Musculoskeletal 2 Flashcards
(58 cards)
1
Q
What is a Contusion?
A
- Soft tissue injury produced by blunt force
- Pain, swelling, and discoloration: ecchymosis
2
Q
What is a Sprain?
A
- Injury to ligaments and supporting muscle fiber around a joint
- Pain, edema, tenderness, severity graded according to ligament damage and joint stability
3
Q
What is a Strain?
A
- Pulled muscle injury to the musculotendinous unit
- Pain, edema, muscle spasm, ecchymosis, loss of function, graded first, second, & third degree
4
Q
What is a Dislocation?
A
- Articular surfaces of the joint are not in contact/alignment
- Traumatic dislocation: medical emergency
- Pain, change in contour, axis, and length of limb, loss of mobility
5
Q
What is a Subluxation?
A
- Partial or incomplete dislocation
- Does not cause as much deformity as a complete dislocation
6
Q
Why should a dislocation be reduced immediately?
A
Can cause avascular necrosis
7
Q
What is Acute Compartment Syndrome?
A
Medical Emergency
Painful condition caused by increased pressure within a muscle compartment, restricting blood flow and potentially leading to muscle and nerve damage
8
Q
What can lead to Acute Compartment Syndrome?
A
- Fracture
- Prolonged compression
- Crash injuries
- Burns
- Medical procedures
9
Q
What are the clinical manifestations of Acute Compartment Syndrome?
A
- Severe Pain
- Tightness
- Numbness
- Tingling
- Potential weakness
- Paralysis
- Pallor
- May see blistering
- loss of pulses
10
Q
What is a Rotator Cuff Tear?
A
A rip in a tendon that connects one of the four rotator muscles to the humeral head
The rotator cuff helps to raise and rotate the arm, stabilizes the humeral head, and keeps the arm in the shoulder socket
11
Q
What are the clinical manifestations of a Rotator Cuff tear?
A
- Aching Pain
- Tenderness with palpation
- Difficulty sleeping on affected side
- Decreased ROM in limb
- Decreased strength
12
Q
What are the different types of Open Fractures?
A
Type I: < 1 cm long clean wound
Type II: Larger wound with minimal soft tissue damage
Type III: Highly contaminated, extensive soft tissue injury, vascular injury, or traumatic amputation
Also called compound or complex fractures
13
Q
What is a Transverse fracture?
A
A fracture straight across the bone shaft
14
Q
What is an Oblique Fracture?
A
A fracture occuring at an angle across a bone (less stable than a transverse fracture)
15
Q
What is a Comminuted Fracture?
A
A fracture in which bone has splintered into several fragments
16
Q
What is an Avulsion Fracture?
A
A fracture in which a fragment of bone has been pulled away by a tendon and its attachment.
17
Q
What is a Stress Fracture?
A
A fracture that results from repeated loading of bone and muscle
18
Q
What are clinical manifestations of Fractures?
A
- Pain
- loss of function
- Deformity
- Shortening of extremity
- Crepitus: (when the area is palpated, can feel a crumbing sensation, it’s caused by the rubbing of bone fragments against each other)
- Edema and/or Ecchymosis: (may not develop for several hours after the injury, in higher severity cases we can see it develop within the hour)
- Muscle Spasm
19
Q
What is the Medical Management of Fractures?
A
- Closed Reduction (w/o surgery - manual manipulation or traction of the bone)
- Open Reduction: (with surgery, ORIF - Open Reduction with Internal Fixation is common)
- Immobilization (usually 4-6 weeks, can be internal or external)
- Restore Function
Reduction should be done as soon as possible, before edema sets in or bone starts to heal
20
Q
When is an External Fixator used with a fracture?
A
Open fractures with soft tissue damage
Discomfort is usually minimal and early mobility may be anticipated
21
Q
Which types of fractures heal slower?
A
Comminuted, complex, and fractures of the mid-shaft heal slower
22
Q
What factors may delay fracture healing?
