Term
Musculoskeletal injuries:
- soft tissue
- fractures
- joints |
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Definition
| Types of Orthopedic injuries |
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Term
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Definition
| #1 reason for musculoskeletal injuries |
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Definition
| blunt trauma, skin not broken |
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Definition
| localized accumulation of blood |
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Definition
| loss of contact between articular surfaces |
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| Break in continuity of bone |
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Rest
Ice
Compression
Elevation |
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Definition
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| decreased edema, decreased pain |
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Definition
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Term
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Definition
•Vasodilatation
•Reduced muscle tension, fibers lengthen
•Use for:
•Joint Disease
•Pain
•Muscle strains
•Hot packs, paraffin bath, Aqua K pad |
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Definition
•Vasoconstriction
•Local anesthesia
•Decreased muscle tension
•Use for:
•Minor burns
•Lacerations
•Injections
•Joint trauma/surgery
•Cold packs, ice bath, gel |
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Definition
•Vasodilation
•Reduced blood viscosity
•Reduced muscle tension
•Increased tissue metabolism
•Increased capillary permeability |
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Definition
•Vasoconstriction
•Local anesthesia
•Reduced cellular metabolism
•Increased blood viscosity
•Decreased muscle tension |
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| Precautions to using hot or cold therapy |
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Definition
•Skin integrity
•burns, ischemia
•Use with caution -- sensory and circulation deficits
•Never apply hot or cold packs directly to skin |
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Term
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Definition
Classified by:
•Type
•Communication with the Environment (Open vs Closed)
•Anatomic Location
•Stable or Unstable |
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Term
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Definition
skin is broken
(fracture type)
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Definition
no communication with outside
(type of fracture)
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Definition
multiple fragments
(type of fracture) |
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preexisting bone disease
(type of fracture) |
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Definition
| pressure causing collapse of bone |
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Definition
| out of proper anatomical alignment |
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Definition
adequate anatomical alignment
(type of fracture) |
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Definition
joint involvement
(type of fracture) |
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Term
| Clinical Manifestations of a fracture |
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Definition
•Ecchymosis/Contusion
•Edema and Swelling
•Occludes Circulation
•Nerve Damage
•Risk for Compartment Syndrome |
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Term
| Clinical manifestations of a fracture |
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Definition
•Deformity = Cardinal Sign
•Loss of Function
•Pain and Tenderness
•Promotes Healing
•Muscle Spasm
•Can displace fractures and prevent healing
•Crepitation
•Diagnosis done by Xray |
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Term
| Collaborative Care of a Closed Fracture |
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Definition
•Non surgical
•Application of Cast |
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| Collaborative care of an open fracture |
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Definition
•Surgical
•ORIF (Open Reduction Internal Fixation)
•Increased Risk for Infection |
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Definition
•Cast
•Splint
•Sling
•Knee immobilizer
•Brace
•Tape
•Ace bandage
•External fixation
•Internal fixation |
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Term
| Complication of Infection in a fracture |
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Definition
¤Irrigation and Debridement (I & D)
¤Antibiotics |
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Term
Complication of fracture:
Compartment Syndrome |
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Definition
¤Pressure within the myofascial compartment compromises neurovascular function
¤Early recognition is essential! Ischemia occurs within 4-12 hours
nNeurovascular Assessment
nLate Signs: Pulselessness, Paresthesia, Paralysis |
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Term
Fracture complication:
Venous Thrombosis |
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Definition
•Precipitating Factors: Casts, Traction, Immobility, Pressure
•Compressing Stockings/Sequential Compression Devices (SCDs)
•ROM
•Anticoagulants
•Heparin, Lovenox |
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Complication of a fracture:
Fat embolism |
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Definition
•Can be fatal, most survive
•Early recognition- 12-72 hours after the injury
•Acute Respiratory Distress (ARDS)
•Changes in Mental Status |
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Term
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Definition
•Hands used to exert pulling force on bone
•For stable fractures or dislocations
•May need conscious sedation |
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Definition
| Open Reduction and Internal Fixation=surgery to open the area and apply hardware to stabilize the bone |
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Definition
| pins inserted into bone, attached to rods to stabilize fracture |
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Definition
•Pins inserted into bone to provide alignment that are external to the body part
•Soft tissue damage has occurred also that prevents the choice of using a cast
•Care of wounds + pin site care
•This is a type of skeletal traction |
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Term
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Definition
•Crystalizing reaction that causes heat to be given off and pt may feel uncomfortable
•Soft after crystalizing action-needs to dry; 24-72 hours
•Do not dent while drying |
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Term
Types of Casts:
Synthetic- Fiberglass |
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Definition
•Water activated hardener, dries quickly
•Can be taken into water
•Must be thoroughly dried with hair dryer
•Non-displaced fx with minimal swelling or long term cast |
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Term
| Potential Complications of a cast |
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Definition
•Compartment syndrome
•Pressure ulcer
•Disuse Syndrome |
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Term
| Possible nursing diagnosis with pt's with casts |
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Definition
•Deficient knowledge r/t treatment
•Pain
•Impaired physical mobility
•Self-care deficit
•Impaired skin integrity
•Risk for peripheral neurovascular dysfunction |
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Term
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Definition
•Circulation - < 3 sec for capillary refill
•Motion - digits
•Sensation - feel touch? |
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Term
•Color
•Warmth
•Movement
•Sensation |
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Definition
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Term
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Definition
•Appearance=color/edema/bleeding /inflammation
•Tissue Perfusion=temp, cap refill, pulses, edema
•Sensation=paraesthesia=tingling
•Pain-increasing? Pressure sensation? |
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Signs/symptoms:
The 6 Ps of Neurovascular Assessment |
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Definition
•Pressure
•Pain (progressive, unrelieved with usual analgesics, present with passive extension)
•Paresthesia
•Pallor, coolness (late sign)
•Paralysis (late sign)
•Pulselessness (late sign) |
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Definition
•Always compare the affected extremity to the unaffected side if possible
•Use the same hand to assess
•Compare wrinkles on toes for edema
•Always check for arterial circulation via peripheral pulses!!
