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AHI > MS Trauma Questions > Flashcards

MS Trauma Questions Flashcards

1
Q

A female patient with osteoporosis comes to the ED after falling suddenly while opening her car door. She said it felt as though her “leg gave way” and caused her to fall. What type of fracture does this patient likely have?
A.Pathologic (spontaneous)
B.Spiral
C.Impacted
D.Incomplete

A

Answer: A

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2
Q

break or disruption in continuity of a bone that often affects mobility and sensory perception

A

Fracture

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3
Q

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

A

Classified by extent of the break: Complete

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4
Q

Break is only through part of the bone

A

Classified by extent of the break: Incomplete

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5
Q

skin surface over the broken bone is disrupted and causes an external wound

A

Classified by the extent of associated soft-tissue damage: Open or compound

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6
Q

does not extend through the skin and therefore has no visible wound

A

Classified by the extent of associated soft-tissue damage: Closed or simple

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7
Q

Occurs after minimal trauma to a bone that has been weakened by disease: Pagets, osteoporosis

A

Classified by the cause of fractures: Pathologic (spontaneous)

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8
Q

Results from excessive strain and stress on the bone

A

Classified by the cause of fractures: Fatigue (stress)

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9
Q

Produced by a loading force applied to the long axis of cancellous bone
Commonly occur in the vertebrae of older patients with osteoporosis
Compressing force

A

Classified by the cause of fractures: Compression

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10
Q

24 to 72 hours after the injury
Hematoma forms at the site of the fracture because bone is extremely vascular

A

Stages of bone healing: Stage 1

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11
Q

3 days to 2 weeks after injury
Granulation tissue begins to invade the hematoma
Formation of fibrocartilage
Foundation for bone healing

A

Stages of bone healing: Stage 2

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12
Q

3-6 weeks
Fracture site is surrounded by new vascular tissue known as a callus
Callus formation is the beginning of a non-bony union occurs
Result of vascular and cellular proliferation

A

Stages of bone healing: Stage 3

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13
Q

3-8 weeks
Callus is gradually resorbed and transformed into bone

A

Stages of bone healing: Stage 4

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14
Q

From 4-6 weeks up to 1 year
Bone remodeling
Length of time depends on the severity of the injury and the age and health of the patient
In young, healthy adult bone, healing takes about 4 to 6 weeks
Extent injury can lengthen time
Healing time is lengthened in older adults
3 months or longer

A

Stages of bone healing: Stage 5

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15
Q

A 30 year-old patient who is hospitalized for repair of a fractured tibia and fibula is experiencing altered mental status. Which complication related to the injury might the patient be experiencing?
A.Hypovolemic shock
B.Fat embolism
C.Acute compartment syndrome
D.Pneumonia

A

Answer: B

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16
Q

Fat embolism syndrome
Acute compartment syndrome
Crush syndrome
Hypovolemic shock
Venous thromboembolism
Infection
Chronic complications

A

Complications of fractures

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17
Q

Fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hours after an injury or illness
Globules clog small blood vessels that supply vital organs and impair organ perfusion
Early signs
Petechiae is a classic manifestation, but is usually the last sign to develop
Can result in respiratory failure or death, often from pulmonary edema

A

Fat embolism syndrome

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18
Q

Altered mental status (earliest sign)
Increased respirations, pulse, and temperature
Chest pain
Dyspnea
Crackles
Low arterial oxygen level

A

Early signs - Fat embolism syndrome

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19
Q

Increased pressure within one or more compartments reduces circulation to the area
Relieve pressure
Pressure can be from an external or internal
Complication:
Early signs of acute compartment syndrome
Late signs

A

Acute compartment syndrome

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20
Q

tight, bulky dressings and casts

A

External - Acute compartment syndrome

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21
Q

blood or fluid accumulation

A

Internal - Acute compartment syndrome

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22
Q

Infection
Persistent motor weakness
Contracture
Myoglobinuric renal
Amputation in extreme cases

A

Complication: - Acute compartment syndrome

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23
Q

pressure, paresthesia, pallor, paralysis,

A

Early signs of acute compartment syndrome - Acute compartment syndrome

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24
Q

pain, cyanosis, decreased pulses, pulselessness (rare), necrosis

A

Late signs - Acute compartment syndrome

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25
Q

Systemic complication
Results from severe or prolonged pressure, hemorrhage and edema after a severe fracture or crush injury
Myoglobin is released into circulation, where it can occlude the distal renal tubules and result in kidney failure
Rhabdomyolysis: myoglobulin in the bloodstream
Priority of care is to prevent Acute Tubular Necrosis

A

Crush syndrome

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26
Q

From blood loss

A

Hypovolemic shock

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27
Q

DVT and PE

A

Venous thromboembolism

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28
Q

Superficial skin wound infections
Deep wound abscesses
Bone infection (osteomyelitis) - IV antibiotics
Clostridial infections can lead to gas gangrene or tetanus and may result in a loss of an extremity

