note cards for test 3 complete.txt
Card Set Information
note cards for test 3 complete.txt
questions for 103 the third test
What is paresis?
What is a hematoma?
large amount of bleeding
What is a contusion?
bleeding into soft tissue, usually from blunt force
What is a strain?
stretching injury to muscle or muscle-tendon unit
What are some strain s/s?
sharp or dull pain
What is the most common area for a strain?
lower back then cervical region
What usually causes a strain?
What is a sprain?
injury to a ligament surrounding a joint
What causes a sprain?
forces going in opposite directions
What are some s/s of a sprain?
loss of ability to move/use joint
What does R.I.C.E. stand for?
How many of the R.I.C.E. are necessary to do?
How are joint, muscle and bone injuries dxed?
x ray for bone and joints
MRI for soft tissue
When should you do R.I.C.E.
first 24 hours
What meds are used for joint, muscle and bone injuries?
: NSAIDs for pain and swelling,
muscle relaxants to reduce muscle spasms,
What are some nursing dx for joint, muscle and bone innjuries?
impaired physical ability
self care deficit
risk for impaired skin integrity
What are the 5 P's
What is a dislocation?
loss of articulation of bone ends in the joint following sever trauma
What are some s/s of sublaxation?
What is sublaxation?
bone ends still partially intact
What is parasthesia?
unusual sensation such as:
What is a fracture?
any break in continuity of bone
How are fractures classified?
What is a simple fracture?
skin is still intact
What is a compound fracture?
skin integrity interrupted
What is a complete fracture?
entire width of the bone is broken
What is a stable fracture/Non-displaced?
the alignment is maintained
What is a compressed fracture?
the bone is crushed
What is a comminuted fracture?
the bone breaks in many places
What is an incomplete fracture?
part of the width of the bone is broken
What is a stress/pathologic fracture?
the bone endures a repetitive overload
so the bone can't repair itself quickly enough,
so the bone's homeostatis in disrupted
What is an unstable/displaced fracture?
the bone is out of alignment
may have muscle spasms,
need to manipulate the bone back into alignment
may need surgery
What is important to determine when presented w/ a stress/pathologic fracture
Why it occurred. Is it cancer? Osteoporosis? etc.
What are the phases of fracture healing?
What are the manifestations of a fracture?
may have soft tissue injuries
may have alteration in circulation
may have obvious deformity or shortening of extremity
may have felt or heard the bone break
Describe the inflammatory phase of fracture healing.
from blood vessels tearing and bleeding
intense inflammatory response caused by
necrotic bone tissue
: because of inflammatory reposne
Describe the reparative phase of fracture healing.
fibroblasts and new capillaries grow into the fracture which forms granulation
tissue replaces the hematoma.
Phago-cytes begin to remove cell debris.
Osteoblasts, bone forming cells, proliferate forming a fibrocartila-ginous callus.
: a web of collagen fibers from both sides of the fracture site that unites the bone fragments
formation usually continues for 2 to 3 months
Describe the bone remodeling phase of fracture healing.
osteoblast/osteoclasts respond to daily stress by remodeling along the site of the fracture
the repaired section of bone then resembles the uninjured bone
What things influence the healing of a fracture?
when treatment was sought
type of fracture
location of fracture
How long does an arm or foot fracture take to heal?
What emergency care should be given to an expected fracture or dislocation?
immobilization of fx with split, pillow, cardboard, etc. elevate
assess 5 Ps
Maintain tissue perfusion
How long does it take a hip fracture to heal?
hip 12-16 weeks
What diagnostic tests are used for fractures and dislocations?
history of incident & assessment
x-ray of bones
: cancer, osteoporosis, electrolytes, etc
What medications might be used for a fracture or dislocation?
1. pain meds
narcotic, for sever, impinged nerves,
2. NSAIDs -beware of bleeding
3. Antibiotics - for open fx,
anti coagulants if on bed rest,
stool softener or stimulate,
anti ulcer med
When should surgery occur for fractures or dislocations?
goal is to have in OR within 6 hrs
What is external fixation?
pins thru the bone to stabilize
What are some things that indicate a need for surgery for a fracture or dislocation?
soft tissue damage involving nerves,
blood vessels needing repair
What is ORIF?
open reduction internal fixation
What does a person who has had ORIF need to remember?
need to remember there is metal there for MRI
What is traction?
application of straightening or pulling force
to maintain or return fractured bones in normal alignment,
prevent muscle spasms
What are traction weights used for?
maintain necessary force
What is straight (skin) traction?
pulling force in straight line;
used to immobilize during transport
What are 4 types of traction?
What is balanced suspension?
more than 1 force of pull
raise and support injury off of the bed
allows increased mobility
What is skeletal traction?
pulling force is applied through pins placed in the bone
What are some risks of skeletal traction?
more risk of infection
What are some complications of immobility a nurse should assess for?
skin break down on back
problems urinating while laying down
constipation, pain meds, lack of privacy, laying down
kidney stone formation from calcium as a result of fracture
pins site could be infected
What does T.R.A.C.T.I.O.N. stand for?
temperature of the extremity/infection
ropes hang freely
circulation check 5 Ps
type of locations of fracture
increase Fluid intake
no weights on bed or floor
What is a cast?
a rigid device applied to immobilize bones & promote healing, usually extends above & below fx
What are 2 types of casts?
Describe a plaster cast.
needs ~48 hrs to dry - don't touch until it's dry
stockinette on skin, then the plaster
Doesn't reach total hardness until 48-72 hrs later.
