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NRSG 102: Med Surg 1 > Exam 4: Chapter 42: Management of Patients with Musculoskeletal Trauma > Flashcards

Exam 4: Chapter 42: Management of Patients with Musculoskeletal Trauma Flashcards

1
Q

What is a contusion?

A

A soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues

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2
Q

What develops at the site where a contusion occured?

A

A hematoma, leaving a characteristic “Black and Blue” appearance

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3
Q

Local symptoms of Contusion include

A

Pain, Swelling, and Discoloration; Ecchymosis

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4
Q

Contusions are managed with what acronym?

A

PRICE

Protection, Rest, Ice, Compression, and Elevation

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5
Q

Most contusions resolve in

A

1-2 weeks

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6
Q

What is a strain?

A

Injury to a muscle or tendon from overuse, overstretching, or excessive stress

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7
Q

Strains can be categorized as

A

acute or chronic

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8
Q

What is a first-degree stain?

A

Mild stretching of a muscle or tendon with no loss of range of motion

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9
Q

Signs of symptoms of first-degree strain?

A

GRadual onset of palpation-induced tenderness and mild muscle spasm

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10
Q

What is a second-degree strain?

A

Involves moderate stretching and/or partial tearing of the muscle or tendom

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11
Q

signs and symptoms of second-degree strain?

A

Acute pain during the precipitating event, followed by tenderness at the site with increased pain with ROM, edema, significant muscle spasm, and ecchymosis

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12
Q

What is a third-degree strain?

A

Severe muscle or tendon stretching with rupturing and tearing of the involved tissue

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13
Q

Signs and symptoms of third-degree strain?

A

Immediate pain described as tearing, snapping, or burning, muscle spasm, ecchymosis, edema, and loss of function

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14
Q

What test should be performed to test for third-degree strain?

A

X rays to rule out bone injury.

MRI and Ultrasound can identify tendon injury

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15
Q

What is a sprain?

A

An injury to the ligaments and tendons that surround a joint. Caused by a twisting motion or hypererxtension of a joint

Disability and Pain increase during first 2-3 hours

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16
Q

Ligaments connect

A

bone to bone

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17
Q

Tendons connect

A

muscle to bone

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18
Q

Function of a ligfament is to

A

stabilize a joint while permititng mobility

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19
Q

First-Degree/Mild Grade Sprain results from

A

tears in some fibers of the ligament and mild, localized hematoma formation

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20
Q

First-Degree/Mild Grade Sprain Manifestations include

A

Mild pain, edema, and local tenderness

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21
Q

Second-Degree/Moderate Grade Sprain involves

A

partial tearing of the ligament

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22
Q

Second-Degree/Moderate Grade Sprain manifestations include

A

increased edema, tenderness pain with motion, joint instability, and partial loss of normal joint function

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23
Q

Third-Degree/Severe Grade Sprain occurs when

A

a ligament is completely torn or ruptured. May also cause avulsion of the bone

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24
Q

Third-Degree/Severe Grade Sprain symptoms

A

severe pain, increased edema, and abnormal joint motion

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25
Q

How is (P)RICE accomplished?

A

Through support of the affected area and/or splinting

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26
Q

How is P(R)ICE accomplished?

A

Rest prevents additional injury and promotes healing

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27
Q

How is PR(I)CE accomplished?

A

Intermittent application of cold packcs during the first 24-72 hours after injury produces vasoconstriction, which decreases discomfort

Ice packs should not be placed for longer than 20 minutes

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28
Q

How is PRI(C)E accomplished?

A

Elastic compression bandage controls bleeding, reduces edema, and provides support for ithe injured tissues

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29
Q

How is PRIC(E) accomplished?

A

Elevation at or just above the level of the heart controls teh swelling

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30
Q

What is a dislocation?

A

Dislocation of a joint is a condition in which the articular surfaces of the distal and proximal bones that form the joint are no longer in anatomic alignment

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31
Q

What is a subluxation?

A

A partial dislocation that does not cause as much deformity as a complete dislocation

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32
Q

A sprian is what type of injury?

A

Tissue injury. You get swelling and you get bleeding into the tissue. That is where the bruising comes from

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33
Q

What is a traumatic dislocation?

A

An emergency with pain change in contour, axis, and length of the limb and loss of mobility

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34
Q

If a dislocation or subluxation is not reduced immediately, what may develop?

A

Avascular Necrosis (AVN).

