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71 Cards in this Set
- Front
- Back
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sprain |
injury to the ligamentous structures surrounding a joint, usually caused by a wrenching twisting motions. -ankle, wrist, knee joints. |
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sprains |
1 degree- mild- tears in only a few fibers, mild tenderness, minimal swelling 2 degree- moderate, partial disruption of the involved tissue w. more swelling + tenderness. 3 degree- severe, complete tearing of ligament in association with moderate to severe swelling. extremely painful. |
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strain |
excessive stretching of a muscle, its fascial sheath, or a tendon. occur in large muscle groups, lower back, calf, hamstrings |
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strain |
1 degree- mild or slightly pulled muscle 2 degree- moderate or moderately torn muscle 3- severely torn or ruptured muscle. |
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clinical manifestations or sprains and strains |
pain edema- local inflammatory response decreased fxn contusion
-self limiting, full fxn return 3-6 weeks |
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Health promotion |
warm up muscles before exercise/acitvity strength, balance, and endurance exercise important. |
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Acute interventions |
1. stop activity 2 apply ice 3. compression 4. elevating 5. analgesia. |
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RICE |
rest ice - immediately for 20-30 mins compression elevation.
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healthy people impact of regular physical exercise |
assist in weight control helps maintain bone mass prevent high b.p increase lean mass, decrease body fat |
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disclocation |
severe injury to the ligamentous structures that suuround a joint. complete displacement or speration of the articular surfaces of joint. *thumb, elbow, shoulder, hip. pain, swelling, tenderness. |
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subluxation |
partial or incomplete displacement of the joint surface. less severe manifestations. |
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repetitive strain injury *rsi |
cumulative trauma disorder ae used to describe injuries resulting from prolong force or repetitive movements or awkward postures. At risk- muscians, dancers, butchers, computer users of mouse and keyboards. |
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carpal tunnel syndrome CTS |
compression of the median nerve which enters the hand through narrow confines of the carpal tunnel. formed by ligaments and bones. most common *muscians, carpenters, computer operators. weakness, pain, numbness, impaired sensation in the distribution of median nerve. |
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Management of CTS |
adaptive devices - splints, special key boards and mouses. change in body positions, frequent breaks. collab care- relieving the underlying cause of nerve compression. injections of corticosteroid may provide short relief. symptoms more then 6 months surgery severs band of tissue around wrist to decrease pressure of nerve |
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contusion |
bruising |
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knee injuries ; ligaments |
ACL- tear, snap is felt, knee gives way, swelling occurs, stiffness and pain follow treatment: nonsurgical or surgical complete healing after surgery can take 6-9 months |
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Knee injuries; meniscus |
MRI common w- basketball, football, soccer, hockey a blow shear between femoral condyles and tibial plateau. unsteady knee may click, pop, lock, give way. rehab - strengthen hams and quads increase ROM Immobilize |
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Treatments/ interventions of disclocation and subluxation |
reduction of joint articulation by surgical or alignment then immbolization focus to prevent complications nerve damage
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Immbolization cast |
materials: plaster, fiberglass, polyester-cotton arms, leg brace, body cast care and client ed cast comps: infection, circulation impairment, peripheral nerve damage, complications of immobility |
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immobilization traction |
provides reduction alignment and rest at that site. prevent muscle spasm, immobilize joint or body part, decrease fract or disloc, treat a pathologic joint condition types- skin, skeletal, plaster, brace, circumferentials care- correct balance, care of weights, skin inspection, pin care, assess neurovascular status. |
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neurovascular assesments |
peripheral vascular- color, temp, cap refill, pulse, edema. peripheral neurologic- sensation, motor fxn, pain |
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bursitis |
inflammation of the burse results from repeated or excessive trauma or friction, gout, RA, or infection. |
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fracture |
disruption or break in the continuity of the structure of bone. |
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classification of fractures |
open- compound, skin rupture closed- simple, skin intact incomplete- occurs partly across bone shaft but the bone is still in one piece complete- completely through bone |
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types of fractrues |
linear, oblique, transverse, longitudinal, spiral |
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displaced |
comminuted- more then two fragments oblique.
