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Assessment
Terms
Pathophysiology
Interventions
Pharmacology
100
What is included in a neurovascular check/assessment?
What is Circulation, motor, sensation Pain Pulses Paralysis Paresthesia Pallor Temperature Capillary refill
100
Definition of Dislocation and Subluxation
What is Dislocation: complete disruption of the bony articulating surfaces in the joint Subluxation: a partial joint disruption that maintains some contact between the surfaces
100
What is a hematoma?
What is -Collection of blood in the tissue -Pain -Risk for swelling, compartment syndrome
100
Splinting Actions
What is Once life and limb-threatening complications ruled out, immobilize the injured extremity to reduce blood loss, pain, and potential for further injury ··Splint as it lies; it is not necessary to realign an extremity unless there is severe angulation that compromises circulation or makes it difficult to apply a splint ··Immobilize joints above and below the injury ··Pad and secure the splint, assess and document the distal circulation after splinting
100
Treatment for hematoma
What is -Ice, elevate, pain medications (NSAIDs, opioids) -No dressing necessary
200
Compartment Syndrome Assessment
What is Severe (disproportional) pain with passive motion Measure pressure as needed (PRN) ··Intracompartmental pressures can be measured (simple manometer attached to a syringe via tubing and stopcock; commercial devices) ··Use intracompartmental pressures with patient’s clinical presentation to determine if a fasciotomy is indicated
200
Joint Effusion definition
What is Collection of fluid in a joint space Etiology ··Knee is most common ··Caused by trauma, overuse injuries, underlying disease/condition
200
Costochondritis definition
What is Inflammation of cartilage at costochondral or costosternal joint Idiopathic, benign ··Differentiate from cardiac, other types of pain Benign cause of chest pain ··The condition is generally self-limiting, but there may be recurrent or persistent symptoms ··The onset is insidious ··May present with chest wall pain and a history of repeated minor trauma or unaccustomed activity (e.g., painting, moving furniture)
200
Interventions for strains and sprains
What is Rest: Avoid use of limb; ROM 4x/day ASAP Ice: 20-minute sessions (ice for the first 48 hours, then use heat for 20 minutes, typically every hour while awake) Compression: Rewrap twice daily, remove at night Elevation: Raise above level of heart for first 24 hours CEN
200
Paint or nail gun nursing/medication interventions
What is Always start with ABCs ··Bleeding control Wound assessment Evaluation of foreign body Antibiotics Tetanus Surgery if needed to drain paint/oil
300
Low back pain assessment
What is Pain ··Location/duration ··Provocation/palliation History of injury Numbness to extremities Incontinence X-rays or MRI if neurovascular compromised or incontinent
300
Bursitis definition
What is Excessive fluid or infection of the bursa sac History of overuse, repetitive movement, inflammatory disease, trauma, or infection Subacromial, olecranon, trochanteric, prepatellar, infrapatellar Increased risk for kidney stones
300
Risk for poor outcome traumatic amputation
What is Crush injury/nerve injury Long ischemic times (greater than 6 hours) Proximal amputations Hypotensive shock Contamination Concomitant injuries Comorbidities Age Poor nutrition Psychiatric illness
300
Crutch walking fitting and teaching
What is Fitting ··Fit with patient wearing shoe on unaffected side ··Arm pieces should be 2 inches (5 cm) below axilla when crutch is at 25° angle with tips 6–8 inches (15–20 cm) to side and in front of foot ··Adjust hand pieces so elbow has a 30° angle of flexion Teaching ··Place crutches 12 inches (30 cm) forward and 6 inches (15 cm) to side when walking on flat surface ··When ascending stairs, uninjured leg leads followed by injured leg and crutches ··When descending stairs, crutches and injured leg go first
300
Medication/treatment Rhabdomyolysis
What is ABC management with large volume IV fluid Correct cause Urine alkalinization, mannitol, loop diuretics Sodium bicarbonate Correct electrolyte, acid-base, metabolic abnormalities Hemodialysis for acute renal failure
400
Your patient has sharp pain or “pop” in heel, is Walking flat-footed, Unable to stand on ball of foot Unable to plantar flex foot, what do they have?