AVN of bone is caused by ischemia, which leads to necrosis or death of the boen cells

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35
Q

Signs and Symptoms of a traumatic dislocation include

A

acute pain, change in or awkward positioning of the joint, and decreased ROM.

XRays conform the diagnosis and reveal any associated fracture

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36
Q

Dislocation: What is used to facilitate closed reduction?

A

Analgesia, muscle relaxants, and possibly anesthesia

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37
Q

Dislocation: The joint is immobilized by

A

splints , casts, or traction and is maintained in a stbale position

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38
Q

Dislocation: Neurovaascular status is assessed at a minimum of

A

every 15 minutes until stable

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39
Q

Dislocation: Danger Signs and Symptoms to look out for include

A

increasing pain, numbness or tingling, and increased edema in the extremity.

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40
Q

Where does a DVT occur?

A

In the actual vessel itself. DVT will be on bed rest for a day ro two and will be given a anticoagulant in order to break it down

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41
Q

For All Knee Ligaments, TEndons, and Menisci, what should you do?

A

PRICE.

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42
Q

What should you do when you sprain a knee?

A

Place it in a brace. No matter what is injured, you want to place it in a brace

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43
Q

What can you teach a patient to assess for neurovascular wise?

A

Wiggle fingers, Feel numbness? Warm? Feel Pain? Check for Pulse. Assess Capillary Refillq

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44
Q

Every joint has

A

tendons

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45
Q

What is a fracture?

A

A complete or incomplete disruption in the continuity of boen structure and is defined according to its type and extent

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46
Q

Fractures occur when

A

the bone is subjected to sress greater than it can absorb

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47
Q

Fractures may be caused by

A

direct blows, crushing forces, sudden twisting motions, and extreme muscle contractions

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48
Q

When the bone is broken, adjacent structres are also affected which may result in

A

soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, reuptured tendons, severed nerves, adn damaged blood vessels

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49
Q

What is a closed (simple) fracture?

A

It is one that does not cause a brek in the skin

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50
Q

What is an open fracture (compound, or complex)

A

One in whicht he skin or mucous membrane would extends to the fractured bone

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51
Q

What is a Type I open wound?

A

Clean wound less than 1 cm long

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52
Q

What is a Type II open wound?

A

Larger wound without extensive soft tissue damage or avulsions

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53
Q

What is a Type III open wound?

A

Highly contaminated and has extensive soft tissue damage. May be accompanied by traumatic amputation and is the most severe

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54
Q

What is a intra-articular fracture?

A

Extends into the joint surface of a bone.

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55
Q

CLinical signs and symptoms of a fracture include

A

acute pin, loss of function, deformity, shortening of the extemity, crepitus, and localized edema and ecchymosis

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56
Q

Fractures: PAin is continuous and icnreases in severity until the boen fragments are

A

immobilized

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57
Q

Fractures: Immediately after a fracture, injured area becomes

A

numb and the surrounding muscles flaccid

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58
Q

Fractures: Muscle spasms that accompany a fracture begin

A

shortly thereafter, whthin a few to 30 minutes and result in more intesne pain

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59
Q

Fractures: sometimes muscle spasms can cause the distal and proximal site of the fracture to

A

overlap , causing the extremity to shorten

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60
Q

What is crepitus?

A

A crumbling sensation that can be felt or may be heart. It is caused by the rubbing of bone fragments against each other

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61
Q

Fractures: Localized edema and ecchymosis occur after a fracture as a result of

A

trauma and bleeding into the itissues. The signs may not develop for several hours

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62
Q

What is a Avulsion Fractures:

A

A fracture in which a fragment of bone has been pulled away by a tendon and its attaachment

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63
Q

What is a Comminuted Fractures:

A

A fracture in which bone has splintered into several fragments

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64
Q

What is a COmpression Fractures:

A

A fracture in which bone has been compressed (seen in vertebral fractures)

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65
Q

What is a Depressed Fractures:

A

A fracture in which fragments are drive inward (seen frequently in fractures of skull and facial bones)

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66
Q

What is Epiphyseal Fractures:

A

A fractures through the epiphysis

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67
Q

What is a Greenstick Fractures:

A

A fracture in which one side of a boen is broken and the other side is bent

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68
Q

What is a Impacted Fractures:

A

A fracture in which a bone fragment is driven into another bone fragment

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69
Q

What is a Oblique Fractures:

A

A fracture occuring at an angle across the bone (lesss stabele than a transverse fracture

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70
Q

What is a Open Fractures:

