62 - Muscoloskeletal Trauma and Orthopedic Surgery Flashcards
(101 cards)
1
Q
sprain
A
injury to LIGAMENTS surrounding joints
-caused by wrenching or twisting
2
Q
most sprain soccur in…
A
ankle, wrist, + knee joints
3
Q
1st degree sprain
A
tears of a few fibers w mild tenderness + swelling
4
Q
2nd degree sprain
A
partial tear/disruption of tissue w more swelling + tenderness
5
Q
3rd degree sprain
A
complete tear of ligament w mod-severe swelling + tenderness
6
Q
strain
A
excessive stretching of MUSCLE, FASCIA, + TENDONS
7
Q
if injury occurs, the immediate focus is on….
A
1 rest (stop activity + limit mvmt) 2 ice 3 compress 4 elevate 5 pain control (analgesia)
8
Q
RICEM is for…… during…..
A
decr local inflammation + pain
acute phase 24-28 hrs
9
Q
cryotherapy
A
- cold cause vasoconstriction
- reduce transmission+ perception of nerve pain impulse
10
Q
cryotherapy is most useful when_____
A
applied immediate after injury
- w/in 24-28 hrs
- apply no more than 20-30 min at a time
11
Q
compression helps …
A
- prevent edema + encourage fluid return
- pain
12
Q
compression
how to
A
- wrap starting distally towards trunk
- leave on 30 min + off 15 min
- too tight if there is numbness , tingling, to swelling beyond
13
Q
how long for elevation
A
24-48 hr
14
Q
HEAT
A
- after acute phase 24-28hr
- warm + moist heat reduce swelling + provide comfort
- dont exceed 20-30 min
15
Q
should patient use their limb that is protected by cast, brace, splint, or taping?
A
yes
- joint mvmt maintains nutrition to cartilage
- muscle contraction improves circulation + helps resolve bruising + swelling
- helps prevent contracture of tendons + ligaments
- exercise + wt bearing helps strengthen + prevent reinjury
16
Q
contracture
A
stiffening
17
Q
dislocation
A
complete displacement or separation of articular surfaces of joint
18
Q
subluxation
A
partial or incomplete displacement of joint surface
19
Q
prophylaxis for injury
A
- tetanus for open fracture
- abx for open fracture, large tissues defects, or mangled extremity injury
20
Q
common causes of dislocation/subluxation
A
- injury + laxity
- forces on the joint that disrupt supporting tissues
- weak/atrophied muscles>chronic joint instability
- sm tears to fribrocartilage>recurrent + chronic dislocation/subluxation
21
Q
the shoulder often dislocates ANTERIORLY. when does POSTERIOR dislocation typically occur?
A
electrocution + seizure
22
Q
most obvious sign of dislocation is…
A
DEFORMITY
23
Q
intraarticular fractures
A
w/in join
24
Q
avascular necrosis
A
bone cell death fr blood supply
25
major complications of dislocation
- open joint injury
- intraarticular fraction
- avascular necrosis
- damage to adjacent nerves + bld vessesl
26
dislocation is considered a ____ emergency bc ____
orthopedic emergency bc assoc w significant vascular injury
27
the longer a joint is dislocated, the greater the risk for ___
avascular necrosis
| ---femoral head of hip joint is especially susceptible
28
first goal of mgmt vs nursing mgmt of dislocation
realign the dislocated part of the joint to its original anatomic position
nursing: pain mgmt + support + protect injured joint
29
Repetitive Strain Injury
injuries resulting fr prolonged force or repetitive mvmt + awkward positions
30
fracture
disruption or break in the continuity of bone
| -commonly caused by trauma but may also be due to cancer or osteoporosis
31
osteoporosis is a type of ___ fracture
pathologic
32
way to classify fractures
- open vs closed
- complete vs incomplete
- displaced vs nondisplaced
- direction of fracture line (linear, oblique, transverse, spiral, longitudinal)
33
an INCOMPLETE Fx is often a result of...
