Med Surge

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Author:
yagurl_dana
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27068
Filename:
Med Surge
Updated:
2010-07-17 22:21:11
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Caring clients Traumatic Musculoskeletal Injuries
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Ch. 62
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  1. What is a strain?
    injury 2 a muscle from excessive stress, overuse, or overstretching.

    Path/eti = small blood vessels in the muscle rupture, and the muscle fibers sustain tiny tears

    S/S = inflammation, local tenderness, and muscle spasms

    Nurse = apply cold packs 2 alleviate local pain, swelling, and bruising.
  2. What is a contusion?
    Soft tissue injury resulting from a blow or blunt trauma.

    S/s = bruises (ecchymosis) or hematoma (collection of blood)

    Nurse= apply cold packs; contusion usually resolves in 2wks
  3. What is a sprain?
    injuries to the ligaments surrounding a joint. Usually 2 wrist, elbow, knee, ankle. Cervical spine sprain = whiplash injury

    Causes= sudden, unusual movement or stretching from falls or accidental injuries.

    S/s = pain immediately, swelling, person usually can't put weight on affected part, bruising

    Tx = ice, chemical cold pack 2 reduce swelling for first 24 to 48hrs, elevation, compression or RICE, sometimes splint or light cast. After 2days if swelling is down apply heat reduces pain.

    Nurse = ice packs, after swelling apply heat, NSAIDS 2 ease discomfort. 4 whiplash cervical collar 2 limit movement.
  4. What is a dislocation?
    Occur when the articular sufaces of a joint are no longer in contact. Usually shoulder, hip, knee are dislocated.

    Path/eti = trauma, diseases of joint, compartment syndrome,

    s/s = popping sound, complaint of something "gave out", pain, affected ext is longer than unaffected ext, ROM limited, swelling, coolness, numbness, tingling, pale dusky color of distal tissues

    Tx = Dr. reduces the displaced part until normal, then immobilizes the joint w/ elastic bandage, cast, splint for several wks, some may require surgery

    Nurse = give pain meds if prescribed, elevating, immobilizing affected limp, applying cold packs, neurovascular assessment every 30mins for several hrs then @least every 2to4hrs for next 1to2days 2 watch 4 compartment syndrome.
  5. What is compartment syndrome?
    a condition in which a structure such as a tendon or nerve is constricted in a confined space.
  6. What is palsy?
    result of compartment syndrome but is decreased sensation and movement
  7. What is Volkmann's contracture?
    if compartment syndrome occurs in a upper ext a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable 2 extend his/her fingers and complains of pain when trying 2 stretch the hand.
  8. What are the most frequent injuries in upper & lower ext?
    shoulder, elbow, wrist, knee, and ankle. They are usually acute injuries like stress fx or tendonitis related 2 sports & exercise and workrelated injuries.
  9. What is tendonitis?
    • inflammation of a tendon caused by overuse ex:
    • Epicondylitis
    • Ganglioncyst
    • Carpal tunnel syndrome

    S/s= pain, inflammation, tennis elbow pain radiating down the dorsal surface of the forearm and a weak grasp.
  10. What is Epicondylitis?
    It's "tennis elbow" its a painful inflammation of the elbow.

    Causes = excessive pronation & supination of the forearm like with playing tennis, pitching ball, rowing.

    s/s = pain radiating down the dorsal surface of the forearm and a weak grasp
  11. What is ganglioncyst?
    its a cystic mass that develops near tendon sheaths and joints of the wrist.

    causes = defects in the tendon sheath or joint capsule and occur more in women younger than 50yrs of age.

    s/s = pain and tenderness in the affected area

    tx = aspiration of the ganglion, corticosteroid injection, and surgical incision
  12. What is carpal tunnel syndrome?
    results from repetitive wrist motion that traumatizes the tendon sheath or ligaments in the carpal canal.

    Causes = repetitive hand movements ex: typists, cashiers, musicians, assemblers, peeps on the computer all the time.

    S/S= pain or burning in one or both hands that radiate to the forearm and shoulder in severe cases more pain @ night and early in the am.

    Tx= Tinel's sign & phalan's sign(flex wrist for 30sec) 2 determing pain or numbness. resting the hands, splinting hand or wrist, NSAIDS, corticosteriod, or surgery.

