med surge

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Author:
cvillarreal
ID:
27101
Filename:
med surge
Updated:
2010-07-17 04:05:45
Tags:
traumatic muscukoskeletal injuries
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ch 62
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  1. strains, contusion, sprains
    • strains
    • injury to muscle when stretched/pulled
    • sm. blood vessels rupture & muscle fibers get sm. tears
    • s/s- inflammation, tenderness, & mscle spasm

    • contusion
    • soft tissue injury from blow/blunt trauma, doesnt affect muscleskeletal structuresm. vessels rupture
    • s/s- ecchymosis (bruise), hemotoma, swelling, pain

    • sprains
    • injury to ligamemts around joint (knees, wrist, ankle, & elbow), from sudden/unusual movement (falls), when severe the ligament attached to bone chips & becomes detached & becomes a avulsion fracturecervicle sprain(whipklash)
  2. Assessments 4 contusion, sprains & strains
    • pain & swells
    • avoid full wt
    • ecchymoses
    • joints unstable until healed

    • DX- visual exam,
    • x-ray- see larger than usual joints 2 check 4 fracture
    • Arthrography- check asymmetry
    • Arthroscopy- check trauma 2 joint capsule

    • medical & surgical manag
    • R- rest
    • I- ice- 24-48hrs
    • C- compression
    • E- elevation
    • S- stability

    • when swellin wont increase more apply heat & relieves edema by improving circulation
    • restrict movement or could lead 2 perm. unstable joint or formation of fibrous adhesions that may llimit ROM
    • NSAIDS
    • splint/light cast 4 several wks,
    • cervicle collar
  3. Dislocation
    articular surface joints not intact, interfers w/ normal use & appearance usually shoulder, hip, knee, partial dislocation AKA subluxation

    • P&E- usually in adults, could result from diseases when joint stretched/torn/relaxed, inljury disrupts blood supply 2 joint, cartilage leading 2 degeneration, chronic pain, & restrict movement
    • compartment syndrome- tendon/nerve constricted in confined space, affects nerve innervation leading 2 subsequent palsy (decreased sensation/movement), if CS 2 upper extremites leads 2 Volkmens contracture-clawlike deformatiy to hand from obstucted arterial blood flow 2 forearm/hand, pt cant move fingers & has pain especially when stretching hand
    • other compication is low deposit of collagen in repair stage resulting in reduced tensile strength & reoccuring dislocations

    • Assess- pt hears popping when it happens they say joint gave out, if b/c trauma high pain happens, altered appearance, if dislocation in extremities injured one could be shorter, ROM limited, swellling, coolness, numbness, tingle, pale/dusky @ distal tissue
    • X-ray, arthoscopy, arthrography

    Medical/surgical manag.- dr. manipulates joints w/ anesthetic, then immobilizes it w/ bandage/cast,splint 4 wks, or surgery

    • nursing manag.- give RX, elevating & immobilzing, applies cold pack, do neurovascular assessment q 30min 4 several hrs, then q 2-4hrs 4 1-2days 2 detect complications like CS, instructs pt 2 certain activities
    • teaching by nurse
    • use of proper equipment @work/althletic activites, & do warm-ups & stretching
    • clear envioment 2 reduce injury
    • exercise reg. to maintain joint/muscle strength
    • healthy wt
    • relax, stretch, & position changes q 2hrs
    • after exercise allow cool off time & stretch
    • if pain/discomfort occurs rest until symtoms subside then slowly reintroduce activity
    • if symptoms persist see DR.
  4. tendonitis
    from overuse, trauma, repeated stress

    Epicondylities(tennis elbow)- tennis, pitching, rowing

    Ganglioncyst- cystic mass near tendon sheaths & joints capsule seen more in women 50y

    Carpal tunnel- narrow inelastic canal thru where carpal tendons & median nerve pass, cashiers, typist, musicians, assemblers,
  5. tendonitis
    Epicondylitis, carpal tunnel, ganglioncyst
    • S/S
    • epicondylitis- radiating pain in forearm, weak grasp
    • ganglioncyst- pain, tenderness
    • carpal tunnel- pain, burning 1-2 arms, radiates to forearm & shoulder, worsty @ nite & early morning, shaking hands can reduce pain by movement of edematous fluid from carpal canal, sansation of fingers could b reduces/loss,

