Chapter 69 Flashcards
What is a strain?
A pulled muscle or tendon.
▪️First degree involves mild stretching of the muscle
▪️Second degree involves a partial tear of the muscle
▪️Third degree involves a major stretch of the muscle or tendon with rupture and tearing of involved tissue
What is a contusion?
A soft tissue injury produced by blunt force causing ecchymosis.
What is a sprain?
An injury to ligaments or tendons surrounding a joint.
▪️First degree involves stretching the ligament with minimal damage.
▪️Second degree involves a partial ligament tear.
▪️Third degree involves a full ligament tear.
How are strains and sprains treated?
RICE, splint brace or cast for third degree strain or sprain.
What is a major complication of a joint dislocation not being corrected quickly?
Avascular necrosis.
How are joint dislocations medically managed?
Prompt reduction using analgesia, muscle relaxants and possible anesthesia.
What is the most important componant of nursing management of joint dislocation?
Frequent neurovascular assessments and pain assessments.
What is a rotator cuff tear?
The rotator cuff is a large tendon comprised of four muscles which combine to form a “cuff” over the upper end of the arm, the head of the humerus. The four muscles—supraspinatus, infraspinatus, subscapularis and teres minor—originate from the “wing bone,” the scapula, and together form a single tendon unit that inserts on the greater tuberosity of the humerus.
The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.
How are rotator cuff tears treated?
NSAIDs, rest, corticosteroid injections, progressive stretching, ROM, lengthening exercises and PT.
What is epicondylitis?
Epicondylitis refers to an inflammation of an epicondyle resulting from excessive, repetitive flexion, extension, pronation and supination of the forearm.
Types include:
Lateral epicondylitis, also known as tennis elbow.
Medial epicondylitis, also known as golfer’s elbow (Also thrower’s elbow).
How is epicondylitis treated?
Ice and NSAIDs, and sometimes a splint or cast for immobilization.
What is a lateral or medial collateral ligament injury?
Medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries of the knee are common. In fact, injury to the MCL is the most common ligamentous knee injury.
How are lateral and medial collateral ligament injuries treated?
RICE and blood aspiration to relieve pressure. Limited weight bearing exercises, braces and ROM.
What is a cruciate ligament injury?
Injuries to the anterior cruciate ligament are more common than injuries to the posterior cruciate ligament.
The posterior cruciate ligament is most commonly damaged in connection with road accidents. When the posterior cruciate ligament is torn across, the shin bone will move backwards on the thigh bone.
A lesion of the anterior cruciate ligament happens mostly in sporting situations where the foot is planted.
How are cruciate ligaments treated?
Braces, PT and surgery.
What are meniscal injuries?
Meniscus injuries mostly occur when the knee is wrenched. In a weight-bearing twisting manoeuvre, the meniscus may be caught between the thigh bone and the shin bone and subsequently damaged.
This type of injury is common if someone is tackled during a football game.
How are meniscal injuries treated?
Immobilization, anti-inflammatories, and analgesia. MRI is used to diagnose and surgical removal is done arthroscopically with the goal the save as much of the meniscus as possible. ROM exercises are encouraged.
What is a rupture of the achilles tendon?
Your Achilles tendon joins the bottom of your calf muscle to your heel, at the back of your ankle. It enables you to point your foot down and raise your heel.
In this case, your Achilles tendon is torn – or ruptured. This typically occurs in men in their forties or fifties whilst playing sports such as squash or badminton. Without treatment you will never be able to bend your foot down with any strength. You would then find going up-stairs difficult. You would be unable to stand on tip-toes.
How are achilles tendon injuries treated?
Immediate surgery with a cast or brace afterwards is necessary for a full tear and for less severe injury a brace or cast used for immobilization may be sufficient.
What is a fracture?
A fracture is a broken bone. A broken bone is a fracture.
What are some types of fractures?
There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed. Displaced and non-displaced fractures refer to the way the bone breaks.
In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined up straight. If the bone is in many pieces, it is called a comminuted fracture. In a non-displaced fracture, the bone cracks either part or all of the way through, but does move and maintains its proper alignment.
A closed fracture is when the bone breaks but there is no puncture or open wound in the skin. An open fracture is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. This is an important difference from a closed fracture because with an open fracture there is a risk of a deep bone infection.
