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Adult Health 2 Test 4 > Musculoskeletal trauma and Ortho Surgery > Flashcards

Musculoskeletal trauma and Ortho Surgery Flashcards

1
Q

What are the structures of the musculoskeletal system?

A 
bones 
joints 
muscle 
cartilage
ligaments and tendons 
fascia 
bursae
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2
Q

What blood test would you do in relation to the musculoskeletal system?

A 
rheumatoid factor (RF)
erythrocyte sedimentation rate (ESR)
antinuclear antibody (ANA)
uric acid
C-reactive protein (CRP)
creatinine kinase (CK)
potassium
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3
Q

What are the types of injuries when it comes to the musculoskeletal system?

A

sprain
strain
dislocation
subluxation

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4
Q

What are the clinical manifestations of strains/sprains?

A 
pain
edema 
decreased function 
contusion 
usually self-limiting
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5
Q

What is the nursing care for sprains and strains?

A

R -rest
I - ice
C - compression
E - elevation

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6
Q

What is the nursing care for dislocation and subluxation?

A

dislocation - needs prompt attention
need reduction then immobilization
put in an IV for pain meds and sedation

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7
Q

What are complications of dislocation and subluxation?

A

avascular necrosis
compartment syndrome
open joint injuries
fractures

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8
Q

What are sports related injuries to the musculoskeletal system?

A

cartilage - knee meniscus
ligaments - ACL
rotator cuff injury
bursitis patellar dislocation

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9
Q

What is the nursing care of various sports injuries?

A

conservative treatments: rest, ice, heat, NSAIDS, corticosteroid injections, PT
surgical repair may be necessary
RICE

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10
Q

What is a fracture?

A

a break or disruption in the continuity of a bone

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11
Q

What are the classifications of fractures?

A 
open 
compound 
closed 
complete 
incomplete
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12
Q

What are signs & symptoms of fractures?

A 
edema and swelling 
pain and tenderness 
muscle spasm 
deformity 
echymosis or contusion 
loss of function 
crepitation
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13
Q

What is the etiology of fractures

A 
Trauma 
   cars, motorcycles, horses, falls, etc
Bone disease 
   cancer 
   osteoporosis
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14
Q

What are the classifications of fractures?

A

pathologic
fatigue/stress fractures
compression fractures

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15
Q

What diagnostic studies do you perform for fractures?

A

simple x-ray
CT scan - complex structures as hip, pelvis and spine
Bone Scan - small bone fractures of fractures from stress or disease
shows inflammatory process well

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16
Q

What does the nursing assessment for a fracture entail?

A 
History of what happens = MOI (mechanism of injury) 
Other history 
Medical 
Allergies 
Occupation 
Nutrition
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17
Q

What does the neurovascular assessment of a fracture entail?

A 
5 P's 
Pain 
Pulses 
Paresthesia 
Pallor 
Paralysis
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18
Q

How do you immobilize a fracture?

A

Splints (always check circulation before and after splinting

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19
Q

What are the goals of medical treatment for fractures

A

anatomic realignment of bone fragments (reduction)
Immobilization to maintain realignment
Restoration of normal or near normal function of injured part

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20
Q

What are the different stages of healing in fractures?

A

Fracture hematoma - immediately after fracture, bleeding & edema occur. Within 72 hours.
Granulation tissue - phagocytosis occurs
Callus formation
Ossification 2-3 weeks after break, a permanent callus of woven bone forms
Consolidation - callus continues to develop decreasing the distance between the bone fragments
Remodeling - union is complete

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21
Q

Wat are the different methods for reducing a fracture?

A

closed reduction
open reduction
traction

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22
Q

What is the collaborative care needed for fractures?

A 
Fracture reduction - closed reduction or open reduction
Traction - skin, skeletal 
Casts 
External Fixation 
Internal Fixation
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23
Q

What does a closed reduction of a fracture entail?

A 
Nonsurgical realignment of the bones 
Its painful 
General or local anesthesia is used 
  "Conscious sedation"
X-ray to confirm alignment 
Casting
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24
Q

What do we need to know about casts?

A

Temporary circumferential immobilization device
Common treatment following closed reduction
Immobilization above and below the joint restricts movement to allow healing
Pad bony prominences
Multiple types
Plaster of Paris - avoid direct pressure to cast,
sets within 15 minutes, no weight bearing 48
hours
Synthetic materials - much lighter
If in a spica cast or one that goes around the abdomen there is a hole to assess bowl sounds (put on stool softeners and H2 receptors)

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25
Q

What can you not do with a cast?

A

get cast wet
remove any padding
insert objects inside the cast
bear weight on new cast for 48hrs (not all casts are made for weight bearing; check with HCP when unsure)
Cover cast with plastic for prolonged periods

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26
Q

What can you do with a cast?

