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NURS 412 Midterm #2 > Musculoskeletal Trauma and Orthopedic Surgery > Flashcards

Musculoskeletal Trauma and Orthopedic Surgery Flashcards

1
Q

Most common cause of musculoskeletal Injuries:

A

Traumatic injuries result in:
- fracture
- dislocation
- soft tissue injury

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2
Q

Fracture

A

a disruption or break in continuity of the structure of bone

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3
Q

Dislocation

A

severe injury of the ligamentous structures around a joint that results in the complete displacement of the bone from its normal position
- immediate action is relocation

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4
Q

Fragility fractures

A

Fracture secondary to disease processes
- cancer or osteoporosis
- force exerted on a bone that shouldn’t normally break the bone but does

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5
Q

Fractures are described and classified according to: (6)

A
  • open or closed
  • complete or incomplete
  • direction of fracture line
  • displaced or nondisplaced
  • anatomical location of fracture or involved bone
  • stable or unstable
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6
Q

Types of Fractures (7)

A
  • Transverse
  • Spiral (twisting force)
  • Greenstick (one side fractured, the other bent - common in kids)
  • Comminuted (two or more fragments)
  • Oblique (horizontal direction)
  • Pathological (cancer eats away at bone)
  • Stress
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7
Q

Fracture classification according to location

A
  • proximal third - towards core
  • middle third
  • distal third
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8
Q

Fractures: Clinical Manifestations (10)

A
  • Edema & swelling - can cause compressure of nerves and vessels feeding the distal limb
  • Pain & tenderness
  • Bruising
  • Muscle spasm (often seen with fractured hip)
  • Deformity (may not be obvious)
  • Inability to bear weight on or loss of function
  • Abnormal movement
  • Crepitation (air in the tissue)
  • Neurovascular changes - decreased sensation, numbness
  • Hypovolemic shock (femur fracture - 1-1.5L of blood loss)
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9
Q

Femur Fracture: Immediate care

A

If a fracture is suspected, immobilize extremity in position it was found

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10
Q

Unnecessary movement: (3)

A
  • increases soft tissue damage
  • may convert a closed fracture into an open one
  • may create further injury to adjacent neurovascular structures
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11
Q

Fracture Healing: First two stages

A

Bone goes through remarkable reparation process of self-healing:
- fracture hematoma
- Granulation tissue

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12
Q

Overall Goals of Fracture Treatment: (3)

A
  • Anatomical realignment of bone fragments (reduction)
  • Immobilization to maintain realignment
  • Restoration of normal or near-normal function of injured parts
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13
Q

Fracture Reduction: Closed Reduction

A
  • nonsurgical, manual realignment of bone fragments to previous anatomical position
  • done under conscious sedation
  • post-reduction x-ray
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14
Q

Fracture Reduction: Open reduction

A
  • correction of bone alignment through surgical incision
  • includes internal fixation (ORIF) with use of wires, screws, pins, plates, intramedullary rods, or nails
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15
Q

Traction

A

Application of a pulling force to an injured or diseased part of the body or extremity while counter-traction pulls in opposite direction

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16
Q

Fracture Immobilization

A
  • Casts
  • Immobilizers
    Casting is done after reduction. Patient’s need to check circulation - swelling occurs
17
Q

External Fixation

A

Metallic device
Applied traction or compresses fracture fragments

18
Q

Internal Fixation

A

Pins, plates, rods

19
Q

Drug therapy

A
  • Varying degrees of pain and muscle spasm
  • Analgesics & muscle relaxers
  • Tetanus-diptheria toxoid -
  • Antibiotics - consider the kind
20
Q

Nutritional therapy

A
  • Proper nutrition
  • Adequate energy for body to repair
21
Q

Collaborative Care: Preventing Complications - Assessments (5)

A
  • Neurovascular assessments are key (more than just CWMS)
    Other assessments depend on type of fracture and stage of healing
  • Vital signs
  • Assessment for shock (femur patient’s)
  • Respiratory assessment
  • Skin integrity
22
Q

Goals of Collaborative Care (3) Surgical Goals (3)

A

Preventing complications
Regaining maximum function - early mobilization
Achieving best cosmetic result
Reduction - closed, open
Immobilization - cast, immobilizer, internal or external fixation, traction
Restore function

23
Q

Neurovascular Assessment - peripheral vascular (5) and neurological assessment (3)

A

Peripheral Vascular Assessment
- colour
- warmth
- capillary refill
- peripheral pulses
- edema
Peripheral Neurological Assessment
- sensation
- motor function
- pain
COMPARE BOTH EXTREMITIES!!

