Musculoskeletal II Flashcards
(145 cards)
1
Q
What is a Contusion injury?
A
Soft tissue injury due to blunt force.
2
Q
how does Contusion manifest itself?
A
Pain, Swelling and Discoloration (echymosis)
3
Q
what is a Strain injury?
A
Pulled muscle injury to the musculotendinous unit.
4
Q
How does a Strain present itself?
A
Pain, edema, muscle spasms, ecchymosis & loss of function.
5
Q
What is a Sprain?
A
Injury to ligaments and supporting muscle fiber and around a joint.
6
Q
How does a Sprain present itself?
A
Pain (incr. w/ motion), edema, tenderness - severity is graded according to ligament damage and joint stability.
7
Q
What is a dislocation?
A
Articular surfaces of the joints ae no longer in contact w/ each other.
8
Q
What is a traumatic dislocation?
A
An emergency w/ pain, change in contour, acis and length of the limb and loss of mobility.
9
Q
What is a Subluxation?
A
Partial or incomplete dislocation.
10
Q
True/ False
Subluxation causes major deformities.
A
False.
They do not cause as much deformity as complete dislocations.
11
Q
For both Dislocations and Subluxations,w hat do we need to do immediately? and why?
A
They must be reduced immediately or they could lead to avascular necrosis.
12
Q
What is avascular necrosis ?
A
Avascular necrosis — also known as osteonecrosis — is the death of bone tissue due to a lack of blood supply.
13
Q
How do we manage Joint dislocations?
A
Goal is to prevent neurovascular complications and to prevent acute compartment syndrome
* Reduce join
* Immobilize limb
* Analgesia & muscle relaxants for pain management
* Monitor for increased pain, numbness/tingling, edema
14
Q
What are neurovascular checks, how do we make them?
A
Neurovascular checks (also called CMS checks – circulation, motion, sensation) are assessments performed to evaluate the blood flow and nerve function in an extremity. They are critical after fractures, orthopedic surgery, casts, or trauma to detect early signs of complications like compartment syndrome or nerve damage.
15
Q
What is acute compartment syndrome?
A
Painful condition caused by increased pressue within a muscle compartment. This restricts blood flow and could potentially lead to nerve and muscle damage.
16
Q
True/False
Acute compartment syndrome is a medical emergency.
A
True.
17
Q
What is the normal cause of acute compartment syndrome?
A
Often result from fractures, prolonged compression, crash injuries, burns, medical procedure.
18
Q
What are the symptoms of acute compartment syndrome?
A
Severe pain, tightness, numbness, tingling and postural weakness or paralysis.
19
Q
What is a rotator cuff?
A
A group of four muscles and their tendons that surrounds the shoulder joint.
20
Q
What is the function of the rotator cuff?
A
To provide stability of the humeral head and to keep the arm in the shoulder socket. It also allow for a wide range of movements - raise & rotate the arm.
21
Q
What is a rotator cuff tear?
A
Rip in a tendon that connects one of the rotator muscles to the humeral head.
22
Q
How does a rotator cuff tear manifest itself?
A
Aching pain, tenderness w/ palpation, difficulty sleeping on affected side, decreased ROM in limb, decreased strenght.
23
Q
Define a fracture.
A
A fracture is the complete or incomplete disruption in the continuity of the bone structure.
24
Q
What are the 3 different MAIN types of fractures?
A
- Closed Fracture - skin doesn’t break
- Open Fracture - skin breakage
- Intra-articular fracture. - fracture extends into the
joint surfaces of the bone.
25
Open fractures are further divided into Type 1, type 2
& Type 3 fractures. Explain.
Type 1 : <1 cm long clean wound
Type 2 : Larger wound w/ minimal soft tissue damage.
Type 3 : Highly contaminated, extensive soft tissue injury, vascular injury or traumatic amputation.
26
What are the 5 sub types of fractures?
Transverse
Oblique
Comminuted
Avulsion
Stress
27
What is a Transverse fracture?
A fracture that is straight across the bone shaft.
28
What is an Oblique fracture?
