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77 Cards in this Set
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- Back
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Nursing considerations: fracture management (3) |
1. Adequate pain control - acute v chronic
2. Prevent infection -monitor fracture site -good pin care
3. Skin care - avoid skin breakdown -pressure ulcers -inside casts |
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Define traction |
Traction is the application of pulling force to an injured or diseased body part or extremity |
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Define counter-traction |
Counter-traction is a force that pulls opposite to traction |
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What usually provides counter traction? |
The patient's own body usually provides counter-traction |
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What are the purposes of traction? (8) |
1. Reduce/realign/promote fracture healing 2. Immobilization 3. Treat dislocations/subluxations 4. Decrease muscle spasms 5. Rest joint 6. Prevent contractures 7. Treat deformities 8. Expand joint space |
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Types of traction? (3) |
1. Manual - hands exert direct pulling force
2. Skin - pulling force applied directly to skin
3. Skeletal - traction forces applied directly to bone |
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Examples of skin traction (6) |
1. Cervical 2. Sidearm 3. Pelvic sling 4. Buck's 5. Bryant's 6. Russell's |
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Traction for cervical spine fractures? |
Halo traction |
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Traction to treat hip or pelvis or femur comminuted fractures? |
Balanced suspension traction -most common traction -uses Steinman pin & Kirschner wires |
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Nursing care of traction: Positioning (3 points) |
1. Proper body alignment
2. Prevent friction
3. Limit elevation of head of bed |
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Nursing care of traction: maintaining traction (2 points) |
1. Maintain prescribed line of pull
2. Prevent obstruction of pulleys - weight must hang freely |
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Complications of fractures (4) |
1. Osteomyelitis (infection)
2. Compartment syndrome
3. Foot drop/wrist drop
4. Disuse syndrome (The last 3 are result of peripheral neurovascular compromise) |
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Causes of complex regional pain syndrome (4 steps) |
Trauma leads to
Injury in nerves and Damage to blood vessels, sweat glands and skin which
Leads to an autoimmune inflammatory response that
Messes with the sympathetic nervous system |
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Alternate name for complex regional pain syndrome? |
Regional Sympathetic Dystrophy |
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Complex regional pain syndrome: clinical presentation (3 big points) |
1. Intense burning pain - out of proportion to injury -put unable to tolerate light touch or weight of sleeves/pants
2. Skin changes -changes in temperature -becomes blotchy -increased sweating
3. Muscle spasms leading to muscle wasting |
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Complex regional pain syndrome: diagnostic testing (2) |
1. Thermography
2. Nerve conduction studies |
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Complex regional pain syndrome: goal of treatment? |
The goal of treatment is to slow the disease; currently no cure. |
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Complex regional pain syndrome: goal of treatment? |
The goal of treatment is to slow the disease; currently no cure. |
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Complex regional pain syndrome: treatments (3) |
1. Stellate ganglion blocks to interrupt sympathetic nervous system signals
2. Beta blockers to increase blood flow
3. Surgical sympathectomy |
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Types of soft trauma (5) |
1. Sprain 2. Strain 3. Subluxation 4. Dislocation 5. Soft tissue injury |
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Trauma prevention measures (6) |
1. Seat belt use 2. Child restraints 3. DUI/MADD 4. Speed limit adherence 5. Home safety 6. Helmets/pads/guards (protective gear) |