    • DX-x-ray 4 abnormalites & rule out fracture
    • carpal tunnel- could have electromyography- 2 stimulates nerve, Tinel's sign- elicits tingle, numbness, & pain, phalen's sign- flexing wrist 30sec. 2 check 4 pain/numbness itz + 4 carpal tunnel, & percussing median nerve (inner wrist) 2 chck 4 response

    • Medical & surgical manag.- cold pack, heat, exercise, steroidal anti-inflammatory meds, injection of corticosteroids, analgesics, NSAIDS, rest, surgeries when tears/ruptures, physical therapy
    • Epicondylities splinting/support of joint, corticosteroids injected
    • Ganglioncyst- aspiration of ganglion, corticosteriod, surgical excision
    • Carpal tunnel- rest, slpinting hand/wrist, NSAIDS, carticosteriod injection, surgery to lower pressure of ligament

    • Nursing manag.
    • info bout meds (if NSAIDS stress 2 take w/ food), if injection explain ? 2 expect & that injection could cause discomfort
    • how 2 care 4 splints
    • perform ROM
    • some hand exercise less painfull if done under warm water
    • how to to ADL/jobs activities
    • rest/position of joint to reduce stress
    • support joints on pillow while sleep
    • apply cold 4 24-48hrs 4 swelling & pain
    • slowly increase joint movement
    • avoid workin/lifting above shoulder, dont push objects w/ arm joints
  6. rotator cuff tear
    • made up of complexity of muscles & tendons that connect the proximal humerus, clavical, & scapula in turn connect w/ sternum & ribs
    • from traumatic injury or chronic overuse or irritation of shoulder joint

    S/S- pain w/ movement worst @ night, limit mobility of shoulder/arm, especially when activity above head

    • DX- physical exam, tenderness on acromioclavicular joint
    • x-ray, arthrography, MRI 2 see extent of tear/ injury

    • Tx- starts w/ NSAID, motify activities, rest joints, corticosteriods injection 2 shoulder w/ exercise & stretching
    • surgical procedures:
    • Arthroscopic debridement of devitalized tissue
    • Arthroscopic tendon repair
    • Open acromioplasty w/ tendon repair
    • pt need to immobilize shoulder 4 days 2 wks, & therapy 4 wk 2 mon.
    • full recovery w/i 6-12mon.
  7. ligament & meniscal(cartilage) injuries
    • 2 knee from trauma
    • occur 2 lateral/medial collateral ligaments which provide stability 2 side of knee or 2 anterior or posterior cruciate ligaments (ACL &PCL) stability 4 forward & backward movement

    • P&E
    • occurs when standing firmly & get blow/twist in differant direction

    S/S- pain, instabilityof joint, hard 2 ambulate, when ACL/PCL tears pt reports popping/tearing sensation, meniscal, knee may click when walking, knee might lock

    • medical & surgical manag.- depends on injury, 1st tx immobilizing % limiting wt, then NSAID, ice 1st 48hr, slow increase of activity
    • surgical tx- repair of ligament/tendon
    • torn meniscal they remove damged cartilage(meniscetomy), recovery takes 3-12mon.
  8. ruptured achillies tendon
    • 2ndary 2 trauma
    • calf muscle contracts suddenly while foot grounded firmly in place, hear a loud sound, severe pain, & cant planter flex foot

    surgery need then pt wears cast/brace 6-8wks, physical therapy

    • nurse teaches:
    • activity restrictions
    • use of ambulatory devices
    • pain management
    • pre/post operative instructions
  9. fractures
    • direct blow or when seizure, weakness of bones, tumors, more bone reabsorption then production (when pt inactive/elders)
    • 10-40min after fracture mucles around bone flacid, going into spasm increasing deformity & interfering w/ vascular & lymphatic circulation
    • healin starts when blood in area clots & fibrin network form between broken bone, fibrin network turns into grandulation tissue, osteoblast which proliferates in clot increase secretion of emzyme that restores alkalin PH leading to calcium deposit & true bone forms, healin mass called callus (holds bone 2gether but cant sustain strain)
    • take bone 1yr to fully heal & get all fat & marrow cells

