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78 Cards in this Set
- Front
- Back
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Musculoskeletal injuries can result in?
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- Fractures
- Dislocations - Soft tissue injuries |
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What are the two most common soft tissue injury?
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- Sprain
- Strains |
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What is a sprain?
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Injury to the tendinoligamentous structures surrounding the joint
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What is a strain?
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Excessive stretching of a muscle and its fascial sheath. Often involves the tendon
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What are the symptoms of a sprain or strain?
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- Pain
- Edema - Decrease in function |
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What is a severe sprain?
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- the ligament pulls loose from a fragment of the bone
- hemarthrosis may occur - There may be complete rupture of the muscle requiring surgical intervention |
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What are the rules for X ray?
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- Age
- Ability to flex - Location of tenderness - Ability to bear weight |
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For a soft tissue injury what would be the immediate interventions? (RICE)
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- Stop the activity
- Apply ice for 20-30 minutes for 24-48 hrs - Compression of the injury - Elevate - Provide pain meds |
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For a soft tissue injury what would be the interventions 48-72 hrs after injury?
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- Apply warm moist heat in 20-30 min intervals
- NSAIDs for pain control - Use the limb if protected |
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Define dislocation
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Injury to the ligamentous structures that surround a joint
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Define subluxation
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Partial or incomplete displacement of the joint surface
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Why is dislocation considered an emergency?
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Possibility of avascular necrosis
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How is realignment accomplished with a dislocation or subluxation?
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Closed reduction under local or general anesthesia
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What is the nursing management for someone with a dislocation or subluxation?
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- Pain management
- Support and protection of site - Restriction of movement |
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What are the 2 causes of fractures?
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- Non- pathologic
- Pathologic |
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What is another term for non pathologic fracture?
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Traumatic
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What is another term for pathologic fracture?
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Non- traumatic
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What are the clinical manifestations of a fracture?
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- S/S on presentation
- Location of pain - Decreased function - Inability to bear weight - Guarding and protecting site |
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Where should you splint a fracture?
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Above and below the fracture site
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Where should you first assess a patient with a musculoskeletal injury after ABC's?
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Neurovascular status distal to the injury
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True or False
Some nursing interventions for a patient with a fracture would be to elevate the limb, apply ice, and do not straighten the fracture. |
True
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What does a neurovascular assessment include?
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- Color
- Temp - Capillary refill - Peripheral pulses - Edema - Sensation - Motor function |
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What is the final element of an assessment?
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Pain
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What are the steps in a fracture healing? time frame for each?
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- Fracture hematoma (first 72 hrs)
- Granulation tissue (3-14 days) - Callus formation (second week) - Ossification (3 weeks- 6 months) - Consolidation - Remodeling (up to 1 yr) |
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Define delayed union fracture
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Fractures that do not heal in the expected time
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Define non- union fracture
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Fractures that do not heal at all
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What is a method to stimulate bone healing?
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Electrical stimulation
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What are the goals of fracture healing?
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- Anatomic reaignment of bone fragments
- Immobilization of the fracture - Restore normal or near normal functioning of the affected limb |
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Define closed reduction
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- Non surgical, manual realignment
- Traction is sometimes used to restore position, length, and alignment - Brace or splint is usually applied after |
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Define open reduction
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- Preformed through surgical incision
- Fixation with wires, screws, plates, etc |
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What is done post op for a patient having an open reduction with internal fixation?
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- Early initiation of ROM
- Continuous passive motion machine is used to prevent complications of immobility and solidify of joints |
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What nutritional management is needed for a patient with a musculoskeletal trauma?
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- 2500 ml/day
- Diet high in bulk/roughage, fresh fruits, vegetables - Prevent constipation by increasing activity and high fluids |
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What is the purpose of traction?
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- Prevent or reduce muscle spasms
- Immobilization of joint or body part - Reduce a fracture or dislocation - Treat a pathologic joint condition |
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What are the two types of traction?
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- Skin
- Skeletal |
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What are the weights limited to in skin traction?
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5-10 lbs
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What are the weights limited to in skeletal traction?
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5-45 lbs
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For traction, are the weight free hanging? do they touch the floor?
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Yes, No
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What do external fixators do? why are they needed?
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- Stabilize a fracture
- Help prevent limbs from being amputated |
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What is the main concern with external fixators?
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Infection
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What is used for cleaning the pin sites of external fixators?
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Half strength hydrogen peroxide and normal saline unless otherwise ordered by MD
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What are the two products casts are made from?