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Types of athletic injuries (2) |
1. Overuse/chronic injuries 2. Acute traumatic injuries |
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Examples of overuse/chronic injuries (3) |
Anything that occurs as result of repetitive trauma or training like: 1. "-itis" injuries 2. Stress fractures 3. Repetitive motion injuries |
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Examples of acute traumatic injuries (2) |
Anything that results from a single blow or application of force: 1. Fracture/dislocation 2. Sprains/strains |
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Most common injury in sports? |
Strain |
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Define strain |
A strain is a traumatic injury to a muscle or tendon and is caused by direct force OR muscle overload OR muscle contraction |
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How is a strain graded? |
A strain is graded from I to III I is stretched III is tearing of fibers |
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Define sprain |
A sprain is a traumatic injury to the ligamentous fibers surrounding a joint and caused by sudden twisting or hyperextension of the joint |
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Why perform a MRI on a sprain or strain? |
The MRI is to rule out an avulsion fracture |
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What are the grades and meaning of the grades for a sprain? |
Grade 1 - first degree; stretching of ligament
Grade 2 - second degree: some tearing of ligamentous fibers
Grade 3 - severe;complete rupture of ligament |
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Define subluxation |
Partial dislocation of articulating surfaces |
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Define subluxation |
Partial displacement of articulating surfaces |
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Define dislocation |
Complete displacement of articulating surfaces |
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Cause for subluxation and dislocation? |
Sudden force applied to the joint |
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Glenohumeral dislocation facts (3) |
1. Most common major joint dislocation 2. 98% occur anteriorly 3. Common cause is a "fall on out stretched hand" (FOOSH) |
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Elbow dislocation facts (3) |
1. Second most frequent major joint dislocation 2. Potential neurovascular emergency 3. Almost all are posterior (like children's nurse maid elbow) |
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PIP joint dislocation/subluxation |
Most common hand injury |
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Hip dislocation/subluxation facts (3) |
1. Associated with severe trauma such as a fall or ramming into the dashboard 2. 90% occur posteriorly 3. Orthopedic emergency - worried about avascular necrosis |
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Patellar/knee dislocation facts (3) |
1. Associated with severe blow or twisting force
2. Anterior dislocation most common lower extremity dislocation
3. Neurovascular/ neurological emergency** |
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Patellar/knee dislocation facts (3) |
1. Associated with severe blow or twisting force
2. Anterior dislocation most common lower extremity dislocation
3. Neurovascular/ neurological emergency** |
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Steps to subluxation/dislocation treatment (4) |
1. Radiographs to rule out fracture
2. Immediate closed reduction by trained personnel
3. Repeat radiographs to rule out fracture
4. Evaluate neurological/vascular status |
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Patellar/knee dislocation facts (3) |
1. Associated with severe blow or twisting force
2. Anterior dislocation most common lower extremity dislocation
3. Neurovascular/ neurological emergency** |
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Steps to subluxation/dislocation treatment (4) |
1. Radiographs to rule out fracture
2. Immediate closed reduction by trained personnel
3. Repeat radiographs to rule out fracture
4. Evaluate neurological/vascular status |
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Some select nursing diagnoses associated with subluxation/dislocation (4) |