Fracture occurring at an angle across the bone (less stable than transverse)
29
What is a Comminuted fracture?
A fracture where bone has splintered into several fragments.
30
What is a Avulsion fracture?
Fracture in which a fragment of bone has been pulled away by a tendon and its attachment.
31
What is a stress fracture?
A fracture that results from repeated loading of bone and muscle.
32
What are the clinical manifestations of fractures?
Pain
Loss of function
Deformity
Shortening if extremity
Crepitus
Edema
Ecchymosis
Muscle spasms.
33
With Edema and Ecchymosis, does this develop straight away after a fracture or within hours.
It usually develop several hours after injury, however in severe cases they can develop within the hour.
34
What is Crepitus?
Crepitus is a grating, crackling, or popping sound or sensation that occurs when two rough surfaces in the body rub together, often during movement.
35
Medical management of fractures include reduction. Explain what reduction is.
Reduction refers to restoring the bone back to the correct anatomic alignment.
36
How soon should reduction be done?
As soon as possible after injury and especially before the onset of edema and healing.
37
Why is it important to reduce the bone before edema sets in?
It is harder to reduce the injury when it's started to heal or has edema.
38
What are the two techniques that we can use to reduce the bone?
Open or closed.
39
What is a closed reduction technique?
When the broken bone is realigned without surgery. Usually done with manual manipulation and fraction of the bone.
40
What is done after a closed reduction technique?
An immobilization device such as a cast or a splint is used to stabilize the bone to keep it aligned until healed.
41
What is a open reduction technique?
When the broken bone is surgically realigned and fixed with plates, screws and pins.
42
What is an ORIF procedure?
Open reduction internal fixation procedure.
Used to treat severe fractures. Immobilization must occur after the bone has been reduced. The bone must be maintained in a proper position until union of the bone which normally takes 4-6 weeks.
43
What kind of immobilization devices are used for a these procedure?
Can be internal : surgically placed metal hardware
External : bandages, cast splints, continuous traction and external fixation.
44
Why are isometric and muscle setting exercises encouraged after fractures?
This help minimize atrophy and promote circulation.
Surgeon determine the amount of movement the bone can sustain and prescribes the exercises.
45
What is an external fixator used for?
Used to manage open fractures w/ soft tissue damage.
It provides support for complicated or various fractures.
46
Bones must have a good _____________ for healing.
Blood supply
47
Which bones heal quickly?
Flat bones (pelvis, sternum, scapula) and fractures at the end of long bones.
48
What are some factors that impair fracture healing?
* Inadequate fracture immobilization
* Inadequate blood supply to fracture site or adjacent tissue
* Multiple trauma
* Extensive bone loss
* Infection
* Smoking & alcohol use
* Malignancy
* medications such as corticosteroids
* Older age & some disease processes such as RA
49
What are 3 common external immobilizers?
Casts
Splints
Braces
50
What is the purpose of using a cast?
Immobilizes reduced fractures to correct or prevent deformities, apply uniform pressure to underlying soft tissue or to support and stabilize weakened joints.
Allows non affected body parts to move freely
while stabilizing affected parts
51
What is common cast materials?
Fiberglass or plaster of Paris - allows for molding.
52
What are the 3 main groups of casts?
Arm, leg, body/spica
53
What is the purpose of using a splint ?
Used for stable fractures, sprains, tendon, and soft tissue injuries. They are beneficial in acute care settings because they are adjustable & easy to apply.
54
What is the purpose of using braces?
Offers long-term support, control
movement, and prevent additional injury
55
What is a potential complication of casts, splints and braces?
Acute compartment syndrome. It is an emergency because Ischemia and irreversible damage can occur within hours.
56
What should we do if we suspect that the patient is experiencing Acute Compartment syndrome as a complication?
Notify physician, cast may be removed and emergency surgical fasciotomy may be necessary.
57
Why is it so important that nurses are doing frequent neurovascular checks when it comes to any condition affecting the Musculoskeletal system?
To prevent potential complications such as acute compartment syndrome.
58
Part of the nursing interventions when patients have Casts, Splints & Braces are assessing the 5 P's. What does the 5 P's stand for?