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- Plaster
- Synthetic acrylic |
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To get full immobilization, a splint/ cast needs to go _____ and _____ the fracture.
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Above and below
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A plaster cast will set in ____ mins but it is not strong enough for weight until ____ hrs.
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15 mins, 24 hrs
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Synthetic cast is molded to the limb and allows for _________ mobility.
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Immediate
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How many inches should there be between the axilla and crutch padding?
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2
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Complications of fractures can either be ________ or _______.
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Direct or Indirect
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Examples of indirect fracture complications are?
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- Compartment syndrome
- Venous thrombosis - Fat embolism - Shock |
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Examples of direct fracture complications are?
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- bone infection
- bone union - Avascular necrosis |
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Compartment syndrome is? what are the 2 kinds?
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- Manifested by an increased compartmental pressure within a confined myofascial complex that causes a compromise in the neurovascular function
- two types: decreased and increased |
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What kind of injury is compartment syndrome associated with?
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- Trauma
- Fracture - soft tissue damage - Crushing injury - Venomous snake bite - IV therapy |
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What are the "six P's" to assess for impending compartment syndrome?
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- Paresthesia
- Pain (distal to injury) - Pallor (coolness, loss of color) - Paralysis - Pulselessness - Pressure (increased) |
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What are the acute interventions of increased compartment syndrome?
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- Do not elevate above heart
- Avoid cold compresses - Remove or loosen bandages - May have to bivalve a cast - Reduction in traction weight |
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What bones/ procedures are most associated with FES?
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- Long bones, ribs, pelvis, tibia
- Joint replacement - Spinal fusion - Liposuction - Crush injuries - Bone marrow transplantations |
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What is the mechanical theory behind FES?
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Fat is released from the marrow of injured bones into the lung capillaries.
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What is the biochemical theory behind FES?
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Catecholamines released during trauma mobilize fatty acids from adipose causing fat globules that lodge in the lungs.
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When will the initial manifestations of FES occur? what are they?
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- 12-72 hrs after injury
- Acute respiratory distress, feeling of impending doom, petechiae of the neck, anterior chest wall, buccal membrane, and conjunctiva |
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Treatment for FES is directed at ________.
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prevention
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Fractures within the hip joint capsule are called?
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Intracapsular
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Fractures occuring outside the joint capsule are called?
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Extracapsular
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Intracapsular fractures are associated with?
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Osteoporosis and minor trauma
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Extracapsular fractures are usually caused by?
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Severe direct trauma and/or falls
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Care of a patient with a fracture of the hip is the same as a patient with an?
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THA
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S/S of a fractured hip are?
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- External rotation
- Muscle spasms - Shortening of affected extremity - Severe pain and tenderness at the site - Possible avascular necrosis |
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What organism usually causes osteomyelitis?
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Staphylococcus aureus
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What is acute osteomyelitis? S/S?
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- Initial infection less than 1 month
- Fever, night sweats, chills, restlessness, nausea, and malaise |
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What is chronic osteomyelitis? S/S?
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- Infection longer than one month
- Constant bone pain, swelling, tenderness, and warmth at the site |
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What is the treatment for osteomyelitis?
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- Vigorous and prolonged IV antibiotics, 4-6 weeks or longer
- May implant antibiotic beads into the site post surgery - Pain management |
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When does primary osteoporosis usually occur?
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- In both genders from normal aging and decreased gonadal functioning
- After menopause and later life in men |
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What drugs lead to osteoporosis?
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- Glucocosteroids
- Tobacco - Heparin - Thyroid hormones - Anticonvulsants |
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What diseases lead to osteoporosis?
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- COPD
- Chronic renal failure - Liver disease - Heart failure - RA - Cushing's disease - Organ transplants |
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What are the main risk factors for osteoporosis?
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- Age
- Female gender - Family history - Smoking - Excessive alcohol intake |
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What are early manifestations of osteoporosis?
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Fractures of the vertebrae, hip, or forearm
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In osteoporosis, bone loss is more rapid during the ________ postmenopausal decade.
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First
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What is the most accurate test for measuring bone density?
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Dual- energy absorptiometry (DEXA)
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If a person is a risk for osteoporosis how often should a bone density test be ordered?
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Every 2 years
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How do you slow down the process of osteoporosis?
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- Intake of Calcium
- Intake of Vit D - Daily exercise - No smoking |
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Bisphosphonates are taken how?
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- With a full glass of water
- Remain upright - Eat nothing by mouth for 30 mins |
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What are the risk factors for low back pain?
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- lack of muscle tone
- excess body weight - poor posture - smoking - stress |
