Medical 9-MS55-Interventions Musculoskeletal Trauma Part 3
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- How do fractures typically occur and how are most clavicle fractures treated?
-
a fall on an outstretched
hand
a fall on the shoulder
a direct injury
most are self-healing using a splint or bandage for immobilization - How are complicated clavicle fractures treated?
- although uncommon, they may require open reduction with internal fixation (ORIF) by pins, wires, or screws
- How do scapular fractures occur and what complications can occur upon fracture?
-
direct impact to the area causing serious internal trauma
pneumothorax
pulmonary contusion
fractured ribs - How is fracture of a scapula treated?
-
immobilize shoulder with
sling and swathe or a
shoulder immobilizer until
fracture heals, usually in
2 to 4 weeks - What may intra-articular neck and glenoid fractures require?
- surgical intervention with plate and screw fixation
-
Fractures of the proximal humerus, particularly impacted or displaced fractures, are common in the 1____.
How is it treated? 2____ -
1 elderly
2 conservatively with a sling
for immobilization - What does a displaced fracture of humerus often require?
- ORIF with pins or a prosthetic device
-
1 How are humeral shaft fractures generally corrected?
2 If necessary, how is the fracture repaired surgically? -
1 by closed reduction and application of a hanging-arm cast or splint
2 with an intramedullary rod or metal plate and screws or with external fixation -
1 What are frequent complications of a humerus fracture?
2 Bone grafting facilitates union; prolonged splinting is necessary while the ___ ____ regenerates -
1 nonunion of the bone and radial nerve palsy
2 radial nerve -
A direct blow to the condyles of the distal humerus can cause either or both condyles to fracture, usually in a 1____-shaped or 2___-shaped configuration. The most serious complication is damage to the 3____ or 4____ nerve.
Condylar fracture is usua -
1 T
2 Y
3 brachial
4 median
5 ORIF -
1 How do fractures of the olecrannon (humerus) occur?
2 How are they treated and what's the healing time?
3 What's used for displaced
fractures? -
1 fall on the elbow
2 closed reduction...
application of a cast...
takes 2 months to heal...
several more months for
full use
3 ORIF, splint is worn during
healing phase -
1 If the ulna of the forearm is fractured, the ____ is usually injured as well.
2 What is the appropriate treatment?
3 What if the fracture is displaced? -
1 radial
2 closed reduction with
casting
3 ORIF with intramedullary rods or plates and screws is required - Which fracture of young adult men is most common in the hand and wrist?
-
carpal scaphoid bone
(misdiagnosed because it's poorly visualized on x-ray) - What is the treatment of choice for a carpal scaphoid injury?
- closed reduction and casting for 6 to 12 weeks
-
Fractures of the 1_____ and 2_____ are usually not displaced, which makes their treatment less difficult than that of other fractures.
Metacarpal fractures are immobilized for 3___ to ___ weeks. Phalangeal fractures are immobilized in finger splints -
1 metacarpals
2 phalanges
3 3 to 4
4 10 to 14 - Define intracapsular?
- within the joint capsule
- Define extracapsular?
- outside the joint capsule
- Intracapsular or extracapsular hip fractures include those involving?
-
the upper third of the femur
(these are further divided according to fracture location) - What causes most hip fractures and what results?
-
falls
impaction or displacement, esp of femoral neck...
osteoporosis increases immobility or may cause permanent immobility - As many as 1___ ___ of older clients who sustain a hip fracture die within 1 year of injury from medical complications caused by the fracture or by the 2_____ that occurs after the fracture. About 3___ cannot return home or live independently after the f
-
1 one third
2 immobility
3 50% -
1 What is the preferred treatment of choice for hip fractures?
2 What may be applied before surgery, which should be scheduled within 24 hours of injury if at all possible? -
1 surgical repair
2 Buck's traction - Depending on the exact location of a hip fracture, what is the treatment?
- open reduction with internal fixation (ORIF) which may include an intramedullary rod, pins, a prosthesis or a fixed sliding plate (such as a compression screw)
- The client with a compression screw following hip fracture surgery may ambulate a ___ days after surgery and has a decreased chance of ___ and nonunion compared to other procedures.