A

Apply ice directly over fracture site for 1st 24 hours
Check with HCP before getting fiberglass cast wet
Dry cast thoroughly after exposure to water
blot dry with towel
use hair dryer on low setting until cast is thoroughly dry
Elevate extremity above level of heart for 1st 48hrs
Move joints above and below cast regularly
Use hair dryer on cool setting for itching
Report signs of possible problems to HCP
Increasing pain
Swelling associated with pain and discoloration of toes or fingers
Pain during movement
Burning or tingling under cast
Sores or foul odor under the cast
Keep appointment to have fracture and cast checked

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27
Q

What does an open reduction of a fracture entail?

A

It’s a surgical procedure
There is an incision over the fracture site
Internal fixation with the use of wires, screws, pins, plates, intramedullary rods or nails
Usually with open (compound) fractures

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28
Q

What is internal fixation of a fracture?

A

Placement of internal hardware to “fix” the fragments in place
Using
rods, pins, nails, screws, metal plates
Promotes early mobility
Preferred for older adults

29
Q

What is an open reduction/internal fixation (ORIF)?

A

A surgical Incision to correct bone alignment

Use of wires, screws, pins nails or rods

30
Q

What is external fixation of a fracture?

A

Similar to internal fixation, but pins inside the bone are attached to a frame outside the body
With extensive soft tissue damage or infection, external fixation allows easy access to the site and facilitates wound care
Allows early mobility while relieving pain
Pin track infection occurs in about 10%

31
Q

What is traction?

A

Application of a pulling force to an injured or diseased part of the body/extremity while countertraction pulls in the opposite direction

32
Q

What are the goals of traction?

A

Prevent/reduce pain/spasms
Immobilize a joint or a part of the body
Reduce the fracture or dislocation
Treat a pathologic joint condition

33
Q

What are the different types of traction?

A 
Skin - uses light weights 
  short term 
  tape, boots or splints 
Skeletal - heavier weights 
  used longer 
  pins or wires inserted into the bone
34
Q

What is buck’s traction most commonly used for?

A

used for fractures of the hip and femur

35
Q

What is the nursing care required for a patient in traction?

A 
Assist in set up
Don't remove weights without an order 
Weights should hang freely 
Inspect skin a minimum of every 8 hours 
Watch areas with pins, wires screws
Assess neurovascular status of affected body part
36
Q

What are complications of traction?

A 
impaired circulation 
inadequate bone alignment 
skin breakdown 
soft tissue injury 
pin track infection (10%)
osteomyelitis
37
Q

What are the pharmacological treatment of fractures?

A 
Muscle relaxants 
  Carisoprodol (Soma)
  Cyclbenzaprine (Flexaril)
  Methocarbamol (Robaxin)
Tetanus and antibiotics for an open fracture 
Pain medications
38
Q

What is the nutritional therapy needed for a fracture?

A 
Ample protein (1g/kg of body weight)
Vitamins (B,C,D)
Calcium
Phosphorus 
Magnesium 
Needed to:
  Promote muscle strength and tone
  Build endurance 
  Provide energy for ambulation and gait-training skills 
Adequate fluid intake 
  2-3L/day
High fiber diet with fruits and vegetables 
If in a body cast (6 small meals a day)
39
Q

What are goals for patients with fractures?

A

Have physiologic healing without associated complications
Obtain satisfactory pain relief
Achieve maximal rehab potential
Anatomic realignment of bone fragments
Immobilization to maintain realignment
Restoration of normal or near-normal function of injured parts

40
Q

What are causes of slow healing with fractures?

A 
Inadequate immobilization 
Excess movement 
Poor alignment 
Infection 
Poor nutrition
41
Q

What are complications of fractures?

A

Acute compartment syndrome
Shock
Fat emboli
Venous Thromboembolism

42
Q

What is compartment syndrome?

A

Compartments have increased pressure compromising nerves and circulation
Resulting in pressure on nerve endings and reduced blood flow
Two sources of pressure
decreased compartment size from casts, splints or dressings
increased compartment content
Relatively rare
MEDICAL EMERGENCY
Ischemia in 4-12 hours
Limb useless or limb loss within 24-48 hours

43
Q

What are the symptoms of compartment syndrome?

A

Ischemia occurs
Increased pain
change in color
paresthesia

44
Q

How do you treat compartment syndrome?

A

fasciotomy

45
Q

What are the 6 p’s of compartment syndrome?

A 
Paresthesia 
Pain
Pressure 
Pallar 
Paralysis 
Pulselessness
46
Q

What is shock in relation to fractures?

