Interventions Musculoskeletal Trauma Part 2

Front 1

Fat embolism syndrome (FES), a serious complication, results from?

Back 1

a fracture, in which fat globules are released from yellow bone marrow into the bloodstream

Front 2

Fat embolism syndrome may occur with what conditions (5)?

Back 2

pancreatitisdiabetic comaosteomyelitisblunt traumasickle cell anemia

Front 3

The release of fat emboli is most likely with fractures of 1____ bones or multiple fractures, although a break in any bone with sufficient bone marrow content can cause complication.

Back 3

1 long

Front 4

Fat embolism syndrome (FES) can occur at any age or in either gender, but young men between ages 1____ and ____ years and older adults between ages 2_____ and ____ years are at greatest risk.The older client with a fractured hip has the highest risk, but FES is also common in clients with fractures of 3_____.

Back 4

1 20 and 40 years2 70 and 80 years3 pelvis

Front 5

What are two theories which have been offered to explain how fat is released from bone marrow?

Back 5

metabolic theorymechanical theory

Front 6

What is the metabolic theory of fat release from bone marrow?

Back 6

elevated concentration of catecholamines, as a result of trauma, causes mobilization of free fatty acids...this leads to platelet aggregation and the formation of fat globules

Front 7

What is the mechanical theory of fat release from bone marrow?

Back 7

pressure within yellow bone marrow is greater than capillary pressure, and therefore fats are released directly from the bone

Front 8

What happens in both the mechanical and metabolic theories of fat release from bone marrow?

Back 8

the fat globules are deposited in small blood vessels that supply the major organs of the body, most commonly the lungs

Front 9

What is the EARLIEST manifestation of FES and what is it caused by?

Back 9

altered mental status...caused by low arterial oxygen level

Front 10

What symptoms follow the EARLIEST manifestation (altered mental status) of FES

Back 10

respiratory distresstachycardiatachypneafeverpetechiae (macular, measles- like rash over neck, upper arms, chest and abdomen... physiologic basis unknown)

Front 11

What are lab findings in FES?

Back 11

increased erythrocyte sedimentation rate (ESR)decreased serum calcium levelsdecreased red blood cell and platelet countsincreased serum lipase level

Front 12

Fat embolism usually occurs within how many hours of the fracture?

Back 12

48 hours

Front 13

Fat embolism may result in?

Back 13

respiratory failure or death, often from pulmonary edema

Front 14

When the lungs are affected, the complication may be misdiagnosed as a ____ ____ from a blood clot.

Back 14

pulmonary embolism

Front 15

Care of the client with fat embolism is similar to that for those with ____ _____, with the primary exception that FES is not treated with ______ agents

Back 15

pulmonary embolianticoagulant

Front 16

Define fat embolism?

Back 16

obstruction of the pulmonary vascular bed by fat globules

Front 17

Origin of fat embolism?

Back 17

95% from fractures of the long bones; occurs usually within 48 hours

Front 18

Assessment findings for fat embolism?

Back 18

altered mental status (earliest sign)increased respirations, pulse, temperaturechest paindyspneacracklesdecreased Sao2petechiae (50% to 60%)retinal hemorrhage (not common)mild thrombocytopenia

Front 19

Treatment of fat embolism?

Back 19

bedrestgentle handlingoxygenhydration (IV fluids)possibly steroid therapyfracture immobilization

Front 20

The PRIMARY cause of a fracture is trauma from a ____ or ____ and is spread over all socioeconomic groups.

Back 20

MVAfall

Front 21

The trauma experienced from a MVA or fall may be a direct blow to the ____ or an indirect force from ____ ____ or pulling forces on the bone. Which sports are contributing factors (3)?

Back 21

bonemuscle contractionssportsvigorous exercisemalnutrition

Front 22

Bone diseases, such as _____, increase the risk of a fracture in older adults

Back 22

osteoporosis

Front 23

The incidence of a fracture depends on the ____ of the injury.

Back 23

location

Front 24

_____ shaft fractures occur most in young and middle-aged adults.

Back 24

Femoral

Front 25

The incidence of ____ ____ (hip) fractures is highest in older adults.

Back 25

proximal femur

Front 26

______ fractures are common in adults; the older the person, usually the more proximal the fracture.

Back 26

Humeral

Front 27

Fractures of the _____ are typically seen in middle and late adulthood?

Back 27

wrist (Colles')

Front 28

It is estimated that more than ____ ____ fractures occur annually in the U.S. as a result of osteoporosis, and occur in middle-aged and older women. By age ____, one in five women has suffered a hip fracture.

