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BIOL MISC EXAM 2 REVIEW[]Texas Tech University
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BIOL MISC EXAM 2 REVIEW[]Texas Tech University
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EXAM 2 REVIEW Orthopedic Injuries & Pain (7-12)
o Fractures (2-3)
Clinical Manifestations
Pain or reduced movement in area of fracture or distal to fracture
Crepitus
Deformity
o Internal rotation of extremity
o Shortened extremity
o Visible bone with open fracture
Muscle spasms
o Due to pulling force of bone when not aligned
Edema
Ecchymosis
Types of Fractures
Closed (Simple) Does not break through skin surface
Open (Compound) Disrupts skin integrity, causes open wound
Displaced Bone fragments are not aligned
Non-Displaced Bone fragments remain in alignment
Fatigue (Stress) Results when excess strain occurs from activities
Pathological (Spontaneous) Occurs to bone that is weak from disease process
Compression Occurs from loading force pressing on callus bone
Directions of Fractures
Comminuted Bone is fragmented
Oblique Fracture occurs at oblique angle across bone
Spiral Occurs from twisting motion (common with abuse)
Impacted Fractured bone is wedged inside opposite fractured fragment
Greenstick Occurs on one side but not extended completely though the bone
Transverse Fracture is strait across
Prioritization
Stabilize ABCs
Monitor vitals and neurological status
o Injuries to vital organs can occur due to bone fragments
Stabilize injury area
o Including joints above & below fracture
o Use splint & avoid unnecessary movement
Determine cause of fracture
Complications
Fat Embolism
o Occur after injury, usually within 12-48 hrs following long bone fractures or with total joint
arthroplasty
o Fat globules from the bone marrow are released into the vasculature
Travel to the small blood vessels, including those in the lungs
Result in acute respiratory insufficiency & impaired organ perfusion
o Early signs include dyspnea, increase respirations, & decreased O 2%
o Late signs include cutaneous petechiae (pinpoint sized hemorrhages on neck, chest, upper arms, &
abdomen)
o Treatment
Maintain bed rest
Prevention includes immobilization, minimal manipulation during turning
Administer O2 for compromised respiratory
Corticosteroids fro cerebral edema, vasopressors, fluids for shock
, Venous Thromboembolism
o DVTs are common complications following trauma, surgery, and immobility
o Encourage early ambulation
o Apply SCD or TED hose
o Administer anticoagulants
o Encourage fluids
o Rotate feet & ankles and other lower extremities exercise
o Monitor for swelling, redness, & heat
Osteomyelitis
o Infection of the bone beginning as an o Treatment
inflammation within the bones secondary 3 month IV antibiotic therapy
to penetration by infections organisms Surgical debridement or implanted
o Bone pain constant pulsating, localized antibiotic beads in bone
& worse with movement Hypercarbia oxygen treatment
o Erythema & edema Amputation
o Fever Neurovascular checks
o Leukocytosis & elevated ESR
Nursing Interventions
Elevate limb above heart & apply ice
Assess for bleeding & apply pressure
Cover open wounds
Remove clothing & jewelry near injury or affected extremity
Assess pain frequently
Initiate & continue neurovascular checks every hour
Prepare client for immobilization
o Amputations (1-2)
Prioritization
Assess capillary refill and pulses by comparing extremities
Observe for edema, necrosis, & lack of hair distribution of extremity due to poor peripheral circulation
Determine if limb is salvageable or not
Stop bleeding
Initiate 2 large bore IVs for fluid replacement
Nursing interventions
Prevent post-op hypovolemia, pain & infection
Assess surgical site for bleeding
o Keep tourniquet at bedside for emergencies
Monitor tissue perfusion of end of residual limb
o Heat can indicate infection
o Compare pulses most proximal to incision with pulse of other extremity
Manifestations of infection
o Poor wound healing below level of adequate tissue perfusion
o Position affected extremity in dependent position to promote blood flow
o Administer antibiotics and dressing changes
Assess for flexion contractures or ability to straighten limb
Evaluation
Management of traumatic amputation
o Implement a medical emergency system (EMS).
o Apply direct pressure using gauze, if available, or clean cloth to prevent life-threatening hemorrhage.
o Elevate the extremity above the heart to decrease blood loss.
o Wrap the severed extremity in dry sterile gauze (if available) or in a clean cloth, and place in a sealed
plastic bag. Submerge the bag in ice water (one part ice and three parts water), and send with the client
o
, Pain
o Monitor and treat pain.
o Differentiate between phantom limb and incisional pain.
o Incisional pain is treated with analgesics.
o Phantom limb pain
Sensation of pain in location of extremity following amputation
Related to severed nerve pathways and is a frequent complication in clients who experienced
chronic limb pain before the amputation
Can be experienced immediately after surgery, up to
several weeks, or indefinitely
Occurs less frequently following traumatic amputation
Often described as deep and burning, cramping, shooting, or aching
Treatment
Administration of calcitonin during first week after having an amputation can decrease
phantom limb pain.
Administering beta blockers, such as propranolol, can relieve continual dull, burning
sensation associated with amputated limb.
Administering antiepileptics, such as gabapentin or pregabalin, can relieve sharp, stabbing,
and burning phantom limb pain.
Some clients can have relief from antispasmodics, such as baclofen, and antidepressant
medication.
The nurse should recognize the pain is real and manage it accordingly.
Alternative treatment
Massage, heat, transcutaneous electrical nerve stimulation (TENS), ultrasound therapy,
biofeedback, or relaxation therapy.
Teach the client how to push the residual limb down toward the bed while supported on a soft
pillow. This helps reduce phantom limb pain and prepare the limb for a prosthesis
Client perception & feelings about amputation
o Allow for client and family to grieve for loss of body part and change in body image.
o Feelings can include depression, anger, withdrawal, and grief.
o Assess the psychosocial well-being of the client. Assess for feelings of altered self-concept and
self-esteem, and willingness and motivation for rehabilitation.
o Facilitate a supportive environment for client and family so grief can be processed.
o Refer client to religious/spiritual adviser, social worker, or counselor.
o Rehabilitation should include adaptation to a new body image and integration of prosthetic and
adaptive devices into self-image
Residual limb preparation & prosthesis fitting
o Residual limb must be shaped and shrunk in preparation for prosthetic training.
o Shrinking interventions
Wrap stump, using elastic bandages (figure-eight wrap) to prevent restriction of blood flow and
decrease edema.
Use a stump shrinker sock (easier for client to apply).
Use an air splint (plastic inflatable device) inflated to protect and shape residual limb and for easy
access to inspect wound
o Teaching
Explain how to care for & wrap residual limb, and how to perform limb-strengthening exercises.
Reinforce proper application and care of prosthesis.
Explain how to safely transfer and use mobility devices and adaptive aids.
Explain how to manage phantom limb pain
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