Beruflich Dokumente
Kultur Dokumente
Donna Peters
Important Facts
Leading cause of death in people under 40
experiencing trauma 80,000 suffer permanent disability each year from trauma
Etiology
Direct blow or trauma to the bone
Crushing force
Sudden twisting motion Extreme muscle contraction Pathologic conditions: osteoporosis, drug use, tumors,
decalcification
Musculoskeletal Injuries
Contusion
Strain
Sprain Dislocation/Subluxation
Fracture
Contusion
Definition - Soft tissue trauma with no damage to MS
structure. Cause rupture of blood vessels resulting in a hematoma S/S - Pain, Swelling, ecchymosis, limited ROM Rx - RICE
Strain
Definition excessive stretching of muscle
Sprain
Definition injury of ligament surrounding the joint
of stability of the joint. Avulsion fx may occur. S/S - Pain, Rapid Swelling, Joint tenderness, limited ROM Rx X-ray, RICE, casting, surgery
RICE
Rest
Ice
Compress Elevate
24 48 hours
After 48 hours- heat
Dislocation
Subluxation - is a partial dislocation
RICE
Reduction Open Closed
Other Injuries
Repetitive Strain injury
Rotator cuff
Meniscus injury Carpal Tunnel Syndrome (CTS)
compression neuropathy
Phalens sign Tinels sign
Classification of Fractures
Closed vs open
Complete vs incomplete
Stable (nondisplaced) vs unstable (displaced) Greenstick Compression Impacted Depressed Spiral Comminuted
Bone Healing
Bone Injury
Callus Formation
Bony Callus Formation Bone Remodeling
Granulation tissue
Callus formation
Ossification (3wks 6mo)
Open fracture
Presence of foreign body Immuno-compromised Decrease circulation Malnutrition Osteoporosis Advanced Age
Clinical Manifestations of Fx
Deformity
Swelling
Pain/ guarding Numbness Crepitus Muscle Spasm Ecchymosis Hypovolemic Shock
Pallor
Pulselessness Paresis Paralysis
Complications of Trauma
Soft tissue damage
Hemorrhage
Ruptured tendons Severed nerves Damaged blood vessels Body organ injuries
Medical Intervention
Closed Reduction
Manual manipulation
Manual traction
Skin traction
Bucks Extension
Russell Traction
Skeletal traction
Traction
Purpose
Maintain Anatomical Alignment
Classifications
Straight
pulls in one direction towards the longitudinal axis of the bone
Vectored
applied in two different directions
Balanced Suspension
applied to elevate extremity
Types
Manual
Skin
Skeletal
Russell
Bryants Cervical Pelvic
Bucks
This traction exerts a straight pull on arm or leg.
Between 5 8 lbs
Temporary
Contraindications
Dermatitis
Impaired circulation
Varicose ulcers Peripheral neuropathies
Complications
Allergic reaction to tape
Irritation of skin
Peroneal nerve palsy Circulation impairment
Pressure sores
Skeletal Traction
Pulling force directly to the bones by metal pins, screws or
Long Bone
Long Bone
Nursing Intervention
Assess traction frequently
ROM QID
Pain
Patient reports pain as 3/1-10
Assess pain level q 2 4 h
Medicate as ordered Monitor for complication i.e. DVT, compartment syndrome
Teach relaxation
Definition
A device of metal percutaneous pins that are attached to an
Indications
Compound fracture Comminuted fractures Leg lengthening Access to open wounds Joint fusion After skeletal traction to
allow mobility
Assessments
Pin sites
Frame
5 Ps Wound site
Fracture Immobilization
External Fixation
Bandages
Casts Splints
Internal Fixation
Open Reduction Internal Fixation (ORIF) Screws Nails Plate/rods
Casts
Rigid immobilizing device
Purpose
Immobilize fracture / subluxations
Correct deformities
Support of weakened
joint, ligament sprains, tears, tendon, nerve and arterial repair
Amputation
Disadvantage
Chemical reaction Heat increases edema Slow drying
Fiberglass
Advantages
Dries quickly Can get wet Light
Disadvantage
Expensive Easier to get off
Application
Assess skin should be clean and dry, note any lesions
Complications
Neurovascular compromise
Hemorrhage
Nerve Damage
Cast Removal
To change cast or splint
Assess complications
Healing of injury Emergency removal
Nursing Interventions
Isometric exercises Active/passive ROM Itching cool hair dryer
by discharge
Notify MD if Pain Numbness Poor color Unable to move toes Stain, odor or heat
Pain
Expected Outcome
Patient states pain free No numbness
Nursing Interventions
Assess pain q 1 2 h Elevate cast Apply ice
Administer analgesic
Monitor for complications
Orthopedic Complications
Complications Following Fractures
Hypovolemic Shock
Assessments
Decreased BP/Tachycardia
Tachypnea Skin cool/clammy
Restlessness
Decreased LOC
Oxygen
Monitor Hbg/Hct Replace fluids
Drowsiness
Irritabiltiy/Confusion/Agitation Sense of impending doom Tachycardia Tachypnea, Wheezing, use of Accessory muscles Petechiae
Bedrest
Question
Tell whether the following statement is true or false. A hallmark sign of acute compartment syndrome is pain that occurs or intensifies with passive ROM.
Answer
True. Rationale: A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive ROM. This pain can be caused by (1) a reduction in the size of the muscle compartment because the enclosing muscle fascia is too tight or a cast or dressing is constrictive or (2) an increase in compartment contents because of edema or hemorrhage.
Tenderness/Cramping/Pai
Infection: Assessment
Malaise/fever
Pain/tenderness of bone
Redness/swelling Difficulty weight bearing
Wound drainage
Infection: Management
Immobilization
C/S Wound
Antibiotics: pencillin, methacillin,vanco Pain Medication
Heat application
Joint Stiffness/Contractures
Joint Stiffness/Contracture
Malunion
Ruptured Tendons Severed nerves Avascular Necrosis
Case Study
A 59 year old right knee replacement with severe pain.
Received oxycontin at 8p and 2 percocets at 10p. Now at 11:30 p patient remains in severe pain. What assessments would your make?
Assessments Findings
Edema
Heat
Erythema Swelling of right leg
Other Assessments
Neurovascular assessment
Homens
Your patient suffered a fractured femur. Which of the following would you tell your nursing assistant to report immediately?
A.
B. C. D.
Complaints of pain Patient is confused Blood Pressure is 136/88 Patient voided using fracture bedpan
You are caring for a pt with a fxulnar, which assessment should you report immediately ?
A. B. C. D.
Complaints of pain and pressure Cast is dry and intact Skin is pink and warm to touch Patient can move all fingers and thumb