BIOL MISCcomplex 2 exam #2 review (1) LATEST UPDATED 2022

Complex 2 Exam Review #2

Orthopedic 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 fracturesgive 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