A
- Inadequate fracture immobilization
- Inadequate blood supply to the fracture site or adjacent tissue
- Multiple traumas
- Extensive bone loss
- Infection
- Cigarette smoking and excessive alcohol use
- Malignancy
- Certain medications (e.g. corticosteroids)
- Older age
- Some disease processes (e.g. RA)
23
Q
What are some potential complications of Casts, Splints, or Braces?
A
- Acute Compartment Syndrome (from increased pressure in confined space compromising blood flow)
- Pressure Injuries
- Disuse Syndrome (muscle atrophy and loss of strength)
24
Q
How fast can ischemia and irreversible damage occur with Acute Compartment Syndrome?
A
Within hours
25
What must always be assessed when someone is in a cast, splint, or brace?
**Neurovascular status!**
26
What are the 5 Ps of a Neurovascular Assessment?
| ***And one T***
* Pain
* Pulses
* Parasthesias
* Paralysis
* Pallor
And temperature!
27
When is traction used?
* To reduce muscle spasms
* To reduce, align, and immobilize fractures
* To reduce deformity
* Used as a short-term intervention until internal or external fixation is possible
28
What are important principles of effective traction?
* Must be continous
* Skeletal traction is never interrupted
* Weights are never removed
* Patient must be in good body alignment and in the center of the bed
* Ropes must be unobstructed
* Weights must hang freely and not rest on bed or floor
* Knots in the rope or footplate must not touch the pulley or the foot of the bed.
29
What is Buck's traction?
A form of **skin traction** to the lower leg
30
When is skin traction used?
Typically used for short-term immobilization and muscle spasm relief before surgery
## Footnote
***Non-invasive method using adhesive materials, bandages, or boots. Not frequently used***
31
How much weight of traction should be used on an extremity during skin traction?
**No more than 2-3.5 kg *(4.5-8lbs)***
32
What is **Skeletal Traction**?
* Invasive method where pins, wires, or screws are inserted into the bone
* Provides long-term, continuous traction for more complex fractures or alignment needs
33
What weight is used for a therapeutic effect for **Skeletal Traction**?
**11 - 18 kg *(25-40lbs)***
34
What are potential complications of **Traction**?
* Atelectasis and pneumonia
* Constipation and anorexia
* Urinary stasis and infection
* Venous thromboembolism
35
What is encouraged to prevent VTE's while in Traction?
Ankle and foot exercises every 1-2 hours while awake
36
What is the treatment for **Rib Fractures**?
* Analgesics
* Incentive spirometry
* Splinting during coughing
* Nerve blocks
* Epidural infusions
## Footnote
***Healing typically happens within 6 weeks***
37
Why is pain control crucial with a rib fracture?
To prevent decreased lung aeration, atelectasis, and pneumonia
38
What are common sports related injuries?
**Fractures:**
* Clavicle
* Wrist
* Ankle
* Metatarsal
**Dislocations:**
* Shoulder
* Elbow
**Sprains:**
* Wrist
* Ankle
**Knee:** Sprains, strains, meniscal tears
39
What are common indications for **Amputation**?
* To control pain
* To control disease process
* To improve function
* To improve quality of life
40
What are potential complications of **Amputation**?
* Postoperative hemorrhage
* Infection
* Skin breakdown
* Phantom limb pain
* Joint contracture
41
What does **RICE** stand for?
**Rest:**
* Promote rest as much as possible
**Ice:**
* Ice for the first 24-72 hours for a max of 20 minutes at a time
**Compression:**
* Elastic compression bandage controls bleeding, reduces edema, and provides support for the injured tissue
**Elevate:**
* At or just above the level of the heart to control swelling
42
What are the nursing interventions for **Fractures**?
* Control edema and pain
* Encourage exercise to maintain strength of unaffected muscles
* Use of assistive devices *(crutches, walkers, special utensils)*
* Educate about modifying home environment *(remove tripping hazards... rugs, toys, cords, clutter)*
43
What are the nursing interventions for **Open Fractures**?
* Monitor for osteomyelitis, tetanus, gas gangrene
* Administer antibiotics and tetanus toxoid if indicated
* Take patient to OR for irrigation/debridement
* Culture wound
* Manage wound vac
* Perform **neurovascular checks** frequently
## Footnote
***Priorities: Perfusion, Immobility, Comfort***
44
What are **Early Complications of Fractures**?
