stable forearm or elbow fractures of unstable wrist fractures- be sure to elevate to reduce edema UNLESS used for proximal humerus fracture
cast syndrome
occurs if body jacket cast is too tight and pt complains of tummy pain, nausea, vomiting, decreased bowel sounds
lower extremity cast or jones dressing
keep foot elevated above heart for first 24 hours to prevent edema
when is external fixation an option?
simple fractures, complex fractures with tissue damage, correction of congenital defects, nonunion or malunion, and limb lengthening, salvages extremities that would have otherwise been amputated
nursing assessment of fractures
pain, pulse, pallor, paresthesia, paralysis, polar
what does pallor indicate?
arterial insufficiency
what does warm, cyanotic indicate?
poor venous return
absent pulse with dopler indicates
emergent! vascular dysfunction and insufficiency
hypercalcemia in fractures
occurs from demineralization causing a rise in urine pH and stone formation- recommend cranberry juice or ascorbic acid to acidify urine
colles fracture
fracture of distal radius, pain, swelling, deformity of wrist, usually a cast unless displaced then internal or external fixation
fracture of humerus
common in young and middle aged people
fracture of pelvis
benign to life threatening, ecchymosis on tummy, hip spica cast, external fixation, open reduction
fracture of hip
common in older adults, external rotations, shortening of extremity, surgical repair, place pillow between pt legs when turning, avoid turning on the affected side
femoral shaft fracture
accompanied by soft tissue damage and lots of blood loss, inability to move hip or knee, stabilize pt and immobilize fracture, open reduction with internal fixation is preferred
fracture of tibia
much force is required to have a tibia injury, complicated by infections, closed reduction and cast
stable vertebral fracture
not likely to cause spinal damage, maintain alignment and reduce pain, surgery often done to stabilize fracture until union can be accomplished
facial fracture
maintain patent airway
incidence for amputation
greater in men, circulatory impairment, traumatic or thermal injury, malignant tumors, uncontrolled or widespread infection, congenital disorder
closed amputation
performed to create a weight bearing residual limb
disarticulation
amputation performed through a joint
syme amputation
disarticulation of ankle
open amputation
leaves surface on the residual limb that is not covered with skin, indicated for control of actual or potential infection, usually closed later by a second surgical process or closed by skin traction (guillotine amputation)
preoperative management for nurse
need to know level of amputation, type of postop dressings, type of prosthesis to be used, begin explaining discharge teaching (phantom limb sensation)
postoperative management for nurse
monitor individuals who had traumatic or unplanned amputation with care, watch vitals, dressing site for hemorrhage, surgical tourniquet must always be available in case of emergency, if excess bleeding occurs CALL PHYSICIAN, neurovascular assessment, anticoagulant therapy
delayed prosthetic
may be the best for amputations above the knee or below the elbow, older adults, debilitated individuals, infectious; can bear full weight on prosthetic approximately 3 months after amputation
flexion contractures
may delay rehabilitation process, most common is hip flexion, to avoid- have pt avoid sitting in a chair for more than 1 hr with hips flexed & do not have pillows under surgical extremity
compression bandage
supports soft tissues, reduces edema, speeds up healing, minimizes pain, promotes residual limb shrinkage and maturation, worn at all times except physical therapy and bathing, removed and reapplied several times a day
osteotomy
remove a wedge or slice or bone to change alignment, ineffective in pt with inflammatory joint disease
debridement
usually performed on knee or shoulder using a fiberoptic arthroscope, outpatient, compression dressing applied, weight bearing permitted after surgery
arthroplasty
reconstruction or replacement of joint to relieve pain, improve or maintain ROM, and correct deformity
hip arthroplasty
implant is cemented in place and may become loose over time, so recommended for older, less active pt
hip resurfacing
femoral head is preserved and reshaped, lower wear and tear, recommended for younger, active pt
arthrodesis
surgical joint fusion done if articular surfaces are too damaged or infected to allow joint replacement, stable but immobile joint
complications of joint surgery
infection, thromboembolism (particularly the surgeries involving lower joints), Doppler used to detect DVT, which if absent is indicative of emboli
