Musculoskeletal
epidural steroid injections
decreases inflammation of nerve root
Buck's traction
decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture
phalen's sign
done by pushing back of your hands together for one minute, positive when it causes the same symptoms of carpel tunnel
carpal tunnel
entrapment neuropathy of median nerve in wrist
check distal circulation capillary refill CMS stabilize IV, pain meds Tetanus shot
for a angulated fracture nursing measures would include
dialysis
for patients with CHF this is another option for treating rhabdo
reactive phase
fracture and inflammation phase, hematoma, granulation tissue formation, painful
compound fracture
fracture in which damage also involves the skin or mucous membranes with the risk of infection great
immobilize nero-vascular assessment CMS full body assessment 5 P's
fracture managment
colles fracture
fracture of the lower end of the radius with displacement of the distal fragment dorsally- falling with outstretched arms on the ground
salter harris fracture
fracture through a growth plate (pediatric)
nondisplaced fracture
fragments in close approximation to each other
depressed fracture
fragments of bone are driven inward from blunt trauma
L4-5 & L5-S1
greatest mechanical stress and greatest degenerative changes
malunion
growth of the fragments of a fractured bone in a faulty position, forming an imperfect union
pain
hallmark sign of compartment syndrome
pain intensifies with PASSIVE ROM
hallmark sign of compartment syndrome
loss of function
hallmark sign of fracture
CRPS
hyperesthesia stiffness fluctuating extremity temperature
compartment syndrome
inability to perform active movement and pain with passive movement.
CPK, myglobin, K+
lab testing for rhabdo will show an elevated
osteomyelitis delayed union malunion, nonunion complex regional pain syndrome hetertopic ossification
late fracture complications
pulselessness
late sign of compartment syndrome
most distal point that will heal successfully
level of amputation is determined by
fat embolism
life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury
sprain
ligament and tendon injury
obesity stress depression
low back pain is aggravated by
sciatica
lumbar(lower back) through the hips and buttocks down one side of body
hypovolemic shock
more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments
end of long bones
more vascular area that heals quicker
CRPS
most common in upper extremities, women, stressed personalities
bucks traction
most common skin traction
radiculopathy
nerve foot involvement
heat/cold therapies avoid twisting, lifting limit sitting to 20-50 mins encourage ADLS lumbar flexion for comfort in bed
nonpharmacological treatments for low back pain
place limb at level of the heart may need to bivalve cast
nursing intervention for patient with compartment syndrome, what are you as the nurse going to do after contacting PCP
pain management wound care-bleeding infection prevention compression dressings contracture prevention- extension prone transfer techniques support
nursing management for amputation
oblique fracture
occurs at an angle across the bone but does not protrude through the skin
subluxation
partial separation or dislocation of joint surfaces
hemorrhagic shock
patients with pelvic fractures are at an increased risk for
VS- CMS (distal to proximal) pain management DVT prophylaxis call doctor for sore throat, hoarseness, dysphagia call doctor if you asses halo sign HA donor site logroll Q2 hours (lumbar supine 24-48 hrs)
post op assessment for cervical disecectomy
hetertopic ossification
presence of bone in soft tissues where bone normally does no exist
strain
pulled muscle or tendon
repetitive movements, OA, trauma, diabetes mellitus exposure to cold, vibration
risk factors for carpal tunnel
crush injuries electrocution heatstroke seziures trauma elderly falls overdose of drugs statins burns 3rd degree
risk factors for rhabdo
hetertopic ossificaton
seen in trauma, spinal cord injuries, total hip replacements, and traumatic brain injuries
closed fracture
skin intact
NV checks q15min/1-2hrs, q30 min RICE heat after 48 hours immobilization
soft tissue injury management
weight bearing
stimulates of stabilized fractures
lower leg
the most common area for compartment syndrome to occur
nonunion
the patient complains of persistent discomfort and movement at the fracture site
remodeling phase
to original bone contour
NSAID- indomethacin local radiation therapy surgical resection to prevent joint mobility
tx for hetertopic ossification
Blood C&S IV antibiotics for 3-6 weeks- PICC oral for next three months bone debridment wound care
tx for osteomyelitis
soft dressing
used for amputation with large amount of drainage or frequent inspection is needed
avascular necrosis
A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect?
pelvic and lower extremity fractures
Elderly clients who fall are most at risk for
nonunion
Failure of fragments of a fractured bone to heal together
300 ml/ hr
Patient being treated for rhabdo should have a urine output of
pressure necrosis compartment syndrome thermal injury can lose reduction
complications of casts/splints
Fe damages renal tubule cells myoglobin obstructs tubules DIC RISK
complications of rhabdo
loss of bone matrix and fractures IE: bedrest
continued bone resorption during times of stress can lead to
open fracture
continuity between wound and fracture
impacted fracture
a bone fragment is driven into another bone fragment
dorsalis pedis pulse
a patient with a pelvic fracture the nurse would want to assess the
urinary tract trauma
all pelvic fractures have this unless proven otherwise
Prevent internal rotation of the affected leg.