Pain
Paresthesia
Paralysis
Pallor
Pulses
59
What could the 5 P's potentially detect?
Early acute compartment syndrome.
60
Apart from Acute Compartment Syndrome, what are some other complications that can arise from Casts, Splints and Braces?
Pressure Injuries
Disuse Syndrome
61
how are pressure injuries caused in terms of casts?
Caused by inappropriately applied casts
* Lower extremity sites most susceptible
* Patient reports painful “hotspot” and tightness
* Provider may cut small window in the cast to inspect and for access
62
how do we treat pressure injuries caused by casts?
dressing applied over exposed skin
63
What is Disuse Syndrome?
Muscles atrophy and lose strength
64
How do we treat disuse syndrome?
Isometric exercises, muscle setting exercises
65
A patient with an open tibial fracture treated with an external fixator reports increasing pain out of proportion to the injury, along with numbness and tingling in the toes of the affected extremity. Upon assessment, the nurse notes pallor and diminished pulses in the foot. Which of the following complications should the nurse suspect FIRST?
Disuse syndrome related to immobilization
Acute compartment syndrome
Pin site infection requiring immediate intervention
Pressure injury from the external fixator device
Acute compartment syndrome
66
A 68-year-old patient who smokes one pack of cigarettes per day and has a history of rheumatoid arthritis (RA) sustained a comminuted fracture of the mid-shaft femur. Which of the following factors is MOST likely to significantly delay bone healing in this patient?
The patient's age and location of the fracture.
The patient's history of rheumatoid arthritis and the use of a cast for immobilization.
The patient's cigarette smoking and the comminuted nature of the fracture.
The patient's age and use of corticosteroids for RA management.
The patient's cigarette smoking and the comminuted nature of the fracture.
67
What is Traction?
The application of pulling force to promote and maintain alignments to injured body parts.
68
What is the purpose of traction?
Reduce muscle spasms & pain.
Reduce, align and immobilize fractures
Reduce deformity
69
When is traction used?
Used as a short-term intervention until internal or external fixation is possible.
70
What are the principles of effective traction? (Long answer)
* Traction must be continuous to be effective in reducing and immobilizing fractures.
* Skeletal traction is never interrupted.
* Weights are not removed unless intermittent traction is prescribed.
* Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated.
* The patient must be in good body alignment in the center of the bed when traction is applied.
* Ropes must be unobstructed.
* Weights must hang freely and not rest on the bed or floor.
* Knots in the rope or the footplate must not touch the pulley or the foot of the bed.
71
What are the two types of traction?
Skin Traction.
Skeletal Traction.
72
What is Skin Traction?
Not frequently used.
Procedure that uses adhesive material such as bandages or boots applied to the skin and uses pulling force to realign broken bones and to stabilize the joints and relief of muscle spasm before surgery
73
No more than ____ - _____ kg of skin traction should be used on an extremity.
2-3.5 kg
74
No more than _____ kg of skin traction should be used on an the pelvis.
4.5-9kg
75
what do we need to monitor for w/ skin traction?
Complications such as skin breakdown, nerve damage and circulatory impairment.
76
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.
77
Skeletal traction therapeutic effect achieved with weights ___ -_____ kg
11-18 kg.
78
What are 4 complications r/t traction?
Atelectasis & Pneumonia
Constipation & Anorexia
Urinary stasis & infection
Venous Thromboembolism
79
How do we assess for the complication of Atelectasis & Pneumonia ? What is a nursing intervention we can do to prevent this.
Auscultate lungs Q4-8H
Use incentive spirometer
80
How do we assess for the complication of Constipation & Anorexia? What is a nursing intervention we can do to prevent this.
Assess BM and eating patterns.
Encourage high fiber and fluids,
Administer stool softeners, laxatives, suppositories, enemas may be required.
81
How do we assess for the complication of Urinary stasis & infection? What is a nursing intervention we can do to prevent this.
Monitor fluid intake and characteristics of urine.
Encourage adequate hydration
Monitor for signs of UTI.