Watch weight bearing
Swelling - wait until goes down, or splint until swelling goes down
don't get it wet
What teaching should a nurse do r/t casts?
nothing in any casts to scratch
use a blow dryer on cool setting for itching
notify doctor if pain, coolness, strange color, etc
Describe a fiberglass cast.
used in ER for nondisplaced fx.
Describe electrical bone stimulation
increases osteoblast and osteoclast activity,
increases blood supply
What are some complications r/t casts?
swelling from too tight cast
What is compartment syndrome?
fascia around muscles doesn't give
swelling increases pressure
usually develops w/in 48 hours after the injury
What are some s/s of compartment syndrome?
loss of movement
decreased distal pulses
What should a nurse do when a pt has s/s of compartment syndrome?
What is a fasciotomy?
surgical incision to cut the fasca to increase blood supply
if urgent they will do it at bed side,
leave incision open for awhile,
put half cast until pressure is relieved,
How is compartment syndrome treated?
What are 3 precursors to VTE
1. venous stasis
2. injury to blood vessel
3. altered blood coagulation
How is VTE dxed?
What are s/s of VTE?
not always painful
How is VTE prevented?
How is delayed or non union diagnosised?
serial xrays to monitor healing
What are treatments for delayed or non union?
surgically re-break it
What are risk factors for delayed or non union?
poor alignment of fracture at repair
didn't see doc in time
sever bone trauma
What is delayed or non union?
not healing or not lining up
How is VTE treated?
bed rest for 5-7 days to prevent dislodgement
heparin IV prevent more clots (doesn't dissolve)
What is reflex sympathetic dystrophy?
caused by muscle, bone, or nerve damage
sever, diffuse, burning pain
hyper sensitive to stimuli
How is reflex sympathetic dystrophy treated?
area nerve block,
What ways do nurses manage pain
always ask pt to describe pain
How do nurses help the pt with copying with pain?
impaired physical mobility (barrier free,assistive devices)
impaired tissue prefusiong and neurovasculare compromise (ceck at least q hour cap refill, sensations, etc)
pressure ulcers, check frequently,
assessment of client's response to trauma (changes in ADL changes at home lots of psych social)
do they need extra help at home, shopping, cleaning etc.
How can nurses help pts prevent fractures?
maintain good weight
What are some nursing diagnoses r/t pain?
risk for peripheral neurovascular dystunction
risk for infection
impaired physical mobility
risk for disturbed sensory perception
What is an amputation?
partial or total removal of a body part
What are some things a nurse needs to teach a client/family about cast care?
can they shower?
edges of cast, smooth rough edges?
follow dr orders r/t how much weight bearing,
ROM of unaffected limbs
elevation to decrease swelling and pain
discharge planning � needed equipment, PT
What are some things that create a need for amputation?
Periphial vascular disease in lower extremity
trauma for upper extremity
sever frost bite
What is always the unerlying issue that creates a need for amputation?
always not enough blood supply either acute or chronic
What are some goals for an amputation?
save as much healthy tissue as possible
increase functional outcome
What is an open amputation?
wound site is left open for awhile to promote healing.
What is a closed amputation?
closed leave a flap to put over knee
What are some concerns about site healing after an amputation?
access circulation to stump
ace wrap, compression wrap in minimize edema
as much activity as possible
What considerations are there for a prostetic?
stump needs to be cone shaped to fit in prosstheis,
wrap from distal to approximal
1st 24 hours, elevate the stump
Why should a stump not be elevated after 24 hours?
because the leg will want to stay that way (flexure contracture)
lay prone some times to keep leg straight
What are some complications of an amputation?
chronic stump pain
How can a pt avoid contractures after an amputation?
avoid prolonged sitting
lay prone, not always supine
don't elevate after 24 hours
What are some nursing diagnosis r/t amputation?
body image distrubance
risk for infection
Name 2 types of repetitive use injuries.
carpal tunnel syndrome
What is carpal tunnel syndrome?
numbness tingling of thumb and index finger
pain in some positions
interfers with sleep
How does surgery help carpal tunnel syndrome?
surgery makes tunnel bigger
What kind of care is required for repetitive use injuries?
What is bursitis?
inflammation of the bursa that's between muscles and tendons,
joint may be tender, hot, red, swollen, joint flex painful,
rest can help,
What kind of meds are used for repetitive use injuries?
med - NSAIDs
What kinds of treatments are used for repetitive use injuries?
remove bursa to make a bigger tunnel
What are some nursing diagnosis for repetitive use syndrome?
What is Osteoarthritis
a degenrative joint disease
most common form of arthritis
loss of articular cartilage
hypertrophy of bones at articular margins
What are some risk factors for osteoarthritis?
What is the pathophy of osteoarthritis?
wear and tear
bone on bone
What are the s/s of osteoarthritis?
pain and stiffness in one or more joints
What is crepytis?
grinding noise with a sensation felt in the joint
might be from bone on bone movement
Hemotoma, necrosis, inflammatory, exudate, white blood cells
First stage of bone healing: inflammatory
lasts 2 - 3 months, fractured area looks like uninjured area
3rd stage, bony callus formation: remodeling
osteoblasts - > collegen web fibers -> connect bone fragments
2nd stage, fibrocartilaginous callus formation: reparative
Why is a fracture supported both above and below the injury?
Supporting the injured extremity above and below the fracture site helps prevent displacement of bony fragments and decreases the risk of further nerve damage.
What s/s might indicate compartment syndrome?
diminished distal pulses
Pulses may __________ in the presence of compartment syndrome.
the slipping of either part of a fractured bone past the other.
a smaller piece of the bone breaks away from the main bone
the growth plate is broken