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46 Cards in this Set

  • Front
  • Back
Musculoskeletal Vocabulary
Contusion: a bruise
Strain: muscle stretching beyond the limits
Sprain: damage to ligament and usually tendons
Fracture: break of bone(s)
RICE:
Rest
Ice (20 minutes on 20 minutes) off with a barrier
Compression
Elevation (i.e.leg up on the seat next to you ottoman against the chair with a pillow no gap it will cause damage or pain)
Contusion, Strain, Sprain
Medications
no narcotics, anti inflammatory NSAID’s for pain, Analgesics – mild
Contusion, Strain, Sprain Nursing diagnoses
Impaired physical mobility, Pain knowledge deficit (if new injury)
Joint Dislocation Assessment
Visual ROM posture change length of arm on upper ↑ extremity=longer on lower ↓ extremity shorter from strong ligaments are very strong muscles on iliac crest if femur is fractured or dislocated pulls ↑
Joint Dislocation Diagnosis
Visual
X ray
CT or MRI only if head of humorous is trapping nerve fibers
Joint Dislocation who will put it back in place
Skilled Orthopedic person to put the dislocation back in may need anesthesia
Fractures
Classifications
1. Simple: closed / open (Compound) risk for infection due to break in skin
2. Fracture line: oblique may have a sling, spiral may be linked to abuse (twisting arm), avulses, comminuted (fragmented) needs surgery cage around fracture and get bones from Pt own iliac crest or cadavers, compresses, impacted motor vehicle or motorcycle significant fall use arm to break, depressed
3. Complete / incomplete
4. Stable (non-displaced) / Unstable (displaced) realign stabilize
5. Description by point of reference
Healing phases of fractures
1. Inflammatory phase happens Immediately 1st 12-24 hours p. 2340
Send in RBC WBC vasoconstriction
2. Reparative phase
Granulation – Callus formation
a. Granulation shifts and become new tissue up to 3 weeks between Inflammatory and granulation bone will need to be put back in place so surgery can wait a few days up to 72 hours before surgery unless a lot of blood vessels have occurred 1st action before surgery will be blood work to make sure they are as healthy as can be before surgery i.e. nutrient blood transfusions
b. Callus formation confirmed by Xray approximately 6 weeks after injury person can not due any weight bearing until true callius has formed Tylenol no more than 8 in 24 hours Dr may reduce or take off a cast up to 6 weeks
3. Remodeling phase
Osteoblastic (pt unaware of the rest of the healing steps), Bone remodeling, bone healing complete
Emergency care of fractures
1. Immobilization of fracture in the position it is found EMT’s
2. Tissue perfusions assessing the pulse unaffected side to effected side and maybe sensation
fractures Medications
Analgesics
Narcotic
Non-narcotic
External Fixation fracture
is aligned put pins through bones above and below the fracture and stabilized the entire bone locked in to reestablish alignment person will go home circulation sensation and motion is maintained person is sent home on crutches, once Callus is formed weight being Diagnoses risk for infection pin care sight important primarily focused on soap and water teach Pt the signs of infection light pink to red increase of drainage call us. Pain gets more and more call us. If infection enter in pi sites inflection will go into the bone. Removal of pins sedations whole I bone will granulate in person can shower in it how to keep toes warm during Winter sweatpants package of tube socks cut to keep toes warm
Internal Fixation fracture
Intramedulary rod make sure it is aligned rod pushed though bone into the bone marrow takes over and the hyper produces stays in permentally titanium not picked up in airport screening allows bone to heal but rod stays in
Traction
used years ago think what would need to occur to get humorous out of alignment back in alignment used weights to pull against major muscle groups around the fracture site contracting
Skin traction
leg on fractured hip is shorter and needs to by time this is called Buck’s foam or shoe shaped devise hooked to a piece or cord to Bulkin frame through a pulley and puts a sand bag may be 15-20 pounds literally pulling fractured hip back down to maintain alignment and not hinder nerve function or blood flow ******NEVER remove the sandbag –if you the upper femur will sift back cause pain and may interfere with nerve root function will be in for 24-48 hours check pulse check for color wiggle toes fixate might see in pediatrics or someone with general hip dysplasia
