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109 Ch. 69

Mgmt of Pts w/ musculoskeletal Trauma

A contusion is the same thing as ecchymosis, bruising
difference b/n strain and sprain strain: pulled muscle/tendon. 3 types from mild to severe Sprain: injury to ligaments/tendons that surround joint. 3 stages mild to completely torn ligament
Tx of strain, sprain, contusion Rest ice- first 24-48 hrs, then heat compression elevation
what is a dislocation articular surfaces of distal/proximal bones not aligned
what is subluxation partial dislocation
what can happen if dislocation or subluxation not reduced immediately avascular necrosis
what is epicondylitis also known as tennis elbow, excessive repetitive extension, flexion, pronation, supination
For the ACL and PCL, which one gets the force forward and backward forward: ACL backward: PCL
what do menisci do and how to best diagnose it act as shock absorbers in knee, MRI
What is injured if you cannot plantar flex foot achilles tendon
what is a fracture complete, incomplete disruption in continuity of bone structure.
what are types of fractures complete- break across entire bone incomplete-thru part(greenstick) comminuted- several bone fragments closed- simple, not break skin open- break skin, compound
what are signs of a fracture acute pain, loss of fx, deformity, shorteningo fextremity, crepitus, edema, ecchymosis
More types of fractures avulsion- muscle pull bone off compression depressed- fragments driven in epiphyseal greenstick- one side broke, other bent impacted- bone driven into bone oblique- angle pathologic- diseased bone spiral, stress, transverse
what does it mean to have fracture reduction restoration of fracture fragments to anatomic alignment and positioning.
Two types of reduction closed- thru manipulation/manual traction open- int/external fixation devices
what is always used to determine proper reduction xrays
how long does a fracture typically take 6 - 8 weeks
what is goal with open fractures prevent infection. Primary wound closure is usually delayed
which fracture heal more quickly, the shaft area of long bones or the ends of long bones The ends becuase more vascular adn cancellous. Weight bearing stimulates healing
what is a fat emboli can develop after fracture of long bone or pelvic bones. Usually in males over 40. Sx: petechiae, hypoxia, tachypnea, tachycardia, pyrexia, confusion, irritability. TX: maintain fluid/electrolyte balance, O2
what is compartment syndrome perfusion pressure falls below tissue pressure in compartment. Decr of blood to distal area of injury. Pain w/ passive ROM Tx: elevate at heart level, bivalve
what are sensory deficits when assessing neurovascular fx after a fracture deep, throbbing, escalating pain, paresthesia, hypothesia(diminished sensation)
Peripheral circulation is assesed by looking for cool skin, pale color, slow capillary refill time, edema, slow pulse(tested with Wick catheter)
After a fracture neurovascular assessment consists of the "5 P's" pain, paralysis, paresthesia, pallor, pulselessness
Pts with fractures of lower extremeties are at high risk for venous thromboemboli DIC- disseminated intravascular coagulation- hemorrhaging systemically and signs are unexpected bleeding after surgery, puncture sites, gastro/intest tract
what is delayed/mal/nonunion delayed: healing doesn't occur in expected time for fracture mal: ends of fractured bone don't unite in normal alignment non: ends of bone don't unite
when repairing nonunions, what kind of bone will doctors use cortical bone for structural strength cancellous bone for osteogenesis corticocancellous for strength and rapid incorporation
what three things can a doctor do to treat nonunion bone graft, internal fixation, electrical bone stimulation
what is CRPS- complex regional pain syndrome painful sympathetic nervous system problem in upper extremities in women. Sx: burning pain, edema, stiffness, discoloration, glossy skin, incr hair/nail growth
what is heterotopic ossification abnormal formation of bone, near bones or in muscle due to trauma
what fracture is seen more in older women fractures of proximal humerous through neck of humerous and impacted fractures of neck Tx: pendulum excercises
With an elbow fracture, what is most common complication Volkmann's contracture usually displaced fractures treated wtih ORIF open reduction internal fixation
With radial and ulnar shafts what is particularly important for nondisplaced fractures immobiliztion including pronation/supination. Long arm cast.
what is a fracture of the wrist called Colles fracture
what does the pelvis consist of sacrum, ilium, pubis, ischium
what is possible complication with the bowels in pelvic fractures paralytic ileus
what are two types of hip fracture intracapsular fractrues- neck of femur Extracapsular - trochanteric region(b/n neck and lesser)
With hip fractures, what is nurses key job in positioning pt keep pillow b/n legs to maintain abduction and alignment. Turn by "log roll"
What are techniques to avoid DVT's fluids, ankle/foot exercises, anti-embolism stockings(remove 20 min 2xday), pneumatic compression devices, anticoagulant therapy, assess legs Q 2-4 hrs(calf tenderness, redness, warmth, swelling)
What are preventions for pulmonary complications(atelectasis, pneumonia) coughing, deep breathing, change position Q2h, incentive spirometer, assess breath sounds Q2-4h
Elevated temperature in early postoperative period can indicate what atelectasis or pneumonia
Where is amputation usually performed at most distal point that will heal successfully. Determined by circulation in part and functionality
What is a Syme amputation modified ankle disarticulation amputation that allows FWB
What is BKA, AKA below knee amputation above knee amputation
what is a staged amputation used when gangrene and infection exist.
what should nurse do if cast or elastic dressing comes off limb immediately wrap limb with elastic compression bandage to prevent excessive edema
What is important to remember about positioning a lower extremity limb never place on pillow, becuase hip contracture can occur
what is first action if limb hemmorrhages first put on tourniquet left by bed, then call surgeon
Created by: palmerag
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