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
prevent internal rotation of affected leg
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
Elevating the leg might lead to a flexion contracture
A patient asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?
tendons
attach muscle to bone
dislocation or fracture nonunion or malunion glandular diseases alcohol abuse long term use of corticosteroids sickle cell anemia
avascular necrosis can be caused by
CRPS
avoid BP, venipuncture in the effected arm with
fiberglass casts
best for simple fractures of upper and lower extremities
immediate immobilization
best prevention for fat embolism to occur
cauda equina syndrome
bilateral leg pain and weakness urinary retention bowel and bladder incontinence
ligaments
bind bone to bone
TENS
blocks nerve impulses that are interpreted by the brain as pain by increasing blood flow and circulation
contusion
blunt force trauma
communited fracture
bone has broken into a number of pieces due to large force or crush injury
avascular necrosis
bone loses blood supply and dies
incomplete fracture
break through only part of the cross-section of the bone
rhabdomyolysis
breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) in the bloodstream occuring 12-24 hours post injury
reparative phase
callus formation, lamellar bone deposition, 3-4 week to months
elderly
communited fractures can occur more frequently with the
promote extension of hip prone position for 20-30 mins several times per day PT
contracture prevention
rigid dressing
controls edema and assists with residual limb shaping after an amputation
shock compartment syndrome rhabdomyolysis fat embolism DVT/PE
early fracture complications
dexamethasone( Decadron) triamcinolone (Kenalog) Soul-medrol
epidural steroid injections
12-24 hrs but up to 10 days
fat embolism can occur within
long bones or pelvic bone fractures due to crush injuries
fat embolisms usually occur in
osteomyelitis
fever leukocytosis increased ESR malaise
skin traction
limited force, no greater than 10lbs
angulated fracture
loss of anatomical position due to direct or lateral force
bone necrosis
occurs when the bone is deprived of blood
greenstick fracture
one side of the bone is broken and the other side is bent; it does not protrude through the skin
lower extremity (tibia)
open fracture most often occurs in the
risk for osteomyelitis
open fractures increase your risk for
phantom limb pain
originates in the spinal cord and brain
complex regional pain syndrome
painful SNS problem with burning pain and edma
deep, throbbing pain increasing pain eve with opiods pain intensifies with passive ROM
s/s of compartment syndrome
AMS tachypnea, tachycardia petechiae- buccal, chest, eyelid fever > 103 ABG PaO2 <60
s/s of fat embolism
altered mental status fever tachypnea tachycardia hypoxemia petechiae
s/s of fat embolism
pain- muscle spasms 20 minutes loss of function deformity shortening crepitus
s/s of fracture
dark reddish urine myalgia elevated CPK, myglobin, K+
s/s of rhabdo
tinel's sign
tapping the median nerve along its course in wrist, positive test will cause worsening of tingling in first finger thru third digits
communited fracture
the bone has splintered into several fragments
sterile dressing
the first thing the nurse should for a patient with an open fracture is to apply a
intra-articular injections of methylprednisolone wrist splints surgery
treatment for carpel tunnel syndrome includes
TCA (Elavil) SNRI (duloxetine)
treatment for chronic back pain
electric bone stimulation
treatment for delayed union
vent support with PEEP corticosteroids vassopressors for obstructive shock
treatment for fat embolism
internal fixation, bone grafting
treatment for nonunion
gabapentin before or within 24 hours of amputation
treatment for phantom limb pain
AGGRESSIVE HYDRATION
treatment for rhabdo
spiral fracture
twists around the shaft of the bone but does not protrude through the skin.
acetaminophen NSAIDS cyclobenzeprine (Flexeril)-muscle relaxant
tx for acute back pain
bucks traction
used in preop hip fractures to decrease spasms and increase comfort
administer analgesics provide comfort measures encourage participation in ADLS promoting physical mobility preventing infections maintaining skin integrity preparing patient for self-care
what nursing interventions are appropriate for a patient with a closed reduction extremity fracture?
lay prone 20-30 minutes at a time
with a patient with an amputation, you will want to prevent contracture prevention by having your patient
