Exam 16 - Traumatic Injuries

Traumatic Injuries: Contusions, Sprains, Whiplash, and Strains

• Contusions: Soft tissue injury caused by blunt trauma. Commonest soft tissue injury. Internal bleeding under skin may form a hematoma. Severity varies based on location. Brain contusion is serious. Higher risk of cellulitis (subcutaneous tissue infection) with large contusions.
• Treatment: Ice packs (15-20 minutes intermittently, 12-36 hours), elevation to reduce swelling and pain.
• Sprains: Ligament tear (partial or complete). Results from twisting or hyperextension of a joint. Damage to blood vessels, muscles, and nerves. Common sites: knee, ankle, cervical spine (whiplash). May cause joint bleeding (hemarthrosis).
• Assessment (ankle sprains): Pain & tenderness (worsening with movement); edema; limited joint movement; ecchymosis around ankle. Radiographic study to rule out bone trauma.
• Treatment (ankle sprains): Similar to contusions. Severe sprains may require surgery. RICE (Rest, Ice, Compression, Elevation).
• Nursing Care (sprains): Elevation, ice (12-36 hours), followed by heat (15-30 minutes, 4x/day after 24 hours) to promote healing; compression dressing; splinting; neurovascular assessments.
• Whiplash: Cervical spine injury. Caused by sudden acceleration/deceleration, often in car accidents. Hyperextension & compression of anatomical structures. May not have obvious symptoms immediately. Potential for cervical fractures.
• Assessment: Pain (initially in neck, may radiate down arm); pain increased with coughing, sneezing, movement; paresthesia (numbness/tingling); headache; blurred vision; weakened hand grip; edema in neck; normal vital signs (except potential for increased intracranial pressure – hypertension, widened pulse pressure, bradycardia).
• Treatment: Analgesics, muscle relaxants, neck brace, intermittent cervical traction (to separate disc and joint surfaces). Surgery for cervical fracture.
• Nursing Care: Limit cervical spine movement (traction), special exercises, heat therapy, pain medication. Use of neck collar. Inspect skin for excoriation.
• Strains: Muscle injury due to overstretching or pulling. Microscopic muscle tears. Common sites: calf, hamstrings, quadriceps, lumbosacral region.
• Assessment: Sudden, severe pain worsening with activity; tenderness; stiffness; soreness. Chronic strain may not be evident for hours. Stiffness, ecchymosis, and edema observed.
• Treatment: Surgery for complete ruptures; analgesics, muscle relaxants, exercises (especially for lumbosacral region),
• Nursing Care: Ice or heat therapy (per doctor’s preference); encourage activity avoidance; firm chair, no high heels, back support. Firm mattress, avoid stomach sleeping (for lumbosacral strain); leg exercises to prevent DVT.

Dislocations

• Definition: Dislocation: Displacement of articular surfaces. Subluxation: Partial/incomplete dislocation. Tearing of joint capsule.
• Causes: Congenital, disease-related, or trauma.
• Symptoms: Tearing of ligaments/tendons, fractures; possible damage to blood vessels; visible or invisible deformity; change in extremity length; pain and loss of function similar to fractures.Common sites: shoulder, hip, knee.
• Assessment: Patient description of injury, pain, and dislocation-specific details (e.g., paresthesia in shoulder dislocation). Erythema (redness); discoloration; edema; pain; tenderness; limited movement; deformity or extremity shortening. Neurovascular assessments (circulatory and nerve function).
• Diagnostic Tests: Physical exam; radiographic studies of the affected site.
• Treatment: Closed reduction (manipulation to correct deformity); possible surgery.
• Nursing Care: Reduce edema and discomfort; immobilization via splints, slings, or elastic bandages; frequent neurovascular assessments; pain management (analgesics, possibly opioids for severe pain, or non-opioids for mild/moderate); positioning; accident prevention.