-
few
infection - If the femoral head or neck is fractured, a _____ device is implanted.
- prosthetic
- Surgeon may replace femoral head or perform total hip replacement depending on patient's age and prior mobility status.
- okay
-
Older clients are at high risk for problems caused by skin or skeletal traction because of inadequate 1_____ and 2_____.
3_____ of any type is not the ideal treatment for the older client because it necessitates a prolonged period of immobilization; -
1 circulation (PVD and
connective tissue disease)
2 sensation
3 Traction
4 pneumonia
5 PE
6 bony prominences
7 superficial nerves
8 peroneal nerve - Fractures of the lower two thirds of the femur usually result from trauma often by ____
- MVA
- A femoral fracture is seldom immbolized by casting because the powerful muscles of the thigh become ____, which causes displacement of bone ends.
- spastic
- Extensive _____ is associated with femoral fracture.
- hemorrhage
- ____ traction, followed by a cast brace or hip spica cast, is the typical nonsurgical treatment for femur fractures.
- Skeletal
- Surgical treatment for femur fractures is?
-
ORIF with nails, rods, or a compression screw
(in a few cases, external fixation may be employed) - What is the healing time for femur fractures?
- 6 months or longer
- How do patellar fractures occur and how are they repaired?
-
direct impact
surgeon repairs by closed reduction and casting or internal fixation with screws - What causes fractures of both tibia and fibula and what are the 3 basic treatment techniques?
-
trauma
closed reduction with casting
internal fixation
external fixation - If closed reduction is used in tibia and fibula fracture, how long is a cast worn and what is not unusual with this type of fracture?
-
8 to 10 weeks
delayed union - If internal fixation is used in a tib-fib fracture, what is the treatment?
- nails or a plate and screws, followed by a long leg cast for 4 to 6 weeks
-
What are the conditions in which external fixation is used in a tib-fib fracture?
If external fixation is used in a tib-fib fracture, what is the treatment? -
usually there is extensive skin and soft-tissue damage
6 to 10 week treatment...
then follow with cast until fracture completely healed - What is the Moore prosthesis used for?
- hip fractures
- Where does a bimalleolar (Pott's) fracture occur?
- medial malleolus of the tibia and lateral malleolus of the fibula
- Why does a Pott's fracture occur? What might be needed if the bone doesn't heal?
- because of the instability of the ankle joint...the ankle has supination and eversion, pronation and abduction, pronation and eversion...these forces generally create spiral, transverse, or oblique breaks...often difficult to treat and present problems in healing...arthrodesis (fusion) may be needed if bone does not heal
- How are foot or phalanges (more painful, but not as serious) fractures treated?
- closed or open reduction
- What are the most common ribs fractured?
- 4 through 8
- What is the major concern with rib and sternal fractures?
-
potential for bone fragments or ends to puncture:
lungs
heart arteries - Fractures of the lower ribs may damage underlying organs, such as?
-
liver
spleen
kidneys - Fractures of the ribs and sternum tend to heal ______ without surgical intervention.
- spontaneously...patient is uncomfortable and requires analgesia
- What is the chief concern in pelvis fracture management?
-
venous oozing or arterial bleeding which may lead to hypovolemic shock
internal damage due to close proximity with major organs and vessels, plus pelvis's vascularity - After head injuries, what is the most common cause of death from trauma?
- pelvic fractures
- What are the most common causes of pelvic fractures in young adults and then older adults?
-
young...MVA and falls from buildings
elderly...falls - With pelvic fractures, internal abdominal trauma is assessed by checking for the presence of blood in the ____ and ____ and by watching the abdomen for the development of rigidity or swelling
- urine and stool
- How does the trauma team assess for hemorrhage?
-
peritoneal lavage
computed tomography scanning
ultrasound (newest) - What is the advantage of using ultrasound as a diagnostic study for pelvic fractures?
-
bedside study
cost effective
noninvasive
rapid
reliable - What are the 2 broad categories that pelvic fractures are divided into?
-
non-weight-bearing
weight-bearing -
1 What is one treatment for a fracture that occurs in a non-weight-bearing part of the pelvis (ex: pubic rami or iliac crest)?