Skeletal traction
Dr will put a pin in below and u shaped bridge close line pulley and weights on the side of the bed ADL issues do to several close lines not used much today replaced by the external
Casting Materials
Fiberglass (more common) colors has to realignment & stabilization
Plaster of paris
Assesment of casted limb
i. Pulses (pulselessness) very concerned extremities cold dusky call Dr( Capillary refill) expect brisk if delay monitor if getting progressively longer
ii. Pain leaves/lessens once bones are stabilized pain should diminish
iii. Pallor circulation
iv. Paresthesia/paralysis (numbness tingles to paralysis
v. Odor fiber glass no order plaster of paris damp order in order increase call Dr
vi. Drainage (with drain in= expected) might be expected if drain put in outline drainage in sharpie if circle increases check to see if drain check OR report if drain then this is okay
Education od Pt in caste
Itchy each to scratch on the opposite side no knitting needles or anything down the catse
Wet cast handle the palms of hand so you don’t have pressure sight cast dryer onb Cool not hot= pressure areas
Showering wrap cast up in plastic bag
Crutch walking
4 point gait 2 points foot crutch foot crutch only used when person has weight bearing position
3 point 2 crutch point and 1 effective site non weight bearing demonstrating before leaving hospital faster than 4 point can use with walker
2 point gait is swing through= spinal cord trauma is partial weight bearing. less support than 4 point
going up and down stairs on Crutches
(up with the good down with the bad)
Wilkinson Volume 2 p 719
Up= lead with unaffected leg
Down lead with affected leg
Sizing Axillary Crutches
Wilinson Volume 2 p 718
1. Have Pt lie down wearing shoes they will use to walk.
Measure distance between heel and the anterior fold of the axilla, then add 1 inch (2.5 cm)
Select crutch that adjusts to this height
Have Pt stand, and posito the cruch tip 4-6 inches(10-15 cm) to the side of the heel.
Adjust the axillary pad 3 fingerbredths below the axilla.
Adjust the handgrips so Pt can confortably grasp the bar while the elbow is slightly flexed.
Nursing Care CSM
Circulation Sensation Motion
Test Tip
Physical needs priority to psychosocial Maslow Hierarchy of needs
Complications related to fractures
Compartment syndrome
Fat Embolism Syndrome
Avascular Necrosis
Osteomyelitis
D.V.T
Compartment syndrome Pathophysiology
Progressive degeneration of muscles that results from a severe interruption of blood flow to an area, secondary to edema within the fascia
Increased pressure in compartments = occlusion of arterial blood supply
Decreased venous return from compartment = edema, which then increases the arterial problem because the fluids are accumulating in a closed space…like a tourniquet, resulting in muscle ischemia
Compartment Syndrome Assessment and Treatment
Pain – greater than injury would lead you to expect
Pressure within the extremity
Paresthesia with passive stretching of affected muscle (do a CSM assessment)
Decreased pulses (arterial flow, remember) – is a LATE sign
Intervention
Surgery to release fascia that is acting like a tourniquet (fasciaectomy) open wound more secondary attention healing then primary
Fat Embolism Syndrome
Fat globules are released from bone marrow and/or damaged tissue
Recognize concept of embolism same thing happens with fat globules releases and causes trauma lodges usually in pulmonary tree usually people
More common with:
Multiple fractures Pt will be on anti coagulation therapy
Long bone fractures
Crushing injuries
(femur, pelvis, tibia, ribs, also seen in THR, TKR)
Fat Embolism Assessment and Treatment
Changes in cognition or L.O.C. (confusion, apprehension, restlessness, lethargy)
Respiratory: tachypnea, dyspnea, wheeze, rales
ABG’s: increase in pH, decrease in O2
Tachycardia
Fever
Intervention = critical care unit
O2 to use of ventilator
Rapid anticoagulation (Heparin)
Avascular Necrosis
literally without bloodflow= tissue death
mostly associated orthopedic event
Can occur with any bone / most common with fracture head and neck of femur
Can occur when trauma causes decrease in circulation
May occur slowly after hospital stay in rehab etc i.e. Pt still using walker at 6 weeks taking 4 grams of Tylenol per 24 hours
SX: intermittent to constant pain on weight bearing and limited full R.O.M.