82
How do we assess for the complication of Venous Thromboembolism? What is a nursing intervention we can do to prevent this.
Encourage ankle and foot exercises Q1-2H when awake.
83
What are the contributing factors to hip fractures?
* Falls (95%)
* Weak quadriceps muscles, slowed reflexes, osteoporosis, poor vision, diminished balance,
general frailty due to age, and conditions that produce decreased cerebral arterial perfusion and cognitive impairment (e.g., transient ischemic attacks, anemia)
* Medications that can cause orthostasis and instability in older adults including: antihypertensive agents, diuretics, beta-blockers, sedatives and hypnotics,
neuroleptics and antipsychotics, antidepressants, benzodiazepines, opioid analgesics,
and NSAIDs
84
What are the clinical manifestations of Hip Fractures?
* Pain over the outer thigh or groin and limited ROM
* Significant discomfort with flexion or rotation of the hip
* Shortening of the leg, adducted and externally rotated
85
With Hip fractures there are usually a shortening of the affected leg, fracture of what, would we see a significant shortening?
Fracture of the femoral extracapsular area will show significantly shortening.
86
With Hip fractures there are usually a shortening of the affected leg, fracture of what, would we see a mild shortening?
Fracture of the femoral neck will show mild shortening
87
how do we assess a fractured hip?
* Health history and presence of concomitant problems
* Pain
* VS, respiratory status, LOC, s/s of shock
* Frequent neurovascular assessment of affected extremity
* Bowel and bladder elimination; bowel sounds, I & Os
* Skin Condition around fracture
* Anxiety and Coping
88
A hip fracture can affect the surrounding nerves in that area, what is a complication that can often happen when this occur?
It can lead to complications such as diminished bladder elimination.
89
What are the major goals for patients w/ hip fractures?
* Relief of pain
* Achievement of a pain-free, functional, and stable hip
* Healed wound
* Maintenance of normal urinary elimination pattern
* Use of effective coping mechanisms
* Remains oriented and participates in decision making
* Absence of complications
90
What kind of trauma does Rib fractures commonly occur from? Give examples.
Rib fractures are common from blunt trauma (e.g., car crashes, falls)
91
True / False
Rib fractures causes major impairments.
False.
Normally causes minimal impairments.
92
How do we diagnose rib fractures?
Diagnosis is based on clinical presentation, chest x-ray, CT scan, or ultrasound
93
What therapy is crucial when it comes to rib fractures, and why?
Pain control is crucial to prevent decreased lung aeration, atelectasis, and pneumonia.
94
how do we treat rib fractures?
Treatment includes regular analgesics, incentive spirometry, splinting during coughing,
and sometimes nerve blocks or epidural infusions
95
What are avoided in rib fractures due to risk of respiratory complications.
Chest binders.
96
How long does it normally take to heal from a rib fracture?
6 weeks, but multiple fractures increase the risk of serious complications like flail chest, pneumothorax, and hemothorax.
97
What are some common sports related fractures?
Clavicle, wrist, ankle, metatarsal stress
98
Where do we normally see sports related dislocations?
Shoulders and elbows
99
Where do we normally see sports related sprains?
Wrists and ankles
100
What sports related injuries do we normally see on the knees?
Sprain, strain and meniscal tears
101
How do we promote prevention of sports r/t injuries?
Prevention involves proper equipment use, sport-specific training, stretching, hydration, and good nutrition.
102
What is the recovery time for sports r/t injuries?
Recovery time varies from a few days to 12 weeks depending on injury severity; return to
play only when pain-free with full ROM.
103
Nursing ranked top ____ on occupations most involved in occupation-related injuries
10
104
What are common occupation-related injuries?
o Strains, sprains, tears
o Cuts, lacerations, contusions, bruises
105
How do we prevent occupation-related injuries?
o Safe patient handling training and proper use of equipment
o Correct use of body mechanics
106
What are some causes/reasons for an amputation?
May be congenital or traumatic or caused by
conditions such as progressive peripheral vascular
disease, diabetes, infection, malignant tumor,
trauma.
107
Why are amputations performed?
