Crush Injuries
- Caused by pressure from a heavy object onto a body part or squeezing of a body part between 2 objects
- “Smiling Death” because they are cheerful before being removed but die shortly after pressure is released
- They die because lack of blood flow causes anaerobic metabolism and as muscle cells die they absorb sodium, water, calcium and release potassium, myoglobin phosphate and other toxins. Once blood flow is returned all these substances circulate throughout the body and cause shock, renal failure, cardiac arrest.
- To lower chances of this happening, treatment must begin before removal of weight
Crush Syndrome
- Due to crush injury, crush syndrome is the systemic manifestations of muscle cell damage.
- Associated with bleeding, bruising, broken bones, open wounds, poor circulation, breakdown of muscle
Rhabdomylosis
- Characterized by muscle necrosis and noted through elevated CK (Creatine Kinase Levels), myoglobin and potassium
- Hallmark is elevated CK
- Manifestations include muscle pain, weakness, and dark red/brown urine
Compartment Syndrome
- Caused by increased pressure in a confined space (usually muscle compartment). Pressure greater than 30 mmHg causes compromised tissue circulation which leads to necrosis MANIFESTATIONS 6Ps P - Pain out of proportion P - Poikilothermia P - Pallor P - Pulselessness P - Paresthesia P - Paralysis
TREATMENT
- KEEP EXTREMITY BELOW HEART TO MAXIMIZE BLOOD FLOW
- DO NOT APPLY COLD TO THE SITE
- Fasciotomy - Incision to decrease pressure in the compartment
Traumatic Asphyxia
- Due to increase in thoracic pressure, and pressure in superior vena cava, inspiration can lead to capillary rupture of the head and neck
MANIFESTATIONS - Cervicofacial cyanosis, edema, subconjunctival hemorrhage, petechial eruptions of the face neck and torso.
- Typically seen after short duration of crushing forces.
Hypovolemic Shock
- Loss of blood or loss of extracellular fluid
- Hemorrhagic shock is hypovolemic shock from blood loss
Erythema/Blistering
- Prolonged hypo-perfused state can lead to ischemia which results in swelling, erythema, blistering of skin
Spinal Cord Injury
- Can damage spinal cord and nerves
Fractures
- Usually in the extremities
Acute Kidney Injury
Fat Embolism Syndrome
- Fat globules released from long bone fractures are deposited throughout body including lung and brain.
- LIFE THREATENING EMERGENCY
- CLASSIC SIGN IS PINPOINT (PETECHIAL) RASH ON CHEST AND AXILLA, hypoxemia and neurologic decline
TREATMENT - ABC’s administer oxygen (may need BiPAP if severe)
- IV fluids to prevent hypovolemic shock
Osteomyelitis
- Infection of the bone (most commonly caused by staph). Can reach bone via blood stream or spread from nearby tissue
- Osteomyelitis can also develop from a skin lesion causing vascular insufficiency most commonly seen in diabetes foot ulcers
RISK FACTORS
- Immunocompromised, DM, PVD, Cancer, Prosthetic Hardware in place, after traumatic injuries
MANIFESTATIONS
- Persistent/Recurring Fevers
- Increased pain at operative/trauma site
- Poor wound healing and separation
- Vascular insufficiency causes local cellulitis, inflammation and necrosis
DIAGNOSIS
- CBC, ESR, C-Reactive Protein, Blood Cultures, Wound Cultures, MRI/CT, Biopsy, Bone Scan
TREATMENT
- Immobilization of affected bone and antibiotics. Given via PICC line.
Amputation
- Removal/Loss of a limb due to trauma, medical illness, surgery.
- Surgery is usually to control pain by removing diseased limbs such as malignant or gangrene.
Traumatic Amputation
- Accidental cutting off/removal of some or all of the body part
- COMPLETE - Total Detachment of limb
- PARTIAL - Some tissue remains at the site
- Most commonly caused by traffic accidents
- Construction accidents, lawnmowers, fireworks, military
Surgical Amputation
- Most commonly caused by DM, PVD, Atherosclerosis, Tumors, Cancers, Infection.
- Need for amputation is based off WBC (Infection), arteriograms, doppler flow studies, venography, pain and effects on ADL’s.
INTERVENTIONS
- Prepare for surgery, utilize community resources, work with orthic about prosthetics teach about phantom pain.
Diffuse Connective Tissue Disease
- Characterized by diffuse inflammation, and degeneration in connective tissue.
- Unknown cause but is immunologically based
- Assess health history with attentino to onset and evolution of symptoms.
Systemic Lupus Erythematosus (SLE)
- Autoimmune disorder (genetic defect or environmental trigger). Environmental causes can include sun exposure, oral contraceptives, pregnancy, anti-seizure medications.
- Host cells attack their own cells.
- Most commonly affects 10-50 years old
- Direct T-cell mediated cytotoxicity has been implicated
- Multiple organs can be effected but most common are joints, kidney, CNS, skin, Blood, Serosal surfaces.
MANIFESTATIONS - Joint pain, butterfly rash in sun exposed areas, hypercoagulability, increased infection risk (especially pneumonia)
DIAGNOSIS - Requires 4/11 typical characteristics of disease be present.
