Cyndi - Week 7 - Exam 4 Flashcards
1
Q
What does ABCDE stand for?
A
■ Airway with cervical spine protection ■ Breathing and ventilation ■ Circulation and hemorrhage control ■ Disability and neurological evaluation ■ Exposure and environmental control
2
Q
what does AMPLE stand for?
A
■ Allergies ■ Medications ■ Past illness ■ Last meal ■ Events leading to the episode
3
Q
what are the Trauma Assessment ‐ Emergency Care Priorities?
A
- Assessment should proceed systematically from head to toe
- Glasgow Coma Scale – evaluate LOC
- Bleeding ‐ compression
4
Q
what are the characteristics of suspected fractures that need immediate evaluation?
A
- Immobilize, support, and splint above and below affected area
- Monitor and maintain tissue perfusion
- PRICES
- MonitorVS, LOC, O2 status, NV, pain
- Prevent infection
5
Q
what does PRICES stand for?
A
Protection, Rest, Ice, Compress, Elevate (but
caution!!), Support
6
Q
what are the diagnostic tests for MS trauma?
A
Xray
CT
MRI
7
Q
what are the 3 ways of preventing fractures?
A
Safety (Throw rugs, little dogs - stable leash, good lighting, clear hallways)
• Hip protectors
• Maximize bone density: calcium,Vit D, bone loss prevention meds
8
Q
how does a patient’s general health affect recovery?
A
• Esp if pt smokes, has vascular disease, orthostatic hypotension, HR problems,
diabetes, cognitive and/or physical limitations, balance problems, continence
issues, poor vision, medications that affect pt safety, etc.
• Living environment
• Family, financial, stairs, clutter, pets, rugs, etc.
9
Q
what are the 5 different weight bearing statuses?
A
- Non–weight‐bearing
- Toe‐touch weight‐bearing
- Partial–weight‐bearing
- Weight bearing as tolerated
- Full–weight‐bearing
10
Q
T/F: Know the prescribed weight‐bearing status
before getting any fracture or orthopedic
surgery patient out of bed!
A
TRUE
11
Q
what is a fracture?
A
a disruption or break in bone structure
12
Q
what are the causes of a fracture?
A
■ Traumatic injury – Cause of most fractures – Watch for blood vessel laceration ■ Pathologic ■ Fatigue (stress) ■ Compression **Soft tissue and neurovascular injury may also occur
13
Q
what is the process of bone healing?
A
- Hematoma phase – 72 H
- Granulation phase – 14 days
- Ossification/Callus phase – 3 w‐ 6 months
- Remodeling phase – 6 mo +
14
Q
what are the 7 different types of fractures?
A
- transverse
- linear
- oblique, nondisplaced
- oblique, displaced
- spiral
- greenstick
- comminuted
15
Q
what are the 4 categories of fractures?
A
- extent of break
- displacement
- closed fracture
- open fracture
16
Q
what are the 3 extent of breaks?
A
- complete
- incomplete (greenstick)
- comminuted
17
Q
what are the two different displacements?
A
- nondisplaced
displaced
18
Q
what are the clinical manifestations of fractures?
A
- Deformity
- Edema, swelling
- Ecchymosis
- Pain, muscle spasm
- Loss of function – can’t bear weight
- Decreased sensation distal to injury
- Open wound
- Crepitus
19
Q
what is important to assess with a fracture?
A
Assess neurovascular status! • Especially distal to injury • Compare one side to the other • Peripheral vascular assessment • Peripheral neuro assessment
20
Q
what are the 5 tx for fractures?
A
- Immobilization, possible ATBs, pain control
- closed reduction - non surgical
- open reduction - surgical
- traction
- cast
21
Q
what are the characteristics of closed reduction?
A
- Stable Fracture
* Requires bedrest and limited activity
22
Q
what are the characteristics of open reduction?
A
- Surgical debridement and culture of wound
- Administer tetanus
- Stabilize bone
- Repair visceral injuries
- May have external fixation
- Critical to evaluate arterial bleeding
23
Q
what are the potential complications of fractures?
