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NUR3220 ADULT HEALTH I > Exam 3 Study Guide - Musculoskeletal Trauma > Flashcards

Exam 3 Study Guide - Musculoskeletal Trauma Flashcards

1
Q

Fracture

A
  • Break or disruption in continuity of a bone tht often affects mobility & sensory perception
  • Classified by extent of break
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2
Q

Complete Fracture

A

Break is across entire width of bone; bone is divided into 2 distinct sections

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3
Q

Incomplete Fracture

A

Break is only through part of the bone

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4
Q

Open or Compund

A

Skin surface over broken bone is disrupted & causes an external wound

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5
Q

Closed or Simple

A

Does not extend through skin & therefore has no visible wound

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6
Q

Pathologic (spontaneous) Fracture

A

Occurs after minimal trauma to a bone tht has been weakened by disease

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7
Q

Fatigue (stress) Fracture

A

Results from excessive strain & stress on bone

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8
Q

Compression Fracture

A
  • Produced by a loading force applied to long axis of cancellous bone
  • Commonly occur in vertebrae of older pts w/ osteoporosis
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9
Q

Complication of Fractures - Acute Compartment Syndrome

A
  • Incrd pressure w/in 1 or more compartments reduces circulation to area
  • Pressure can be external or internal
    > external: tight, bulky dressings/casts
    > internal: blood or fluid accumulation
  • Complication
    > infection
    > persistent motor weakness
    > contracture
    > myoglobinuric renal
    > amputation in extreme cases
  • Early signs of acute compartment syndrome: pressure, paresthesia, pallor, paralysis
  • Late signs: pain, cyanosis, dcrd pulses, pulselessness (rare), necrosis
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10
Q

Complication of Fractures - Crush Syndrome

A
  • Systemic complication
    > results from severe or prolonged pressure, hemorrhage, & edema after a severe fracture or crush injury
  • Myoglobin is released into circulation, where it can occlude distal renal tubules & result in kidney failure
  • Rhabdomyolysis: myoglobulin in bloodstream
  • Priority of care is to prevent Acute Tubular Necrosis
  • Hypovolemic Shock
    > from blood loss
  • Venous Thromboembolism
    > DVT & PE
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11
Q

Complication of Fractures - Fat Embolism Syndrome

A
  • Fat globules are released from yellow bone marrow into bloodstream w/in 12-48hrs after an injury or illness
    > globules clog small blood vessels tht supply vital organs & impair organ perfusion
  • Early Signs:
    > altered mental status (earliest sign)
    > incrd resps, pulse, & temp
    > chest pain
    > dyspnea
    > crackles
    > low arterial oxygen lvl
  • Petechiae is a classic mani, but is usally last sign to develop
  • Can result in resp failure or death, often from pulm edema
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12
Q

Complication of Fractures - Infection

A
  • Superficial skin wound infections
  • Deep wound abscesses
  • Bone infection (osteomyelitits)
  • Clostridial infections can lead to gas gangrene or tetanus & may result in loss of extremity
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13
Q

Complication of Fractures - Chronic Complications

A
  • Ischemic necrosis
    > from loss of blood supply to bone
  • Delayed Union
    > fracture tht has not healed w/in 6mnths of injruy
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14
Q

Fractures - Assessment

hx
CMs

A
  • Hx
    > mechanism of injury
    > med hx: DM, osteoporosis, CKD
    > drug hx; including substance abuse
  • CMs
    > depends on specific traumatic event
    > moderate to severe pain
    > edema: could be rapid & result in neurovascular compromise
    > ecchymosis (bruising): bleeding into underlying soft tissues
  • Check for neurovascular compromise
    > skin color & temp; distal to injury
    > movement
    > sensation; any numbness or tingling (paresthesia)
    > pulses; distal to fracture site
    > capillary refill (least reliable)
    > pain
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15
Q

