Med Surg: Care of pt with musculoskeletal trauma

Question 1

What are strains?

Answer 1

excessive stretching of a muscle or tendon

treatment: heat and cold applications, exercise with activity limitations, anti-inflammatory medications and muscle relaxants

May require surery if there is a reptured muscle or tendon

Question 2

What are sprains?

Answer 2

excessive stretching of a ligament usually caused by a teisting motion, chracterized by pain and swelling

Question 3

What are the types of fractures?

Answer 3

Classified by extent of break

• complete: break across entire width of the bone so that it is divided into 2 distinct sections
• imcomplete: break does not divide the bone into 2 portions

Define by extent of soft tissue damage

• open or compound: bone broke the skin
• closed or simple: skin over fx remains intact

Question 4

What are the causes of the types of fractures?

Answer 4

Pathologic (spontaneous): from minimal trauma to bone that has been weakened by the disease

Fatigue (stress): from excessive stress and strain on bone

Compression: loading force applied to the long axis of cancellous bone

Question 5

What are te common type of fractures?

Answer 5

Comminuted or fragmented: bone is splintered or crushed, 3 or more fragments, bad fracture especially if through skin

Displaced: ends of bone are not in opposition to each other, not lined up

Oblique: extends down length of bone

Spiral: partially encircles the bone

Impacted: part of the fractured bone is driven into another

Greenstick: one side of bone is broken and the other is bent

Question 6

What is the assessment of fractures?

Answer 6

Pain or tenderness over the area

Decrease or loss of muscular strength or function

Obvious deformity of affected area

Muscle spasm and neurovascular impairment: check ciruculation, motion and CNS sensation

Question 7

What is the treatment of fractures?

Answer 7

Immobilize: prevent movement above and below injury, can pull bones out of alignment and furthering injury

Cover any open wounds with sterile gauze: prevent contamination

Radiological exam: xray, CT, MRI

Definitive treatment and stabilization:

• closed reduction: no incisions, common nonsurgical
• open reduction: incision made
• internal fixation: hardware (pin, plate, sereus)
• external fixation: skin penetrated by pin/screw on outside
• traction: pulling
• casting: immoblize affected area, rigid

Question 8

What is a reduction in a fracture?

Answer 8

Restores bone to proper alignment

Closed: nonsurgical intervention using manual manipulation, perfoormed under local or general anesthesia, cast may be applied following reduction

Open: surgical intervention, may use internal fixation devices, may be placed in cast or splint following procedure

Question 9

What is the fixation of fractures?

Answer 9

Internal: application of screws, plates, pins or intramedullary rods to hold fragments in alignment

External: use external frame to stablize a fracture by arraching skeletal pins through bone fragment to reigid external support

• frequently used when massive tissue trauma is present
• need to monitor pin stability
• risk of infection-need pin site care to decrease risk

Question 10

What is traction of fracture?

Answer 10

Exerction of pulling force applied in 2 directions to reduce, align and immoblize a fracture, and muscle spasm

Running traction-pulling force in 1 direction and body act as countertraction

Balanced suspension provides countertraction so pulling force is not altered when bed or patient is moved

Question 11

What are the types of traction fractures?

Answer 11

Skeletal: traction applied mechanically to the bone using pins, wires, tongs or screws.

• femur fractures, cervical spine fractures

Skin: applied using Velcro boot, belt or halter

• cervical skin, Buck’s extension, Russell’s, Pelvic skin

Question 12

What are the casts used for fractures?

Answer 12

Used to immoblize bones and joints in correct alignment after a fracture or injury

• plaster: heavy, longer drying time
• fiberglass: light weight, quick drying time, can bear weight on cast if allowed

Question 13

What is the cast care for fractures?

Answer 13

Handle with palms only while wet

Check circulation, sensation of distal extremity

Note drainage

Note any c/o burning and pain

Elevate and apply ice for 24-36 hours: decrease edema

Teach children not to put small objects down in cast

Keep cast dry

Question 14

What is amputation?

Answer 14

Removal of a part of the body

Surgical: open or closed

Traumatic especially with upper extremities

Question 15

What are the general principle of post-op care?

Answer 15

Monitor for infection, hemorrhage, necrosis and neuroma

Mark bleeding and drainage on dressing

Evaluate for phantom limb sensation and pain

Maintain surgical dressing, elastic compression wrap or elastic stump

Encourage verbalization regarding loss of body part

Once incision healed, wash and dry with mild soap & water

Progressive resistance exercises to prepare for prosthesis