2 What is the complication and intervention of this type of fracture?
3 What is the healing time? -
1 bedrest on a firm mattress or bed board
2 very painful...client may need stool softeners to facilitate defecation because of hesitancy to move...
3 well stabilized fractures usually heal in 2 months - A pelvis fracture in the weight-bearing part of the pelvis requires what kind of treatment (ex: multiple fractures of pelvic ring which creates instability or a fractured acetabulum)?
-
external fixation
open reduction with internal
fixation (ORIF)
both
progression to weight bearing depends on the stability of the fracture after fixation...
some clients can fully bear weight within days of surgery...others in traction may take as long as 12 weeks - When taking x-rays, let the patient know?
- to stand still during the procedure and that exposure to radiation will be minimal
-
While taking x-rays, any client who cannot walk from a wheelchair to the x-ray table should go to the radiology department on a ____ ?
The client is positioned for each of the desired views and is asked not to move just before each x-ray. Foll -
stretcher
okay - When a patient is undergoing cerebral angiography, check to see if client is allergic to?
- iodinated contrast agents
- When undegoing cerebral angiography, explain to the patient the importance of (2)?
-
not moving during the procedure...
keeping head immobilized - When undergoing cerebral angiography, the patient is allowed nothing by mouth for ___ to ____ hours before the test.
- 4 to 6 hours
- For cerebral angiography, most hospitals require that the nurse complete a preop checklist that includes?
-
remove the client's hairpins
and jewelry
record neurologic and vital
signs
ask the client to empty the
bladder before the
procedure - Pill rolling movements of the hand is an early symptom of?
- Parkinson's disease... early symptoms include coarse resting tremors of the fingers and thumb...akinesia and aspiration are late signs of Parkinson's disease...dementia occurs in only 20% of the clients with Parkinson's disease
- To evaluate the effectiveness of levodopa-carbidopa (Sinemet), a nurse would watch for?
- lessened rigidity and tremor....levodopa-carbidopa increases the amount of dopamine in the CNS, allowing for more smooth, purposeful movements
- Which anti-Parkinsonian drug can cause drug tolerance or toxicity if taken for too long at one time?
- levodopa-carbidopa (Sinemet)
- Multiple sclerosis is more common in?
- white women ages 20 to 40 years with a secondary onset between 40 to 60 years.
- What is the pathophysiology of multiple sclerosis?
- development of demyelination of the myelin sheath, interfering with nerve transmission
- What is a usual early symptom of multiple sclerosis?
- diplopia (double vision)
- To avoid the exacerbation of multiple sclerosis, teach patient the importance of?
- sleeping 8 hours each night
- What might exacerbate multiple sclerosis?
- pregnancy
- What abnormality is typically found in CSF of clients with MS who have undergone a lumbar puncture?
- increased levels of protein
- What is nystagmus?
- jerking movements of the eye
- What is diplopia?
- double vision
- Define oculogyric crisis?
- deviation of the eyes
- What is most important for the client having a tonic-clonic seizure?
- maintain patent airway...DON'T put anything in the mouth during a seizure because teeth may be dislodged or tongue pushed back, further obstructing airway
- What is the unnpleasant odor called that a client may feel before a seizure?
- aura
- What is a postictal experience?
- occurs after a seizure, during which the client may be confused, somnolent, fatigued, and may need to sleep
- What adverse effect may occur during phenytoin (Dilantin) therapy?
- somnolence
- What two symptoms may occur with a phenytoin level of 32 mg/dl?
-
ataxia and confusion
(therapeutic level of phenytoin is 10 to 20 mg/dl) - What precaution must be taken when giving phenytoin (Dilantin) to a client with a nasogastric (NG) tube for feeding?
-
Give phenytoin 1 hour before or 2 hours after NG tube feedings to ensure absorption.
Nutritional supplements and milk interfere with absorption of phenytoin, decreasing its effectiveness.
Phenytoin levels are checked before giving the drug and the drug is withheld for elevated levels to avoid compounding toxicity. - Does alcohol increase or decrease the effects of phenytoin?
- decreases
- When assessing vital signs in a client with a seizure disorder, what type of temperature should be taken instead of oral?
- axillary