Back 28

1.5 million80

Front 29

The introduction of ___ and seatbelts has decreased the number of severe injuries and deaths, but it has increased the number of ____ extremity and ____ fractures, esp in older adults

Back 29

airbagsankle

Front 30

Programs nurses might endorse to help decrease risk of falls are?

Back 30

osteoporosis screening and educationfall preventionhome assessment and modificationdrinking and drivingmedication safetyolder adults and driving

Front 31

Assessment for fractures?

Back 31

cause?specific events leadingn to injury?Force (incisional, crush, acceleration, deceleration, shearing, or friction)?

Front 32

Incisional (knife wound) and crush injuries cause ____ and disrupt blood flow to major organs.

Back 32

hemorrhage

Front 33

Acceleration or deceleration injuries cause direct trauma to the ____, ____, and ____ when these organs are moved from their fixed locations in the body.

Back 33

spleenbrainkidneys

Front 34

Shearing and friction damage the ____ and cause a high level of wound contamination.

Back 34

skin

Front 35

A fall forward often results in _____ fracture of the wrist because the person tries to catch himself or herself with an outstretched hand.

Back 35

Colles'

Front 36

Knowing the mechanism of injury helps the nurse to determine whether other types of injury, such as _____ and _____ ____ injury, might be present

Back 36

head and spinal cord

Front 37

A medication history, including substance abuse, as a person may sustain injuries due to alcohol or drugs which cause dizziness and loss of balance.

Back 37

okay

Front 38

Which disease often do not achieve union?

Back 38

Paget's diseasebone cancer, too

Front 39

Occupational, hobbies, sports, jogging, marching band and recreational activities may lead to fractures

Back 39

okay

Front 40

Inadequate nutrition contributes to fractures.

Back 40

okay

Front 41

The client with a fracture often sustains trauma to other ____ ____; assess all major body systems _____ for life-threatening complications, including head, thoracic, and abdominal injuries

Back 41

body systemsFIRST

Front 42

When inspecting the site of a possible fracture, look for a change in ____ ____.

Back 42

bone alignment

Front 43

The bone may appear deformed, or a limb may be ____ or ____ rotated.

Back 43

internally externally

Front 44

Accompanying these deviations may be an alteration in the length of 1______ (usually a shortening) or a change in bone 2____.

Back 44

extremityshape

Front 45

During musculoskeletal assessment, ask the client to move the involved body part, but if pain is elicited, _____ the movement immediately. ROM is typically decreased. When the affected part is moved, the nurse may hear _____, a grating sound created by bone fragments.

Back 45

STOP STOP!!!crepitation

Front 46

Observe skin for integrity. If fracture closed, the area over the fracture may be ____from bleeding into underlying soft tissues.

Back 46

ecchymotic (bruised)

Front 47

Define ecchymotic?

Back 47

bruised

Front 48

What is condition called when the appearance of bubbles under the skin because of air trapping?

Back 48

subcutaneous emphysema(not uncommon but seen later)

Front 49

_____ at the fracture site is rapid and can result in marked neurovascular compromise

Back 49

Swelling

Front 50

Perform a thorough neurovascular assessment and compare the injured area with its _____ counterpart.

Back 50

symmetric

Front 51

What is assessed distal to the fracture site?

Back 51

skin colortemperaturesensationmobilitypainpulses

Front 52

If the fracture involves an extremity, check the nails for _____ ____ by applying pressure to the nail and observing for speed of blood return.

Back 52

capillary refill

Front 53

If nails are brittle or thick, the skin _____ to the nail is assessed.

Back 53

adjacent

Front 54

Checking for capillary refill is not as reliable as other indicators of ____.

Back 54

perfusion

Front 55

A neurovascular assessement evaluates which 3 things?

Back 55

circulationmovementsensation

Front 56

For an open fracture, determine the ( ? ) and the amount of overt bleeding.

Back 56

degree of soft-tissue damage

Front 57

If skin is disrupted, palpate with _______ _____ on.

Back 57

sterile gloves(if skin not disrupted, it's okay to palpate skin without gloves.)

Front 58

Clients often complain of moderate to severe pain at the site of the fracture or in an adjacent or 1_____ area.For example, clients with a fractured hip may have 2___ ____ or pain referred to the back of the 3____.

Back 58

1 distal2 groin pain3 knee

Front 59

Pain is usually due to ____ ____ and ____ , which result from the fracture.

Back 59

muscle spasm and edema

Front 60

In clients with one or more fractured ribs, severe pain occurs when _____ _____ are taken.

Back 60

deep breaths

Front 61

Assess ___ status, which may be severely compromised from pain or pneumothorax (air in the pleural cavity).

