musculo j

Clinical manifestations of a strain/ sprain

Pain, edema, ↓ function, contusion

Acute intervention for sprains and strains

-rest (R)
-ice (I)
-compression (C)
-elevation (E)

When applying ice on a sprain or strain apply for \___-\___ minutes per application, then warm-up for \___-\___ minutes before reapplication

apply for 20-30 minutes per application, then warm-up for 10-15 minutes before reapplication

do we apply ice directly to the skin?

no

When can we start to use heat?

24-48 hours

If there is numbness felt below the area of compression or there is additional pain or swelling beyond the edge of the bandage what does that mean?

the bandage is too tight

When should we elevate the extremity after a sprain?

continuously (even when sleeping)
-prevents further edema

Hemarthrosis

bleeding into a joint space, can occur with injury

Dislocation

a severe injury of the ligaments that surround a joint, resulting in the complete displacement or separation of the articular surfaces of the joint

Subluxation

partial or incomplete displacement of the joint surface

Clinical Manifestations of a Dislocation

-deformity
-pain/tenderness
-loss of function
-swelling

Manifestation of a hip dislocation

affected limb is shorter and often externally rotated

complications of a dislocation

avascular necrosis and compartment syndrome

What is avascular necrosis?

bone cell death resulting from lack of blood supply

goal of dislocation treatment?

realignment

After dislocation or subluxation there sound be a \___________ return to normal activities

gradual

Carpal tunnel syndrome (CTS) symptoms

-Weakness (esp. Thumb)
-burning pain
-numbness
-clumsiness in fine hand movements

When are carpal tunnel symptoms most often seen?

often seen during the premenstrual period, pregnancy, and menopause, suggesting hormones may be involved

Who is a risk for carpal tunnel?

those that have hobbies or occupations associated with repeated or continuous wrist movements

Management of carpal tunnel syndrome

-educate on mobilization
-corticosteriod injections
-surgical decompression

Avulsion fracture

The tendon or ligament pulls bone away at the site of attachment

comminuted fracture

fracture in which the bone is splintered or crushed
-completely shattered

Greentick Fracture

Incomplete fracture with one side splintered and one side bent
-like a stick you can't break in half

impacted fracture

fracture in which one bone fragment is pushed into another
-impaction

Interarticular fracture

fracture involves bones within a joint
-interarticular(inside joint)

longitudinal fracture

a fracture that runs parallel to the long axis of the bone
-longitudinal\=long ways

oblique fracture

fracture at an angle to the bone
-oblique\= slanted

spiral fracture

a fracture in which the bone has been twisted apart

stress fracture

a small crack in the bone that often develops from chronic, excessive impact

transverse fracture

occurs straight across the bone
-transverse cut

Pathological fracture

Chronic infection caused these fractures and bone erosion

Clinical Manifestations of Fractures

-pain
-Guard against movement
-May or may not have deformity

What is a closed fracture reduction?

Nonsurgical, manual realignment of bone fragments

Nursing interventions for closed reduction

-put the pt under local or general anesthesia
-immobilization/traction afterward

What is an open fracture reduction?

-Surgical incision
-Internal fixation

After an open reduction what must we do as the nurse?

early ROM of joint to prevent adhesions
-early ambition

risks of open reduction

risk for infection

Purpose of traction

-Reduce muscle spasms/ pain
-Reduce, align, and immobilize fractures
-Reduce deformity

Is skin traction short-term or long-term?

short term (48-72 hours)

How much does skin traction weigh?

5-10 pounds

What is Buck's traction?

Application of pulling force to part of the body to reduce, align, and immobilize fractures and relieve muscle spasms

What is imperative when using skin traction?

skin assessment and prevention of skin breakdown

What is skeletal traction?

A traction applied directly to the bone with pins and wires
-Used when prolonged traction is needed

Is skeletal traction short-term or long-term?

long term

How much can skeletal traction weigh?

5-45 pounds

What what we ensure about the weights when using traction?

keep the weights off the floor

What is a risk with skeletal traction?

risk for infection and complications of immobility

What is continuous passive movement (CPM)?

Machines that help prevent extraarticular and intraarticular adhesions (bands of fibrous tissue)

A cast for a fracture typically incorporated what joints?

joints above and below fracture

How long does it take the cast to set?

15 minutes

Wait \___-\____ hours after the cast is applied before weight bearing

24-72 hours before weight bearing

What is petaling a cast?

applying waterproof tape around the edges of a cast (protecting the skin from rough edges and adds a layer of protection)

What is a sling used for?

To support and elevate arm

When is a sling contraindicated?

proximal humerus fracture

What is a body jacket brace used for?

