musculoskeletal trauma Flashcards
describe joint dislocation
- joint no longer in anatomical alignment
- subluxation = partial dislocation
- orthopedic emergency: trauma dislocations
what are some complications of joint dislocation
- avascular necrosis
- check NV status immediately
describe acute interventions for joint dislocation
- xray
- immobilize and reduce joint
- may need sedation or heavy pain meds (fentanyl)
- please get informed consent before meds
whats some nursing considerations and education for joint dislocation
- NV assessment
- discuss exercises: PRICE
what are some causes of fractures
- direct blows
- crushing forces
- sudden twisting motion
how will the client present for fractures
- pain with movement (lessened when immobilized)
- muscle spasm
- deformity (often)
- eccymosis and edema at site (possible)
what are some diagnostic tests for fractures
- xray
- CT (excessive soft tissue damage)
what are some acute interventions for fractures
- NV assessment
- open: cover with saline gauze; prepare for surgery
- closed: reduction and immobilization, conscious sedation and informed consent
what are some complications of fractures
- complicated fractur: ORIF/external fixation, skeletal traction
- avascular necrosis
- osteomyelitis
- hemorrhage
- fat embolus (femur)
- compartment syndrome
- VTE ( from immobilization)
- DIC (bleed and use up all the clotting factors, treated with hep)
- nonunion (not together) and malunion (together but not right)
how can nurses help with fractures
education
- discuss conscious sedation for reduction
- aid in immobilization
- discuss splinting and casting
- PRICE
- NV assessment
- pain control
- monitor for complications
- discuss home care and follow up
what are some causes of pelvic fractures
- falls from great height; crush injuries
- MVA; vehicle vs pedestrian (ouch)
how will a client with pelvic fractures present
- ecchymosis (bc theres a shot ton of big vessels) and tenderness to A&P pelvis
- edema and NT to pubis, gentials, and thighs
- pain when weight bearing
whats the biggest concern with pelvic fractures
hemorrhage
what are some labs/diagnostics for pelvic fractures
CT and CBC
what are some acute interventions for pelvic fractures
- immobilize until surgery
- blood transfusion
what are some complications of pelvic fractures
- severe back pain (retroperitoneal bleed)
- hemorrhage (open book; rock pelvis)
- fat emboli
- NV compromise to lower extremities
what are some nursing considerations for pelvic fractures
- stable vs unstable
- monitor w bedrest and assess for complications of immobility
- painful to sit/defecate = sitz baths, stool softner
- early mobilization; rehab for full weight bearing in 3 months
- monitor for paralytic ileus (no bowel sounds)
what are some causes of hip fractures
falls
how will a client present with hip fracture
- affected leg shortened w external or internal rotation of foot
- pain in hip/groin/knee (upon slightest movement)
what are some diagnostic tests for hip fractures
- XRAY
- CT if worried about more damage
what are some acute interventions for hip fractures
- immobilize
- surgery (withi 24 hrs)
what are some complications of hip fractures
avascular necrosis
what are some nursing considerations for hip fractures
- standard post op care
- complications of immobility
- abductor pillow; les than 90 degrees; elevated toilet seat
- ambulate first day post op (in most cases)
- LTCF/rehab on floor/rehab at home w PT consult
- delirium on older adults
whats a cause of femur fractures
MVA
how will a client with a femur fracture present
- edema
- deformity
- pain to thigh/knee
what are some labs/diagnostics for femur fractures
- doppler US and Xray
- CBC
what are some acute interventions for femur fractures
- immobilize!
- assess NV function to extremity
- skeletal traction -> surgery
what are some complications of femur fractures
- hemorrhagic shock
- compartment syndrome
- fat emboli
what are some nursing considerations for femur fractures
- same as general post op
- may take up to 6 months to walk (intensive PT)
what are some causes of fat embolism syndrome (FES)
- orthopedic trauma
- rare: bone marrow transplant, osteomyelitis
whats happening with fat embolism syndrome (FES)
- fat emboli enter into microcirculation
- induce SIRS (systemis inflammatory response syndrome) = pulmonary, cutaneious, neurological, retinal symptoms
whats happening with fat embolism syndrome (FES)
- altered mental status (early)
- tachypnea, tachycardia, fever
- petechial rash
- resp depression (75%) - mild to ARDs to mechanical ventilation
- common systemic: resp distress, altered mental status, and rash
describe treatment of fat embolism syndrome (FES)
- largely supportive
- fix long bone fractures early = decerased liklihood of developing FES
- corticosteroids
what are some nursing considerations for fat embolism syndrome (FES)
- can occur when manipulating fractures
- monitor for hypoxemia
- GCS to assess for LOC (eye opening, verbal response, motor response)
- petechial rash transient (up to 24 hours)
- supportive care - monitor for ARDS
what are some causes of amputation
- diseases (vascular, DM, osteomyeltis)
- injuries
- surgery to remove tumors
what are some different levels of amputation
- performed at most distal point to allow for healing
- based on circulatory status of limb
- goal: achieve good proesthetic fit
- preservation of joints desirable (knee/elbow)
what are some complications of amputation
- hemorrhage
- infection
- joint contracture
- phantom limb pain
describe nursing focus and education for amputation
- rigid cast dressing: uniform compression and residual limb shaping
- rehabilitation (nurse, social worker, doctor, PT/OT, psych and prosthetist)
- pain
- promotion of wound healing
- enhancing body image
- coping/grief
- helping patient achieve mobility and independent care
describe pain management for amputation
- surgical pain = opioids
- changing positions/sandbag to residual limb
- phantom limb pain: mirror, massage, acupuncture, VR
- beta blockers (metorpolol)
- anticonvulsants (gabapentin)
- TCAs (amitriptyline)
what positioning is used to prevent hip/knee joint contractures
prone positioning
prone 20-30minutes TID
