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Flashcards in Chapter 69 Deck (79):

What is a contusion?

A soft tissue injury produced by blunt force causing ecchymosis.


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 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
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 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.


How is avascular necrosis of the bone treated?

Bone graft, prosthetic replacement and joint fusion.


What causes a clavicle fracture?

Clavicle fractures are often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In babies, these fractures can occur during the passage through the birth canal.


What are symptoms of a clavicle fracture?

Clavicle fractures can be very painful and may make it hard to move your arm. Additional symptoms include:

Sagging shoulder (down and forward)
Inability to lift the arm because of pain
A grinding sensation if an attempt is made to raise the arm
A deformity or "bump" over the break
Bruising, swelling, and/or tenderness over the collarbone


What are non-surgical treatments of clavicle fracture?

Arm support, medication, PT, medical follow-up to ensure the bone has healed and there is no malunion or non-union.


What are some surgical treatments of clavicle fracture?

Plates, screws, pins inserted surgically.


What are some clavicle fracture complications?

Injury to brachial nerve plexus, injury to subclavian vein or artery and malunion.


How are fractures to the humerus managed?

General principles: the fracture should be immobilised as soon as possible and potent analgesia given. Keep the patient comfortable and minimise any need for movement. Open fractures, those associated with a shoulder dislocation or combined with fracture in the forearm are a surgical emergency and an immediate orthopaedic opinion is necessary.
Most fractures are extra-articular and minimally displaced.

Surgery involves either closed reduction with percutaneous fixation, open reduction and internal fixation, or proximal humeral head replacement.
Fracture dislocations and fractures of the anatomical neck should be referred for orthopaedic review.


What is a Volkmann's contracture?

Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This usually occurs when there is increased pressure due to swelling, a condition called compartment syndrome.


How is Volkmann's Contracture managed?

Peripheral neurovascular assessment, assess for parasthesia, evaluate pain, directly measure pressure as directed, and report impaired neurovascular function promptly.


How are radial head fractures treated?



How are fractures to the radial and ulnar shaft treated?

Cast immobilization for closed fractures and ORIF for open fractures.


How are wrist fractures treated?

Closed fractures are treated with short arm casts. Comminuted fractures are treated with ORIF, arthroscopic pinning or external fixation to maintain reduction.


How are hand fractures managed?

They often require extensive reconstructive surgery. ORIF may be done and pins may be used. Splints are used for immobilization.


How does pelvic fracture manifest?

A broken pelvis is painful, often swollen and bruised. The individual may try to keep the hip or knee bent in a specific position to avoid aggravating the pain. If the fracture is due to a high-energy injury, there may also be injuries to the head, chest, abdomen, or legs. There is usually considerable bleeding, which can lead to shock. Emergency services should be called. These injuries must be stabilized and the individual taken to a trauma center for definitive care.


How are pelvic fractures diagnosed?

All pelvic fractures require X-rays, usually from different angles, to show how out of place the bones are. A computed tomography (CT) scan may be ordered to define the extent of the pelvis injury and other associated injuries. The physician will also examine the blood vessels and nerves to the legs to see if they have been injured.


How are pelvic fractures treated?

Crutches or walker, analgesia, anticoagulants to help prevent DVT, external fixator and sometimes traction.


What causes hip fracture?

Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting.


How do hip fractures manifest?

The patient with a hip fracture will have pain over the outer upper thigh or in the groin. There will be significant discomfort with any attempt to flex or rotate the hip.

If the bone has been weakened by disease (such as a stress injury or cancer), the patient may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, the leg may appear to be shorter than the noninjured leg. The patient will often hold the injured leg in a still position with the foot and knee turned outward (external rotation).


How is hip fracture diagnosed?

X-ray, CT and MRI


What are the types of fractures?

▪️️️Intracapsular Fracture
These fractures occur at the level of the neck and the head of the femur, and are generally within the capsule. The capsule is the soft-tissue envelope that contains the lubricating and nourishing fluid of the hip joint itself.
▪Intertrochanteric Fracture
This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. The lesser trochanter is an attachment point for one of the major muscles of the hip. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. The greater trochanter is the bump you can feel under the skin on the outside of the hip. It acts as another muscle attachment point.
▪️Subtrochanteric Fracture
This fracture occurs below the lesser trochanter, in a region that is between the lesser trochanter and an area approximately 2 1/2 inches below.


