1. strain (염좌)
| • Strains are excessive stretching of a muscle or tendon. (뼈와 근육) ex) 아킬레스건 | • RICE
• Administer NSAIDs and muscle relaxants. • Surgical repair may be required. |
2. sprain (삠)
| • Sprains are an excessive stretching of a ligament. (뼈와 뼈) ex) 십자인대 | • Casting may be required. |
3. carpal tunnel syndrome
| • caused by compression of a median nerve within the carpal tunnel at the wrist → narrowing |
• pain
• paresthesia |
• wrist splinting particularly at nighttime → prevents excessive flexion or extension • Repetitive hand exercise and elastic compression would make it worse. |
4. rotator cuff injuries
| • The musculotendinous or rotator cuff of the shoulder can sustain a tear. | • drop arm test: the inability to maintain abduction of the arm at the shoulder | • sling support |
5. joint dislocation and subluxation
| • Dislocation is the injury of the ligaments surrounding a joint, which leads to displacement or separation of the articular surface of the joint.
• Subluxation is the incomplete displacement of joint surfaces when forces disrupt the soft tissue that surrounds the joints. |
• pain
• swelling • asymmetry of the contour of affected body pars |
• reduction
• Intravenous conscious sedation, local, or general anesthesia is used during joint manipulation. • Initial activity restriction is followed by gentle range-of-motion activities and a gradual return of activities to normal levels while supporting the affected joint. |
6. fracture
| • A fracture is a break in the continuity of the bone caused by trauma, twisting as a result of muscle spasm or indirect loss of leverage, or bone decalcification and disease that result in osteopenia.
• complications of fractures |
• pain over the involved area
• edema • obvious deformity of the affected area • decrease or loss of muscular strength or function, muscle spasm, and neurovascular impairment |
• Assess the extent of the injury and immobilize the affected extremity.
• If a compound fracture exists, cover the wound with a sterile dressing. Apply a clean dressing if a sterile dressing is unavailable. • RICE • cast or splint, • Assess the neurovascular status of the extremity. |
7. ★ complication of fracture
1) fat embolism & pulmonary embolism
| • A fat embolism originates in the bone marrow and occurs after a fracture when a fat globule is released into the bloodstream. Fat embolism can occur within the first 48 to 72 hours following the injury.
• Clients with long bone fractures are at the greatest risk for the development of a fat embolism. |
• cough with blood-tinged sputum, dyspnea, cyanosis, tachypnea
• chest pain • apprehension and restlessness, feeling of impending doom • distended neck veins, hypotension, tachycardia • petechiae over the chest and axilla • crackles and wheezes |
• Notify the RRT.
• Reassure the client. • Elevate the head of the bed. • Prepare to administer oxygen. • Obtain V/S and check lung sounds. • Prepare to obtain an ABG. • Prepare for the administration of heparin therapy or other therapies, such as embolectomy or placement of a vena cava filter if necessary. • Finally, the nurse documents the event, interventions taken, and the client’s response to treatment. |
2) compartment syndrome
| • Compartment syndrome occurs when pressure increases within one or more compartments, leading to decreased blood flow, tissue ischemia, and neurovascular impairment. | • unrelieved or increased Pain
• Pulselessness • become Pale • Paresthesia |
• Notify the HCP immediately and prepare to assist HCP.
• Loosen tight dressings or bivalve restrictive cast as prescribed. • If severe, assist the HCP with fasciotomy to relieve pressure and restore tissue perfusion. |
3) avascular necrosis
| • Avascular necrosis occurs when a fracture interrupts the blood supply to a section of bone, leading to bone death. | • pain
• decreased sensation |
• Prepare the client for removal of necrotic tissue because it serves as a focus for infection. |
4) infection and osteomyelitis
| • osteomyelitis: inflammatory response in bone tissue | • fever (usually above 101℉)
• tachycardia • erythema and pain |
• Initiate aggressive and long-term intravenous antibiotic therapy.
• Administer hyperbaric oxygen therapy to promote healing. • surgery |
8. amputation
| • Amputation is the surgical removal of a limb or part of the limb. | • When traumatic amputation, call 911. Stay with the client. Elevate the extremity above heart level. Check the amputation site, apply direct pressure with gauze or cloth. Do not remove applied pressure dressing to prevent dislodging of a formed clot.
• If fingers were amputated, place in a watertight sealed plastic bag and place the bag in ice water (not directly on ice) and transport to the emergency department with the victim. |
9. ★ RA (Rheumatoid Arthritis)
| • RA is a chronic systemic inflammatory disease. Pannus forms at the junction of synovial tissue and articular cartilage and projects into the joint cavity, causing necrosis. | • pain with morning stiffness
• inflammation of joint, joint deformities • low-grade fever • elevated ESR, positive rheumatoid factor |
• remission: Provide range-of-motion exercises to maintain joint motion and muscle strengthening. Preserve joint function.