bending or crushing forces applied to the bone
34
displaced fracture
2 ends of the broken bone are separated fr each other
| -often COMMINUTED or OBLIQUE
35
nondisplaced fracture
bone fragments stay in alignment
| -usually TRANSVERSE, SPIRAL, or GREENSTICK
36
7 manifestations of a fracture
```
1 bruising
2 crepitation
3 deformity
4 edema + swell
5 loss of function
6 muscle spasm
7 pain + tenderness
```
37
bruising
discoloration of skin from extravasation of blood in subq tissues
-may appear immediately after injury
38
crepitation
grating or crunching of bony fragments
| -may incr chance of nonunion if bone ends are allowed to move excessively
39
micromvmt of postfracture fragments _____
helps w osteogenesis
40
deformity
abnormal position of extremity or part fr of forces of injury
- classic sign of fracture
- if uncorrected, may cause problems w boy union + restoration of function
41
edema + swelling
disruption or penetration of skin or soft tissue by bone fragments
or
bleeding into surrounding tissues
-may occlude blood vessels + damage nerves + incr risk of compartmnt syndr
42
muscle spasm
irritation of tissues + protective responsive to injury + fracture
-may displace nondisplaced fractures or prevent it fr reducing spontaneously
43
stages of fracture healing
```
1 hematoma (bleed to semi-clot)
2 granulation (forms osteoid)
3 callus
4 ossification
5 consolidation
6 remodeling
```
44
osteoid
basis of new bone substance in granulation phase
45
granulation phase
new bld vessels, fibroblast, osteoblast, + osteoid
46
callus formation
mostly cartilage, osteoblast, Ca + P
minerals like Ca, P, Mg
new bone matrix
47
closed reduction
nonsurgical manual realignment of bone fragments to their anatomic position
- may use local or general anesthesia
- traction, casting, splints, orthoses/braces
48
open reduction
correction of bone alignment w incision
| -usually internal fixation w wired, screws, pins, plates etc
49
pros + cons of open reduction
PRO: early ambulation
CON: risk of infection, complication w anesthesia, + effects of preexisting conditions
50
traction
application of pulling force to an injured or diseased body part or extremity
51
Why is traction used?
```
1 prevent/reduce pain +spasms
2 immobilize
3 reduce fracture/dislocation
4 treat pathologic joint condtn
5 prevent soft tissue damage
6 promote active/passive exercise
7 expand a joint space during procedure/reconstructions
```
52
skin traction
- usually for short term treatmt (48-72hr) until skeletal traction or surgery is available
- tapes, boots, splints, buck's,
53
skin traction weights
5-10 lb
54
assess key pressure points in skin traction every ___
2-4 hr
55
skeletal traction
used to align injured bones + joints or to treat joint contractures + congenital hip dysplasia
-HCP inserts pins + wires into bones
56
weight for skeletal traction
5-45 lbs
57
major complications of skeletal tractions
- infection are pin sites
| - effects of prolonged immobility
58
balanced suspension is a common type of ____
skeletal traction
59
fracture immobilization is achieved w
casts brace, splints, immobilizers
60
cast
temporary immobilizer often applied after closed reduction
- to ensure stability
- restricts tendon + ligament mvmt
61
casts made from fiberglass or other synth material (NOT plaster of paris) is activated by....
submerging in cool or repid water
62
should you cover a fresh plaster cast?
NO, must be allowed to air dry.
if covered, it will retain moist heat
-carry gently w palm to not make any dents
63
reduce the edema of cast by....
