Ch 43 muscoskeletal trauma
when can a patient apply heat to a sprain or contusion
after 2 days
closed reduction for fractures
align bone fragments thru manipulation or traction held in place while cast is applied
tourniquets should be in sight for for
amputations
RICE
rest ice compression elevation immobilize and anti inflammatory
treatment of achilles tendon rupture
rest don't bear weight
fat embolism r/t
rupture long bone
hypovolemic shock r/t
rupture of femoral artery
pain relief for ampuations
sand bag on residual TENS transcutaneous electrical nerve stimulation
Dislocation
separation of joint surfaces change in length and contour occurs distal and proximal are no longer aligned
left femur during a horseback riding accident
highest risk for infection
grade 3 fracture
highly cont soft tissue damage trauma requires amputation
complications of fractures
hypovolemic shock fat embolism compartment syndrome delayed union or non-union
pelvic unstable fx
immediate ER stabilize decompress bleeding at risk for shock
mortality rate of hip fx
1/3 in post year
treatment for collateral damage
6-8 weeks
fracture in which a bone has splintered into several pieces
Comminuted
right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold and feeling clammy shiny skin that is growing more hair in the injured extremity
Complex regional pain syndrome (CRPS)
Colles' fracture
Distal radius usually from result of a fall on an open, dorsiflexed hand
subtle personality changes, restlessness, irritability, and confusion in a patient who has sustained a fracture
Fat embolism syndrome
management of join dislocation
immobilize with splints, casts traction closed reduction gentle active and passive ROM monitor for compartment syndome
Pulselessness, a very late sign of compartment syndrome, may signify
Lack of distal tissue perfusion
reaction to an internal fixation device
Pain and decreased function
assessment findings of the leg are consistent with a fracture of the femoral neck
Shortened, adducted, and externally rotated
fractures complete
entire cross section
heteortrophic ossification
abnormal bone formation
radial, ulnar, wrist and hand fx
active ROM fingers & shoulder functional rehab
RX femoral fx
active and passive ROM of knee internal fixtures post 24 hours
measures for a patient with a fracture reduction
administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the patient for self-care
avoid movement for ampuations
abduction external rotation flexion turn frequently and prone position
pelvic stable fx
bedrest anti-emoblytic stockings at risk for paralytic ileus monitor bowel sounds
avascular necrosis
bone loses blood supply also seen dislocations limit movement surgical decompression
treatment for ACL or PCL
brace
hip fx nursing interventions
buck traction immob fx of proximal femur and hip avoid catheters use aseptic technique wounds ankle exercises
cruciate ligaments
direct force backwards and forwards POP noise
clavicle fx
don't elevate arm above shoulder for 6 weeks exercise below wrist and fingers
epicondylitis
chronic excessive repetive extension, flexion, pronation, supination of forearm
grade 1 fracture
clean and less than a cm long
a patient with disloaction is likely to experience complications of
compartment syndrome must be checked q15 minutes
pelvic fx
early mobilization reduce problems related to mobility
traumatic
emergencies because of blood supply
Factors that inhibit fracture healing
diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection
sprain
injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion
grade 2 fracture
large without extensive soft tissue damage
medial epicondyle
lateral: tennis elbow medial: golf and pitchers elbow
why residual limbs cannot be elevated on a pillow
lead to a flexion contracture
meniscural injury
left and right side of proximal tibia slip of meniscus prevents full extension click knee locks
stable T7 spinal fracture with no neurologic deficits should
maintain limited bed rest with the head of the bed lower than 30 degrees
Avascular necrosis
manifested by pain and limited movement
elbow fx
monitor nv compromise and compartment syndrome
treatment for slipped meniscus
surgery
hip
surgery done
treatment for avascular necrosis
surgical decompression bone grafts
open reduction for fractures
surgically aligned with internal fixation
rotator cuff tears
tear in tendon of muscles to humeral head acute and chronic pain upon lifting arm above shoulder complaint of night pain
what is given to open fractures
tetanus prophylaxis closure may be delayed
types of femoral fx
transverse oblique spiral comminuted
spiral fracture
twisting around the shaft of the bone
what does achilles attach to
attach to soleus and gastrocnemous to heel
lateral and medial collateral damage
foot planted, knee struck medial or lateral inabiity to walk without assistance
delayed union or non union r/t
healing not occured
amputation
mostly vascular disease -chronic myelitis -malignant tumor -burns -gas gangrene
Strain
muscle pull or tear, loss of function "My knee got twisted when I was going down the stairs."
Heterotrophic ossification
muscular pain and limited muscular contraction and movement
close or simple
no break in the skin
Compartment syndrome
normal pressure of a compartment is altered injury itself, by development of edema hemorrhaging at the site of the injury outside pressure caused by constriction from a dressing or cast
greenstick fracture
one side of a bone is broken and the other side is bent
incomplete fracture
only part of cross section
complex regional pain syndrome
painful SNS prob most upper extremity
femoral fx
painful thigh cannot move hip or knee
Subluxation
partial separation or dislocation of joint surfaces
humeral fx
pendulum exercises
patient(s) is most likely to have compartment syndrome after sustaining a fracture
plaster cast applied immediately after injury The patient with hemorrhage in the site of injury The patient with elevated pressure level within the muscles
avulsion fracture
pulling away of a fragment of bone by a ligament or tendon and its attachment
75-year-old patient had surgery for a left hip fracture at risk for
sepsis, skin breakdown, pneumonia, delirium
S&S complex regional syndrome
severe burning pain, fluctuating between warm and cold
compartment syndrome r/t
severe decrease in blood flow ischemic necrosis
phantom leg pain r/t
severed peripheral nerves admin analgesics
what suggest torn ACL/PCL
significant swelling 2 hours post
open or complex
skin or mucous membrane wound extends to fractured bone
contusion
soft tissue injury caused by blunt force bruising
femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?
vitals and level of consciousness for signs of shock
elbow fx are a potential for
volkmans contracture -acute compartment syndrome from antecubital swelling to brachial artery active ROM
causes hip fx
weak quads slowed reflexes general frailty and other conditions
rupture occurs
when contract while foot is planted cannot plantar flex