NCM 116 PERCEPTION AND COORDINATION

[NCM 116 PERCEPTION & COORDINATION]:

INJURIES • Comminuted
- Bone has splintered into several fragments
A. Injuries • Avulsion
a. Fracture - A fragment of bone has been pulled away by a
b. Motor vehicle collision
tendon and its attachment
c. Sports injury
B. Degenerative • Greenstick
a. Osteoporosis - One side of a bone is broken and the other side is
• Coordination involves an interplay of several parts. A bent
problem with coordination results to problem with action • Stress
and movement. - Results from repeated loading of bone and muscle
• We need proper coordination for normal functioning and • Impacted
protect the body from any harm - A bone fragment is driven into another bone
• Coordination is equally important as Perception fragment
• Injuries result in problems in coordination. Movement is • Pathologic
affected - Occurs through an area of diseased bone (such as
in: osteoporosis, bone cyst, Paget disease, bony
FRACTURE metastasis, tumor); can occur without trauma or fall
• A break / disruption in the continuity of the bone • Pathologic
• Occur when the bone is subjected to stress greater than - twists around the shaft of the bone
it can absorb • Oblique
• When the bone is broken, adjacent structures are - occurring at an angle across the bone
• affected which result in: • Transverse
o soft tissue edema - Straight across the bone shaft
o hemorrhage into the muscles and joints
o joint dislocations
o ruptured tendons
o severed nerves
o damaged blood vessels
• Complete or incomplete

• Segmental
TYPES OF FRACTURES - A segment of the bone is broken; divided into 3
Simple sections
- Remains contained with no disruption of the skin • Torus
integrity - Thickening of bone, there is new growth (not
serious, benign only)
Depressed
- Usually on the mouth
- Fragments are driven inward (examples: skull,
face)
CAUSES
• Compression • Direct blows
- Bone has been compressed (example: vertebra) • Crushing forces
• Open/ Compound • Sudden twisting motions
- Damage also involves the skin or mucous • Extreme muscle contractions
membranes SIGNS AND SYMPTOMS
• Acute pain
• Loss of function
• Deformity
• Shortening of the extremity
• Crepitus
• Localized edema and ecchymosis
FIRST AID FOR FRACTURES
• Ice
• Immobilized by use of splint to prevent additional injury
DIAGNOSTIC EXAMINATIONS
• Xray
• CT scan

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 NCM 116 PERCEPTION AND COORDINATION

MEDICAL MANAGEMENT o Lacerations

REDUCTION o Fractures
• restoration of the fracture fragments to anatomic o Amputations
alignment and positioning • Head-on collisions: occur when the front ends of two cars
o Closed – through manipulation and manual traction hit each other; often fatal
o Open – through surgery
IMMOBILIZATION
o Internal fixation - metallic pins, wires, screws,
plates, nails, rods
o External fixation - bandages, casts, splints,
continuous traction, external fixators