Performed to control pain or disease process,
improve function, and improve quality of life
108
How do we assess a patient with an amputation?
* Neurovascular and functional status of affected extremity or residual limb, and of unaffected extremity
* Signs and symptoms of infection
* Nutritional status
* Concurrent health problems
* Psychological status, grief, and coping
109
What are potential complications of an amputation?
* Postoperative hemorrhage
* Infection
* Skin breakdown
* Phantom limb pain
* Joint contracture
110
A patient with a fractured femur is placed in skeletal traction. Which of the following principles is MOST important for maintaining effective traction?
Intermittently releasing the traction weights to allow for muscle relaxation.
Ensuring the weights hang freely without resting on the bed or floor.
Allowing knots in the rope to touch the pulley to provide additional friction.
Placing the patient at the head of the bed, regardless of the direction of pull.
Ensuring the weights hang freely without resting on the bed or floor.
111
What are contusions?
Contusions — commonly known as bruises — are injuries that cause bleeding beneath the skin without breaking the skin surface
112
For management of Contusions, Strains & Sprains, we use the RICE method for management. What does RICE stand for?
Rest, Ice, Compression & Elevation
1. Promote rest
2. Intermittent cold application during first 24-72 hrs, for max 20 min at a time.
3. Elastic compression bandage controls bleeding, reduces edema & provide support for injured tissue.
4. Elevate at or just above the level of the heart to control the swelling.
113
Apart from the RICE method, what are some other nursing managements that we do for contusions, strains and sprains?
Pain management w/ NSAIDS
Monitor Neurovascular status and document any changes in sensation, mobility, pain.
114
What is a fat embolism?
A fat embolism is a serious condition that occurs when fat globules enter the bloodstream and block blood vessels, most commonly after a long bone fracture.
115
With a fat embolism, where does the fat move to?
Lungs, Heart & Brain
116
What are the S&S of a fat embolism?
Restlessness, Tachypnea
117
How do we treat fat embolisms?
By supporting hemodynamics. There is really not other treatment and we monitor and watch the patient as the body attempt to dissolve the fat clot.
118
How do we support hemodynamics in fat embolism cases?
To support hemodynamics in a patient with a fat embolism, the goal is to maintain adequate perfusion, oxygenation, and organ function. Since there’s no specific treatment to remove the fat emboli, management is supportive and aimed at stabilizing the cardiovascular and respiratory systems.
119
In compartment syndrome, what are some signs and symptoms that we may see due to the cut off circulation caused by swelling?
SKin will be pale.
There may be fluid filled blisters as fluids are pushed out of the tissue, there may also be loss of pulse and sensation distal to the area.
120
What is the emergency treatment for compartment syndrome?
Fasciotomy - helps relieve pressure within the cavity.
121
What is a Fasciotomy?
A fasciotomy is a surgical procedure in which the fascia (connective tissue layer) is cut open to relieve pressure and restore circulation to tissues beneath the skin, most often in the arms or legs - wound is closed once pressure goes down.
122
What are the main nursing management tasks 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 (e.g. area rugs, toys, misplaced items)
123
With fractures, why is it so important to control edema?
Controlling edema after a fracture is critically important because unmanaged swelling can lead to serious complications, including compartment syndrome, delayed healing, and impaired circulation.
124
what are patients with open fractures at higher risk for?
Various infections. We need to monitor for Osteomyelitis, Tetanus & gas gangrene.
125
With patients with open fractures, what do we want to administer?
Abx & tetanus toxoid.
126
Why do we often avoid closing open fracture wounds?
They want to go back and irrigate or debride the wound - the patient would have a wound vac inbetween.
127
What are some early fracture complications?
* Shock (Hypovolemic or traumatic shock)
* Fat embolism
* Acute compartment syndrome
* Rhabdomyolysis
* VTE/DVT/PE
* Disseminated intravascular coagulation
* Infection
* Loss of bladder control (incontinence/retention)
128
What is the classic triad of fat embolism?
Hypoxia
Neurologic compromise
Petechia rash
129
What are the two main ways manage compartment swelling when we first notice it.