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nondisplaced |
periosteum is intact across fracture and bone is still in alignment transverse, spiral, greenstick. |
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manifestations of fractures |
immediate localized pain decreased fxn inability to bear weight obvious bone deferment may not be present. |
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fracture healing |
6-8 weeks fracture hematoma granulation tissue callus formation ossification' consilidation remodeling |
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collaborative care |
xray, ct, scan, history and physical exam maniupulation, skin traction, closed reduction casting, traction, external/internal fixation surgical debridement and irrigation, immbolization, antibiotic therapy |
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traction |
application of a pulling force to an injured or deased part of the body or extremity. counter traction pulls in opposite direction. |
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nursing diagnosis |
impaired physical mobility r/t loss of integrity of bone structures, movement of bone fragments, and prescribed movement restrictions risk for peripheral neurovascular dysfunction r/t vasc insuff acute pain r/t edema readiness for enhanced self-health management |
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goals |
patient will: have healing with no associated complications obtain satisfactory pain relief achieve maximal rehab potential |
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health promotion implementation |
no drinking/driving maintain exercise routine for strength, balance, flexibility. proper shoes/equipment |
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acute intervention |
pre-op- inform of immbolization and assistive devices that will be used, assure needs will be met, pain management for them. post-op- nuero checks, monitor turning, positioning. pain can be minimized. observe/report signs of bleeding or drainage from cast or dressings. *prevent constipation by increased patient activity and fluids more then 2500 ml a day. maintain reg time. stool softener. |
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compartment syndrome |
condition in which swelling and increased pressure within a limited space press on a compromise the fxn of blood vessels, nerves, and tendons that run through that compartment. leg, arm, shoulder, buttocks. |
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6 p's clinical manifestations of cs |
pain- distal to injury that is not relieved by opiod analgesics and pain on passive stretch of muscle through compartment pressure- increasing in compartments paresthesia- numbness and tingling pallor- coolness and loss of normal color paralysis- loss of fxn pulselessness- diminished or absent peripheral pulses |
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collab care |
assess location, quality, and intensity of pain. pain unrelieved is first sign of cs pulselessness and paralysis are later signs of CS. do not elevate above heart, dark urine possible, venous thromobo are common- blood thinner. |
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fat embolism syndrome FES |
characterized by systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury. fes mortality assoc. w fractures TJR, spinal fusions, lipo, crush injuries, bone marrow transplants. |
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clinical manifiests of FES |
24-48 hrs after injury fat emboli in lungs cause hemmoragic interstitial pnueomonitis that cuase acute resp distress, chest pain, tachypnea, dyspnea, cyanosis, tachycardia, decrease PoO2. |
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collab care FES |
prevention careful immbolization of long bone fracture repoisition as little as possible before frac imboliz or stabilize encourage coughing! deep breathing! |
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Amputation |
removal of a body extremity by trauma or surgery 2 million people in us are living w. limb loss middle age - because of PVD, atherosclerosis, and vascular changes r/t diabetes. young- mva's, landmines, farm injuries. |
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clinical indications |
peripheral neuropathy that progress to trophic ulcers and subsequent gangrene. thermal injuries, tumors, osteomyelitis, congenital disorders. Necessary - increase WBC, vascular tst, Doppler studies, venography. |
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collab care |
elective- assess patients health trauma- management of patient physically and emotionally is more complicated |
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nursing assessment |
assess preexisting illness *vascular problems vascular and neuro status |
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nursing diagnosis |
disturbed body image r/t loss of body part and impaired mobility impaired skin integrity r/t immobility chronic pain r/t phantom limb sensation impaired physical mobility r/t amputation |
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planning |
have adequate relief from the underlying health problem have satisfactory pain control reach max rehab potential cope with body image changes make satisfying lifestyle adjustments |
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health promotion |
control of caustative illnesses report of changes in skin , color, temp, decrease or absence of sensation, tingling, burning pain, lesions |
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acute interventions |
recognize psychological n social implications caused by amputation. use therapeutic communication to assist patient and caregiver to come to a realistic attitude of future |