Back 61

respiratory

Front 62

What is a pneumothorax?

Back 62

air in the pleural cavity

Front 63

For fractures of the SHOULDER and UPPER ARM, the physical assessement is best done with the client in a 1_____ or ______ position, if possible, so that shoulder drooping or other abnormal positioning can be seen. Support the affected arm and 2____ the ____ to promote comfort during the assessment. For more distal areas of the arm, the assessment is done with the client in a 3_____ position so that the extremity can be elevated to reduce 4_____.

Back 63

sitting1 sitting or standing2 flex the elbow3 supine4 swelling

Front 64

For assessment of the LOWER EXTREMITIES and PELVIS, place the client in a 1_____ position. A client with an impacted hip fracture may be able to walk for a 2____ time after injury, although not recommended. The client with any type of hip fracture has pain in addition to decreased 3____ in hips.

Back 64

1 supine2 short3 ROM

Front 65

Some fractures can cause internal organ damage, resulting in _____.

Back 65

hemorrhage

Front 66

When a pelvic fracture is suspected, assess (3)?

Back 66

vital signsskin colorlevel of consciousness for indications of possible hypovolemic shock

Front 67

For internal fractures, check the urine for ____, which indicates damage to the urinary system, often the bladder. If the client is unable to void, the nurse suspects damage to the ____.

Back 67

bloodurethra

Front 68

Hospitalization is usually not required for a single, uncomplicated fracture, and the client may return to usual daily activities within a _____ days.

Back 68

few

Front 69

Healing of a fracture is usually complete in a young adult in ___ to ____ weeks.

Back 69

4 to 6

Front 70

In contrast, a client suffering multiple trauma can be hospitalized for ____ and may undergo many surgical procedures, treatments, and prolonged rehabilitation.

Back 70

weeks

Front 71

Body image and sexuality may be altered by (3)?

Back 71

deformitytreatment modalities for fracture repairlong-term immobilization

Front 72

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjurySkin color?Normal findings?

Back 72

inspect the area distal to the injury...no change in pigmentation compared with other parts of the body

Front 73

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjurySkin temperature?Normal findings?

Back 73

palpate the area distal to the injury (the dorsum of the hands is most sensitive to temperature)...the skin is warm....

Front 74

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjuryMovement? Normal findings?(there are two)

Back 74

1. ask the client to move the affected area or the area distal to the injury (active motion)...the client can move without discomfort2. move the area distal to the injury (passive motion)...no difference in comfort compared with active movement

Front 75

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjurySensation?Normal findings?

Back 75

1. ask the client if numbness or tingling is present (paresthesia)...no numbness or tingling...2. palpate with a paper clip (esp the web space betweenthe first and second toes or the web space between the thumb and forefinger)...no difference in sensation in the affected and unaffected extremities (loss of sensation in these areas indicates perineal nerve or median nerve damage)

Front 76

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjuryPulses?Normal findings?

Back 76

palpate the pulses distal to the injury...pulses are strong and easily palpated; no difference in the affected and unaffected extremities

Front 77

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjuryCapillary Refill (least reliable)?Normal findings?

Back 77

press the nail beds distal to the injury until blanching occurs (or the skin near the nail if nails are thick and brittle)...blood returns (return to usual color) within 3 sec. (5 sec for older clients)

Front 78

Assessment Technique of Neurovascular Status in Clients with Musculoskeletal InjuryPain?Normal Findings?

Back 78

ask the client about the location, nature, and frequency of the pain...pain is usually localized and is often described as stabbing or throbbing (pain out of proportion to the injury and unrelieved by analgesics might indicate compartment syndrome)

Front 79

NO special lab tests are available for assessment of _____.

Back 79

fractures

Front 80

Are hematocrit and hemoglobin low or high because of bleeding around the fracture injury?

Back 80

low

Front 81

If extensive soft-tissue damage accompanies the fracture, the ( ? ) may be elevated, which indicates the expected inflammatory response.

Back 81

erythrocyte sedimentation rate (ESR)

Front 82

If the ESR increases during fracture healing, the client may have a _____ _____.

Back 82

bone infection

Front 83

During healing stages, ____ ____ and _____ levels are often increased as the bone releases these elements into the blood.

Back 83

serum calciumphosphorus

Front 84

What two radiographic studies are ordered to confirm a diagnosis of fracture?

Back 84

standard x-raystomograms (CT scan, computed tomography)(if no fractures viewed, and patient is symptomatic, then repeat with additional views)

Front 85

What does the computed tomography show?

Back 85

fractures of complex structures, such as hip and pelvis...also identifies compression fractures of the spine

Front 86

Two other diagnostic assessments beside radiographic include?