A

Infection

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29
Q

From loss of blood supply to the bone

A

Chronic complications - Ischemic necrosis

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30
Q

Fracture that has not healed within 6 months of injury

A

Chronic complications - Delayed union

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31
Q

A patient has a fracture of the right wrist. What is an early sign that indicates this patient may be having a complication?
A.Patient loses ability to wiggle fingers without pain
B.Fingers are cold and pale; capillary refill is sluggish
C.Pain is severe and seems out of proportion to injury
D.Patient reports numbness and tingling

A

Answer: D
AN EARLY SIGN

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32
Q

History
Clinical manifestations
Lab
Imaging

A

Assessment

33
Q

Mechanism of injury
Medical history (Hx of DM, osteoporosis, CKD)
Drug history (including substance abuse)

A

History

34
Q

Depends on the specific traumatic event
Moderate to severe pain
Edema
Ecchymosis (bruising)
Check for neurovascular compromise

A

Clinical manifestations

35
Q

could be rapid and result in neurovascular compromise; acute compartment syndrome

A

Edema

36
Q

Bleeding into the underlying soft tissues

A

Ecchymosis (bruising)

37
Q

Skin color and temperature – distal to the injury
Movement
Sensation – any numbness or tingling (paresthesia)
Pulses - distal to the fracture site
Capillary refill (least reliable) - compromised from other things as well
need know baseline
Pain

A

Check for neurovascular compromise

38
Q

No special laboratory tests are available for assessment of fractures
Hemoglobin and hematocrit
Erythrocyte sedimentation rate (ESR) may be elevated
Increased WBC
Elevated serum calcium and phosphorus

A

Lab

39
Q

Low because of bleeding caused by the injury

A

Hemoglobin and hematocrit - Lab

40
Q

Indicates inflammatory response

A

Erythrocyte sedimentation rate (ESR) may be elevated - Lab

41
Q

Indicates bone infection

A

Increased WBC - Lab

42
Q

During healing, bone releases these elements into the blood

A

Elevated serum calcium and phosphorus - Lab

43
Q

X-rays: tells if have fracture; gold standard to look at fractures
CT
MRI

A

Imaging

44
Q

Useful for fractures of complex structures, e.g., joints, spine, pelvis

A

CT

45
Q

Useful in determining the amount of soft tissue injury

A

MRI

46
Q

Acute pain related to one or more fractures, soft-tissue damage, muscle spasm, and edema - quite bit pain pain
Risk for neurovascular compromise related to tissue edema and/or bleeding - precandent over pain
Risk for infection related to a wound caused by an open fracture
Impaired physical mobility related to need for bone healing and/or pain - not weight bearing for awhile

A

Priority nursing diagnoses and collaborative probs

47
Q

Keep her warm and in a supine position
Check the neurovascular status of the area distal to her fracture
Immobilize and elevate the extremity above the heart level
Partial splint therapy
Ice (24 to 48 hours)
Drug therapy
Not walk until know what going on

A

What care would you expect for treatment of her fracture?

48
Q

pain, pallor, pulse, paresthesia, paralysis

A

Check the neurovascular status of the area distal to her fracture

49
Q

Assess ABC’s and perform a quick head-to-toe assessment
Remove clothing from the fracture site - swelling
Remove jewelry on the affected extremity
Apply direct pressure on the area if there is bleeding
Keep the patient warm and in a supine position
Check the neurovascular status of the area distal to the fracture
Immobilize the extremity
Cover any open areas with a dressing

A

Emergency care of the patient with an extremity fracture

50
Q

temperature, color, sensation, movement, and capillary refill
compare the affected and unaffected limbs

A

Check the neurovascular status of the area distal to the fracture

51
Q

preferably sterile

A

Cover any open areas with a dressing

52
Q

The nurse is reviewing the orders for a patient who was admitted for 24-hour observation of a leg fracture. A cast is in place. Which order should the nurse question?
A.Oxycodone PO PRN for pain
B.Neurovascular assessments every 8 hours
C.CBC and BMP in the morning
D.Regular diet as tolerated

A

Answer: B
Done more often; assess often

53
Q

Closed reduction and immobilization with a bandage, splint, cast, or traction
Cast care
Arms, legs, braces, and body or spica casts. Depending on what pat did
Prevent neurovascular dysfunction or compromise
Elevate extremity higher than the heart
Ice for the first 24 to 48 hours
Drug therapy
Improve physical mobility and prevent complications of impaired mobility
Prevent infection

A

Nonsurgical management

54
Q

For small, closed incomplete bone fractures in the hand or foot, reduction is not required

A

Closed reduction and immobilization with a bandage, splint, cast, or traction

55
Q

Four primary groups of casts

A

Cast care

56
Q

Primary nursing concern
Assess the neurovascular status every hour for the first 24 hours and then every 1-4 hours

