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MedSurg 1 > Acute Musculoskeletal > Flashcards

Acute Musculoskeletal Flashcards

1
Q

Sprain

A

ligament stretched beyond its capacity

typically occur when the joint is overextended

can cause over stretching of the joints, tear or slipping of the ligament

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2
Q

Sprain S/Sx

A 
pain
swelling
ecchymosis
decreased ability to move the limb
if the ligament is ruptured, one may hear a popping sound
difficulty using the affected extremity
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3
Q

Sprain Diagnosis

A

Assessment
Plain radiograph to rule our fracture
MRI to visualize injury (rare)

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4
Q

Sprain Severity: Grade 1

A

overstretching or slight tearing
no joint instability
minimal pain, swelling, and little or no loss of functional ability
bruising is absent or slight
usually able to put weight on the affected joint

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5
Q

Sprain Severity: Grade II

A 
partial tearing of the ligament
bruising, moderate pain, and swelling
some difficulty putting weight on t he affected joint
some loss of function
an xray or MRI may be needed
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6
Q

Sprain Severity: Grade III

A

complete tear or rupture
pain, swelling, and bruising are usually severe
unable to put weight on the joint
radiograph is usually taken to rule out fracture
often requires immobilization and possibly surgery
can also increase the risk future muscles sprains in that area

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7
Q

Sprain Tx

A

RICE
Rest: no additional force should be applied on site of the sprain
Ice: applied immediately to reduce swelling pain (10-15 min, 3-4x a day)
Compression: used to immobilize the sprain and provide support (wrap distal to proximal, always check CMS after applied)
Elevate: above the level of the heart

NSAIDS: to control inflammation and pain

Therapeutic ultrasound can be used to breakd own poorly healed muscle strains and permit them to heal properly

Limit time of immobilization so that we limit muscle weakening

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8
Q

Strain

A

result of muscular-fiber tears due to overstretching

can happen while doing everyday activities

athletes are more at risk due to increased muscle use

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9
Q

Strain: First Degree

A

sudden overstretch or contraction of the muscle (when the muscle is either not warmed up enough or not flexible enough)

eccentric (lengthening) loading of the muscles is the major cause of this type of injury (ex. sprinting puts a lot of strain on the hamstrings because they work eccentrically to slow down the leg as it moves forward)

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10
Q

Strain: Second Degree

A

partial tear of the muscle

bleeding within the muscle

  • leads to more scarring
  • more functional loss
  • will not return to its original state
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11
Q

Strain: Third Degree

A

complete tear of the muscle

usually occurs when a muscle has been previously injured

steroids also make muscle more susceptible to tear

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12
Q

Dislocation

A

occurs when bones in a joint become displaced or misaligned

often caused by a sudden impact to the joint

ligaments always become damaged as a result of dislocation

most can be reduced

  • ASAP
  • blood supply to the joint (or distal anatomy) may be compromised
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13
Q

Subluxation

A

partial dislocation

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14
Q

Fractures

A

break in the continuity of the bone

result of high force impact or stress

certain medical conditions that weaken the bones (pathologic)

  • osteoporosis
  • bone cancer
  • osteogenesis imperfecta
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15
Q

Fracture Healing

A
  1. fracture hematoma
  2. fiberous network forms
  3. deposition of calcium
  4. callous ossification
  5. remodeling
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16
Q

Bryant’s Traction

A

mainly used in young children who have fractures of the femur or congenital abnormalities of the hip

  • both pt’s limbs are suspended in the air vertically at 90 degree angle from the hips and knees slightly flexed
  • over period of days, the hips are gradually moved outward from the body using a pulley system
  • the pt’s body provides the countertraction
17
Q

Buck’s Traction

A

longitudinal traction of the leg

proper alignment of a leg fracture

application of force through a cord over a pulley, suspending a weight, elevation fo the foot of the bed allows the body to act as a coutnerweight

non-constricting boot with weights is worn

18
Q

Russell’s Traction

A
  • unilateral or bilateral
  • combines suspension and traction to immobilize, position, and align the lower extremities
  • tx of fractured femurs, hip and knee contracture
  • applied as adhesive or non-adhesive skin traction
  • uses a sling to relieve the weight of the lower extremities
  • jacket restraint is often incorporated to help immobilize the pt
19
Q

Dunlop’s Traction

A
  • immobilize the upper arm in the treatment of contracture or supracondylar fracture of the elbow
  • uses a system of traction weights, pulleys, and ropes
  • skeletal traction is usually applied unilaterally but may also be applied bilaterally
20
Q

Therapy

A

Collaborative care:
drug therapy
-muscle relaxants (to help with muscle spasms that can be very painful)
-narcotics
-antibiotics for open fracture
-tetanus immunoglobulin for open fractures (always err on side of admin it over not)

Nutritional therapy:

  • protein
  • calcium
  • vitamin D
  • Vitamin C
  • magnesium
21
Q

Fractures: Nursing Implementation

A 
ambulatory and home care
cast care (cast needs to be changed every 2 weeks, due to muscle atrophy)
psychosocial problems
ambulation
assistive devices
counseling and referrals
22
Q

Compartment Syndrome

A
  • limb threatening and life threatening
  • compression of nerves, blood vessels, and muscle inside a closed space
  • leads to tissue death from lack oxygenation
  • most often involves the forearm and lower leg
  • acute, subacute, and chronic
23
Q

Compartment Syndrome: 5 P’s

A

Pain (out of proportion to what is expected)
Paresthesia
Pallor
Paralysis
Pulselessness
*sometimes a 6th P, for polar/poikilothermia (failure to thermoregulate)

24
Q

Fasciotomy

A

surgical procedure

  • fascia is cut to relieve tension or pressure
  • treat the resulting loss of circulation to an area of tissue or muscle
  • limb-saving procedure
  • has a very high rate of success
  • most common problem being accident damage to a nearby nerve
25
Q

Joint Replacement Surgery

A

arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis

tx when severe joint pain or dysfunction is not alleviated by less-invasive therapies

more than 1 million americans have a hip or knee replaced each year

26
Q

Joint Replacement Surgery: Causes

A 
OA
RA
Avascular necrosis or osteonecrosis (part of bone dies, can be caused by steroid use)
Congenital dislocation of the hip joint
Hip dysplasia
Acetabular dysplasia
Trauma
27
Q

Joint Replacement Surgery: Conservative Measures

A 
NSAIDS
Physical Therapy (water therapy)
Joint Injection (steroid - localized anti-inflammatory) v. Viscosupplimentation
Arthroscopy (scope procedure where joint is cleaned and edges are smoothed)
28
Q

Joint Replacement Surgery: Risks

A

Infection (pneumonia, UTI, surgical site infection)
Anesthesia risk
Thrombolytic
Nerve/blood vessel damage

MedSurg 1 (18 decks)

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