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adults > musculoskeletal trauma > Flashcards

musculoskeletal trauma Flashcards

1
Q

describe joint dislocation

A
  • joint no longer in anatomical alignment
  • subluxation = partial dislocation
  • orthopedic emergency: trauma dislocations
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2
Q

what are some complications of joint dislocation

A
  • avascular necrosis
  • check NV status immediately
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3
Q

describe acute interventions for joint dislocation

A
  • xray
  • immobilize and reduce joint
  • may need sedation or heavy pain meds (fentanyl)
  • please get informed consent before meds
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4
Q

whats some nursing considerations and education for joint dislocation

A
  • NV assessment
  • discuss exercises: PRICE
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5
Q

what are some causes of fractures

A
  • direct blows
  • crushing forces
  • sudden twisting motion
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6
Q

how will the client present for fractures

A
  • pain with movement (lessened when immobilized)
  • muscle spasm
  • deformity (often)
  • eccymosis and edema at site (possible)
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7
Q

what are some diagnostic tests for fractures

A
  • xray
  • CT (excessive soft tissue damage)
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8
Q

what are some acute interventions for fractures

A
  • NV assessment
  • open: cover with saline gauze; prepare for surgery
  • closed: reduction and immobilization, conscious sedation and informed consent
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9
Q

what are some complications of fractures

A
  • 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)
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10
Q

how can nurses help with fractures

A

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

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11
Q

what are some causes of pelvic fractures

A
  • falls from great height; crush injuries
  • MVA; vehicle vs pedestrian (ouch)
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12
Q

how will a client with pelvic fractures present

A
  • 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
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13
Q

whats the biggest concern with pelvic fractures

A

hemorrhage

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14
Q

what are some labs/diagnostics for pelvic fractures

A

CT and CBC

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15
Q

what are some acute interventions for pelvic fractures

A
  • immobilize until surgery
  • blood transfusion
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16
Q

what are some complications of pelvic fractures

A
  • severe back pain (retroperitoneal bleed)
  • hemorrhage (open book; rock pelvis)
  • fat emboli
  • NV compromise to lower extremities
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17
Q

what are some nursing considerations for pelvic fractures

A
  • 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)
18
Q

what are some causes of hip fractures

A

falls

19
Q

how will a client present with hip fracture

A
  • affected leg shortened w external or internal rotation of foot
  • pain in hip/groin/knee (upon slightest movement)
20
Q

what are some diagnostic tests for hip fractures

A
  • XRAY
  • CT if worried about more damage
21
Q

what are some acute interventions for hip fractures

A
  • immobilize
  • surgery (withi 24 hrs)
22
Q

what are some complications of hip fractures

A

avascular necrosis

23
Q

what are some nursing considerations for hip fractures

A
  • 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
24
Q

whats a cause of femur fractures

A

MVA

25
Q

how will a client with a femur fracture present

A
  • edema
  • deformity
  • pain to thigh/knee
26
Q

what are some labs/diagnostics for femur fractures

A
  • doppler US and Xray
  • CBC
27
Q

what are some acute interventions for femur fractures

A
  • immobilize!
  • assess NV function to extremity
  • skeletal traction -> surgery
28
Q

what are some complications of femur fractures

A
  • hemorrhagic shock
  • compartment syndrome
  • fat emboli
29
Q

what are some nursing considerations for femur fractures

A
  • same as general post op
  • may take up to 6 months to walk (intensive PT)
30
Q

what are some causes of fat embolism syndrome (FES)

A
  • orthopedic trauma
  • rare: bone marrow transplant, osteomyelitis
31
Q

whats happening with fat embolism syndrome (FES)

A
  • fat emboli enter into microcirculation
  • induce SIRS (systemis inflammatory response syndrome) = pulmonary, cutaneious, neurological, retinal symptoms
32
Q

whats happening with fat embolism syndrome (FES)

A
  • 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
33
Q

describe treatment of fat embolism syndrome (FES)

A
  • largely supportive
  • fix long bone fractures early = decerased liklihood of developing FES
  • corticosteroids
34
Q

what are some nursing considerations for fat embolism syndrome (FES)

A
  • 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
35
Q

what are some causes of amputation

A
  • diseases (vascular, DM, osteomyeltis)
  • injuries
  • surgery to remove tumors
36
Q

what are some different levels of amputation

A
  • 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)
37
Q

what are some complications of amputation

A
  • hemorrhage
  • infection
  • joint contracture
  • phantom limb pain
38
Q

describe nursing focus and education for amputation

A
  • 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
39
Q

describe pain management for amputation

A
  • surgical pain = opioids
  • changing positions/sandbag to residual limb
  • phantom limb pain: mirror, massage, acupuncture, VR
  • beta blockers (metorpolol)
  • anticonvulsants (gabapentin)
  • TCAs (amitriptyline)
40
Q

what positioning is used to prevent hip/knee joint contractures

A

prone positioning

prone 20-30minutes TID

adults (51 decks)

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