A

A fracture in which damage also involves the skin or mucous membranes, also called a compound fracture

71
Q

What is a Pathologic Fractures: q

A

A fracture that occurs through an area of diseased bone ; can occur without trauma or fall

72
Q

What is a Simple Fractures:

A

A fracture that remains ontained with no didsruption of the skin integrity

73
Q

What is a Spiral Fractures:

A

A fracture that twists around the shaft of the bone

74
Q

What is a Stress Fractures:

A

A fracture that results from repeated laoding of bone and muscle

75
Q

What is a Transverse Fractures:

A

A fracture that is straight across the bone shaft

76
Q

Immediately after a fracture, the body part must be

A

immobilized

77
Q

Joints proximal and distal to the fracture also must be

A

immobilized to prevent movement of fracture fragments

78
Q

With an open fracture the wound is covered with

A

a sterile dressing to prevent contamination of deeper tissues

79
Q

What is a Fracture Reduction?

A

Restoration of the fracture fragemnts to anatomic alignment and positioning. Closed Reduction or Open Reduction may be used to reduce fracture

80
Q

Closed Reduction is accomplished by

A

bringing the bone fragments into anatomic alignment through manipulation and manual traction

81
Q

Closed Reduction: Extremity is held in the aligned position while

A

a cast, splint, or other device is applied

82
Q

Closed Reduction: What is used after to verify that the bone fragments are correctly aligned?

A

X-Rays

83
Q

Closed Reduction: What may be used until patient is physiologically stable to undergo surgical fixation?

A

Traction (Skin or Skeletal)

84
Q

What is a Open Reduction?

A

Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices may be used to hold the bone fragments in position.

85
Q

When does Immobilization occur?

A

After the fracture has been reduced and maintained in proper position and alignment

86
Q

Immobilization may be accomplished by

A

external or internal fixation.

87
Q

Methods of external fixation include

A

bandages, casts, splints, continuous traction, and external fixators

88
Q

Fracture: Edema is controlled by

A

elevating the injured extremity and applying ice as prescribed

89
Q

Fracture: What Neurovascular status do we keep an eye on?

A

Circulation, motion, and sensation

90
Q

Fracture: How can you test to see if you have an infection?

A

You can perform a WBC count, SED Rate, and Temperature

91
Q

Closed Fracture: Healing and Restoration of strength and mobility may take

A

an average of 6-8 weeks

92
Q

In an open fracture, there is a risk for

A

osteomyelitis, tetanus, and gas gangrene

93
Q

Open Fracture: What is given upon patients arrival?

A

Intravenous ANtibiotics along with Intramuscular Tetanus Toxoid is needed

94
Q

Open Fracture: What is initiated in the operating room as soon as possible?

A

Wound irrigation and debridement

95
Q

Open Fracture: Heavily contaminated wounds are left

A

unsultured and treated with vacuum-assited closures (VAC) to facilitate wound drainage

96
Q

Open Fracture: Extremity is elevated to eliminate

A

edema

97
Q

Factors that impair fracture healing include

A

Inadequate fracture immobilization

Inadequate Blood Supply To the Fracture Site

Multiple Trauma

Extensive Bone Loss

Infection

Corticosteroiods

Older Age

98
Q

Fracture: Hypovolemic shock resulting from hemorrhage is more frequently noted in

A

trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragemnts

99
Q

Fracture: Treatment for shock consists of stablizing

A

the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieving the patients pain, providing proper immobilization, and protecting the patient from further injury

100
Q

What is Fat Embolism Syndrome? (FES)

A

This describes the clinical manifestations that occur when fat emboli enter circulation following orthopedic trauma, especially long bone fractures

101
Q

How does Fat Embolism Syndrome occur?

A

Fat globules may diffuse from the marrow into the vascular compartment. They may occlude the small blood vessels that supply the lungs, brian, kidneys, and other organs

102
Q

Fat Embolism Syndrome onset of symptoms?

A

Rapid, within 12-72 hours.

103
Q

Clinical Manifestations of Fat Embolism Syndrome?

A

Hypoxemia

Neurologic Compromise

Petechial Rash

104
Q

Typical first manifestations of FES are

A

Pulmonary and includ ehypoxia, tachypnea, and dyspnea acompained by tachycarida, chest pain, fever, crackles.

