Exam 3 - Chpt 37 Musculo. Trauma Flashcards
soft tissue injury produced by blunt force
contusion
contusion s/sx
pain
swelling
discoloration (ecchymosis)
pull muscle injury to the musculotendinous joint
strain
strain s/sx
pain edema muscle spasm ecchymosis loss of function --graded 1st, 2nd, 3rd degree
injury to ligaments and supporting muscle fiber around a joint
sprain
sprain s/sx
joint tenderness
painful movement
edema
disability, pain increases during the first 2-3 hours
articular surfaces of the joint are not in contact
dislocation
when is a dislocation an emergency
pain
changes in contour, axis, length of limb
loss of mobility
RICE
rest
ice
compression
elevation
- immobilization
- anti-inflammatory meds
2 types of factures
open, closed
-no break in the skin
open fractures are aka
compound/complex fractures
open/compound/complex fractures extend to the ___
bone
how many grades of open/compound/complex fractures are there?
3
grade 1 open/compound/complex fracture
1cm long, clean wound
grade 2 open/compound/complex fracture
large wound without extensive damage
grade 3 open/compound/complex fracture
high contaminated
extensive soft tissue injury
–may have amputation
intra-articular fracture extends into the ___ ___
joint surface
s/sx of fracture
acute pain loss of function deformity shortening of extremity crepitus local swelling, discoloration
Dx a fracture
symptoms
pt reports injury to the area
radiography
fracture emergency management
immobilize
splinting
assess neuro before, after splinting
emergency management for an open fracture
cover with a sterile dressing to prevent contamination
restoration of the fracture fragments to anatomic alignment and positioning
fracture reduction
medical management of fractures
fracture reduction
closed: manipulation, manual traction
open: internal fixation
immobilization
factors that affect fracture healing
inadequate immobilization inadequate blood supply multiple trauma extensive bone loss infection poor adherence to Rx restrictions malignancy older age some disease process -RA certain meds -corticosteroids
early complications of fractures
shock (hypovolemic)
fat embolism
compartment syndrome
VTE, PE
hypovolemic shock is common with which fracture
pelvis
fat embolism is common with which fracture
long bone
delayed fracture complications
delayed union, malunion, and nonunion
avascular necrosis of bone
complex regional pain syndrome (CRPS)
heterotrophic ossification
prolongation of expected healing time for a fracture
delayed union
death of a tissue secondary to poor perfusion and hypoexmia
avascular necrosis
rehab r/t clavicle fracture
strap, sling
exercise elbow, wrist, fingers ASAP
how soon after a clavicle fracture can you elevate the arm above the shoulder
6 weeks
rehab r/t humeral neck, shaft fracture
slings, bracing
activity limitations until adequate period of immobilization
what to monitor for regularly with elbow fractures
neurovascular
how long to limit elbow movement after immobilization and healing for nondisplaced, casted
4-6 weeks
how long to limit elbow movement after internal fixation
about 1 weeks
rehab r/t radial, ular, wrist, and hand fractures
early rehab exercises
active ROM for fingers, shoulder
rehab r/t pelvic fracture
depends on fracture and associated injuries
stable fractures are tx’d within a few days of bed rest, symptom management
early immobilization reduces problems r/t mobility
rehab r/t hip fracture
sx is usually done to fixate
care is similar to THA
rehab r/t femoral shaft fractures
low leg, foot, hip exercises to preserve function, improve circulation
early ambulation
PT, weight bearing as Rx
active, passive knee exercises ASAP to prevent restriction of knee movement
technique used with dressing changes
aseptic
rigid, external immobilizing device
cast
cast materials
nonplaster (fiber glass)
plaster of Paris
uses for cast
immobilize a reduced fracture
correct a deformity
apply uniform pressure to soft tissue
support, stable weak joints
when are contoured splints of plaster or pliable thermoplastic materials used
rigid immobilization not required
anticipated swelling
special skin care required
braces (orthoses) are used for
support
control movement
prevent additional injury
6 P’s of neurovascular changes
pain poikilothermia (cool to touch) pallor pulselessness paresthesia paralysis
occurs from increased pressure in a confined space; compromises blood flow
compartment syndrome
what is the early indicator of compartment syndrome
pain
compartment syndrome treatment
notify physician
- cast may be removed
- emergency fasciotomy may be necessary
pt will c/o this with a cast pressure ulcer
painful “hot spot” and tightness
muscle atrophy and loss of strength
disuse syndrome
disuse syndrome treatment
isometric exercises
muscle setting exercises
what is used to relieve cast itching
hair dryer on cool setting
application of pulling force to a part of the body
traction
purpose of traction
reduce muscle spasms
reduce, align, immobilize
reduce deformity
increase space between opposing forces
–used short term
all tractions are applied in how many directions?
2
the lines of pull are aka
vectors of force
types of skin traction
buck extension
cervical head
pelvic
musculoskeletal traction is
skeletal traction
how often to inspect the skin if pt is in traction
TID
how often to assess pressure points with traction
q8h
TKA and THA are commonly performed d/t
obesity
how to reposition a pt after a THA
log roll
methods to prevent dislocation of THA
correct positioning using splint, wedge, pillows
keep abduction with turning, adduction when transferring
limit flexing the hip less than __ degrees
90
should the legs cross midline of the body after a THA
No
how soon do pts ambulate after THA
POD1
THA are at risk for infection up to ___ months
24
neuro checks how often with TKA
q2-4h
acute rehab for TKA
1-2 weeks
total: 6 weeks recovery
orthopedic preop assessment
routine preop assessment hydration status med hx knowledge support, coping possible infection --ask about colds, dental problems, UTI, infections within 1-2 weeks
what baseline needs to be obtained prior to sx
pain
when should a foley be removed
POD1
when should you assess for voiding
4 hours after foley has been removed
a fever within 24 hours post op is indicative of
PNA
a fever 48-72 hours post op is indicative of
UTI
a fever 72 hours post op is indicative of
wound infection
large amounts of ___ should not be given to orthopedic pts are on bedrest
milk
d/t hypercalcemia
