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Nursing 4 Exam 1 > Unit 5 MS Trauma > Flashcards

Unit 5 MS Trauma Flashcards

1
Q

What should be the initial nursing assessment for a suspected MS injury?

A
  1. Ensure scene safety
  2. Get help
  3. Ensure ABC
  4. Control external breathing
  5. Provide PT comfort/psychosocial support
  6. Do not leave PT alone
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2
Q

What is the nursing management of a known MS trauma?

A

-Initial treatment of injured site

Neurovascular status distal to injury
Splint joints above and below fracture sites
Elevate if possible
Do not attempt to straighten fractured or dislocated joint or manipulate protruding bones
Pain management
Prepare dx tests

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3
Q

What are the two parts two a neurovascular assessment?

A

Peripheral vascular assessment:

  • Color
  • Temp
  • Cap refill
  • Distal pulses
  • Edema

Peripheral neurological assessment

  • Sensation
  • Pain
  • Motor function
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4
Q

What are diagnostic tests for MS injuries?

A

X-rays (joints, bones, muscles)

Arthrogram ( x-rays to obtain a series of pictures of a joint after a contrast material injected into it)

Bone scan - injects radioisotope (couple hrs before exam) via IV, camera scans entire body front and back

EMG - looks at health of muscles; the nerves

MRI - soft tissues

CT scan (if contrast needs to be NPO)

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5
Q

What needs to be asked prior to a PT ingesting contrast before a diagnostic test?

A

Ask if the PT is allergic to seafood or Iodine

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6
Q

What are types of soft tissue injuries?

A

Strain - tear in muscle or tendon

Sprain - stretching or tearing of ligaments (3-6 weeks to heal)

Avulsion fracture - Small chunk of bone that pulls away from the rest

Hemarthrosis - Bleeding in joint w/o other trauma

Dislocation - injury to joint (where to or more bones come together)

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7
Q

What is the nursing care for a dislocated joint?

A

Pain management

Support joint

Protect from injury

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8
Q

What s and s’s are suggestive of a fracture? What acronym helps?

A 
B ruising pain
R educed movement
O dd appearance
K racking sounds!
E dema and Erythema 
N umbeness and neurovascular impairment
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9
Q

What are possible causes of fractures?

A

Contact sports
MVA
Falls
Osteoporosis

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10
Q

Where are common fracture locations?

A

Hip/Femur

Ulnar/Radius/Humeral (usually from putting hands out when falling)

Tibia/Fibula (bone may break through skin with these)

Pelvic (open and closed with high incident of hemorrhage)

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11
Q

After casting what nursing intervention is especially important?

A

Neurovascular assessment Q2h

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12
Q

What are the classifications of fractures according to type/communication?

A

Closed

Open/compound (breaks through skin)

Comminuted (tiny fragments)

Displaced (broken and shifted)

Oblique (harry potter going down)

Spiral (usually twisting injury)

Impacted

Greenstick (hook going up; usually seen in pediatric PT’s)

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13
Q

What is the fracture healing process? What could delay it?

A
  1. Inflammation then granulation
  2. Repair
  3. Remodeling

Infections, systemic diseases, etc.

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14
Q

What are the types of treatments for fractures and general description?

A
  1. Traction (decrease muscle spasms, correct deformity)
  2. Closed and Open reduction (simple fractures
  3. Bandages/Splints (for Non-weight bearing bones)
  4. Casts (for complex fractures/lower extremities
  5. Slings (for elbow and shoulder)
    * *want to avoid frozen shoulder**
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15
Q

What are the therapeutic purpose of tractions?

A

Align and immobilize

Reducing muscle spasms

To lessen, prevent, or correct deformity

May be used as primary treatment or prior to Sx

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16
Q

What are the two kinds of traction?

A

Skin/Bucks traction:

  • Usually short term
  • Via adhesive/boot directly to skin

Skeletal traction:

  • For longer term
  • Via metal pin/wire inserted directly in bone
17
Q

What is the nursing care for tractions?

