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Med Surg > Musculoskeletal Trauma > Flashcards

Musculoskeletal Trauma Flashcards

1
Q

Contusions

A

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

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2
Q

Strains

A

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

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3
Q

Sprains

A

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

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4
Q

Strain and sprain treatment

A

RICE

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5
Q

Fractures causes

A

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

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6
Q

Fractures clinical manifestations

A

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

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7
Q

Greenstick fracture

A

partial

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8
Q

closed

A

no open wound

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9
Q

open

A

breaks through skin

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10
Q

comminuted

A

3 or more fragments

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11
Q

compression

A

impact fracture

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12
Q

oblique

A

fracture runs in slanted direction

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13
Q

Spiral

A

fracture coils around bone

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14
Q

transverse

A

fracture straight across the bone

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15
Q

Fracture diagnostics

A
  • X-ray: to confirm bone disruption, misalignment, deformity
  • CT-scan: for complicated fractures
  • Bone Scan
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16
Q

Fracture complications

A

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

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17
Q

Fracture emergency care

A

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

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18
Q

Closed reduction

A

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

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19
Q

Open reduction and internal rotation

A

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

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20
Q

Fiberglass cast

A

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

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21
Q

Plaster cast

A

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

22
Q

Splints

A

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

23
Q

possible complications of external fixators, casting and splinting

A

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

24
Q

What are compartments?

A

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

25
Q

Compartment syndrome and causes

A

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

26
Q

Compartment syndrome symptoms

A

deep, throbbing, intense pain that intensifies with passive movement

27
Q

Compartment syndrome assessment

A

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

28
Q

Compartment syndrome treatment

A

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

29
Q

Compartment syndrome complications

A

rhabdo, AKI, infection, limb loss

30
Q

Healing process for fractures

A

48-72 hrs: osteoblasts rush to site&raquo_space;> 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

31
Q

Nursing care of fractures

A

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&raquo_space;»
* Refer to PT/OT

32
Q

Crutches

A

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

33
Q

Other assistive devices

A

cane, quad cane, walker

34
Q

Traction

A

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

35
Q

Skin traction

A

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

36
Q

skeletal traction

A

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

37
Q

Traction nursing care

A

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

38
Q

Hip fractures

A

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

39
Q

Hip fracture treatment

A

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

40
Q

Post op nursing comps for hip fractures

A

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&raquo_space; uninjured side, use of pillow between legs, use overhead trapeze, out of
bed to chair POD #1, Physical Therapy, assistive devices

41
Q

Amputation

A

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

42
Q

Amputation complications

A

hemorrhage, infection, skin breakdown, joint contracture

43
Q

Phantom limb pain

A

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

44
Q

BKA vs AKA amputation

A

maintenance of knee- improved post op mobility

45
Q

Guillotine amputation

A

amputation w/o closure of the skin, urgent situation

46
Q

Amputation nursing care

A

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

47
Q

Rhabdomyolysis

A

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

48
Q

Rhabdo causes

A

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

49
Q

Rhabdo symptoms

A

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

50
Q

Rhabdo treatment

A

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

Med Surg (15 decks)

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