How are hip fractures treated?

The type of surgery you have generally depends on the location of the fracture in the bone, the severity of the fracture and your age. Surgical options may include:

Repair with hardware. Surgeons may insert metal screws into the bone to hold it together while the fracture heals. In some cases, screws are attached to a metal plate that runs down alongside the femur. Another option is to insert a rod, known as a nail, into the marrow part of the thigh bone. A screw then passes through the upper part of the rod, through the femoral neck and into the ball portion of the hip joint.
Replace part of the femur. If the ends of the broken bone aren't properly aligned or they've been damaged, your doctor may remove the head and neck of the femur and install a metal replacement (prosthesis). This procedure is called a partial hip replacement.
Replace the entire hip joint. A total hip replacement involves replacing your upper femur and the socket in your pelvic bone with artificial parts called prostheses. Total hip replacement may be a good option if arthritis or a prior injury has damaged your joint, affecting its function even before the fracture.


What are some gerentologic considerations with hip fractures?

Chronic conditions must be monitored, hydration and nutrition as well as possible muscle weakness must be considered.


What are some nursing considerations for hip fracture?

Assessing pain, bleeding, infection and DVT prevention, and maintaining abduction to prevent dislocation.


What are some important nursing considerations?

Positioning, promoting exercise, monitoring and managing potential complications and health promotion.


What are the most common femoral shaft fracture types?

The most common types of femoral shaft fractures include:

Transverse fracture. In this type of fracture, the break is a straight horizontal line going across the femoral shaft.

Oblique fracture. This type of fracture has an angled line across the shaft.

Spiral fracture. The fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture.

Comminuted fracture. In this type of fracture, the bone has broken into three or more pieces. In most cases, the number of bone fragments corresponds with the amount of force required to break the bone.

Open fracture. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for complications — especially infections— and take a longer time to heal.


How are femoral shaft fractures managed?

Frequent neurovascular assessments as well as internal fixation within 24 hours with hardware. Infrequently, skeletal traction may be used. Active and passive knee exercises are begun as soon after surgery as possible.


What is a knee fracture?

Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity, and tibial plateau. Direct and indirect forces can cause these fractures.


How are knee fractures diagnosed?

CT and MRI


What is the medical management for knee injury?

Opioid analgesics and nonsteroidal anti-inflammatory agents are the DOCs for pain associated with fractures.

Nondisplaced transverse fractures with an intact extensor mechanism are treated with a knee immobilizer, crutches, restriction to only partial weight bearing, and 6 weeks of immobilization.

Displaced fractures, or fractures associated with a disrupted extensor mechanism, are referred to orthopedics for possible open reduction and internal fixation. A partial or total patellectomy may be required for severe comminution.

Patients with open fractures should receive antibiotics and orthopedics should be consulted for emergency irrigation and debridement.


What are the most common below the knee fractures?

Tibia and fibula fractures.


How do tibia a fibula fractures present?

When examining a patient for a lower leg fracture one should first examine the patient for edema, ecchymosis, and point tenderness. Gross deformities should be noted and splinted. A careful neurovascular assessment should be performed, and an emergent fracture reduction should be performed if neurovascular deficits are present.


How are tibial fractures treated?

Immobilize nondisplaced fractures and have the patient remain nonweightbearing.
Obtain an orthopedic consultation for displaced (depressed) fractures, which require open reduction and internal fixation. Articular depression of greater than 3 mm may be considered for surgery.


What is a major complication of lower leg fractures?

If compartment syndrome is suspected, obtain an emergent orthopedic consult and measure compartment pressures. Compartment syndrome must be treated promptly with an emergency surgical fasciotomy. If untreated, the increased compartment pressures can cause ischemia and necrosis of the structures within that facial compartment and permanent disability.


What is a rib fracture?

