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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?
- local tenderness
- 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
- rapid swelling
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?
- analgesics: NSAIDs for pain and swelling,
- muscle relaxants to reduce muscle spasms,
What are some nursing dx for joint, muscle and bone innjuries?
- acute pain
- 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?
- pain deformity
- limited motion
What is sublaxation?
- partial dislocation,
- 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.
- hematoma: from blood vessels tearing and bleeding
- intense inflammatory response caused by necrotic bone tissue
- vasodilation: because of inflammatory reposne
- exudate forms
- white cells migrate
Describe the reparative phase of fracture healing.
- clotting begins
- fibroblasts and new capillaries grow into the fracture which forms granulation
- granulation tissue replaces the hematoma.
- Phago-cytes begin to remove cell debris.
- Osteoblasts, bone forming cells, proliferate forming a fibrocartila-ginous callus.
- fibrocartila-ginous callus: a web of collagen fibers from both sides of the fracture site that unites the bone fragments
- Bony callus 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?
- other conditions
- when treatment was sought
- physical activity
- 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
- Open wounds
- sterile dressings
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
- additional tests: 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,
- 4. others:
- anti coagulants if on bed rest,
- stool softener or stimulate,
- multi vitamin
- 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?
- displaced fx,
- 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;
- Buck's extension
- used to immobilize during transport
What are 4 types of traction?
- straight (skin)
- balanced suspension
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
- overhead trapeze
- 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
- keep dry
Describe a fiberglass cast.
- used in ER for nondisplaced fx.
- dries quickly
Describe electrical bone stimulation
- promotes healing
- increases osteoblast and osteoclast activity,
- increases blood supply
What are some complications r/t casts?
- compartment syndrome
- swelling from too tight cast
What is compartment syndrome?
- fascia around muscles doesn't give
- swelling increases pressure
- very painful
- causes ischemia
- usually develops w/in 48 hours after the injury
What are some s/s of compartment syndrome?
- decreased sensation
- loss of movement
- decreased distal pulses
What should a nurse do when a pt has s/s of compartment syndrome?
- elevate limb
- call dr.
- measure circumference
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
What are s/s of VTE?
- not always painful
How is VTE prevented?
- TED hose,
- early ambulation
How is delayed or non union diagnosised?
serial xrays to monitor healing
What are treatments for delayed or non union?
- surgically re-break it
- bone graft
- electrical stimulation
What are risk factors for delayed or non union?
- poor nutrition
- inadequate immobilization
- 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
- decreased motion
How is reflex sympathetic dystrophy treated?
- pain meds,
- area nerve block,
What ways do nurses manage pain
- always ask pt to describe pain
- what kind?
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?
- actue pain
- risk for peripheral neurovascular dystunction
- risk for infection
- impaired physical mobility
- risk for disturbed sensory perception: tactile
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?
- bear weight?
- 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?
- aleviate pain,
- 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?
- prevent infections
- 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?
- delayed healing
- chronic stump pain
- phantom 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
- ineffective coping
- impaired mobility
- skin integrity
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?
- collaborative care
- pain relieve
- increase mobility
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
- home care
What are some nursing diagnosis for repetitive use syndrome?
- acute pain
- inpaired mobility
- home care
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?
- excessive weight
What is the pathophy of osteoarthritis?
- wear and tear
- bone spurs
- bone on bone
What are the s/s of osteoarthritis?
- pain and stiffness in one or more joints
- decrease rom
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?
- Unrelenting pain
- 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