A
- Venous thromboembolism
- Dislocation
- Compartment Syndrome
- Infection
- Fat embolism syndrome
- Shock
- Other (• Fracture blisters
- PosttraumaticArthritis
- Ischemic necrosis/Avascular Necrosis
- Delayed union
- Nonunion
- Malunion
- Pseudoarthrosis)
24
Q
what is compartment syndrome?
A
Pressure within compartment area exceeds the ability to perfuse tissue
• Increased volume ‐ ie: blood, edema, swelling
• External restriction ‐ ie: cast, or muscle
25
what is cellular ischemia?
When pressure in compartment exceeds capillary perfusion
| pressure
26
how is compartment syndrome diagnosed?
Compartment Pressure Test
27
what are the sxs of compartment syndrome?
a cascade of deterioration
• Area already swollen from trauma
• Six P’s
• Treatment not helping
• Neuromuscular status and pain continue to worsen
(Ischemia can occur 4‐8 hours after onset
• 4‐6 hours after onset neuromuscular damage can be irreversible
• Limb useless within 24 to 48 hours)
28
what is the tx for compartment syndrome?
* No elevation or ice !!
* Surgery (Emergent)
* Fasciotomy = surgical decompression
29
what are the characteristics of infection?
May result from contamination at time of injury or during surgery
• May lead to osteomyelitis
• Any complication decreasing blood supply increases infection risk
• Organisms include Pseudomonas, Staphylococcus, or Clostridium
• ATBs
• Sterile dressing change technique!!
30
what is dislocation?
an emergency d/t the potential for vascular necrosis
31
what are the sxs of dislocation?
Edema, erythema, discoloration
• Pain
• Limitation of movement
• Deformity or shortening of the extremity
32
what is subluxation?
minimal displacement, less severe
33
what is fat embolism syndrome and what are the characteristics?
Fat globules from bone get into vascular circulation
• Risk of causing a pulmonary embolism (PE)
• Most likely to occur 24‐48hrs after injury
• Fat cells in urine, blood, sputum, etc
34
what are the risk factors of fat embolism syndrome?
* Large bone fractures
* Total joint replacements
* Spinal fusion
* Liposuction
* Marrow transplants
35
what are the sxs of fat embolism syndrome?
• Can be rapid onset
• CP, tachypnea, cyanosis, dyspnea, anxiety, tachycardia,
hypoxemia, altered LOC, feeling of impending doom
• Same symptoms as VTE caused – PE, without local s/s
36
what are the diagnostics for fat embolism syndrome?
ABGs, EKG, CXR, CT chest
37
what is the tx for fat embolism syndrome?
* Greenfield, or IVC, filter
* Supportive care
* ABC’s
* Fluid resuscitation
* Correction of hypoxia
* Supplemental oxygen – intubation
38
what are the characteristics of shock?
```
Bone is very vascular
Trauma can sever the adjacent arteries
• Watch out for those pelvic fractures!!!
• Hemorrhage
• Hypovolemic shock
• Too little circulating blood volume
• Decreased MAP (hypotension)
• Body demand for O2 not met by supply
■ Emergency!
```
39
what is the purpose of traction?
* Minimize muscle spasms
* Immobilize fracture and reduce deformity
* Prevent soft tissue damage
40
what are the different types of traction?
• Skin (sling) – short term, like Buck’s (boot)
-- **Care of weight – must hang freely
• Skeletal– pin/wire inserted into bone – internal/external
-- May be internal for stabilization
-- May be external fixation device that needs:
-- **Skin inspection, pin site care
• Countertraction – keeps pt stable during traction
Helpful to provide trapeze to help with mobility
****Frequent neurovascular status assessment
41
what is a cast?
a temporary circumferential immobilization device
42
what are the characteristics of a cast?
* Protects fracture and limits movement until ossification occurring
* Encircles area for immobilization
* Allows for movement of limb
43
what are the NI for a cast?