Carpal Tunnel Syndrome

• Definition: Median nerve compression in the wrist. Often caused by inflammation and edema of tendon sheaths.
• Symptoms: Paresthesia (pins-and-needles) and hypoesthesia (decreased sensation) of the thumb, index, middle fingers. Burning pain, numbness, weakness, especially thumb. Increased incidence in obese middle-aged women. Repetitive hand movements are a risk factor.
• Assessment: Burning pain, tingling in hand relieved by shaking/exercise, aggravated at night. Numbness (hypoesthesia) of thumb, index, ring fingers especially after sustained wrist flexion. Inability to grasp small objects. Edema in hand, wrist or fingers. Muscle atrophy; depressed appearance of thenar eminence.
• Diagnosis: Physical exam (Tinel's and Phalen's signs); electromyogram, MRI, electroneurometer test.
• Treatment: Mild symptoms: splints, injections. Severe/atrophy: Surgery (transverse carpal ligament sectioning).
• Nursing Care: Immobilization (e.g., wrist cock-up splint); Elevation; ROM exercises; pain control; postoperative care (if surgery) includes elevation of hand, active finger and thumb motion; assessing circulation and movement; vital signs; administering pain medication.

Herniated Intervertebral Disk (HNP)

• Definition: Rupture of intervertebral disk causing nerve root pressure. Lumbar and cervical herniations are most common.
• Causes: Sudden trauma (lifting, twisting), or gradual changes (degenerative).
• Symptoms (Lumbar): Low back pain worsening with movement; pain radiating to buttock and down leg; numbness/tingling in leg. (Cervical): Neck pain, headaches, neck rigidity. Common in people 20-45 (lumbar) and 45+ (cervical). Pain in the back radiating down the leg (sciatica); Activity intolerance; bowel/bladder issues (constipation, urinary retention).
• Assessment: Pain description; pain relief methods; activity impact; radiating leg pain; activity limitations, bowel/bladder changes. Limited spinal flexibility; gait changes; breathing changes; bowel/bladder assessments.
• Diagnostic Tests: Detailed history, physical exam, radiographic studies, CT scans, myelography, and electromyography.
• Treatment: Conservative 4-week therapy: Braces, heat/ice, ultrasound/massage, TENS, analgesics, NSAIDs, muscle relaxants, epidural corticosteroids. Surgery if needed.
• Surgery Types: Artificial disk replacement, chemonucleolysis (chymopapain injection), discectomy, endoscopic spinal microsurgery, laminectomy, spinal fusion.

Tumors of the Bone

• Types: Primary (often in young people) or secondary (metastatic from other cancers); benign or malignant.
• Secondary Tumor Types: Prostate, lung, breast, thyroid, kidney.
• Osteogenic Sarcoma: Aggressive; fast-growing; primary malignant bone tumor; affects long bones (femur, tibia, humerus); metastasizes; peaks in males 10-25.
• Clinical Presentation (Sarcoma): Spontaneous fractures; anemia if bone marrow invasion; metastasis to other bones/lungs.
• Osteochondroma: Common benign; single or multiple; mostly affects males 10-30; affects humerus, tibia, femur; often no spread.
• Clinical Presentation (Osteochondroma): Pain; possible pressure on nerves or blood vessels; rarely cancerous.
• Assessment: Pain (especially with weight-bearing). Spontaneous fracture pain; tenderness. Possible edema, discoloration.
• Diagnostic Tests: Bone scan; bone biopsy; labs (CBC, serum protein, alkaline phosphatase); MRI.
• Treatment: Surgery (wide excision/resection, bone curettage; amputation), radiation, chemotherapy, depending on tumor type.
• Nursing Considerations: Safety precautions related to chemotherapy/radiation; education for patients/families; Pre/post-op care (neurovascular assessment, pain management, cast care, mobility promotion).

Amputations

• Reasons: Malignant bone tumors, injuries, impaired circulation (diabetes/arteriosclerosis), congenital deformities, infections.
• Surgical Implications: Blood loss, potential anemia if long bones.
• Preoperative Assessment: Patient understanding of the situation, pain, neurovascular compromise, level of orientation.
• Diagnostic Tests: CBC, BUN, potassium, urinalysis, ECG.
• Medical Management: Traumatic amputation: restoring circulation, controlling pain, infection prevention, plastic repair. Elective: patient assessment prior to proceeding; treating any infection.
• Post-op Assessment: Pain (including phantom limb pain); hemorrhage observation, drainage; neurovascular assessments; care of remaining extremity; infection prevention.
• Nursing Interventions: Pain management; contracture prevention, teaching; prosthetic preparation; phantom limb pain strategies.
• Patient and Family Education: Lifting limits, driving, and twisting restrictions; follow-up appointment schedule.

This quiz covers key concepts related to traumatic injuries such as contusions, sprains, whiplash, and strains. It focuses on the definition, treatment options, and assessment methods for these injuries. Test your knowledge on symptoms, care protocols, and management strategies.