    • Nurse = Tell client take NSAIDS w/ food
    • Corticosteriod injections explain what 2 expect and let them know injections might cause more discomfort.
    • Show how 2 use adn care 4 splints and ROM exercises or underwater hand exercises causes less pain
    • Rest joint
    • Support affected arm on pillow while sleeping
    • Apply cold 4 24 to 48hrs 2 reduce swelling & pain
    • Gradually increase joint movement
  13. What is a rotator cuff tear?
    it's a traumatic injury or from chronic overuse or irritation of the shoulder joint.

    s/s = pain w/ movement and limited mobility of the shoulder and arm, peeps have hard time 2 with activities tht involve stretching their arm above their head, can't sleep on affected side.

    • Tx= NSAIDS, modify activities 2 rest joint, corticosteroid injections, progressive passive and active exercises and stretching, or surgical procedures:
    • Arthroscopic debridement of devitalized tissue
    • Arthroscopic tendon repair
    • Open acromioplasty w/ tendon repair
    • immobilize shoulder 4 several days 2 wks then physical therapy. Full recovery 6 to 12months.
  14. What are ligament & meniscal injuries?
    injuries 2 the knee occur as a result of a traumatic injury. Menisci(cartilages in the knee)

    These ligaments provide stability 2 forward & backward movements

    causes= twisting of the knee or repeated squating. They say knee gave out and may experience click in knee as they ambulate.

    Nurse = immobilize, NSAIDS, rehab w/ gradual weightbearing. RECOVERY win 3to12months depending on injury or surgery if required.
  15. What is a ruptured achilles tendon?
    occurs secondary 2 trauma but as the client engages in activity the calf muscle contracts suddenly while the foot is grounded firmly in place. Usually loud "pop".

    s/s = severe pain and inability 2 plantar flex the affected foot

    tx= requires surgical repair 4 complete healing 2 occur, after surgery client wears a cast or brace for 6 to 8 wks, thn PT

    Nurse = teach client about activity restrictions, use of ambulatory aids, and pain management
  16. What is a fracture?
    is a break in the continuity of a bone and may affect tissues or organs near the bones as well. They are classified according 2 type and extent.

    Causes= sudden direct force from a blow or fall causes most fx, underlying weakness by bone infections, bone tumors. 10-40mins after bone breaks the muscles surrounding the bone are flacid and spasm.

    S/s= swelling from hemorrhage, edema, pain, loss of function, deformity, false motion, crepitus(grating of bone over bone), spasms.

    Nurse= assess 4 neurovascular & systemic complications, give pain meds as prescribed, provide comfort measures, assist ADLs, prevent constipation, promote physical mobility, prevent infection, maintain skin integrity, self-care,
  17. What does the nurse do if the client is in traction?
    • the nurse
    • teaches simple and direct explanations about the traction and its purpose
    • Point out activities that are allowed or contraindicated
  18. What is shock complications of fx?
    hypovolemic shock related 2 blood loss and loss of extracellular fluid from damaged tissue.

    Nurse = administer blood & fluid volume replacements as prescribed 2 prevent further losses.
  19. What is a fat embolism complication of a fx?
    fat gobules released after fx of pelvis or long bones

    s/s= onset is rapid, with client experiencing respiratory distress and cerebral disturbances

    Nurse= moniter client 4 symptoms, which occur w/in 48-72hrs. To prevent fatty emboli, provide early respiratory support, ensure rapid immobilization of fx, and observe client closely 4 signs of respiratory and nervous system problems
  20. What is a fx femur?
    usually occurs in automobile accidents but may occur in falls from ladders or other high places, or in gunshot wounds, severe trauma.

    S/s= severe pain, swelling, ecchymosis may be seen, can't move hip or knee, sometimes and open wound or a protusion of bone may be seen

    Nurse= implements measures 2 provent complications of immobility and inactivity. Puts clients in line with the pull exerted by the traction, cleans pin sites w/ prescribed agent 2 prevent infection.
  21. What is a fx hip?
    results from a fall and occurs more in elderly w/ osteoporosis.

    s/s= severe pain that increases with leg movement, pain frequently radiated 2 the knee, large blood loss may happen cuz subtrochanteric and intertrochanteric fx leading 2 hypovolemic shock. may be extensive bruising and swelling in hip, groin and thigh.

    Nurse= Watch older peeps more for complications, prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muslce atrophy and contractures. Watch wound drain usually in place for 1 to 2 days after surgery READ PG996

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