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109 Ch. 69
Mgmt of Pts w/ musculoskeletal Trauma
| Question | Answer |
|---|---|
| A contusion is the same thing as | ecchymosis, bruising |
| difference b/n strain and sprain | strain: pulled muscle/tendon. 3 types from mild to severe Sprain: injury to ligaments/tendons that surround joint. 3 stages mild to completely torn ligament |
| Tx of strain, sprain, contusion | Rest ice- first 24-48 hrs, then heat compression elevation |
| what is a dislocation | articular surfaces of distal/proximal bones not aligned |
| what is subluxation | partial dislocation |
| what can happen if dislocation or subluxation not reduced immediately | avascular necrosis |
| what is epicondylitis also known as | tennis elbow, excessive repetitive extension, flexion, pronation, supination |
| For the ACL and PCL, which one gets the force forward and backward | forward: ACL backward: PCL |
| what do menisci do and how to best diagnose it | act as shock absorbers in knee, MRI |
| What is injured if you cannot plantar flex foot | achilles tendon |
| what is a fracture | complete, incomplete disruption in continuity of bone structure. |
| what are types of fractures | complete- break across entire bone incomplete-thru part(greenstick) comminuted- several bone fragments closed- simple, not break skin open- break skin, compound |
| what are signs of a fracture | acute pain, loss of fx, deformity, shorteningo fextremity, crepitus, edema, ecchymosis |
| More types of fractures | avulsion- muscle pull bone off compression depressed- fragments driven in epiphyseal greenstick- one side broke, other bent impacted- bone driven into bone oblique- angle pathologic- diseased bone spiral, stress, transverse |
| what does it mean to have fracture reduction | restoration of fracture fragments to anatomic alignment and positioning. |
| Two types of reduction | closed- thru manipulation/manual traction open- int/external fixation devices |
| what is always used to determine proper reduction | xrays |
| how long does a fracture typically take | 6 - 8 weeks |
| what is goal with open fractures | prevent infection. Primary wound closure is usually delayed |
| which fracture heal more quickly, the shaft area of long bones or the ends of long bones | The ends becuase more vascular adn cancellous. Weight bearing stimulates healing |
| what is a fat emboli | can develop after fracture of long bone or pelvic bones. Usually in males over 40. Sx: petechiae, hypoxia, tachypnea, tachycardia, pyrexia, confusion, irritability. TX: maintain fluid/electrolyte balance, O2 |
| what is compartment syndrome | perfusion pressure falls below tissue pressure in compartment. Decr of blood to distal area of injury. Pain w/ passive ROM Tx: elevate at heart level, bivalve |
| what are sensory deficits when assessing neurovascular fx after a fracture | deep, throbbing, escalating pain, paresthesia, hypothesia(diminished sensation) |
| Peripheral circulation is assesed by looking for | cool skin, pale color, slow capillary refill time, edema, slow pulse(tested with Wick catheter) |
| After a fracture neurovascular assessment consists of the "5 P's" | pain, paralysis, paresthesia, pallor, pulselessness |
| Pts with fractures of lower extremeties are at high risk for | venous thromboemboli DIC- disseminated intravascular coagulation- hemorrhaging systemically and signs are unexpected bleeding after surgery, puncture sites, gastro/intest tract |
| what is delayed/mal/nonunion | delayed: healing doesn't occur in expected time for fracture mal: ends of fractured bone don't unite in normal alignment non: ends of bone don't unite |
| when repairing nonunions, what kind of bone will doctors use | cortical bone for structural strength cancellous bone for osteogenesis corticocancellous for strength and rapid incorporation |
| what three things can a doctor do to treat nonunion | bone graft, internal fixation, electrical bone stimulation |
| what is CRPS- complex regional pain syndrome | painful sympathetic nervous system problem in upper extremities in women. Sx: burning pain, edema, stiffness, discoloration, glossy skin, incr hair/nail growth |
| what is heterotopic ossification | abnormal formation of bone, near bones or in muscle due to trauma |
| what fracture is seen more in older women | fractures of proximal humerous through neck of humerous and impacted fractures of neck Tx: pendulum excercises |
| With an elbow fracture, what is most common complication | Volkmann's contracture usually displaced fractures treated wtih ORIF open reduction internal fixation |
| With radial and ulnar shafts what is particularly important for nondisplaced fractures | immobiliztion including pronation/supination. Long arm cast. |
| what is a fracture of the wrist called | Colles fracture |
| what does the pelvis consist of | sacrum, ilium, pubis, ischium |
| what is possible complication with the bowels in pelvic fractures | paralytic ileus |
| what are two types of hip fracture | intracapsular fractrues- neck of femur Extracapsular - trochanteric region(b/n neck and lesser) |
| With hip fractures, what is nurses key job in positioning pt | keep pillow b/n legs to maintain abduction and alignment. Turn by "log roll" |
| What are techniques to avoid DVT's | fluids, ankle/foot exercises, anti-embolism stockings(remove 20 min 2xday), pneumatic compression devices, anticoagulant therapy, assess legs Q 2-4 hrs(calf tenderness, redness, warmth, swelling) |
| What are preventions for pulmonary complications(atelectasis, pneumonia) | coughing, deep breathing, change position Q2h, incentive spirometer, assess breath sounds Q2-4h |
| Elevated temperature in early postoperative period can indicate what | atelectasis or pneumonia |
| Where is amputation usually performed | at most distal point that will heal successfully. Determined by circulation in part and functionality |
| What is a Syme amputation | modified ankle disarticulation amputation that allows FWB |
| What is BKA, AKA | below knee amputation above knee amputation |
| what is a staged amputation | used when gangrene and infection exist. |
| what should nurse do if cast or elastic dressing comes off limb | immediately wrap limb with elastic compression bandage to prevent excessive edema |
| What is important to remember about positioning a lower extremity limb | never place on pillow, becuase hip contracture can occur |
| what is first action if limb hemmorrhages | first put on tourniquet left by bed, then call surgeon |
Created by:
palmerag
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