Simple rib fractures are the most common injury sustained following blunt chest trauma, accounting for more than half of thoracic injuries from nonpenetrating trauma.


How do rib fractures present?

Tenderness on palpation, crepitus, and chest wall deformity are common findings of rib fracture.


How do rib fractures manifest?

Tenderness on palpation, crepitus, and chest wall deformity are common findings of rib fracture.


How are rib fractures managed?

Goal of initial ED care is stabilization of the trauma patient and multisystem trauma evaluation.

This includes respiratory care, pain control, rib belts and binders, and CT to check for injury.


What medications are used to treat rib fractures?

Pain control remains the mainstay of treatment, usually with nonsteroidal anti-inflammatory or oral narcotic agents.


What is a thorocolumbar fracture?

Defined as vertebral fracture with compromise of the anterior and middle column can be unstable because both anterior and middle columns are involved


How does thorocolumbar fracture manifest?

Acute tenderness, swelling, paravertebral muscle spasms and change in the normal curvature of the spine or gaps in spinous bearings.


How are thorocolumbar fractures treated?

Non-surgical: bracing with a thoracolumbosacral orthosis is
indicated in patients that are neurologically intact and stable

Surgical: surgical decompression & spinal stabilization indications
neurologic deficits with radiographic evidence of cord/thecal sac compression both complete and incomplete spinal cord injuries require decompresssion and stabilization to facilitate rehabilitation.

Medical treatment includes non-operative treatments such as
cervical collar initiated at scene of injury until directed examination performed, early active range of motion indications "whiplash-like" symptoms and cleared from a serious cervical injury by exam or imaging


How are sports injuries prevented?

Proper equipment, training and conditioning.


What are the most common occupational injuries?

Sprains, strains, tears, cuts, lacerations and punctures, bruises and contusions, fractures, soreness and pain, multiple injuries and back pain.


What is in amputation?

When performing an amputation, a surgeon removes a limb, or part of a limb, that is no longer useful to you and is causing you great pain, or threatens your health because of extensive infection. Most commonly, a surgeon must perform this procedure on your toe, foot, leg, or arm. Physicians as well as patients consider amputation a last resort.


Why are amputation surgeries performed?

Although amputations may be required for other reasons, such as severe injury or the presence of a tumor, the most common reason you may need an amputation is if you have peripheral arterial disease (PAD) due to atherosclerosis (hardening of the arteries). In PAD, the blood vessels in your limbs become damaged because of hardening of the arteries or diabetes.


What are risks of amputation surgery?

Risks of any surgery are:

Blood clots in the legs that may travel to the lungs
Breathing problems
Risks of this surgery are:

A feeling that the limb is still there. This is called phantom sensation. Sometimes this feeling can be painful. This is called phantom pain.
The joint closest to the part that is amputated loses its range of motion, making it hard to move. This is called joint contracture.
Infection of the skin or bone.
The amputation wound does not heal properly.


How are residual limbs treated postoperatively?

The end of your leg (residual limb) will have a dressing and bandage that will remain on for 3 or more days. You may have pain for the first few days. You will be able to take pain medicine as you need them.

You may have a tube that drains fluid from the wound. This will be taken out after a few days.

Before leaving the hospital, you will begin learning how to:

Use a wheelchair or a walker
Stretch your muscles to make them stronger
Strengthen your arms and legs
Begin walking with a walking aid and parallel bars
Start moving around the bed and into the chair in your hospital room
Keep your joints mobile
Sit or lay in different positions to keep your joints from becoming stiff
Control swelling in the area around your amputation
Properly put weight on your residual limb. You will be told how much weight to put on your residual limb. You may not be allowed to put weight on your residual limb until it is fully healed.
Fitting for prosthesis, a manmade part to replace your limb, may occur when your wound is mostly healed and the surrounding area is no longer tender to the touch.


What are nursing interventions for amputation surgery?

Relieving pain, minimizing altered sensory perceptions, promoting wound healing, enhancing body image, helping a patient resolve grieving, promoting independent self-care, helping the patient to achieve physical mobility, monitoring and managing potential complications, promoting home and community based care