Maintaining the extremity at heart level and removing constricted dressings.
130
What are some late fracture complications?
Delayed Union, malunion or nonunion.
Avascular necrosis of bone
Complex regional pain syndrome
Heterotopic ossification
131
What is Heterotopic ossification?
Heterotopic ossification (HO) is the abnormal formation of bone in soft tissues where bone does not normally exist — such as muscles, tendons, or other non-skeletal tissues.
132
Before we place a Cast, Splint or Braces on a patient, what are some assessments we should make? (long answer)
o General health
o Emotional status
o Condition of the body part to be immobilized: Skin integrity, neurovascular status, and Swelling, bruising, and skin abrasion
o Treat lacerations and abrasions before application
o Determine if tetanus booster is required (if last known booster was >5years)
o Patient education involves explaining the condition, purpose of immobilization, what to expect during application, and reinforcing treatment adherence.
133
After we have placed a Cast, Splint or Braces on a patient, what are some assessments we should make? (long answer)
o Neurovascular checks are essential—done hourly for the first 24 hours, then every 1–4 hours, focusing on circulation, motion, and sensation.
o The “5 Ps”—pain, pallor, pulselessness, paresthesia, and paralysis—help detect early neurovascular compromise to prevent loss of function.
o Swelling management includes elevation of the limb above heart level for 24–48 hours and ice application if prescribed.
o Evaluate pain- distinguish between normal pain and signs of complications like compartment syndrome or pressure injuries.
o Never ignore complaints of pain!
134
How do we differentiate between pain related to the injury and pain related to the complication of compartment syndrome?
Pain related to compartment syndrome is often described as a relentless pain, more severe and not controlled by interventions such as elevation, cold therapy or usual dose of analgesics agents.
135
How do we differentiate between pain related to the injury and pain related to the complication of pressure injury?
Pain will be described as a burning pain over the bony prominences such as heels, anterior ankles or elbows.
136
For patients that have gotten a cast, splint or brace, what things do we want to educate them on?
* Activity, exercise, and rest - no excessive use.
* Techniques for drying cast - using hair dryer on cool setting, avoid getting cast wet.
* Controlling swelling and pain - elevating the limb, ice and NSAIDs
137
how should patients care for minor skin irritations r/t cast, brace or splint?
* Pad rough edges with tape or moleskin
* Blow with hair dryer to relieve itching
* Do not stick foreign objects into the cast
138
What signs and symptoms should the patient know to report back to us after receiving a cast, splint or braces?
o Persistent pain or swelling
o Changes in sensation, movement, skin color, or temperature
o Signs of infection
o Pressure areas
139
True/False
Which patients that have a traction, the nurse can adjust the weights as needed.
False.
The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights defeats their purpose and
may result in injury to the patient
140
What are some nursing managements that the nurse should do for patients that have traction?
* Evaluate traction apparatus and patient position
* Maintain alignment of body
* Report pain promptly
* Teach to use trapeze to help with movement
* Assess pressure points in skin at least every 8 hours
* Regular shifting of position
* Special mattresses or other pressure reduction devices
* Perform active foot exercises and leg exercises every hour
* Pin care
141
In patients with skeletal traction, can we apply anti-embolism stockings & compression devices.
Yes.
142
For patients with skeletal traction, how do we perform pin care?
After the first 48 to 72 pin site care should be
performed daily or weekly.
143
What is the most effective cleansing solution for pin care?
Chlorhexidine solution is the most effective cleansing solution.
o ½ sterile water + ½ hydrogen peroxide is also frequently used.
o Saline solution is used if other solutions are contraindicated
144
How often must nurses inspect pin site?
The nurse must inspect the pin sites at least every 12 hours for signs of hypersensitivity/allergic reaction (e.g., contact dermatitis, pruritus, urticaria, angioedema), irritation (e.g., normal changes that occur at the pin site after insertion) and infection.
144
What are contractures?
Contractures are permanent tightenings of muscles, tendons, skin, or other tissues that cause joints to become stiff or deformed, limiting normal movement and flexibility.
