Musculoskeletal Disorders 1 Flashcards
any disruption in the continuity of the bone, when more stress is placed on it than it can absorb
fracture
create massive spasms, the proximal portion remains intact while the distal portion can be displaced in response to force and spasm.
Large muscle groups
break across entire cross-section of bone & often displaced
Complete
though only part of the cross-section
Incomplete: (greenstick)
simple) intact skin over site of injury
Closed
produces several bone fragments
Comminuted
Physical Assessment may reveal
Deformity (hemorrhage or spasm)
Shortening
Swelling
Ecchymosis
Muscle spasm
Pain, tenderness
Loss of function, altered mobility & crepitus
Neurovascular changes
Characterized by neurologic dysfunction, pulmonary insufficiency, and petechial rash on chest, axilla & upper arms
Fat Embolism Syndrome
occlude small vessels of lungs, brain, kidneys, & other organs in Fat embolism syndrome?
Fat globules (emboli)
Fat Embolism Syndrome What to Look for:
Hypoxia PaO2 < 60 mm Hg
Tachypnea, tachycardia, pyrexia
Deterioration in LOC
Confusion , agitation
Manifestations of fat emboli occur within
24-72 hours but may be up to a week after injury:
Complications
Drainage through cast or cast opening
Sudden unexplained body temperature elevation
“Hot Spot” felt over cast lesion
May result in osteomyelitis
What Helps? DVT
Bed cradle
Heat
Minimize compression
Active & passive exercises as ordered
Frequent change in position
Fracture: Early Complications
Shock
Nerve damage, arterial damage
Infection
Cast syndrome
Compartmental Syndrome
Volkmann’s Contracture
Fat Embolism Syndrome
Deep Vein thrombosis & Pulmonary Embolism
Closed reduction: usually done under
anesthesia
Closed reduction: usually done under
anesthesia
Usually performed with internal fixation devices (screws, pins, plates, wires)
Open Reduction: incision and realignment
maintain position for unstable fractures & for weakened muscles, allow for use of contiguous joints while affected part remains immobilized
External Fixation
application of a pulling force to an injured body part or extremity while a counter-traction pulls in the opposite direction.
Traction:
Assess for complications following cast
Compartment syndrome
Fat emboli
Infection
DVT
Cast syndrome
Edema from a fracture causes an
increase in compartmental pressure that decreases capillary blood perfusion.
Pulselessness: slow nail bed capillary refill (>3sec)
Skin pallor, blanching, cyanosis or coolness
Increasing pain, swelling,pain on passive motion, painful edema peripheral to cast.
What complication of Fracture?
Compartmental Syndrome:
Cast syndrome results to
from the compression of the duodenum between the aorta and the superior mesenteric artery. The external compression is usually caused by a tight body cast.
If you diagnosed the cast syndrome, you correctly identified the clinical signs consistent with this syndrome. This is due to an extrinsic compression of
the third portion of the duodenum by the superior mesenteric artery
what lab is ordered in Cast syndrome?
Abdominal flat-plate
Can result in unresolved compartment syndrome. Arterial blood flow decreases, leading to ischemia, degeneration & contracture of muscle
Volkmann’s Contracture
characterized by neurologic dysfunction, pulmonary insufficiency, and petechial rash on chest, axilla & upper arms
Fat embolism syndrome (FES)
Immobility increases risk for
fat embolism, atelectasis, and pulmonary emboli.
KNOW the SIX Ps: Cast Assessment
Pain
Pallor
Paresthesia
Pulselessness
Paralysis
Polar
Watch out for ____________ after skeletal or muscular injury/surgery!
Deep Vein Thrombosis
10% volume loss =
tachycardia
memorize stages of blood loss
Stage I up to 15% (up to 750 ml)
Stage II 15-30% (up to 1500 ml) -subtle signs
Stage III 30-40% (1500-2000 ml) –obvious shock
Stage IV over 40% (over 2000 ml)
Muscle Spasms Interventions
Heat
Intervention: DVT/PE/FES
Client wears elastic stockings.
Teach leg exercises.
Observe for changes in mental status, chest pain and SOB.
Observe for swelling, redness and pain in legs (DO NOT MESSAGE).
Is accomplished by surgically inserting metal wires or pins thru distal bones to the # site or by anchoring metal tongs in the skull
Skeletal Traction
Check the four P’s of traction maintenance
Pounds
Pull
Pulleys
Pressure
Anterior cruciate ligament injuries
Tear of ACL
Mostly preformed on knee and shoulder by use of a fibroptic arthoscope
Arthroscopy
Complications of Arthroscopy
Infection
Blood in joint (hemarthrosis
Swelling
Synovial rupture