105
Q

FES: Petechial Rash may develop

A

2-3 days after the onset of symptoms

106
Q

FES: Petechial Rash is secondary to

A

dysfunction in the microcirculation and/or thrombocytopenia and is typically located in nondependent regions

107
Q

FES: Neurologic Deficits can include

A

Restlessness, agitation, seizures, focal deficits, and encephalopathy

108
Q

What may reduce the incidence of fat emboli?

A

Immediate Immobilization

Minical Fracture Manipulation

Adequate support for fractured bones

109
Q

FES: What can be used as supportive therapy?

A

Vasopressors, Mechanical Ventilation, and Sometimes Corticosteroids

110
Q

What is Compartment Syndrome characterized by?

A

Elevation of pressure within an anatomic compartment that is above normal perfussion pressure

111
Q

COmpartment Syndrome arises from an increase in

A

compartment volume, (from edema or bleeding), a decrease in compartment size, or aspects of both

112
Q

Compartment Syndrome: WHen the pressure within an affected compartment rises above normal,

A

perfusion to the tisseus in impaired, causing cell death, which may lead to tissue necrosis and permanent dysfunction

113
Q

The patient with acute Compartment Syndrome reports

A

deep, throbbing, unrelenting pain, which is unrelieved by medications, and intesifies with passive ROM

114
Q

What are the five P’s

A 
Pain
Pallo
Pulselessness
Paresthesias (Burning or Tingling Sensation)
Paralysis
115
Q

Compartment Syndrome: Peripheral Circulation is elevated by assessing

A

color, temperature, capillary refill time, edema, and pulses

116
Q

Compartment Syndrome: Cyanotic nail beds suggest

A

venous congestion

117
Q

Compartment Syndrome: Pallor or dusky and cold digits, prolonged capillary refill time, and dimished pulses suggest

A

impaired arterial perfusion.

118
Q

Compartment Syndrome: Palpation of the muscle reveals it to be

A

swollen and hard, with the skin taut and shiny

119
Q

Compartment Syndrome: Normal pressure in muscle?

A

8 mmHg or less. Prolonged pressure of mor than 30 mmHg can result in permanent dysfunction

120
Q

Compartment Syndrome: Delaying treatment may result in

A

permanent nerve and muscle damage

Necrosis

infection

Rhabdomolysis with acute kidney injury and amputation

121
Q

Compartment Syndrome: If conservative measures do not restore tissue perfusion and relieve pain, what is done?

A

Fasciotomy (Surgical Decompression with excision of the fascia) is indicated to relieve the constrictive muscle fascia

122
Q

Compartment Syndrome: After fasctiotomy, wound is left

A

not sutured but is left open to llow the muscle tissues time to expand

123
Q

Compartment Syndrome: Wound covered with

A

moist, sterile salien dressings or with artifical skin

124
Q

Compartment Syndrome: Affected arm or leg is splinted ina functional position and at a

A

elevated heart level

125
Q

Compartment Syndrome: After 2-3 days when swelling has resolved

A

wound is debrided and closed (possibly with skin grafts0

126
Q

Compartment Syndrome: Pain management accomplished with

A

opioid analgesia

127
Q

What is Disseminated Intracascular Coagulation (DIC)?

A

A systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia

128
Q

Early manifestations of DIC include

A

unexpected bleeding afer surgery and bleeding from the mucous membranes, venipuncture sites, and GI and urinary tracts

129
Q

Delayed union occurs when

A

healing does not occur within the expected time frame for hte location and type of fracture

130
Q

Nonunion results from

A

failure of the ends of the fractured bones to unite

131
Q

What is Malunion?

A

Healing of fractured bones in a malaligned positioned

132
Q

Fractures: Nonsurgical Treatment Modalities include

A

Ultrasound Stimulation

Electrical Bone Stimulation and shold be used everyday to be most effective

133
Q

Fractures: Surgical Interventions include

A

Bone Frafts

Internal and External Fixation

134
Q

Fractures: Cortical Bone is used for

A

Structual Strength

135
Q

Fractures: Cancellous Bone used for

A

Osteogenesis

136
Q

Fractures: Corticocancellous bone used for

A

strength and rapid incorporation

137
Q

Fractures: Bivalving Cast: May need to

A

open up the cast in order to relieve some of the pressure. When in the cast, you would assess the Five P’s

138
Q

Amputation: IF the health care team communicates a positive atittude, the patient

A

adjusts to the amputation more readily and actively particpates in the rehabilitative plan, learning how to modify activites

139
Q

Amputation: May be

A

congenital or traumatic or caused by conditions such as progressive peripheral vascular disease, infection, or malignant tumor

140
Q

Amputation: Is used to relieve

A

symptoms, improve function, and improve quality of life

141
Q

Amputation: The parts most likely to be amputated are

A

legs, and the leading cause is because of diabetes. Its because of neuropathy and CVD

142
Q

What is a syme Amputation?