24
Q

Ambulatory & Home Care Cast Care: DO (7)

A
  • Apply ice directly over fracture site for first 24 hours
  • Dry cast after exposure to water
  • Elevate extremity above level of heart for first 48 hours
  • Use hair dryer on cool setting for itching
  • move joints above & below cast regularly
  • report signs of possible problems
  • keep appointment to have fracture & cast checked
25
Q

Ambulatory & Home Care Cast Care: DON’T

A
  • Get plaster cast wet or remove any padding
  • Insert any objects inside cast or bear weight on new cast for 48 hours
  • Cover cast with plastic for prolonged periods
26
Q

Fracture Complications Direct and Indirect (6)

A
  • Infection (Direct)
  • Fat embolism syndrome (ID)
  • Compartment Syndrome (ID)
  • VTE (ID)
  • Rhabdomyolysis (ID)
  • Hypovolemic Shock (ID)
27
Q

Direct: Infection
- which fractures?

A
  • Associated with open fractures and soft-tissue injuries - where there has been significant damage and blood flow is impeded
  • Often related to high-energy trauma
  • Massive/blunt soft tissue trauma often has more serious consequences than the fracture itself
28
Q

Infection: Collaborative Care (4)

A
  • Aggressive surgical debridement
  • Early sterile N/S lavage
  • Extent of soft tissue injury determines whether the wound is closed or left-open (vac dressing)
  • IV antibiotics for 3-7 days
29
Q

Indirect: Fat Embolism Syndrome
- What is it?
- Most frequent cause?

A

Presence of systemic fat globules from fractures distributed into tissues & organs after a traumatic skeletal injury
Happens 1- 3 days after
- Fat globules -> occlusion of pulmonary vessels -> pulmonary edema, severe hypoxia & cardiovascular compromise
Most often fractures of long bones (90%), ribs, tibia, & pelvis

30
Q

Signs & Symptoms of Fat Embolism (9) and Key prevention

A

hypoxia, anxiety, dyspnea, tachypnea, tachycardia, cyanosis, crackles
Neurologic abnormalities
- petechiae around the neck are a distinguishing feature
Prevention is KEY through immobilization of long bone fractures

31
Q

Indirect: Compartment Syndrome
- what is it?

A

Elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
- capillary perfusion below level necessary for tissue viability - ischemia occurs

32
Q

Compartment Syndrome: Etiology

A
  • decreased compartment size (restrictive dressings, splints, casts, excessive traction or premature closure of fascia)
  • increased compartment content (bleeding, edema, chemical response or intravenous infiltration)
33
Q

Compartment Syndrome: Early Recognition

A

Early Recognition & treatment essential
- ischemia can occur within 4-12 hours
Regular neurvascular assessments
May occur initially or may be delayed for several days
Classic Sign - pain that is not commensurate with injury. given morphine and still in extreme pain

34
Q

Compartment Syndrome: Clinical Manifestations - 6 Ps

A
  • Paresthesia - numbness and tingling
  • Pain - distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through compartment
  • Pressure - increased in compartment
  • Pallor - coolness, and loss of normal colour of extremity
  • Paralysis - loss of function
  • Pulselessness - diminished/absent peripheral pulses
35
Q

Compartment Syndrome: Clinical Manifestations - Urine Output
- signs of myoglobinuria

A
  • Urine output must be assessed because there is a possibility of muscle damage
  • Myglobin released from damaged muscle cells precipitates as a gel-like substance - causes obstruction in renal tubules
  • large amounts of myoglobinemia may result in acute tubular necrosis. Acute tubular necrosis causes acute renal failure
  • Common signs of myoglobinuria:
    Dark reddish brown urine - clinical manifestations associated with acute renal failure
36
Q

Compartment Syndrome: Collaborative Care

A
  • Prompt accurate diagnosis
  • Extremity should NOT be elevated above heart level - elevation may decrease venous pressure and slow arterial perfusion
  • Application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome
  • May be necessary to remove or loosen bandage or bivalve cast
  • Reduction in traction weight may decreased external circumferential pressures
  • Surgical decompression may be necessary (Fasciotomy)
37
Q

Long Term Fracture Complications (3)

A
  • joint stiffness or post-traumatic arthritis
  • avascular necrosis
  • altered union (malunion, delayed union, non union)
38
Q

Take Home Message: Assessments

A

Ongoing assessments are key to the prevention of complications
- Vital signs
- Assessment of fracture site
- Neurovascular assessments
- Respiratory, cardiovascular, integument, neurological

39
Q

Fractures: Preventative Interventions Include: (5)

A
  • Maintaining adequate tissue perfusion
  • maintaining immobilization of fracture site
  • Performing post-operative exercises
  • Maintaining hydration and nutritional status
  • Preventing infection

NURS 412 Midterm #2 (18 decks)

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