Some fracture types are:
Greenstick fracture: an incomplete fracture in which the bone is bent. This type occurs most often in children.
Transverse fracture: a fracture at a right angle to the bone’s axis.
Oblique fracture: a fracture in which the break has a curved or sloped pattern.
An impacted fracture is one whose ends are driven into each other. This is commonly seen in arm fractures in children and is sometimes known as a buckle fracture. Other types of fracture are pathologic fracture, caused by a disease that weakens the bones, and stress fracture, a hairline crack.
Other types of fracture are pathologic fracture, caused by a disease that weakens the bones, and stress fracture.
How does bone fracture manifest?
Many fractures are very painful and may prevent you from moving the injured area. Other common symptoms include:
Swelling and tenderness around the injury
Bruising
Deformity — a limb may look “out of place” or a part of the bone may puncture through the skin.
How are bone fractures treated?
All forms of treatment of broken bones follow one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed. In many cases, the doctor will restore parts of a broken bone back to the original position. The technical term for this process is “reduction.”
Doctors use a variety of treatments to treat fractures:
Cast Immobilization
A plaster or fiberglass cast is the most common type of fracture treatment, because most broken bones can heal successfully once they have been repositioned and a cast has been applied to keep the broken ends in proper position while they heal.
Functional Cast or Brace
The cast or brace allows limited or “controlled” movement of nearby joints. This treatment is desirable for some, but not all, fractures.
Traction
Traction is usually used to align a bone or bones by a gentle, steady pulling action.
External Fixation
In this type of operation, metal pins or screws are placed into the broken bone above and below the fracture site. The pins or screws are connected to a metal bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position while they heal.
In cases where the skin and other soft tissues around the fracture are badly damaged, an external fixator may be applied until surgery can be tolerated.
Open Reduction and Internal Fixation
During this operation, the bone fragments are first repositioned (reduced) in their normal alignment, and then held together with special screws or by attaching metal plates to the outer surface of the bone. The fragments may also be held together by inserting rods down through the marrow space in the center of the bone.
What is nursing management for closed bone fractures?
For closed fractures, instructions on reducing edema and managing pain.
What are some possible complications with open bone fractures?
Osteomyelitis, tetanus and gas gangrene. The main objective of nursing care is to prevent infection.
What are early complications of bone fractures?
Hympovolemic shock, fat emboli, compartment syndrome, venous thromboemboli, DIC (disseminated itravascular cooagulation) and infection.
What are some delayed complications with bone fractures?
Delayed union, nonunion, avascular necrosis, reaction to internal fixation devices, complex regional pain syndrome.
How does fat emobolism syndrome manifest?
Symptoms of fat embolism syndrome are usually evident 24 to 72 hours after an injury, and involve the lungs, the brain and the skin. Symptoms include:
An altered mental state with symptoms including irritability, agitation, headache, confusion, seizures or coma
Lung problems including rapid breathing, shortness of breath (dyspnoea), difficulty breathing and a low oxygen level
A rash on the skin (petechiae) - blockages in small blood vessels leading the small pin-point haemorrhages, usually in the upper torso. These haemorrhages also occur in the eye.
How is fat embolism syndrome treated?
There is no specific therapy for fat embolism syndrome because it is a self-limiting illness. The treatment is therefore supportive, with the aim being to provide adequate oxygen to all of the tissues of the body. In minor cases oxygen therapy with an face mask may be adequate however in severe cases where the ALI is severe patients will require admission to ICU and full breathing (respiratory) support using a breathing machine (ventilator). The best way to prevent fat embolism when patients have fractures is to immobilise these fractures early.
What is compartment syndrome, how does it manifest and how is it treated?
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.
The classic sign of acute compartment syndrome is pain, especially when the muscle within the compartment is stretched.
The pain is more intense than what would be expected from the injury itself. Using or stretching the involved muscles increases the pain.
There may also be tingling or burning sensations (paresthesias) in the skin.
The muscle may feel tight or full.
Numbness or paralysis are late signs of compartment syndrome. They usually indicate permanent tissue injury.
Acute compartment syndrome is treated with a fasciotomy.
How is bone delayed union, malunion or nonunion treated?
Internal fixation, bone grafting and electronic bone stimulation.