Fractures - Assessment

lab
imaging

A
  • Lab
    > no special lab tests available for assessment of fractures
    > H/H: low bc of bleeding caused by injury
    > Erythrocyte Sedimentation rate (ESR) may be elevated: indicates inflamm response
    > Incrd WBC: indicated bone infection
    > Elevated serum calcium & phosphorus: during healing, bone releases these elements into blood
  • Imaging
    > x-rays
    > CT: usefule for fracture of complex structures; joints, spine, pelvis
    > MRI: useful in determining amnt of soft tissue injury
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16
Q

Nonsurgical Management

immobilization
cast care
neurovascular

A
  • Closed reduction & immobilization w/ a bandage, splint, cast, or traction
    > for small, closed incomplete bone fractures in hand or foot, reduction is not required
  • Cast care
    > 4 primary groups of casts: arms, legs, braces, & body or spica casts
  • Prevent neurovascular dysfunction or compromise
    > primary nursing concern
    > assess neurovascualr status every hr for first 24hrs & then every 1-4hrs
17
Q

Nonsurgical Management

elevate & ice
drug
mobility
infection

A
  • Elevate extremity higher than heart
  • Ice for first 24-48hrs
  • Drug therapy
    > opioid & non-opioid analgesics, anti-inflamm drugs, muscle relaxants
    > Meperidine (Demerol) should never be used for older adults bc it has toxic metabolites tht can cause seizures & other comps
  • Improve physical mobility & prevent comps of impaired mobility
    > PT/OT
  • Prevent infection
    > proper wound care
    > IV antibiotics
    > wound vacuum-assisted closure system; VAC
18
Q

Surgical Management

A
  • If needed to realign bone for healing process
  • Open reduction w/ internal fixation (ORIF) most common method of reducing & immobilizing a fracture
    > open reducton
    > internal fixation
    > external fixation
19
Q

Open Reduction

A

Allows surgeon directly view fracture site

20
Q

Internal Fixation

A
  • Uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing
  • After bone achieves union, metal hardware may be removed, depending on location & type of fracture
21
Q

External Fixation

A
  • Pins or wires are inserted through skin & affected bone and then connected to rigid external frame
  • Incrd risk for pin site infection
22
Q

Amputation Types

A
  • Elective
    > r/t comps of peripheral vascualr disease, arteriosclerosis
  • Traumatic
    > often result of accidents
23
Q

Levels of Amputation for Lower Extremities

A
  • Toe
  • Mid-foot
  • Syme
    > most of foot is removed, but ankle remains
  • Below-knee
  • Above-knee
24
Q

Complications of Amputations

A
  • Hemorrhage
  • Infection
  • Phantom limb pain
    > more common in pts who had chronic limb pain b4 surgery & less common in those who have traumatic amps
    > sensation is felt in amputated part immediately after surgery & usually dimishes over time
    > if sensation persists & is unpleasant or painful, it is referred to as phantom limb pain
  • Neuroma
    > sensitive tumor consisting of damaged nerve cells
    > mroe common in upper extrem amputations
  • Flexion Contractures
    > hip or knee flexion contractures are seen in pts w/ amps of lower extrems
25
Q

Amputation Intervetnions - Emergency Care for Traumatic Amputations

A
  • Stop bleeding, stabilize pt
  • Wrap amputated part in a clean or sterile cloth
  • Place it in water tight sealed plastic bag
  • Place bag in ice water; but never directly on ice
  • Avoid contact btwn body part & water to prevent tissue damage
26
Q

Amputation Intervetnions -Assess Tissue Perfusion

A
  • After surgical closure, the skin flap at end of remaining limb should be pink in a light-skinned person & not discolored in a dark-skinned pt
  • Tissue should be warm, not hot
27
Q

Amputation Intervetnions

basic info

A
  • Manage pain
    > pain meds
    > IV infusions of calcitonin (Miacalcin, Calcimar) during week after amp can reduce phantom limb pain
    > massage
    > heat
    > TENS unit
    > ultrasound therapy per PT
  • Prevent infection
  • Promote mobility & prep for prosthesis
  • Promote body image & lifestyle adaptation

NUR3220 ADULT HEALTH I (13 decks)

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