note cards for test 3 complete.txt

partial paralysis

large amount of bleeding

bleeding into soft tissue, usually from blunt force

stretching injury to muscle or muscle-tendon unit

• swelling
• local tenderness
• sharp or dull pain

lower back then cervical region

mechanical overloading

injury to a ligament surrounding a joint

forces going in opposite directions

• loss of ability to move/use joint
• pop
• discoloration
• pain
• rapid swelling

• rest
• ice
• compress
• elevate

all

• x ray for bone and joints
• MRI for soft tissue

first 24 hours

• analgesics: NSAIDs for pain and swelling,
• muscle relaxants to reduce muscle spasms,

• acute pain
• impaired physical ability
• self care deficit
• risk for impaired skin integrity

• pain
• pallor
• pulse
• parasthesia
• paralysis

loss of articulation of bone ends in the joint following sever trauma

• pain deformity
• limited motion

• partial dislocation,
• bone ends still partially intact

• unusual sensation such as:
• numbness
• tingling
• burning
• prickling

any break in continuity of bone

• simple
• compound
• complete
• incomplete
• comminuted
• stable
• unstable
• stress

• closed
• skin is still intact

• open
• skin integrity interrupted

entire width of the bone is broken

the alignment is maintained

the bone is crushed

the bone breaks in many places

part of the width of the bone is broken

• the bone endures a repetitive overload
• so the bone can't repair itself quickly enough,
• so the bone's homeostatis in disrupted

• the bone is out of alignment
• may have muscle spasms,
• need to manipulate the bone back into alignment
• may need surgery

Why it occurred. Is it cancer? Osteoporosis? etc.

• inflammatory
• reparative
• remodeling

• may have soft tissue injuries
• may have alteration in circulation
• may have obvious deformity or shortening of extremity
• may have felt or heard the bone break

• hematoma: from blood vessels tearing and bleeding
• intense inflammatory response caused by necrotic bone tissue
• vasodilation: because of inflammatory reposne
• exudate forms
• white cells migrate

• clotting begins
• fibroblasts and new capillaries grow into the fracture which forms granulation
• granulation tissue replaces the hematoma.
• Phago-cytes begin to remove cell debris.
• Osteoblasts, bone forming cells, proliferate forming a fibrocartila-ginous callus.
• fibrocartila-ginous callus: a web of collagen fibers from both sides of the fracture site that unites the bone fragments
• Bony callus formation usually continues for 2 to 3 months

• osteoblast/osteoclasts respond to daily stress by remodeling along the site of the fracture
• the repaired section of bone then resembles the uninjured bone

• age
• health
• other conditions
• when treatment was sought
• physical activity
• nutrition
• type of fracture
• location of fracture
• co-morbidities
• compliance
• smoking

6-8 weeks

• immobilization of fx with split, pillow, cardboard, etc. elevate
• assess 5 Ps
• Maintain tissue perfusion
• Open wounds
• sterile dressings

hip 12-16 weeks

• history of incident & assessment
• x-ray of bones
• additional tests: cancer, osteoporosis, electrolytes, etc

• 1. pain meds
• narcotic, for sever, impinged nerves,
• 2. NSAIDs -beware of bleeding
• 3. Antibiotics - for open fx,
• 4. others:
• anti coagulants if on bed rest,
• stool softener or stimulate,
• multi vitamin
• calcium
• anti ulcer med

goal is to have in OR within 6 hrs

pins thru the bone to stabilize

• displaced fx,
• soft tissue damage involving nerves,
• blood vessels needing repair

open reduction internal fixation

need to remember there is metal there for MRI

• application of straightening or pulling force
• to maintain or return fractured bones in normal alignment,
• prevent muscle spasms

maintain necessary force

• pulling force in straight line;
• Buck's extension
• used to immobilize during transport

• manual
• straight (skin)
• balanced suspension
• skeletal

• more than 1 force of pull
• raise and support injury off of the bed
• allows increased mobility

pulling force is applied through pins placed in the bone

• invasive
• more risk of infection

• skin break down on back
• problems urinating while laying down
• constipation, pain meds, lack of privacy, laying down
• kidney stone formation from calcium as a result of fracture
• pins site could be infected

• temperature of the extremity/infection
• ropes hang freely
• alignment
• circulation check 5 Ps
• type of locations of fracture
• increase Fluid intake
• overhead trapeze
• no weights on bed or floor

a rigid device applied to immobilize bones & promote healing, usually extends above & below fx

• plaster
• fiberglass

• needs ~48 hrs to dry - don't touch until it's dry
• stockinette on skin, then the plaster
• Doesn't reach total hardness until 48-72 hrs later.
• Watch weight bearing
• Swelling - wait until goes down, or splint until swelling goes down
• don't get it wet

• nothing in any casts to scratch
• use a blow dryer on cool setting for itching
• notify doctor if pain, coolness, strange color, etc
• keep dry

