Musculoskeletal Trauma

Question 1

Contusions

Answer 1

soft tissue injury, resorts from blunt force, hematoma at site of impact, pain, discoloration, swelling, employ RICE

Question 2

Strains

Answer 2

Injury to muscle or tendon, from overuse and overstretching
1st degree: mild pain, no loss of ROM
2nd degree: moderate pain w/ ROM, edema
3rd degree: severe stretching w/ rupture/tearing

Question 3

Sprains

Answer 3

Injury to ligament, causes joint instability, due to twisting, stretching, hyperextension (Xray to r/o bone injury)
1st degree: tears in fibers, mild pain & swelling
2nd degree: partial tear
3rd degree: complete tear, severe pain & swelling

Question 4

Strain and sprain treatment

Answer 4

RICE

Question 5

Fractures causes

Answer 5

Direct force – falls, trauma
* Torsion – twisting such as skiing
* Disease processes –
osteoporosis, cancer
* Stress – runners, sports

Question 6

Fractures clinical manifestations

Answer 6

Bleeding
* Pain
* Deformity
* abnormal position of bone
* Edema
* Ecchymosis
* extravasation of blood into tissue
* Crepitus
* “crunching” of bony fragments

Question 7

Greenstick fracture

Answer 7

partial

Question 8

closed

Answer 8

no open wound

Question 9

open

Answer 9

breaks through skin

Question 10

comminuted

Answer 10

3 or more fragments

Question 11

compression

Answer 11

impact fracture

Question 12

oblique

Answer 12

fracture runs in slanted direction

Question 13

Spiral

Answer 13

fracture coils around bone

Question 14

transverse

Answer 14

fracture straight across the bone

Question 15

Fracture diagnostics

Answer 15

• X-ray: to confirm bone disruption, misalignment, deformity
• CT-scan: for complicated fractures
• Bone Scan

Question 16

Fracture complications

Answer 16

Compartment Syndrome
* Rhabdomyolysis
* DVT, PE
* Fat embolism
* Rapid, within 12 hours of injury
* dyspnea, hypoxia, chest pain, fever, crackles, restlessness
* Avascular necrosis (osteonecrosis)
* Osteomyelitis

Question 17

Fracture emergency care

Answer 17

Remove clothing
* Assessment of site
* Neurovascular assessment
* 5 P’s
* Control bleeding
* Immobilization
* Control pain
* Wound care

Question 18

Closed reduction

Answer 18

Manual re-alignment of bone
* Application of cast or splint afterward
* Local or general anesthesia

Question 19

Open reduction and internal rotation

Answer 19

Surgical re-alignment with pins, nails, or screws
to stabilize fracture

Question 20

Fiberglass cast

Answer 20

lighter weight, stronger, water resistant, dry fast, durable, more difficult to mold, best
for simple fractures, better Xray pictures

Question 21

Plaster cast

Answer 21

less expensive, heavier, not water resistant, may take up to 72 hrs. to dry
* requires padding, may have rough edges&raquo_space;> smoothing, petaling of edges may be
necessary, application of moleskin or stockingette

Question 22

Splints

Answer 22

most often for simple fractures, sprains, & soft tissue injuries
* May provide initial stability for complicated fractures

Question 23

possible complications of external fixators, casting and splinting

Answer 23

Compartment syndrome
* Infection
* Pressure injury
* Disuse syndrome & muscle atrophy

Question 24

What are compartments?

Answer 24

46 anatomic compartments in body
* each is encased by fascia
* fibrous membrane that covers &
separates muscles

Question 25

Compartment syndrome and causes

Answer 25

Increased compartmental pressure >>> tissue ischemia >>> tissue death >>> Causes: edema, bleeding, restriction from cast * Usually occurs within 8 hours of injury

Question 26

Compartment syndrome symptoms

Answer 26

deep, throbbing, intense pain that intensifies with passive movement

Question 27

Compartment syndrome assessment

Answer 27

5 P’s * nail beds, capillary refill, sensation, * palpation of muscle >>> hard & swollen, taut skin

Question 28

Compartment syndrome treatment

Answer 28

immediate * fasciotomy to relieve pressure * closure of wound in 2-3 days * if wound NOT closed, kept moist w/ saline dressing * wound VAC may be applied * keep limb elevated above heart level * passive ROM can be performed