```
• Check edges (no sharp areas)
• Circulation distal to cast
• Circulation impairment
• Infection risk
• Compartment syndrome
• Peripheral nerve damage
• Complications of immobility
– Atrophy, incontinence, skin, nutrition deficit
Partial casts, splints, braces
```
44
what are the risk factors/causes of hip fractures?
* Osteoporosis
* Minor trauma
* Direct trauma
* Falls
45
what are the sxs of hip fractures?
* Discoloration
* Lack of voluntary control
* External rotation, shortened leg
* Muscle spasms, severe pain
46
what are the diagnostic tests for hip fractures?
* X‐ray, CT scan, MRI
| * Labs – UA, CBC, H&H, platelets, PT, PTT
47
what is the tx for hip fracture?
Stabilization prior to surgery
• Pain control
• Is pt on blood thinners?
• Monitor neurovascular status distal to break
48
what are the common location?
intracapsular fracture
intertrochanteric fx
subtrochantaric fx
49
what are the characteristics of surgery for hip fx?
Surgery – educate, consent,ATBs
• Anterior vs posterior approach for hip replacements
• May have more activity restrictions with posterior
50
what are the characteristics of post op collaborative care?
* Physical therapy
* Mobilize, trapeze on bed, safety
* Teach precautions if indicated
* Weight bearing status – important to know!
51
what is the post op nursing care for hip fx?
* Wound and drain assessment – monitor distal leg CMS
* IS – mouth care‐ turn every 2 hours – maintain alignment
* DVT prophylaxis
* Pain meds/ATBs
* Sterile dressing changes
* Assess discharge, education, home care needs
52
what are the complications of post op hip fx?
```
Complications – many!
• Nonunion – Avascular necrosis due to disruption of circulation
• Pneumonia/ atelectasis
• Decreased circulation to affected limb
• Infection
• Dislocation
• Skin breakdown/ poor wound healing
• Nutrition deficits
• Constipation (opiates, immobility)
```
53
what is "pinning"?
```
“ORIF
= Open Reduction Internal Fixation”
• No abductor pillow
• Non
‐weight bearing
• No total hip precautions
```
54
what is posterior approach replacement?
* Abductor pillow
* Able to weight bear
* Danger of dislocation
* Total hip precautions
55
what is the goal of a total knee replacement?
to restore motion of the joint, to relieve pain, or to correct
deformity
56
what is the post op care for a TKR?
* Pain management
* Trapeze, CPM machine – flexion, extension
* Neuro checks, CMS distal,VS
* Promote respiratory function
* Up with PT until cleared for nursing to mobilize
* Sterile dressing change (surgeon does first one)
* Diet as ordered
57
what re the indications for amputation?
* Peripheral vascular disease ‐Atherosclerosis
* Vascular changes due to diabetes
* Malignant tumors, congenital deformities, infections
* Trauma (accident, MVA, war, terrorism)
58
what are the NI for amputation?
Preoperatively educate pt on reason, plan, pain
Psychological implications
Phantom Limb Pain
• Frequently occurs
• Intense, burning, crushing, cramping, or feels like it is in a weird position
• Mirror therapy
• Pain interventions – it is still medicated!
59
what is the tx for amputation?
Goal of amputation to remove damaged tissue, preserve function and length
• Disarticulation removes at joint
• Open (called “guillotine”)
• Closed (has flap)
• Level of limb determined by many factors
***Goals for surgery after a traumatic amputation – repair, clean, close
60
what is the post op care for amputation?
• Elevate to prevent edema; change position to prevent contractures – prone
• Compression bandage (stump care)
• Educate regarding plan for prosthetic device if used
• When is it going to be fit/placed?
– Healing of area necessary with reduced swelling for a good fit
• Using prosthetic takes a great deal of energy
• Pain, including phantom pain
• Mobilize – ROM, strengthening safety
• Monitor for complications such as infection, poor healing