What is Achilles Tendon Rupture
400
Types of Sprains
What is I (mild) Microdamage Stable X II (moderate) Partial tearing of the ligament Stable X X III (severe) Significant tears of the ligament Significantly unstable X X X
400
The Six P's
What is Pain-Earliest sign is deep aching that is disproportionate to injury; as it worsens, pain is exacerbated by external pressure or movement distal to injury Paresthesia-Nerves are compressed, leading to symptoms of numbness and tingling or feeling “asleep” Pallor-Loss of circulation as microcirculation is impaired, appearing pale or dusky Poikilothermia-Extremity becomes generally cool to the touch, but warmer proximal to the affected compartment Paralysis (late)-Indicator of poor outcome Pulselessness (late)-Usually not evident until pressures in compartment are close to systolic pressure, obstructing arterial blood flow
400
Blood Pressure and Interventions Compartment Syndrome
What is Pressure Intervention -Less than 10 mm Hg-None; -Normal 20 to 30 mm Hg-Close observation, elevate to the level of the heart, remove external compression -Greater than 40 mm Hg Surgical decompression
400
Abrasion medication/nursing interventions
What is Cleansing with soap, water, and irrigation Pain control (topical anesthetics/parenteral) prior to cleansing extensive abrasions Topical antibiotics and non-adherent dressings can be used, but change daily Minor abrasions can be left open to air Tetanus prophylaxis if needed
500
The 4 stages of pressure ulcers and a description of each
What is Stage 1 ŸŸNon-blanchable erythema of intact skin ŸŸDiscoloration, warmth, induration (hardening) with patients with darker skin • Turn patient, alleviate pressure to wound • Protect/cushion/cover area Stage 2 ŸŸPartial-thickness skin loss, involving epidermis and/or dermis ŸŸSuperficial ulcer, presents as abrasion or blister • Cover/protect with dressing • Use lotions/emollients with padding Stage 3 ŸŸFull thickness, may extend to fascia ŸŸHigh rate of infection • Prevent infection • Cover/protect wound • Alleviate pressure Stage 4 ŸŸExtensive destruction ŸŸTissue necrosis/damage to muscle, bone, underlying structures with and without full-thickness skin loss • Prevent infection • Surgical removal of necrotic tissue
500
Different Types of Fractures
What is Transverse- Direct Oblique- Twisting; loss of leverage Spiral- Rotating force along axis of limb (twisting) Comminuted- Multiple fractures Avulsion- Muscle (ligaments) contract forcefully, tear fragments from bone Impacted- Bone ends jam together Greenstick- Incomplete (children) Compressed- Vertebrae forced together Depressed-Blunt trauma to flat bone
500
Blast Injury Phases
What is Primary: Initial blast or air wave; primarily affects air-filled organs ··Tympanic membrane perforation ŸŸPermanent deafness can occur ··Blast lung ŸŸPneumothorax ŸŸAlveolar rupture ··Air embolus ··Gastrointestinal contusions, rupture, and perforations ··Central nervous system ŸŸVarious types of focal and diffuse cerebral hemorrhage ŸŸCerebral air embolism Secondary: Flying debris acts as projectiles; injuries will vary depending on the size of the projectiles and site of impact ··Penetrating injuries; lacerations; impaled objects Tertiary: Injuries from being thrown from the blast site ··Blunt or crush traumatic injuries ··Fractures ··Traumatic amputation ··Brain injury Quaternary: Inhalation of dust or toxic gases ··Thermal burns ··Radiation ··Chemical, biological, radiological, nuclear (CBRN) ··Lungs, skin, eyes most commonly injured
500
Gouty Arthritis discharge teaching
What is Avoid thiazide diuretics, alcohol Decrease purine intake ··Avoid herring, mussels, yeast, salmon, sardines, anchovies, veal, bacon, organ meats Avoid aspirin ··Interferes with uric acid excretion
500
Puncture wound medications/nursing interventions
What is Irrigate and clean uncomplicated, uncontaminated wounds less than 6 hours old All puncture wounds are considered tetanus-prone and require prophylactic vaccination Routine use of antibiotics not recommended for uncomplicated puncture wounds in healthy individuals; use can actually predispose a patient to a secondary infection with pseudomonas Monitor for signs of complications