elevating the extremity w a sling
| or if its a lower body cast, then elevate on pillow during first 24 hr
64
cephalosporin (cefazolin)
bone penetrating abx
| -used prophylactically
65
drugs for pain meds
carisoprodol (Soma)
cyclobenzaprine
methocarbamol (Robaxin)
66
nutritional therapy
- protein (1g/kg)
- vit B, C, D, Ca, P, Mg
- fluid (2k-3k mL/day)
- 6 small meals a day
- high in bulk + roughage
67
a thorough ___ assessment should be done following a fracture
neurovascular assessment of affected area + distal to the fracture site
68
peripheral vascular assessment
- color
- temp
- periph pulse
- edema
69
peripheral neurologic assessment
- sensation
- motor function
- pain
70
pallor or cool colot can indicate
arterial insufficiency
71
warm cyanotic extermity can indicate
poor venous return
72
slow cap refill can indicate
arterial insufficiency
73
late signs of neurovasc damage
- paresthesia (abnorm sensatn like tingling numbness)
- hypersensation/hyperesthesia
- paresis (partial loss of sensatn)
- paralysis (total loss of sensatn)
74
rapid deconditioning of cardiopulmo system can occur from prolonged bed rest resulting in ____
orthostatic hypotension + decr lung capacity
75
we always encourage patients to elevate their cast unless ______ is suspected
compartment syndrome
76
nursing dx for fracture
- impaired phys combility
- risk for infection
- acute pain
77
bone breakage causes a release of Ca in the blood which puts patient at high risk for
renal calculi
| -drink lots of water
78
if cast is itchy...
patient can place a cool hair dryer under the cast
79
DIRECT complications of fractures
bone infection, bone union, avascular necrosis
80
INDIRECT complications of fractures
compartment syndrome, VTE, fat embolism syndrome, rhabdomyolysis, hypovol shock
81
rhabdomyolysis
breakdown of skeletal muscle cells
- causes release of myoglobin into bloodstream
- ----precipitates + cause obstruction in renal tubules
- ---may lead to acute kidney injury
82
compartment syndrome
swelling causes incr pressure w/in limited space
- cont swelling can compromise the function of bld vessels + nerves
- cap perfusion is reduced
83
2 basic causes of compartment syndrome
1 decr compartment size (restrictive dressing, splints, casts, excessive traction premature closing of fascia
2 incr compartment contents due to bleeding, inflammation, edema, or IV infiltration
84
compartment syndrome is usually assoc w...
- fractures of long bone
- extensive soft tissue damage
- crush injury
*distal humerus + proximal tibia are msot common
85
ischemia can occur w/in ____ after the onset of compartment syndrom
4-8 hrs
86
paresthesia
abnormal sensation
| numbness + tingling
87
early signs of compartment syndrome
pain + paresthesia
88
later signs of compartment syndrome
pulselessness + paralysis
89
with compartment syndrome do not _______ + _______
elevate or ice
90
high risk for VTE
- lower extremities + hip after a fracture
- limited mobility
- inactivity
91
prophylactic meds for VTE
anticoagulants for 10-14 days
| like warfarin, heparin, aspirin
92
preventative measures for VTE
- anticoag
- compression stockings
- pneumatic compression device
- dorsiflex/plantarflex against resistance
- ROM exercise unaffected leg
93
fat embolism syndrome
fat globules entering circ system fr fractures
| -collect in areas w abundant bld vessels like lungs + brain
94
fat embolism syndrome is commonly assoc w fractures of
- long bone
- ribs
- tibia
- pelvis
95
FES can occur after
- total joint replacement
- spinal fusion
- lipo
- crush injuries
- bone marrow transplant
96
fat emboli in the LUNGS
```
hemorrhagic interstitial pneumonitis
s/s: acute resp distress syndrome
-PETECHIAE IN NECK, CHEST, AXILLA, BUCCAL, + CONJUCTIVA in eye
-chest pain
-tachypnea
-cyanosis
-dyspnea
-tachycardia
-hypoxemia
```
97
fat embolism syndrome in lab test
- fat cells in blood, urine, or sputum
- decr PaO2 <60mmHg
- decr platelet + hematocrit
- ST + T wave change son ECG
98
with FES, chest x ray may show...
bilateral pulmonary infiltrates
99
FES
| management
- dont move/reposition patient
- administer O2
- fluid administration (prevent hypovol shock)
- dobutamine + nitrous oxide
100
rhabdomyolysis
| common s/s
dark reddish brown urine + symptoms of AKI
101
soft tissue injuries include
sprain
strain
subluxation
dislocation