Question 29

Compartment syndrome complications

Answer 29

rhabdo, AKI, infection, limb loss

Question 30

Healing process for fractures

Answer 30

48-72 hrs: osteoblasts rush to site >>> production of granulation tissue or new bone Week 1: formation of hematoma at site Week 2-3: callus formation (bony network composed of cartilage, osteoblasts, calcium Week 4-16: callus ossifies & prevents movement of fracture Week 17+: callus continues to develop & closes fracture Healing length: 6 wks – young adult; 3-6 mos - older adult Inhibits Healing: smoking, diabetes, RA, age >40, chronic steroid use, infection

Question 31

Nursing care of fractures

Answer 31

Pain management * Immobilization, as indicated * Monitor neurovascular status * Maintain skin integrity * Monitor for complications * Prevent infection * Patient education * Promote mobility * As indicated * ROM exercises * Assistive Devices >>>> * Refer to PT/OT

Question 32

Crutches

Answer 32

tripod stance, crutches out to side and in front of toes, increases stability, should have large rubber tips, patients should wear firm soled, well- fitting shoes

Question 33

Other assistive devices

Answer 33

cane, quad cane, walker

Question 34

Traction

Answer 34

Pulling force (with weights) to promote & maintain alignment * Not commonly used anymore * depends on orthopedic surgeon’s treatment plan & choice * surgical reduction more effective * ??? actual effectiveness of traction

Question 35

Skin traction

Answer 35

Short-term use to stabilize fracture & immobilize limb * 4-8 lbs. for an extremity * Up to 9 lbs. for pelvis * Use of boots, straps * Bucks Traction * For lower leg

Question 36

skeletal traction

Answer 36

For longer period of use * Used when heavier weight is needed to stabilize & immobilize * 25-40 lbs. * Metal wire or pin is passed through bone

Question 37

Traction nursing care

Answer 37

assessment, monitor for complications, alignment, pressure injury prevention, infection prevention, pain management, DVT prevention (slides 17-18)

Question 38

Hip fractures

Answer 38

Age > 65 * Fall = major cause * Greater risk = women, osteoporosis * Mortality rate = 25% * Diagnosis: x-ray

Question 39

Hip fracture treatment

Answer 39

ORIF, closed reduction with fixation, or replacement of femoral head w/ prosthesis * maintain abduction * ice packs * pain management * use of trapeze for bed; assistive devices

Question 40

Post op nursing comps for hip fractures

Answer 40

Pain management Neurovascular assessment Prevent complications * Bleeding: site assessment, monitor BP * DVT: TED stockings, SCD’s, anticoagulants, encourage fluids, foot exercises * Infection: monitor temp, CBC, mental status, wound assessment, wound care * Respiratory: I.S., deep breathing exercises, repositioning, lung assessment * Skin breakdown: skin care, repositioning, foam mattress, good nutrition, toileting Positioning * maintain abduction, turn >> uninjured side, use of pillow between legs, use overhead trapeze, out of bed to chair POD #1, Physical Therapy, assistive devices

Question 41

Amputation

Answer 41

> 50% amputations are due to diabetic complications * higher risk = African American * Extent of amputation determined by circulatory status * evaluated by: Doppler flow studies, Angiography

Question 42

Amputation complications

Answer 42

hemorrhage, infection, skin breakdown, joint contracture

Question 43

Phantom limb pain

Answer 43

due to severing of peripheral nerves * affects 50-80% patients * amputated limb feels “crushed, cramped, twisted” * can last up to 2 yrs

Question 44

BKA vs AKA amputation

Answer 44

maintenance of knee- improved post op mobility

Question 45

Guillotine amputation

Answer 45

amputation w/o closure of the skin, urgent situation

Question 46

Amputation nursing care

Answer 46

pain relief, wound care, assess for infection, psychosocial support, promote self care, promote mobility (slide 37)

Question 47

Rhabdomyolysis

Answer 47

“striated muscle dissolution” * rapid breakdown of skeletal muscle following injury * Large amts. of creatinine, myoglobin, potassium, phosphate “leak” into circulation * Precipitates acute tubular necrosis >>> acute kidney injury

Question 48

Rhabdo causes

Answer 48

traumatic injury, crush injury, compartment syndrome, falls, overexertion, alcohol abuse, illicit drug use, burns

Question 49

Rhabdo symptoms

Answer 49

Tea-colored urine * Myoglobinuria * myoglobin = protein which carries & stores O2 in muscle cells * Hyperkalemia * Elevated CK levels normal < 200 > 6000 = diagnostic * CK found in skeletal muscle, heart, brain * CK-MM = muscle * CK-MB = heart * Myalgia & Muscle Weakness

Question 50

Rhabdo treatment

Answer 50

Adequate IV hydration to prevent AKI * Splinting and/or repair of muscle damage * Control bleeding