RX: Total Hip Replacement
Osteomyelitis
Infection involving cortex and/or marrow of bone
Infection from external or internal source
can move into a state of dormant for a year or 2 then pop up later like cellulitis
Assessment:
Low grade T., pain, local tenderness, warmth, purulent drainage
Skull Glasgow Coma Scale, pupils
Facial bones Airway, nutrition
Spine neurological paralysis mobility
Intervention
high dose of Antibiotics (routine today to prevent this complication)
Adequate debriedment of wounds
D.V.T.
(covered in vascular content) PREVENT with Venodyne boots [SCD’s] / TEDS
Assessment
warmth of calf some may have pain when dorsoflex
Intervention
Bedrest and call Dr
Heparinization
Coumadin
skull fracture
neurological issues
Clavicle (shoulder) fracture
shoulder ROM no surgical intervention no casting sling to limit mobility
Humerous Fracture
ADL's impacted, may need rod axcilla to risk impaired circulation
Elbow Fracture
ADL's impacted may need total elbow replacement
Radius Ulna Fracture
cast no stay in hospital unless other issues CHF Diabetics ADL’s
Rib fracture
Oxygenation issues
puncture lung risk can break uneven shape and go in Incentive spiromiter may cause pneumonia
Issues sleeping to pain no longer do constrictive wraps- caused pneumonia
Pelvis fracture
Mobility pain issues transferring bed to Commode
If it impacts ADL’s high priority
Osteoarthritis
pain when active, more active = more pain get spikes from mobility Pt chooses to be less active or reaching or NSAID midday
Rheumatoid Arthritis
when you are getting ready for action standing up immobility calms but gets better with activity weight bearing joints (hips knees ankles) hurt
Hip Fractures / Osteoarthritis
Classifications:
Intracapsular within joint capsule i.e. head and neck of femur
Extracapsular ouside the joint capsule
Treatment
1. O.R.I.F. (Open Reduction Internal Fixation)made an incision ran plate and drilled screws into the femur become very stable 24 hours after surgery no changes to the bone
2. Total / Partial hip replacement Fracture hip from a fall selling total hip replacement for stability in the future uses manmade Manmade ball for acitabulium put surgical cement person will be non weight bearing while cement finishes to harden
Head of femur and ascitabluim will be solid titanium
Care after hip replacement
Considerations:
Wound care
Keeping incision clean and dry
Home management of incision
Recognition of signs of infection
Mobility
Use of assistive devices
Changing position frequently
Limitations on hip flexion and adduction (must avoid acute flexion and crossing legs / adduction so don't pop out asitablium out of the femur head )
Avoid low-seated chairs
Sleeping with pillows between legs to prevent adduction
after hip replacement ADL's and Potential problems
A.D.L’s
Use of raised toilet seat
Use of reachers to aid in dressing
Acceptance of assistance
Potential problems
Dislocation of prosthesis
Increased pain / shortening of leg
Inability to move leg, popping sensation in leg
D.V.T.
Wound infection – swelling, purulent drainage, pain, fever
Pulmonary Emboli – sudden dyspnea, tachypnea, pleuritic chest pain
Priority after hip replacement
Priority Pain management on PCA some with basal rate transiting within 48 hours to oral narcotic rehab with Tylenol works well with orthopedic trauma
Think about pain management with physical therapist appointment should be at peak of pain medicine
Muscle-Setting Exercises
Quadriceps-Setting Exercise: person stretch out on bed back of knee to push into mattress while lifting ankles off mattress
Gluteal-Setting Exercise squeezing and releasing buns