    complications- compartment syndrome, thromboembolism, fat embolism, delayed healing, nonunion, malunion, infection, & avascular necrosis(death of bone from low blood supply), pt prone 2 pneumonia, thrombophlebties, pressure sores, UTI, renal canculi, constipation, muscle atrophy, wt gain, depression
  10. S/S of fractures
    • pain
    • loss of function- depends on intact bone
    • deformity
    • false motion- unusual motion @ site
    • crepitus- grating sound of bones rubbing 2gether, also heard as popping by air trapped in soft tissue
    • edema
    • spasm-muscle near fracture, reason 4 pain, may cause limb shorten when long bone involved

    if nerve damage could lead to paralysis

    DX- x-ray, some stress factures may not show by x-ray for few wks, CT, MRI

    • medical & surgical mang- goal 2 reestablish function
    • tx- traction, open/closed reduction, internal/external fixation, cast application, tx depends on 1st aid given, location, severity, age, physical condition

    • nursing mana.
    • assess neurovacular & systemic complication, administer analgesic, provide comfort, assist w/ ADL, preventing constipation, promoting physical mobility, preparing pt 4 self-care, family teaching, instuct on devices used, exercise, when in traction info should be kept simple & direct, activites allowed & restricted
  11. fractures femur
    common in car accidents, falls, gunshots, always peeps have other fractures b/c of severity

    Assess: pain, swelling, ecchymosis, pt cant move hip or knee, if compound fracture open wound or protrusion of bone seen, x-ray done 2 show type & location

    • medical & surgical manag.- traction to prevent deformaties
    • skeletal tration & external fixation 2 align fracture in prep 4 future reduction if occured in lower 2/3 of femur, once aligned spica cast used

    nursing manag.- prevent complication of immobility or inactivity, correct positioning during traction, clean pin sites
  12. fractured hip
    • affect proximal end of femur
    • results from falls or osteoporosis
    • occur in femoral neck (intracapsular or inside hip joint capsule), between trochanters(intertrachanters-extracapsular)

    assess:severe pain w/ leg movemets, pain radiates to knee, sensation pressure in outer aspect of hip, discontinuity & spasm shorten & external rotation of leg, large blood loss accompany subtrochanteric & intertrochanteic factures lead 2 hypovolimic shock, bruising, swelling of hip, groin, thigh, femoral neck fracture are intercapsular so bleeding more likely to b contained w/i joint capsule, x-ray- show location

    medical & surgical manag.- intracalsular factures prone 2 nonunion & avascular necrosis, fractured head/neck replaced by metal device (austin-moore or thompson prosthesis) referred 2 hemiarthroplasty faster then traction, plates, bands, screws, & pins & could b removed when healed, but could perm., precaution w/ hemiarthroplasty r greater b/c they dislocate hip to replace head, pt may have total hip arthroplasty

    • nurses manag.- measure 2 prevent skin breakdown, infection, pneumonia, constipation, urinary retention, muscle atrophy, & contractures, pt usually has wound drainage for 1-2 days after surgery, monitor drainage & give antibiotic med, show pt to use trapeze, placements of trochanter roll, abductors pillow between legs when turning pt., instruction hip prosthesis, avoid adduction till healed
    • after surgery assist w/ ambulation, chair should b elevated either w/ structures or pillows so hips dont flex beyond 90*
  13. types of fractures
    Avolusion:a pulling awa of a fragment of bone by a ligament or tendon and its atachment.
  14. Comminuted:a fracture in which bone has splintered into sveral fragments
    Compound:a fracture in which damagealso involves the skin or mucous membranes
  15. Compression:a fracture in which bone has been compressed (seen in verbal fractures)
    Depressed:a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bones)
  16. Epiphyseal:a fracture through the epiphysis
    Greenstick:a fracture in which one side of the bone is broken and the other side is bent
  17. Impacted:a fracture in which a bone is driveninto another bone fragment
    Oblique:a fracture occurring at anangle across the bone (less stable than transverse)
  18. Pathologic:a fracture that accurs an area of diseased bone (bone cyst, Pagt's Disease, bony metastasis, tumor);can occur without trauma or fall
    Simple:a fracture that remains contained; does not break the skin
  19. Spiral:a fracture shifting around the shaft of the bone
    Transverse:a fracture that is straight across the bone

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