1. Risk for peripheral neurovascular dysfunction
2. Risk for impaired physical mobility
3. Risk for ineffective tissue perfusion and injury (check cast!)
4. Risk for injury (crutches can injure brachial plexus) |
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P-RICE-MM stands for... |
P - protection R - rest I - ice C - compression E - elevation M - medications M - modalities |
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P-RICE-MM stands for... |
P - protection R - rest I - ice C - compression E - elevation M - medications M - modalities |
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What are the Medications from the M in P-RICE-MM? |
1. NSAIDS 2. Analgesics 3. Muscle relaxants |
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What are the Modalities from the second M in P-RICE-MM? (2) |
1. Diagnostic testing
2. Physical therapy |
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What are the Modalities from the second M in P-RICE-MM? (2) |
1. Diagnostic testing
2. Physical therapy |
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Uses of imaging for sports injuries? (4) |
1. Differential diagnosis - rule out fracture and loose body
2. Gradation of injury - G1-3/sprain/separation
3. Determine treatment protocols - reductions; conservative tx vs surgery
4. Asses post-treatment status -reductions -healing status -union v non-union |
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Pinched nerve syndrome: mechanism of injury |
Sudden direct blow to one side of head |
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Pinched nerve syndrome: mechanism of injury |
Sudden direct blow to one side of head |
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Pinched nerve syndrome: clinical presentation |
Numbness or tingling on upper extremity |
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Pinched nerve syndrome: mechanism of injury |
Sudden direct blow to one side of head |
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Pinched nerve syndrome: clinical presentation |
Numbness or tingling on upper extremity |
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Pinched nerve syndrome: diagnostic testing |
X-rays EMG NCS Bone scan |
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Pinched nerve syndrome: conservative treatment (3) |
1. Initial immobilization 2. P-RICE-MM 3. Protective collar for return to play |
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Cervical sprains/ strains: mechanism of injury |
Direct trauma with a whiplash effect Sprain - stretching or tearing muscle Strain - stretching or tearing of ligaments |
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Cervical sprains/ strains: mechanism of injury |
Direct trauma with a whiplash effect Sprain - stretching or tearing muscle Strain - stretching or tearing of ligaments |
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Cervical sprains/ strains: clinical presentation (2) |
1. Immediate onset of pain and muscle spasms
2. Decreased active range of motion |
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Cervical sprains/ strains: conservative treatment (2) |
1. P-RICE-MM 2. Muscle relaxants |
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Mechanism of injury for Impingement Syndrome |
Overuse of shoulder |
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Mechanism of injury for Impingement Syndrome |
Overuse of shoulder |
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Impingement syndrome/ rotator Cuff injury: clinical presentation (5) |
1. Pain over lateral and anterior shoulder (deltoid muscle) 2. Pain with activity initially 3. Progresses to pain at rest 4. Decreased/painful range of motion 5. May feel shoulder "catch" with motion |
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Shoulder impingement/ rotator cuff injury: tests at physical examination (5) |
1. Impingement sign + 2. Painful arc at 90 degree/abduction/ adduction 3. Hawkins test - cross chest adduction + 4. Tenderness with movement 5. Drop at test - + with complete rotator cuff tear |
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Shoulder impingement/ rotator cuff injury: diagnostic testing |
X-rays - rule out fracture MRI - impingement v rotator cuff tear |
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Shoulder injuries: conservative treatment (3) |
1. P-RICE-MM 2. Extensive physical therapy 3. Cortisone injections (NOT during acute injury phase) |
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Shoulder injuries: conservative treatment (3) |
1. P-RICE-MM 2. Extensive physical therapy 3. Cortisone injections (NOT during acute injury phase) |
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Shoulder injuries: surgical interventions (4) |
1. Arthroscopic debridement & anterior acromioplasty/ possible AC joint resection
2. Open acromioplasty
3. Rotator cuff repair
4. Mini open repair of rotator cuff |
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Shoulder injuries: conservative treatment (3) |
1. P-RICE-MM 2. Extensive physical therapy 3. Cortisone injections (NOT during acute injury phase) |
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Shoulder injuries: surgical interventions (4) |
1. Arthroscopic debridement & anterior acromioplasty/ possible AC joint resection
2. Open acromioplasty
3. Rotator cuff repair
4. Mini open repair of rotator cuff |
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Shoulder Instability: mechanism of injury |
Can be traumatic, can be overuse syndrome |
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Shoulder injuries: conservative treatment (3) |
1. P-RICE-MM 2. Extensive physical therapy 3. Cortisone injections (NOT during acute injury phase) |
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Shoulder injuries: surgical interventions (4) |
1. Arthroscopic debridement & anterior acromioplasty/ possible AC joint resection
2. Open acromioplasty
3. Rotator cuff repair
4. Mini open repair of rotator cuff |
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Shoulder Instability: mechanism of injury |
Can be traumatic, can be overuse syndrome |
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Shoulder Instability: clinical presentation (4) |
1. Patient reports a "slipping" within the joint
2. Can be in one or multiple directions
3. + relocation test (physical exam)
4. + sulcus sign (physical exam) |
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Shoulder Instability: diagnostic imaging |
X-rays MRI |