- Positive anti-nuclear antibody (ANA) test, Elevated Anti-DNA, Anti-Smith, and ESR
TREATMENT - I&O, daily weight, 24 hour urine protein, creatine clearance, assessment of bleeding, neuro assessment
- Prevention of complications
- Avoid stress
MEDICATIONS - NSAIDs, Corticosteroids (prednisolone), immunosuppressants,
EDUCATION - Differentiating between exacerbation and remission and how to prevent exacerbations (avoid fatigue, overexposure to sun, emotional stress, infection, drugs, surgery, pregnancy)
- Exacerbations are common post-partum
Sjogren’s Syndrome
- Autoimmune disease where b-cell mediated antibodies attack exocrine glands which cause gland dysfunction/destruction. (Genetic)
MANIFESTATIONS
- Dry Eyes and Mouth
- Palpable purpura, optic neuritis, neuropathy, vertigo, Raynaud’s Phenomenon, cough, dyspnea, abdominal pain.
DIAGNOSIS
- 6 Factors (Dry Eyes, Tear Production, Dry Mouth, Salivary Gland Evaluation to see cause of dry mouth, Autoantibodies test)
MANAGEMENT
- No cure, so we treat symptoms.
- Artificial tears for dry eyes, topical cyclosporine, punctum plugs,
NURSING DIAGNOSIS
- Altered skin integrity, self-care deficit, deficient knowledge of self-management techniques
NURSING INTERVENTIONS
- Education about meds and diet
Scleroderma
- Overproduction of collagen which leads to platelet aggregation and fibrosis
- Collagen disrupts normal organ function (lungs, kidneys, heart, GI tract)
- Caused by exposure to coal, plastic, silica dust
MANIFESTATIONS
C - Calcinosis (painful deposits of calcium on the skin)
R - Raynaud’s Phenomenon (First Complaint fingers change color with temperature)
E - Esophageal Dysfunction (Difficulty swallowing due to scarring)
S - Sclerodactyly (Fingers in semi-flexed position from tightening of skin)
T - Telangiectasia (Red spots on hands, forearms, palms, face, and lips)
OTHER SYMPTOMS
- GERD from fibrosis, diarrhea/constipation, cough from pleural thickening, pulmonary fibrosis,
- CAN LEAD TO RENAL DISEASE WHICH IS THE MAJOR CAUSE OF DEATH
TREATMENT
- Physical/Occupational Therapy
- Nifedipine (Procardia) to treat Raynaud’s disease
- Corticosteroids for inflammation
- NSAID’s For Pain
- Cimetidine/Omeprazole for GERD
- Tetracycline for Diarrhea
- Captopril for HTN
- Methotrexate for Immunosuppression
NURISNG INTERVENTIONS
- Education about temperature extremes with raynaud’s, moist heat to aid skin flexibility, 4-6 small meals a day, don’t smoke.
METABOLIC BONE DISEASES
- Disorders of bone strength and structure
- Most common is osteoporosis
Paget’s Disease
- Irregular bone breakdown and formation
- New bone is produced more rapidly than old bone can breakdown
- BONES ARE LARGER AND WEAKER THAN NORMAL
MANIFESTATIONS
- Bone pain, fatigue, edema, deformity, waddling, loss of height, increased skull size, hearing loss, visual defects, headache, dementia
COMPLICATIONS
- Pathologic fractures, hypercalcemia, renal calculi, spinal cord injury, bone sarcoma
MEDICAL MANAGEMENT
- Pain relief (NSAID’s), prevention of bone loss, Firm Mattress, Calcitonin, Biphosphates (Fosamax)
NURSING MANAGEMENT
- Palliative treatment, exercise, diet, importance of maintaining healthy weight.
Bone Cancer
- Most commonly affects the pelvis or long bones of extremities
- Benign tumors are slow and symmetrical in growth
- Pathological tumors can displace tendons and muscles and weaken bone. They can cause bone destruction, surface bone changes, and enlarged bone contours.
MANIFESTATIONS
- Bone pain worse at night or after exercise. Limited ROM
Primary/Secondary Bone Cancer
Primary - Come from connective/supportive tissue cells of bones. Caused by acquired mutations
Secondary - Cancer comes from breast, prostate, kidney, or lung cancer.
Osteosarcoma
- Most Common Bone Cancer
MANIFESTATIONS
- Pain, Swelling
- Sunburst appearance on x-ray
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1.1 Synergy Model33
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2.1 Pathophysiologic Mechanism65
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3.1 Perioperative Care46
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3.2 Intraoperative Care60
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3.3 Postoperative Care82
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4.1 Care of Upper/Lower GI System87
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5.1 Care for Hepatobiliary System and Colorectal Cancer55
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6.1 Respiratory Part 173
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7.1 Respiratory Part 276
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8.1 Cardiovascular Part 182
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9.1 Cardiovascular Part 281
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10.1 Renal78
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11.1 Endocrine53
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12.1 Endocrine Part 272
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13.1 Musculoskeletal Part 139
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13.2 Musculoskeletal Part 224
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14.1 Complex Musculoskeletal27