Back 86

bone scan (with technetium or gallium)... MRI

Front 87

Although not commonly used, a ____ ____ can pick up fractures of small bones or occult fractures easier than conventional x-rays.In addition, it can better determine fracture complications, such as (3)?

Back 87

bone scandelayed bone healing infectionischemic necrosis.

Front 88

What is the MRI useful in determining with fractures?

Back 88

the amount of soft-tissue damage that may have occured with fracture....visualizing vertebral and skul fractures

Front 89

Common nursing diagnoses for fractures?Risk for peripheral neurovascular dysfunction related to?

Back 89

bone and soft-tissue trauma

Front 90

Common nursing diagnoses for fractures?Acute pain related to?

Back 90

biologic injury (bone disruption, soft-tissue damage, muscle spasm, and edema

Front 91

Common nursing diagnoses for fractures?Risk for infection related to?

Back 91

trauma

Front 92

Common nursing diagnoses for fractures?Impaired physical mobility related to?

Back 92

pain

Front 93

Common nursing diagnoses for fractures?Imbalanced nutrition: Less than body requirements related to?

Back 93

additional metabolic need for healing of bone and soft tissues

Front 94

Additional Nursing Diagnoses for fractures?Activity intolerance related to?

Back 94

pain and impaired mobility

Front 95

Additional Nursing Diagnoses for fractures?Constipation related to?

Back 95

opioids and prolonged immobility (particularly in older adults)

Front 96

Additional Nursing Diagnoses for fractures?Ineffective coping related to?

Back 96

prolonged immobility, hospitalization, or lifestyle changes

Front 97

Additional Nursing Diagnoses for fractures?Compromised family coping related to?

Back 97

prolonged hospitalization or lifestyle changes

Front 98

Additional Nursing Diagnoses for fractures?Self-care deficit related to?

Back 98

pain and immobility

Front 99

Additional Nursing Diagnoses for fractures?Disturbed body image related to?

Back 99

deformity and/or treatment modality

Front 100

Additional Nursing Diagnoses for fractures?Sexual dysfunction related to?

Back 100

pain and immobility

Front 101

Additional Nursing Diagnoses for fractures?Disturbed sleep pattern related to?

Back 101

chronic pain or prolonged hospitalization

Front 102

Additional Nursing Diagnoses for fractures?Fear related to?

Back 102

possible nursing home placement or death (particularly in older adults)

Front 103

Additional Nursing Diagnoses for fractures?Impaired skin integrity and impaired tissue integrity related to?

Back 103

bone injury and immobility

Front 104

What are some potential problems with SEVERE fractures...potential for?

Back 104

acute compartment syndromehypovolemic shockfat embolism syndromevenous thromboembolismischemic necrosisdelayed healing, malunion, or nonunion

Front 105

Expected outcomes that indicate the fractured area is receiving adequate blood flow through the small vessels of the extremities to maintain tissue function are?

Back 105

capillary refillsensationskin colormuscle functionextremity skin colorpedal pulses

Front 106

Emergency care of the client with extremity fracture.Remove the client's 1_____ (cut if necessary) to inspect the affected area while supporting the injured area above and below the injury. ___ ____ ____ because this can cause increased trauma.

Back 106

1 clothing2 DON'T REMOVE SHOES

Front 107

Apply 1____ _____ on the area if there is bleeding and pressure over the 2____ ____ nearest the fracture.Keep the client warm and in a 3_____ position.Check the neurovascular status of the area distal to the extremity; ( (5) ? ) Compare affected and unaffected limbs.Immobilize the extremity by splinting; include joints above and below the fracture site. Recheck circulation after splinting. Cover the affected area with a dressing (preferably 5_____).

Back 107

1 direct pressure2 proximal artery3 supine4 temperature, color, sensation, movement, and capillary refill. 5 sterile

Front 108

Intervention activities for the client at risk for peripheral neurovascular dysfunctionCirculatory Care (arterial insufficiency/venous insufficiency):Promotion of arterial and venous circulation.(List 4 interventions)

Back 108

perform a comprehensive appraisal of peripheral circulations (e.g. check peripheral pulses, edema, capillary refill, color, and temperature)...monitor degree of discomfort or pain...protect the extremity from injury...place extremity in a dependent position, as appropriate

Front 109

Intervention activities for the client at risk for peripheral neurovascular dysfunction;Peripheral sensation management: Prevention or minimization of injury or discomfort in the client with altered sensation.(List 4 interventions)

Back 109

monitor for paresthesia: numbness tingling hyperesthesia hypoesthesiamonitor fit of bracing devices, prostheses, shoes, and clothing...administer analgesics asnecessary...discuss or identify causes of abnormal sensations or sensation changes

Front 110

A fracture can happen anywhere, and it may be accompanied by multiple injuries to vital _____

Back 110

organs

Front 111

For any client who experiences trauma, first assess for (3)?