• used in ER for nondisplaced fx.
• dries quickly

• promotes healing
• increases osteoblast and osteoclast activity,
• increases blood supply

• compartment syndrome
• swelling from too tight cast

• fascia around muscles doesn't give
• swelling increases pressure
• very painful
• causes ischemia
• usually develops w/in 48 hours after the injury

• pain
• decreased sensation
• loss of movement
• decreased distal pulses
• cyanosis

• elevate limb
• call dr.
• 5Ps
• measure circumference

• surgical incision to cut the fasca to increase blood supply
• if urgent they will do it at bed side,
• leave incision open for awhile,
• put half cast until pressure is relieved,

• bivalve cast
• fasciotomy

• 1. venous stasis
• 2. injury to blood vessel
• 3. altered blood coagulation

• doppler
• venogram

• swelling
• tenderness
• not always painful

• anticoagulants
• TED hose,
• early ambulation

serial xrays to monitor healing

• surgically re-break it
• re-cast
• re-pin
• bone graft
• electrical stimulation
• debridement

• poor nutrition
• inadequate immobilization
• poor alignment of fracture at repair
• didn't see doc in time
• infection/necrosis
• age
• immunosuppression
• sever bone trauma

not healing or not lining up

• bed rest for 5-7 days to prevent dislodgement
• heparin IV prevent more clots (doesn't dissolve)
• coumadin

• caused by muscle, bone, or nerve damage
• sever, diffuse, burning pain
• hyper sensitive to stimuli
• decreased motion

• pain meds,
• area nerve block,

• always ask pt to describe pain
• what kind?

• impaired physical mobility (barrier free,assistive devices)
• impaired tissue prefusiong and neurovasculare compromise (ceck at least q hour cap refill, sensations, etc)
• pressure ulcers, check frequently,
• assessment of client's response to trauma (changes in ADL changes at home lots of psych social)
• do they need extra help at home, shopping, cleaning etc.

• Calcium
• exercise
• maintain good weight
• balance

• actue pain
• risk for peripheral neurovascular dystunction
• risk for infection
• impaired physical mobility
• risk for disturbed sensory perception: tactile

partial or total removal of a body part

• can they shower?
• bear weight?
• edges of cast, smooth rough edges?
• follow dr orders r/t how much weight bearing,
• ROM of unaffected limbs
• elevation to decrease swelling and pain
• discharge planning � needed equipment, PT

• Periphial vascular disease in lower extremity
• trauma for upper extremity
• sever frost bite
• burns
• electrocution

always not enough blood supply either acute or chronic

• aleviate pain,
• save as much healthy tissue as possible
• increase functional outcome

wound site is left open for awhile to promote healing.

closed leave a flap to put over knee

• prevent infections
• access circulation to stump
• ace wrap, compression wrap in minimize edema
• as much activity as possible

• stump needs to be cone shaped to fit in prosstheis,
• wrap from distal to approximal
• 1st 24 hours, elevate the stump

• because the leg will want to stay that way (flexure contracture)
• lay prone some times to keep leg straight

• infection
• delayed healing
• chronic stump pain
• phantom pain
• contractures

• avoid prolonged sitting
• lay prone, not always supine
• don't elevate after 24 hours

• body image distrubance
• risk for infection
• pain
• grief
• ineffective coping
• impaired mobility
• skin integrity

• carpal tunnel syndrome
• bursitis

• numbness tingling of thumb and index finger
• pain in some positions
• interfers with sleep
• posistioning

surgery makes tunnel bigger

• collaborative care
• pain relieve
• increase mobility

• inflammation of the bursa that's between muscles and tendons,
• joint may be tender, hot, red, swollen, joint flex painful,
• rest can help,

med - NSAIDs

• splint
• heat/cold
• surgery
• remove bursa to make a bigger tunnel
• home care
• rehab

• acute pain
• inpaired mobility
• home care
• rehab

• a degenrative joint disease
• most common form of arthritis
• loss of articular cartilage
• hypertrophy of bones at articular margins

• age
• genetics
• excessive weight
• inactivity
• hormones

• wear and tear
• autoimmune
• bone spurs
• bone on bone

• gradual
• pain and stiffness in one or more joints
• immobility
• decrease rom
• crepytis

• grinding noise with a sensation felt in the joint
• might be from bone on bone movement

First stage of bone healing: inflammatory

3rd stage, bony callus formation: remodeling

2nd stage, fibrocartilaginous callus formation: reparative

oblique fracture

incomplete fracture

complete fracture

comminuated fracture

Supporting the injured extremity above and below the fracture site helps prevent displacement of bony fragments and decreases the risk of further nerve damage.

• Unrelenting pain
• pallor
• diminished distal pulses
• paresthesias
• paresis

remain strong,

overriding fracture

transverse

spiral

avulsion

epipthyseal