* Shock *(typically hypovolemic or traumatic)*
* Fat embolism *(usually in a long bone fracture, fat from bone marrow enters the bloodstream)*
* Acute Compartment Syndrome
* Rhabomyolysis
* VTE, PE, DVT
* Disseminated Intravascular Coagulation (DIC)
* Infection
* Loss of bladder control *(incontinence or retention)*
45
What is the classic triad seen with **Fat Embolism**?
* Hypoxia
* Neurologic Compromise
* Petechial Rash
46
What is **Disseminated Intravascular Coagulation**?
A systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia
*Clots around body "use up" the body's clotting factors, increasing the risk of hemorrhage*
47
What are **Late Complications of Fracture**?
* Delayed union, malunion, nonunion: *union = bones coming together*
* Avascular necrosis of bone
* Complex regional pain syndrome
* Heterotropic ossification *(benign bone growth in an atypical location)*
48
What is Complex Regional Pain Syndrome?
* Complex and rare disorder
* Regional pain in a limb that is disproportionate following a fracture, soft tissue injury, or surgery
* Dysfunctional peripheral and central nervous system responses that mount an excessive response to the precipitating event
49
What are some nursing interventions **Before application** of a **Cast, Splint, or Brace**?
* Emotional status
* Skin integrity, neurovascular status, swelling, bruising, and skin abrasions
* Treat lacerations and abrasions before application
* Determine if tetanus booster is needed *(last booster was > 5 years prior)*
* Patient education: explain condition, purpose of immobilization, what to expect, reinforce treatment adherence
50
What are some nursing interventions **After application** of a **Cast, Splint, or Brace**?
* **Neurovascular checks!**: hourly for first 24 hours, then every 1-4 hours
* Swelling management: elevation of the limb above heart level for 24-48 hrs; ice if prescribed
* Evaluate pain: *Never ignore complaints of pain!!* *(Must report increased pain to provider)*
51
What Patient Education is important after Casts, Splints, or Braces are applied?
* Techniques for drying cast: hairdryer on cool setting
* How to control swelling: elevation, ice, NSAIDs
* Pad rough edges with tape or moleskin
* Use hair dryer to relieve itching
* Do not stick foreign objects into the cast!
52
What signs and symptoms should patients report to provider after cast, splint, or brace application?
* Persistent pain or swelling
* Changes in sensation, movement, skin color, or temperature
* Signs of infection
* Pressure areas *(pain)*
53
What patient education is important for cast removal and after care?
* Dead skin: Wash and gentle exfoliation
* Mild to moderate stiffness is normal
* Gradually increase weight bearing limits
54
What relieves muscle spasms during skeletal traction?
* Heat
* Massage
* Medication
* Repositioning
55
How often should patients be turned in skeletal traction?
Q2H
56
Nursing Management:
**Skeletal Traction: Pin Care**
* After first 48-72 hours, pin site care should be performed daily or weekly
* Most effective cleaning solution: **Chlorhexadine**
* Other cleaning solutions: 1/2 sterile water + 1/2 hydrogen peroxide; Saline solution
* **Strict hand hygiene** before and after pin care
* Inspect pin sites every 12 hours for signs of sensitivity, infection, irritation, loosening
57
What nursing interventions help **resolve grief and enhance body image** after **Amputation**?
* Encourage expression of feelings
* Encourage patient to look at, feel, and care for residual limb
* Help patient resume self-care and independence
* Referral to counselor, social worker, case management, PT/OT, support groups
* Focus on safety and mobility
58
What nursing interventions help **with physical mobility** after **Amputation**?
* Proper positioning of limb, avoid abduction, external rotation, and flexion
* Turn frequently, prone positioning if possible - can help prevent hip flexion contractures
* Prevent contractures with proper positioning: avoid positions that promote flexion *(knees bent, using a pillow under knees)*
* Use of assistive devices
* Passive ROM exercises
* Muscle strengthening exercises
* Pre-Prosthetic care: proper bandaging, massage, "toughening" of the residual limb