A

Performed most frequently for extensive foot trauma. Saves the heel in order for them to have balance

143
Q

Amputation: Complications?

A 
Hemorrhage
Infection
Skin Breakdown
Phantom Limb Pain
Joint Contracture
144
Q

Phantom limb pain is caused by severing of

A

peripheral nerves

145
Q

Amputation: Joint contracture caused by

A

positioning and a protctive flexion withdrawal pattern associated with pain and muscle imbalance

146
Q

Amputation: Rigid dressing removed several days after surgery for

A

wound inspecion, and is then replaced to control edema

147
Q

Amputation: Edema is better controlled with

A

semi-rigid dressings for certain types of amputations

148
Q

Amputation: If infection or gangrene develops, the patient may have associated

A

enlarged lymph nodes
FEver
Purulent Drainage

149
Q

Amputation: Diet with what is essential to promote wound healing?

A

Adequate Protein and Vitamins

150
Q

Amputation: Some Nursing Diagnosis?

A

Acute Pain RT Amputation

Impaired Skin Integrity RT Surgical Amputation

Distrubted Body Image RT Amputation

Impaired Physical Mobility RT Amputation

151
Q

Amputation: Potential COmplications include?

A

Hemorrhage

Infection

Skin Breakdown

152
Q

Amputation: Major goals of the patient may include

A

Relief of Pain

Wound Healing

Acceptance of Altered Body Image

Resolution of the Grieving Process

153
Q

Amputation: What can be done to improve paitents level of comfort?

A

Changing the patietns position or placing a light sandbag on the residual limb to counteract the muscle spasm

154
Q

Amputation: Surigcal pain can be effectively controlled with

A

opioid analgesics

155
Q

Amputation: Phantom Pain feels like

A

the limb is being crushed, cramped, or twisted in an abnormal position

Sometimes accompanied by numbness, tingling, or burning sensations

156
Q

Amputation: Perioperatively, patient may be managed with

A

Acetaminophen

NSAIDS

GABAPENTINOIDS

Opioids

Ketamine

157
Q

Amputation: What may be used during and immediately after the operative?

A

Epidural and Perineural Catheter Analgesia

158
Q

Amputation: What may be effective in relieving postoperative pain?

A

Opoid Analgesics

159
Q

Amputation: What may releive dull, burning discomfort?

A

Beta-Blockers

160
Q

Amputation: What controls stabbing and cramping pain?

A

Anticonsulsants

161
Q

Amputation: What may be prescribed to alleviate phantom limb pain and to improve mood and coping ability?

A

Tricyclic Antidepressants

162
Q

Amputation: What should be done every 8-12 hours postoperatively?

A

Measure the limb to assess for edema formation

163
Q

Amputation: Why should the residual limb not be placed on a pillow?

A

Flexion contracture of the hip may result

164
Q

Patient with AKA may need to lie

A

prone 20-30 minutes 3x per day to avoid contractures

165
Q

Amputation: ROM excercies include

A

hip and knee exercises for patients with BKAs and hip exercises for patietns with AKAs

166
Q

Amputation: Resolving Grief and Enhancing Body Image

A

Encourage Communication

Create Accepting Atmosphere

Provide Support

Help Pt Set Goals

Help Pt Resume Self-Care

167
Q

Amputation: Avoid what type of movements?

A

Avoid abduction, external rotation, and flexion

168
Q

Amputation: You shoudl turn

A

frequently , prone positioning if possible

169
Q

Amputation: “Preprosthetic CarE”

A

Proper bandaging, massage, and toughening of the residual limb

170
Q

Amputation: With the Upper Limb Amputation, exercises should be focused on

A

shoulders.

171
Q

Amputation: Bandaging supports the soft tissue and minimizes the formation of

A

edema while the residual limb is in the dependent position

172
Q

Amputation: Educating About Self-Care

A

Encourage active participation in care
Continue support in rehabilitation facilitiy or at home
Focus on safety and mobility

173
Q

Potential Complications of Fractures?

A 
Hemorrhage
Peripheral Neurovascular Dysfunction
DVT
Pulmonary Emboli/Pneumonia
Pressure Ulcers

NRSG 102: Med Surg 1 (52 decks)

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