• exacerbation: Splints may be used. Prevent flexion contractures. • Instruct the client in measures to protect the joints. Instruct the client to sit in a chair with a high straight back. Instruct the client to use only a small pillow when lying down. Avoid large pillows under the head or knees. • Apply heat or cold therapy as prescribed to joints. • Instruct the client in measures to conserve energy, such as pacing activities and obtaining assistance when possible. • medications : NSAIDs, DMARDs, glucocorticoids • surgical intervention |
10. ★ OA (OsteoArthritis, degenerative joint disease)
| • OA is marked by progressive deterioration of the articular cartilage. OA causes bone buildup and the loss of articular cartilage in peripheral and axial joints. | • pain that diminishes after rest and intensifies after activity
• Heberden’s nodes or Bouchard’s nodes joint swelling, crepitus |
• Splints may be used. Prevent flexion contractures.
• Instruct the client in measures to protect the joints. Instruct the client to sit in a chair with a high straight back. Instruct the client to use only a small pillow when lying down. Avoid large pillows under the head or knees. • Apply heat or cold therapy as prescribed to joints. • Instruct the client that exercises should be active rather than passive and to stop the exercise if pain occurs. • Maintain weight within the normal range to decrease stress on the joints. • medications: acetaminophen, NSAIDs, muscle relaxants Prepare the client for corticosteroid injections into joints as prescribed. • surgical management |
11. ★ gout
| • Gout is a systemic disease in which urate crystals deposit in joints and other body tissues. | • swelling of the joints, leading to excruciating pain (gout attack)
• Tophi (hard and irregularly shaped nodules in the skin containing chalky deposits of sodium urate) |
• Provide bed rest during an acute attack, with the affected extremity elevated. Position the joint in mild flexion during an acute attack. Protect the affected joint from excessive movement or direct contact with sheets or blankets.
• Provide heat or cold for local treatments to affected joints as prescribed. • Administer medications such as analgesic, anti-inflammatory, and uricosuric agents as prescribed. • Provide a low-purine diet as prescribed. Avoid foods such as organ meats, wines, and aged cheese. Instruct the client to avoid alcohol and starvation diets because they may precipitate a gout attack. Encourage a high fluid intake of 2000 mL/day to prevent stone formation. Encourage a weight reduction diet if required. |
12. ★ [Pediatric] developmental dysplasia of the hip
| • Disorders related to abnormal development of the hip that may develop during fetal life, infancy, or childhood. In these disorders, the head of the femur is seated improperly in the acetabulum, or hip socket, of the pelvis. | • limited range of motion in the affected hip
• positive Galeazzi’s sign (Allis’s sign): shortening of the limb on the affected side • positive Ortolani’s test: The examiner abducts the thigh and applies gentle pressure forward over the greater trochanter. A ‘clicking’ sensation indicates a dislocated femoral head moving into the acetabulum. • positive Barlow’s test: The examiner adducts the hips and applies gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. • unequal gluteal folds when the infant is prone and legs are extended against the examining table. • positive Trendelenburg’s sign: The child stands on one foot and then the other foot, holding onto a support and bearing weight on the affected hip. The pelvis tilts downward on the normal side instead of upward, as it would with normal stability. |
• Splinting of the hips with a Pavlik harness to maintain flexion and abduction and external rotation.
• Gradual reduction by traction followed by closed reduction or open reduction under general anesthesia. The child is then placed in a hip spica cast for 2 o 4 months until the hip is stable, and then a flexion-abduction brace is applied for approximately 3 months. |
13. [Pediatric] congenital clubfoot
| • Complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus. | • Manipulation and casting are performed weekly for about 8 to 12 weeks because of the rapid growth of early infancy. A splint is then applied if casting and manipulation are successful. Surgical intervention may be necessary if normal alignment is not achieved by about 6 to 12 weeks of age.
• Contact the HCP immediately if signs of neurovascular impairment are noted in a child with a cast or brace. |
14. [Pediatric] idiopathic scoliosis
| • Three-dimensional spinal deformity that usually involves lateral curvature, spinal rotation resulting in rib asymmetry, and hypokyphosis of the thorax. | • asymmetry of the ribs and flanks is noted when the child bends forward at the waist and hangs the arms down toward the feet
• Hip height, rib positioning, and shoulder height are asymmetrical. |
• non-surgical intervention: brace
• surgical intervention: spinal fusion, which may be done by thoracoscopic surgery, placement of an instrumentation system, or use of metallic staples placed into vertebral bodies |
15. [Pediatric] juvenile idiopathic arthritis
| • Autoimmune inflammatory disease affecting the joints and other tissues, such as articular cartilage. | • Instruct parents and children in the administration of medications. Medications may be given alone or in combination and are prescribed in a step-like manner depending on the disease response to each level.
• Encourage and support prescribed physical and occupational therapy. • Assist the child with range-of-motion exercises and instruct in prescribed exercise. Encourage normal performance of activities of daily living. • Instruct parents and children in the use of hot or cold packs, splinting, and positioning the affected joint in a neutral position during painful episodes. • Instruct in the importance of preventive eye care and reporting visual disturbances. |
16. [Pediatric] Marfan syndrome
| • disorder of connective tissue that affects the skeletal system, cardiovascular system, eyes, and skin | • Monitor for the curvature of the spine. Instruct parents that the child should avoid participating in competitive athletics and contact sports to avoid injuring the heart.
• Cardiac medications may be prescribed. Surgical replacement of the aortic root and valve may be necessary. • Monitor for vision problems. |