A

Maintain balance between traction pull and counter-traction force

Make sure pulleys work beforehand

Inspect skin

Maintain body alignment

Assessment r/t immobility

Infection prevention/pin care for skeletal traction

18
Q

Describe Closed Reduction.

A

Non-surgical, external manual realignment of bones.

May used external fixation devices or casts/splints.

19
Q

What are advantages to splints and slings?

A

They are removable

20
Q

What are the purpose of casts?

A

Immobilization

Prevent or correct deformity

Promotion of healing with early weight bearing

21
Q

What are important aspects to cast care?

A

Patient education including:

  • Don’t get cast wet
  • Should have two finger space in-between cast
  • Elevate to level of heart first 24 hrs
  • Report odor or elevated temp, could be infection
  • Drying of the cast
22
Q

Describe Open Reduction also with Internal Fixation (ORIF).

A

Correction of bone alignment though a surgical incision

Internal Fixation is a device putting pins inside to the bone - risk for infection is greater and longer period of immobility

23
Q

What complicates fracture healing?

A

Movement**
Pain
Nutritional status
Fluid intake

24
Q

What are complications of MS trauma/fracture?

A 
Blood loss
Avascular Necrosis (bone loses blood supply and dies) 
Delayed Union (extra long healing time)
Non Union (failure to heal)
Infection (ex: osteomyelitis)
DVT
Pain
Muscle spasms
Foot drop
Muscle atrophy
Contractures
  • Rhabdomyolysis
  • Compartment syndrome
  • Fat emboli
25
Q

What is Rhabdomyolysis and what is the classic sign?

A

A breakdown of muscle tissue that releases a damaging protein (myoglobin) into the blood.

PT’s can go into acute renal failure
Can occur during excessive exercise; crash injury

Classic sign is dark urine.

26
Q

What are the signs and symptoms of Rhabdomyolysis and what is the management?

A

S and S’s are:

  • Muscle pain
  • Dark urine
  • Asymptomatic

Management:

  • Correction of cause
  • Fluid resuscitation
27
Q

What is Acute Compartment Syndrome? How is it treated?

A

Serious condition that involves increased pressure in a muscle compartment.
It can lead to muscle and nerve damage and problems with blood flow.

Treated by MD with fasciotomy (cut in the muscle to release pressure)

28
Q

What are the earliest signs of ACS?

A
  1. Progressive severe pain not relieved with analgesics
  2. Inability to actively extend digits
  3. Increased pain from PROM of digits
29
Q

How is ACS usually diagnosed? What are the 6 P’s?

A

Usually dx’d when one or more of the 6 P’s are present.

Pulselessness
Pallor
Paralysis
Pain with passive stretching
Paresthesia/hypoesthesia 
Palpably tense compartment
30
Q

What is the nursing management for ACS?

A

Notify physician

Place extremity at heart level

Remove or losses restrictive dressings or splints

Medicate for pain

31
Q

What is Fat Embolism Syndrome?

A

Fat globules are deposited in small blood vessels that supply major organs.

Often associated with fracture of long bones.
Can occur 24-48 hrs after sx.

EMERGENCY SITUATION.

32
Q

What are Fat Embolism general sign and symptoms and when it travels to the lungs?

A

Changes in MS
Fever
***Petechiae (little broken blood vessels all over)

Chest pain
Tachypnea
Dyspnea
Apprehension
Decreased PO2
Cyanosis
33
Q

What is the treatment for Fat embolism?

A

O2

Fluids

Steroids

Cardiac monitoring

C and DB

Stabilize fracture

34
Q

How are pain and muscle spasms treated?

A

Pain:

  • NSAIDS**
  • Ibuprofen
  • Naxproxen
  • Aspirin
  • Toradol

Skeletal muscle relaxants: (for spasms)

  • cyclobenzaprine (Flexeril)
  • methocarbamol (Robaxin)

(careful when driving at night)

Nursing 4 Exam 1 (6 decks)

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