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preop management |
reinforce information, reasons, proposed prosthesis, mobility programs. phantom limb sensation- feels like limb is still present after surgery |
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post op management |
ptsd for traumatic injury event surgical site, bleeding. |
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evaluation |
accept changed body image no evidence of breakdown skin have reduction or absence of pain become mobile within limitations imposed by amputation |
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strain |
pulled muscle pain, edema, muscle spasm, ecchymosis, loss of fnx RICE NSAIDS TEACHING |
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sprain |
injury to ligaments xray to r/o fx history of injury RICE NSAIDS Fixation - external vs internal |
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rotator cuff injuries |
shoulder pain: cannont initiate or maintain abduction of arm at shoulder drop arm test conservative treatment: NSAIDS, pt, sling support, ice or heat during healing surgical repair for complete tear |
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tendon ruptures |
rupture of Achilles tendon is common in adults who participate in strenuous sports for severe damage surgical repair is followed by leg immobilized in cast 6-8 weeks tendon transplant may be needed
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CRPS, RSD |
a poorly understood disorder includes debil pain, artrophy, autonomic dysfxn, and motor impairment collab management- pain relief, maintaining rom, endoscopic thoracic sympathectomy, psychotherapy |
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interventions for fractures |
support coping patient safety encourage self care coughing deep breathing adequate hydration apply ted hose or SCD encourage ankle exercises patient and family teaching |
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relief of pain |
administer analgescs use of bucks traction as perscribed handle extreme gently support extremity with pillows when moving position for comfort provide frequent position changes provide alt pain relief methods |
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complications of fractures |
infection- prolonged pain, delay healing, wound swelling drainage, cast softening spots, fever hemmorage shock fat embolism compartment syndrome delayed union/nonunion avascular necrosis reaction to internal fixation devices CRPS |
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fat embolism |
>long bone fx >24-48 hours after injury altered mental status increased tpr decrease SAo2 hypotension dyspnea/chest pain petechial hemmorage high mortatlity interventions= bedrest, o2, ivs, possible steroids, immobilization of fx |
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venous thromboemolism |
DVT anytime after surgery asymptomatic unilateral tenderness, swelling |
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pulmonary embolism |
>5 days after injury alterned mental status increased tpr decrease sa02 hypotension/dizziness dyspnea/chest pain interventions= leg exercises, bed rest, compression devices, o2 respiration, anticoagulants, thrombolytics, ivs |
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ishemic necrosis |
pain loss of fxn long term complication >long joint injury no prediction tx joint replacement fracture blisters delayed union, nonunion, malunion |
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complications Acute compartment syndrome |
within 4-6 hours after onset causes: edema, cast, tight dressings neuromuscular damage is irreversible pathophysiologic changes ischemia-edema cycle vasodialiation: increased edema necrosis - paresis/paralysis monitior compartment pressures |
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compartment syndrome clinical manifest. |
urine output must be assessed because there is a possibility of muscle damage myoglobin released from damaged muscle cells parcipitates as gel-like substance- causes renal tubule obstruction large amts of myoglobin may result in acute tubular necrosis acute tubular necrosis casues acute renal failure common signs of myoglobinuria- dark brown urine. cm associated with acute renal failure |
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emergency care: c/s |
fasciotomy may be performed to relieve pressure pack n dress wound aftr fasciotomy infection > amputation motor weakness- irreversible- braces volkmanns contractures- shortening of ischemic msucle
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crush syndrome |
can occure when leg or arm injury includes multiple compartments acute c/s, hypovolemia, hyperkalemia, rhabdomyolysis, acute tubular necrosis treatment: adequate iv fluids, low-dose dopamine, sodium bicarbonate, kaylexalate, hemodialysis |
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achiving physical mobility: amputation |
provide proper positioning of limb: avoid abduction, external rotation and flexion turn patient frequently, use prone position if possible assist devices trapeze and overhead frame, firm mattress implement rom exercises implement muscle strengthening exercises provide preposthetic care - bandaging, massaging, toughening of residual limb |
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phantom limb pain |
pain intense, burning feeling crushing sensation or cramping some patients feel body part removed is in a distorted position real pain and interferes with adls phantom limb pain must be distinguided from stump pain bc they are mananged differently
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pain management |
opioids for stump pain phantom pain: iv calcitonin, beta blockers, anticonvulsants, antispasmodics |