•Understand distal vs proximal pulses |
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Term
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Definition
•Compartment syndrome
•Fat embolism syndrome (FES)
•Osteomyelitis (can be emergent or chronic) |
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Term
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Definition
•Increased tissue pressure in limited anatomic space obstruction of circulation --> venous occlusion edema…
•Insufficient arterial flow --> inadequate circulation/ischemia muscle and nerve fibers destroyed.
•Associated with fractures, crush injury |
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Term
| Treatment of Compartment Syndrome |
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Definition
•Prompt accurate diagnosis!
•Loosen dressing
•Split cast prn
•Do not use ice
•Do not elevate greater than heart
•Surgical intervention
•Fasciotomy-leave open; may need wound vac |
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Term
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Definition
•Usually from injury to the femur, tibia, or pelvis
•Fat is released from the marrow in the bone with injury and enters circulation
•Blocks areas in the lungs, brain, heart, kidney, or skin. |
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Term
| Symptoms of Fat Embolism Syndrome (FES) |
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Definition
•Possible rash on upper torso, neck, conjunctiva
•Symptoms which indicate lack of oxygen to tissues:
•Chest pain, tachypnea, dyspnea, tachycardia, cyanosis, dropping Sats, mental status changes |
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Term
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Definition
•Bone becomes infected from:
•Extension of soft tissue infection (wound or incision)
•Contamination from bone surgery: open fracture, traumatic injury
•Bloodborne infection spread from an infected site: teeth, pneumonia, etc. Usually starts in an area of bone that has trauma or lowered resistance. |
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Term
| Prevention of Osteomyletitis |
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Definition
•Most common pathogen is Staphlococcus aureus – 70-80%
•Other organisms include: Proteus, Pseudomonas, and E. Coli
•Prophylactic antibiotics for 24 hours after surgery
•Get the catheters and tubes out asap
•Prophylactic antibiotics for pts with joint replacement surgery whenever they have invasive procedures |
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Term
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Definition
Application of a pulling force to a part of the body |
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Term
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Definition
•Provide proper body alignment
•Regain normal length of bone
•Management of muscle spasms/pain
•Immobilization
•Reduction of fracture or joint dislocation
•Treat joint pathologies
•Correction of deformities
•Rest diseased joint |
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Term
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Definition
•Applied directly to skin
•Short-term
•Monitor skin integrity
Not more than 7-10 lbs |
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Definition
•Using skeleton to achieve pull
•For > 10 lbs. (5-45)
•Increased chance of infection due to break in skin---pin site care
•Longer duration = increase complications
•External fixators |
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Term
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Definition
•Buck’s-for the lower leg to provide immobilization after fx of the femur before surgical repair
•Cervical head halter-used to treat neck pain
•Pelvic belt-to treat back pain |
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Definition
•Short-term (48-72 hours)
•Limited weights (5-10 pounds)
•Examples of skin traction:
•Buck’s Traction |
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Definition
•Traction to the bone through the use of a metal pin surgically placed into the bone
•15-25 lb average
•Balanced traction=weights on both sides of the pt bed (head and foot); pt weight is part of this equation also
•The purpose of balanced traction is to allow for nursing care and pt independence |
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| General Principles of Traction |
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Definition
•Maintain continuous traction
•Keep weights free (off floor, free from bed frame)
•Align distal and proximal fragments
•Maintain correct body alignment
•Allow for maximum nursing care
•Prevent skin friction
•Exercise, diversion |
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Term
| Complications of Traction |
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Definition
•Pressure ulcers
•Pneumonia
•Constipation
•Poor appetite/anorexia
•Urinary stasis/uti
•DVT |
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Term
| Preoperative Nursing Interventions |
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Definition
¤Immobilization/Assistive Devices
¤Education
¤Pain Management
¤Infection Prevention |
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| Postoperative Nursing Interventions |
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Definition
¤Pain Management
¤Frequent Neurovascular checks
¤Wound/Incision/Pin Site Care
¤Promote Mobility |
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Term
•Pressure
•Pain (progressive, unrelieved with usual analgesics, present with passive extension)
•Paresthesia
•Pallor, coolness (late sign)
•Paralysis (late sign)
•Pulselessness (late sign) |
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Definition
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