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