A

bone is vascular
femur fracture-patient can lose 1L of blood
Large blood volume loss associated with fractures

47
Q

How do you treat shock?

A

fluids

blood replacement

48
Q

What is a venous thromboembolism?

A

Includes:
DVT - deep vein thrombosis
PE - pulmonary emboli
Most common complication of lower extremity surgery or trauma
Aggravated by inactivity of muscles that normally assist in pumping action of venous blood

49
Q

Hpw dp ypi prevent and treat DVTs?

A

anticoagulants
compression devices - TEDS, sequential stockings
early ambulation
ROM exercises

50
Q

What is Fat Embolism Syndrome

A

Fat globules are released from exposed marrow into blood stream
May migrate to lungs
Too large to pass through pulmonary circulation
Lodge in capillaries
Break down into fatty acids

51
Q

What are the signs and symptoms of fat embolism syndrome?

A 
Most patients manifest symptoms 24-48 hours after injury
Respiratory distress is first 
Tachycardia 
Tachypnea 
Fever 
Confusion
Decreased LOC 
Petechiae over neck, upper arms, chest or abdomen
52
Q

How do you treat fat embolism syndrome?

A 
prevention 
fluid resuscitation 
encourage coughing and deep breathing 
gentle handling 
oxygen 
ventilatory support 
diuretics for pulmonary edema 
corticosteroids (controversial)
53
Q

What are the diagnostic studies performed prior to amputation?

A

Arteriogram: x-ray exam with the use of contrast material to visualize the blood flow to the arteries; invasive procedure
Venogram: x-ray exam with the use of contrast material to visualize the blood flow to veins; invasive procedure
Doppler studies: can detect the arterial and venous blood flow patterns; non-invasive procedure

54
Q

What are the clinical indications for amputation?

A

circulatory impairment
traumatic or thermal injuries
malignant tumors
widespread infection of extremity

55
Q

What nursing care is provided for amputation patients?

A 
prevention and detection of problems 
assess dressing, change as indicated 
infection, bleeding 
compression bandages 
pain control 
psychosocial issues 
prosthetic fitting
56
Q

What nursing care needs to be provided for prosthesis and wound care after amputation?

A

Prevention of infection is paramount
PT and OT to assist in ADL’s
Wrapping stump correctly for reducing edema to help prepare for prosthesis

57
Q

What are the overall goals of amputation?

A

Preserve extremity length and function while removing all infected, pathologic, or ischemic tissue
Relief from underlying health problems
Satisfactory pain control
Reach maximal rehabilitation potential with prosthesis (if indicated)
Cope with body image change
Make satisfying lifestyle adjustments
Keep chronic health problems under control (diabetes, COPD)

58
Q

What are nursing implications of amputation?

A

Health promotion:
Control of the causative illness such as:
PVD, DM, pressure ulcers
Psychologic and Social implications
Allow the patient to go through the grieving process
Pre-operative management
Post-operative management

59
Q

What are complications of amputations?

A 
hemorrhage 
infection 
phantom limb pain
flexion contractures 
psychosocial issues
60
Q

What do we need to know about infection in relation to fractures and amputation?

A

body’s defense interrupted
superficial wound infection to deep wound
clostridial infection - gangrene
osteomyelitis - bone infection - open fracture

61
Q

How do you treat infection in relation to fractures and amputation?

A

prevention
debridement
surgery
antibiotics

62
Q

Where can hip fractures occur?

A 
Intracapsular 
  head and neck of hip
Extracapsular 
  trochanteric area 
Femoral neck
Intertrochanteric 
Common in elderly due to falls
63
Q

How do you treat hip fractures?

A

bucks traction
ORIF rods, pins, prosthesis, plates
If femoral head or neck fractured-may need prosthetic device implanted
Total hip replacement

64
Q

Gemur fractures

A

usually result of major trauma

patient can lose up to 1-1.5L of blood in thigh

65
Q

Pelvis fracture

A

stable or unstable

patient can lose up to 2-3 L of blood

66
Q

Compression fractures

A

vertebral fractures
associated with osteoporosis
bone mass diminishes

67
Q

What are the medical and nursing interventions for fractures?

A 
always check ABC's first 
visualize area of concern
Assess 
Immobilize/splint
Non-surgical interventions (closed reduction - moderate sedation)
Surgical interventions
68
Q

What are the nursing diagnoses for fractures?

A 
acute pain
risk for peripheral neurovascular dysfunction 
impaired physical mobility 
risk for infection 
impaired nutrition 
potential for elimination disturbances
69
Q

What is the nursing care required for fractured?

A 
concern for blood loss
pain control 
mobility-need to know do's and don'ts 
neurovascular assessment 
incision assessment 
nutrition and elimination

Adult Health 2 Test 4 (5 decks)

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