Unit 5 MS Trauma Flashcards
What should be the initial nursing assessment for a suspected MS injury?
- Ensure scene safety
- Get help
- Ensure ABC
- Control external breathing
- Provide PT comfort/psychosocial support
- Do not leave PT alone
What is the nursing management of a known MS trauma?
-Initial treatment of injured site
Neurovascular status distal to injury
Splint joints above and below fracture sites
Elevate if possible
Do not attempt to straighten fractured or dislocated joint or manipulate protruding bones
Pain management
Prepare dx tests
What are the two parts two a neurovascular assessment?
Peripheral vascular assessment:
- Color
- Temp
- Cap refill
- Distal pulses
- Edema
Peripheral neurological assessment
- Sensation
- Pain
- Motor function
What are diagnostic tests for MS injuries?
X-rays (joints, bones, muscles)
Arthrogram ( x-rays to obtain a series of pictures of a joint after a contrast material injected into it)
Bone scan - injects radioisotope (couple hrs before exam) via IV, camera scans entire body front and back
EMG - looks at health of muscles; the nerves
MRI - soft tissues
CT scan (if contrast needs to be NPO)
What needs to be asked prior to a PT ingesting contrast before a diagnostic test?
Ask if the PT is allergic to seafood or Iodine
What are types of soft tissue injuries?
Strain - tear in muscle or tendon
Sprain - stretching or tearing of ligaments (3-6 weeks to heal)
Avulsion fracture - Small chunk of bone that pulls away from the rest
Hemarthrosis - Bleeding in joint w/o other trauma
Dislocation - injury to joint (where to or more bones come together)
What is the nursing care for a dislocated joint?
Pain management
Support joint
Protect from injury
What s and s’s are suggestive of a fracture? What acronym helps?
B ruising pain R educed movement O dd appearance K racking sounds! E dema and Erythema N umbeness and neurovascular impairment
What are possible causes of fractures?
Contact sports
MVA
Falls
Osteoporosis
Where are common fracture locations?
Hip/Femur
Ulnar/Radius/Humeral (usually from putting hands out when falling)
Tibia/Fibula (bone may break through skin with these)
Pelvic (open and closed with high incident of hemorrhage)
After casting what nursing intervention is especially important?
Neurovascular assessment Q2h
What are the classifications of fractures according to type/communication?
Closed
Open/compound (breaks through skin)
Comminuted (tiny fragments)
Displaced (broken and shifted)
Oblique (harry potter going down)
Spiral (usually twisting injury)
Impacted
Greenstick (hook going up; usually seen in pediatric PT’s)
What is the fracture healing process? What could delay it?
- Inflammation then granulation
- Repair
- Remodeling
Infections, systemic diseases, etc.
What are the types of treatments for fractures and general description?
- Traction (decrease muscle spasms, correct deformity)
- Closed and Open reduction (simple fractures
- Bandages/Splints (for Non-weight bearing bones)
- Casts (for complex fractures/lower extremities
- Slings (for elbow and shoulder)
* *want to avoid frozen shoulder**
What are the therapeutic purpose of tractions?
Align and immobilize
Reducing muscle spasms
To lessen, prevent, or correct deformity
May be used as primary treatment or prior to Sx
What are the two kinds of traction?
Skin/Bucks traction:
- Usually short term
- Via adhesive/boot directly to skin
Skeletal traction:
- For longer term
- Via metal pin/wire inserted directly in bone
What is the nursing care for tractions?
Maintain balance between traction pull and counter-traction force
Make sure pulleys work beforehand
Inspect skin
Maintain body alignment
Assessment r/t immobility
Infection prevention/pin care for skeletal traction
Describe Closed Reduction.
Non-surgical, external manual realignment of bones.
May used external fixation devices or casts/splints.
What are advantages to splints and slings?
They are removable
What are the purpose of casts?
Immobilization
Prevent or correct deformity
Promotion of healing with early weight bearing
What are important aspects to cast care?
Patient education including:
- Don’t get cast wet
- Should have two finger space in-between cast
- Elevate to level of heart first 24 hrs
- Report odor or elevated temp, could be infection
- Drying of the cast
Describe Open Reduction also with Internal Fixation (ORIF).
Correction of bone alignment though a surgical incision
Internal Fixation is a device putting pins inside to the bone - risk for infection is greater and longer period of immobility
What complicates fracture healing?
Movement**
Pain
Nutritional status
Fluid intake
What are complications of MS trauma/fracture?
Blood loss Avascular Necrosis (bone loses blood supply and dies) Delayed Union (extra long healing time) Non Union (failure to heal) Infection (ex: osteomyelitis) DVT Pain Muscle spasms Foot drop Muscle atrophy Contractures
- Rhabdomyolysis
- Compartment syndrome
- Fat emboli
What is Rhabdomyolysis and what is the classic sign?
A breakdown of muscle tissue that releases a damaging protein (myoglobin) into the blood.
PT’s can go into acute renal failure
Can occur during excessive exercise; crash injury
Classic sign is dark urine.
What are the signs and symptoms of Rhabdomyolysis and what is the management?
S and S’s are:
- Muscle pain
- Dark urine
- Asymptomatic
Management:
- Correction of cause
- Fluid resuscitation
What is Acute Compartment Syndrome? How is it treated?
Serious condition that involves increased pressure in a muscle compartment.
It can lead to muscle and nerve damage and problems with blood flow.
Treated by MD with fasciotomy (cut in the muscle to release pressure)
What are the earliest signs of ACS?
- Progressive severe pain not relieved with analgesics
- Inability to actively extend digits
- Increased pain from PROM of digits
How is ACS usually diagnosed? What are the 6 P’s?
Usually dx’d when one or more of the 6 P’s are present.
Pulselessness Pallor Paralysis Pain with passive stretching Paresthesia/hypoesthesia Palpably tense compartment
What is the nursing management for ACS?
Notify physician
Place extremity at heart level
Remove or losses restrictive dressings or splints
Medicate for pain
What is Fat Embolism Syndrome?
Fat globules are deposited in small blood vessels that supply major organs.
Often associated with fracture of long bones.
Can occur 24-48 hrs after sx.
EMERGENCY SITUATION.
What are Fat Embolism general sign and symptoms and when it travels to the lungs?
Changes in MS
Fever
***Petechiae (little broken blood vessels all over)
Chest pain Tachypnea Dyspnea Apprehension Decreased PO2 Cyanosis
What is the treatment for Fat embolism?
O2
Fluids
Steroids
Cardiac monitoring
C and DB
Stabilize fracture
How are pain and muscle spasms treated?
Pain:
- NSAIDS**
- Ibuprofen
- Naxproxen
- Aspirin
- Toradol
Skeletal muscle relaxants: (for spasms)
- cyclobenzaprine (Flexeril)
- methocarbamol (Robaxin)
(careful when driving at night)
