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BIOL MISCcomplex 2 exam #2 review (1) LATEST UPDATED 2022
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BIOL MISCcomplex 2 exam #2 review (1) LATEST UPDATED 2022
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Complex 2 Exam Review #2Orthopedic Injuries, Pain
Fractures ATI pg. 451-460
Clinical Manifestations
Pain
Deformity
Loss of function
Mechanism of injury – where did they get hurt? Tetanus shot
Muscle spasm
Crepitus: a grating sound created by the rubbing of bone fragments
Monitor VS and neurological status because injury to vital organs can occur
due to bone fragments (pelvis and ribs)
o Continue neuro checks every hour and report any changes
immediately
Prioritization
INFECTIONS!!!
o Antibiotics
ABCs!!
Nursing Interventions
ABC’S
o High flow oxygen
o Check capillary refill and pulses
o 2 IV sites (minimum of 20… try for 16)
o FLUIDS, FLUIDS, FLUIDS
Never manipulate Question: Fell out of a tree,
Casts/Splints multiple fracturesgive fluids
Traction due to low BP
o Skin
o Check for skin abnormalities because it can cause skin
breakdown
o Skeletal
o Hanging man
o Pins
o Turn every 2 hours
o
ORIF
o surgery
External Fixation
o Device sits outside of body
o Complicated fractures
o Can be permanent or temporary (until surgery)
o Check perfusion, skin breakdown, and look for infection
Assess perfusion, swelling, numbness, tingling
Meds
o Pain medications (opiates)
o Muscle relaxers (robaxin)
, o Anticoagulants (they can’t walk around)
o Might need tetanus shot
Complications
Infection – usually in open fractures
Embolism – admin anticoagulants, PT, ROM
Fat embolism – Petechial hemorrhage on chest/abdomen
o Happens from crush injuries and long bone fractures
o Fat broken off from bone marrow and goes into lungs
o More common in older adults – from hip fractures
Compartment Syndrome=Medical Emergency
Closed fracture:
o Compartment syndrome
5 P’s: pain, pallor, paresthesias, pulselessness, paralysis
Select all about 5 P’s
don’t pick the one
Amputations ATI pg. 441-444 about pain going
Prioritization away when elevating
ABC’s!!!!!! extremity
Prevent hypovolemia
Limb is salvageable if:
o Blood flowing to the distal portion of the extremity
o Blood vessels not damaged
Evaluation
Hemodynamics
Monitor for perfusion
Assess site for bleeding; have tourniquet at bedside
Prevent flexion contractures
Change dressings
Monitor for phantom limb pain—normal
Assess psychological status
Adapt to new body image
Integrate prosthetic device
Therapy
Nursing Interventions
Stop the bleeding
Insert 2 large bore IV’s
FLUIDS, FLUIDS, FLUIDS
Monitor vitals
Monitor perfusion
Discharge teaching
o Educate on signs and symptoms of infection
o Figure 8 Technique
o ROM
o Managing pain
, Compartment Syndrome (2-3 Questions) ATI pg. 456
Clinical Manifestations
Severe metabolic abnormalities
Initial = pain that appears late & out of proportion of initial injury
Ischemia unable to read pulse ox Question: compartment
> 30 mmHg = compartment syndrome syndrome faciotomy
Late signs pallor, poor cap refill, pulselessness neurovascular check
Paresthesias
Evaluation of Care
VS return to normal
Urinary output
Hemodynamics
Diagnosis made on clinical findings, hx of injury, physical s/s & high index of
suspicion
Prioritization
Crush Injuries handout
Test question describes a crush injury and it is a medical emergency
DO NOT TOUCH IF THEY HAVE AGONAL BREATHING
Clinical Manifestations
Edema Question: MVA what is the
Swelling priority patient crushing
Urine dark red/brown syndrome and potassium 5.9
Volume loss/hemorrhage
Prioritization
ABCs!!!!!
Check circulatory status capillary refill, distal pulses
IV – FLUIDS
o Warm fluids – NS or LR
o Draw blood type & cross-match, ABGs, other labs
o Get whole blood, PRBC
o While the cross-match is being tested (one hour) use type O
blood or type specific blood
o Start two large bore IV’s (14-16 gauge)
Immobilize extremity
Require surgery
LIFE OVER LIMB!
Pain (1-2 Questions) ATI pg. 25-30
Clinical Manifestations
Subjective – it is what the person says it is
Pain scales
Chronic pain - >3 mo
Acute pain - <3 mo
KNOW DIFFERENT TYPES OF PAIN:
o Nociceptive – from damage to tissue somatic visceral, referred
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