A

Prevent neurovascular dysfunction or compromise

57
Q

Opioid and non-opioid analgesics, anti-inflammatory drugs, muscle relaxants
Meperidine (Demerol) should never be used for older adults because it has toxic metabolites that can cause seizures and other complications

A

Drug therapy

58
Q

Involve PT/OT for exercise and inpt/outpt therapy

A

Improve physical mobility and prevent complications of impaired mobility

59
Q

Proper wound care
IV antibiotics depending on type fracture or wounds
Wound vacuum-assisted closure system - VAC: depending on size wound area; heal from inside out; prevent osteomyelitis

A

Prevent infection

60
Q

A nurse cares for four patients in casts on the orthopedic unit. Which patient should the nurse prepare for a window procedure?
A.Patient in a full leg cast, toes slightly cool, takes ibuprofen for pain
B.Patient developed pressure ulcer under the cast
C.Patient in a partial cast, toes slightly swollen and warm
D.Patient whose cast became soiled with urine

A

Answer: B
Window: cut out little piece of cast to look at it - eventually replace it - diff areas of compression getting

61
Q

If needed to realign the bone for the healing process
Open reduction with internal fixation (ORIF) most common method of reducing and immobilizing a fracture

A

Surgical management

62
Q

Open reduction
Internal fixation
External fixation

A

Open reduction with internal fixation (ORIF) most common method of reducing and immobilizing a fracture

63
Q

Allows the surgeon to directly view the fracture site

A

Open reduction

64
Q

Uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing
After the bone achieves union, the metal hardware may be removed, depending on the location and type of fracture
Might take out hardware

A

Internal fixation

65
Q

Pins or wires are inserted through the skin and affected bone and then connected to a rigid external frame
increased risk for pin site infection - good pin care

A

External fixation

66
Q

related to complications of peripheral vascular disease, arteriosclerosis

A

Amputations: Types: Elective

67
Q

often result of accidents

A

Amputations: Types: Traumatic

68
Q

Toe
Mid-foot
Syme
Below-knee
Above-knee

A

Levels of amputation for lower extremities

69
Q

most of the foot is removed, but the ankle remains

A

Syme

70
Q

Hemorrhage - traumatic
Infection - can be sig
Phantom limb pain
Neuroma
Flexion contractures

A

Complications of amputations

71
Q

More common in patients who had chronic limb pain before surgery and less common in those who have traumatic amputations; elective amputations
Sensation is felt in the amputated part immediately after surgery and usually diminishes over time
If sensation persists and is unpleasant or painful, it is referred to as phantom limb pain

A

Phantom limb pain - Complications of amputations

72
Q

Sensitive tumor consisting of damaged nerve cells
more common in upper extremity amputations

A

Neuroma - Complications of amputations

73
Q

Hip or knee flexion contractures are seen in patients with amputations of the lower extremity

A

Flexion contractures - Complications of amputations

74
Q

Emergency care for traumatic amputations
Assess tissue perfusion
Manage pain
Prevent infection
Promote mobility and preparation for prosthesis - want them up and moving
Promote body image and lifestyle adaptation - some psychological concerns: talk about that with them

A

Interventions

75
Q

Stop the bleeding, stabilize the patient
Wrap the amputated part (finger, hand, toe) in a clean or sterile cloth
Place it in a water tight sealed plastic bag
Place the bag in ice water – but never amputated part directly on ice
Avoid contact between the body part and the water to prevent tissue damage

A

Emergency care for traumatic amputations - Interventions

76
Q

After surgical closure, the skin flap at the end of the remaining limb should be pink in a light-skinned person and not discolored in a dark-skinned patient
Tissue should be warm, but not hot - not show signs of infection
Sig edema

A

Assess tissue perfusion - Interventions

77
Q

Pain medications per HCP
IV infusions of calcitonin (Miacalcin, Calcimar) during the week after amputation can reduce phantom limb pain - talk to them about it; not dismiss pain
Massage
Heat
TENS unit
Ultrasound therapy per PT - vibration to deliver heat

A

Manage pain - Interventions

78
Q

Which of the following statements identifies the patient as at highest risk for musculoskeletal trauma?
A.“I removed my area rugs at home so that I don’t trip over them”
B.“My mother had osteoporosis, so I am very careful when I ride my motorcycle”
C.“I don’t drink alcohol if I have to drive”
D.“I always wear my helmet when I ride my bicycle.”

A

Answer: B
Fam history and ride motorcycle

79
Q

Health teaching should focus on: - SAFETY
Airbags and seatbelts
Osteoporosis screening and self-management
Fall prevention
Home safety assessment and modification, if needed; rugs, not as many steps
Dangers of drinking and driving
Drug safety (prescribed, OTC, illicit)
Older adults and driving - ensure safe to cont that
Helmet use when riding bicycles, motorcycles, all-terrain vehicles (ATVs), and skateboards

A

Health promotion and maintenance

AHI (77 decks)

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