Immobilization and support for stable spine injuries

When using a body jacket brace what are patients at risk for?

superior mesenteric artery syndrome (cast syndrome)

How do we treat superior mesenteric artery syndrome (cast syndrome)?

Treat with gastric decompression

A patient with a hip spica cast are at risk for

cast syndrome as well

How does a patient with a hip spica cast go to the bathroom?

fracture bed pan

In a patient with a lower extremity immobilizer (cast) what would we assess for?

signs of compartment syndrome/ increased pressure

What is external fixation?

Metallic device composed of metal pins inserted into the bone, attached to external rods to stabilize the fracture while it heals

What do we assess for if our patient has external fixation?

-Assess for pin loosening and infection
-Patient teaching
-Pin site care

What is internal fixation?

Metal hardware is surgically inserted to immobilize the fracture during healing.

Drug therapy for patients with internal fixation

-muscle relaxants
-pain management
-tetanus shot
-prophylactic antibiotics

What would we assess during a neurovascular assessment on a patient with any fixation?

-Color and temperature
-Capillary refill
-Pulses
-Edema
-Sensation and motor function
-Pain

Patients in a body jacket or hip spica cast are recommenced how many meals a day?

6 small meals a day

Complications of immobility (traction)

-constipation
-renal calculi
-DVT/ pulmonary emboli

What can the patient use for itching under a cast?

hair dryer on cool setting

When would we report to the doctor that there is an issue with a cast?

-pain despite elevation, ice, and analgesia
-swelling w/ pain
-burning
-sores or foul odor

Assessments when a patient is in traction

-inspect skin
-monitor pin sites
-proper positioning
-exercise
-psychosocial needs

When a patient is using an assistive devices we must discourage what?

reaching out for support (to grab the device --\> falls)

Interventions when a patient gets an infection from an open fracture

-surgical debridement
-closed suction drainage
-antibiotics

What is compartment syndrome?

Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.

What is essential for compartment syndrome?

early recognition and treatment

Ischemia can occur within \___ to \____ hours after the onset of compartment syndrome

4 to 8 hours

What are the 6 P's of compartment syndrome?

-Pain!!
-Pressure
-Pallor
-Pulses
-Paresthesia
-Paralysis

What is another way we can assess for compartment syndrome?

Asses urine output and kidney function

What urine output could mean compartment syndrome?

-dark urine
(myoglobinuria)
\[tea/cola colored]

What intervention do we never want to implement for compartment syndrome?

NO elevation above the heart or ice/ compression
-leads to less blood flow

How do we treat compartment syndrome?

fasciotomy

What is a fasciotomy?

fascia is cut to relieve tension or pressure commonly to treat compartment syndrome

How do we prevent a venous thromboembolism (VTE)?

-Prophylactic anticoagulant drugs
-Antiembolism stockings
-Sequential compression devices
-ROM exercises

What is a fat embolism?

Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury

When are fat embolisms the most common to occur?

Most common with fracture of long bones, ribs, tibia, and pelvis

symptoms of fat embolism

-fever
-tachycardia
-new onset of respiratory distress
-petechiae

In a patient with a fat embolism where will we see fat cells?

blood, urine, or sputum

How do we prevent fat embolism?

Careful immobilization of a long bone fracture

Respiratory interventions for a patient with a fat embolism

-Cough/deep breathing
-Minimize patient movement.
-Oxygen/intubate/ mechanical ventilation

Clinical manifestations of a hip fracture in an elderly patient

-External rotation
-Muscle spasm
-Shortening of the affected extremity
-Severe pain

How do we treat a hip fracture?

-traction
-surgery (total or partial hip replacement)

Patient education after a hip replacement (arthroplasty)

-abduction pillow between legs (6 wks)
-no crossing legs/ankles
-no bending over to put on shoes
-elevated toilet seats/ shower chair

We must do a neuromuscular assessment \_______ to surgery site

distal

Immediately after a knee arthroplasty what interventions will be implemented?

-continuous passive motion machine
-anti-embolytic stockings/ pneumatic compression device

Goal of stable vertebral fractures

keep spine in alignment

Outpatient procedures for stable vertebral fractures

-vertebroplasty (cement)
-kyphoplasty (balloon--\> cement) [less leakage]

What is the primary concern with facial fractures?

airway
-treat them as a C-spine injury

Causes for a mandible fracture

-trauma
-fractured therapeutically to correct underlying malocclusion problem

A mandible fracture treatment includes immobilization with jaw wiring (intermaxillay fixation) for \__ to \__ weeks

4 to 6 weeks

In a patient with jaw wiring (intermaxillay fixation) what needs to be at bedside at ALL times?

-wire cutters
-tracheotomy tray
-oral suctioning

When do we teach the patient to cut their wires at home?

vomiting --\> leads to aspiration