Back 111

respiratory distressbleeding head injury

Front 112

Things for the emergency team to do besides initial care?Inspect the fracture site for intactness of skin, swelling, and deformity (e.g., 1____ and _____);palpates the area 2_____ to determine temperature (coolness, decreased sensation, and blanching)assesses 3_____ pulses by comparing affected and unaffected extremities, if applicableassesses for motor function by asking the client to move an area distal to the fracture (e.g., if a femoral fracture is suspected, he or she is asked to move the ankle and foot on the affected side; the upper portion of the leg remains immbolized)

Back 112

1 shortening and rotation2 lightly3 distal

Front 113

An emergency team should immobilize a fractured area by splinting to (3)?

Back 113

prevent further damagereduce painincrease circulation

Front 114

Any object or device that extends to the joints above and below the fracture can be used as a _____.

Back 114

splint

Front 115

At the scene of an accident, the emergency team may need to improvise splinting by using available materials, such as a ____.

Back 115

board

Front 116

If the skin is broken, loosely apply a clean (preferably sterile) ____ to prevent further contamination of the wound.

Back 116

cloth

Front 117

Neurovascular assessment is rechecked after ______.

Back 117

splinting

Front 118

What are 2 methods of reduction or realignment of bone ends for proper healing?

Back 118

closed method (e.g., traction)...open (surgical) procedure

Front 119

Immobilization of a fracture is achieved by?

Back 119

bandagescaststractioninternal fixationexternal fixation

Front 120

The health care provider selects the treatment method of a fracture based on (3)?

Back 120

typelocationextent of fracture

Front 121

Nonsurgical management typically involves?

Back 121

closed reduction and immobilization with one or a combination of:bandagesplintcast tractionFor each one of these, the nurse's PRIMARY concern is assessment and prevention of neurovascular dysfunction or compromise.

Front 122

Assess the neurovascular status of the client who has sustained a fracture every 1____ for the first 2____ hours and every 3___ to ____ hours thereafter.

Back 122

1 hour2 243 4 to 8

Front 123

Elevate the fractured extremity higher than the 1____, and apply ice for the first 2___ to ___ hours, as appropriate, to reduce edema.Assess dressings, splints, casts, and traction for neurovascular compromise.

Back 123

1 heart2 24 to 48

Front 124

When caring for a fracture, pay particular attention to EARLY signs and symptoms of ACS by doing a ____ assessment.

Back 124

pain

Front 125

The client with early ACS typically complains of severe, diffuse pain that is not relieved by 1______; pain during passive motion is greater than pain during active motion. If the client presents with this complaint, notify the health care provider 2______.

Back 125

1 analgesics2 IMMEDIATELY

Front 126

What is the most common nonsurgical method for managing a simple fracture?

Back 126

closed reduction

Front 127

In a closed reduction maneuver, the nurse applies a 1_____ ____, or traction, on the bone, the health care provider manipulates the bone ends so that they 2____.Anesthesia or analgesia is typically used during this procedure to minimize pain. An x-ray verifies that the bone ends are 3______ before the bone is immobilized

Back 127

1 manual pull2 realign3 approximated

Front 128

For certain areas of the body, such as the _____ and ____, an elastic bandage or commercial mobilizer may be used to immbolize the bone during healing

Back 128

scapulaclavicle

Front 129

Because upper extremity bones do not bear weight, _____ may be sufficient to keep bone fragments in place.

Back 129

splints

Front 130

_______, a durable, flexible material for splinting, allows custom fitting to the client's body part.

Back 130

Thermoplast

Front 131

The nurse's primary responsibility is to assess the area _____ to the bandage or splint for neurovascular compromise.

Back 131

distal

Front 132

The client usually complains of increased discomfort that is not relieved by _____ if the splint or bandage is too tight.

Back 132

analgesics

Front 133

______ the need for elevation as appropriate and teach how to assess for circulatory changes.

Back 133

Reinforce

Front 134

The client is reminded to keep the device as dry and clean as possible to prevent ____ _____ and _____.

Back 134

skin breakdown and infection.

Front 135

For more complex fractures or fractures of the lower extremity, the physician or orthopedic technician applies a cast to hold bone fragments in place after _____.

Back 135

reduction

Front 136

Define cast?

Back 136

a rigid device that immbolizes the affected body part while allowing other body parts to move.