COMPLICATIONS OF FRACTURES
EARLY
• Hypovolemic shock
• Fat embolism syndrome (FES)
- hypoxemia, neurologic compromise, petechial rash
• Compartment syndrome
- elevation of pressure within an anatomic
compartment above normal perfusion pressure
(increase from edema or bleeding; decrease from
restrictive cast)
• Venous thromboembolism (VTE)
- deep vein thrombosis (DVT)
- pulmonary embolism (PE) SPORTS INJURY
DELAYED • Occur when engaging in sports or exercise
• Delayed union • May result from:
- Distraction, infection, poor nutrition, comorbidity o overtraining
(diabetes, autoimmune disease) o lack of conditioning
• Nonunion o improper form or technique
- Failure of the ends of fractured bone to unite
• May result to:
(example: tibia)
o bruises
• Malunion
o strains
- Healing of fractured bone in misaligned position
(example: hand, fingers) o sprains
o tears
MEDICAL TREATMENT o fractures
• Ultrasound stimulation
• Electrical bone stimulation
MOST COMMON SPORTS INJURY
Pulled muscle/muscle strain
SURGICAL TREATMENT • muscle is overstretched and tears
• Bone grafts • pain, swelling, weakness, difficulty or inability to use
muscles
• Internal and external fixation
• quadriceps, calves, hamstrings, groin, low back, shoulder
• rest, ice, compression, elevation (RICE)
NURSING CARE MANAGEMENT OF FRACTUR
• NSAIDs
• Maintain stabilization and alignment of fractures
• Relief of pain Torn ACL (anterior cruciate ligament)
• Regain mobility • occur when landing the wrong way, changing direction,
stopping quickly, direct blow to the knee
• Prevent skin breakdown
• pain, swelling, loss of ROM
• Achieve timely (wound, if any) healing
• braces, physical therapy
• Verbalize understanding of the condition, prognosis, and
complications • surgical reconstruction; rehabilitation
• Demonstrate optimal performance of ADL Torn MCL (medial collateral ligament)
• occur when the knee joint is pushed sideways when
making a wrong move or receiving direct blow to the
knee
• pain, swelling, instability of the joint
MOTOR VEHICLE COLLISION/ ACCIDENT
• ice, bracing, physical therapy
INJURIES • surgery
• occurs when a vehicle collides with another vehicle,
Shin splints
pedestrian, or stationary obstruction
• occur in runners or beginning to exercise
Behavioral risk factors:
• repetitive use injury
speeding
• muscles and tendons around the tibia are inflamed
seat belt nonuse
• throbbing, aching, or stabbing pain on the insides of the
driving after drinking alcohol
lower leg
use of device for talking or texting
• stretching, resting, ice
• May result from: • NSAIDs, bandaging
o being pinned behind the steering wheel, etc • orthotics and proper athletic shoes
o being ejected from the seat Stress fracture
• May result to: • overuse injury that occurs when muscles are no longer
o Contusions able to absorb the impact from physical activity; bone
o Abrasions absorbs the pressure resulting in a break

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 NCM 116 PERCEPTION AND COORDINATION

• can occur when increasing activity too quickly • pain, popping, cracking
• lower legs, feet • rest, ice, compression, elevation
• pain with activity • NSAIDs, physical therapy, orthotics
• rest, special shoe, brace • rarely, surgery for severe cases
Plantar fasciitis
• inflammation of ligament PREVENTION OF SPORTS INJURY
• heel pain often felt the first thing in the morning after • use of correct equipment
getting out of bed or after being active • wear protective gear
• Risks factors: stress and strain on the feet, obesity, • rest between workouts
tight calf muscles, repetitive use, high arches, new • start activity slowly and gradually increase strength,
athletic activities flexibility, and endurance
• rest, ice, NSAIDs, stretching exercises • listen to the body and back-off at the first signs of pain,
• cushion insoles, wear splints at night discomfort, stress, or overheating
• cortisone injections, physical therapy, surgery
Sprained ankle
• occurs when the ligaments that support the joint OSTEOPOROSIS
become overstretched • degenerative disease of the bone characterized by reduced
• stepping on uneven surface or stepping in a way that mass, deterioration of matrix, and
twists or rolls the foot • diminished architectural strength
• mild to severe sprain and pain • osteopenia (low bone mineral density)
• rest, ice, compression, elevation o precursor
• NSAIDs • bone fracture
• brace or cast for several weeks o consequence
Tennis elbow • rate of bone resorption maintained by osteoclasts is greater
• overuse injury that involves inflammation of the than the rate of bone formation maintained by osteoblasts
• tendons on the outside of the elbow caused by • results to reduced total bone mass
• small tears • bones become progressively porous, brittle, fragile
• pain, weak grip • compression fractures (thoracic and lumbar spine), hip
• rest, NSAIDs fractures, Colles fractures of the wrist
• wear special brace on the forearm • Kyphosis (Dowager hump)
• physical therapy o loss of height
• steroid injections • Postural change
• surgery o relaxation of abdominal muscles, protruding
abdomen
Low back pain
• Deformity
• may be due to overuse such as playing one too
o pulmonary insufficiency
• many rounds of golf or lifting heavy weights
• Risk for falls
• usually resolves on its own without treatment
o balance issues
• rest, anti-inflammatory medications Loss of bone mass over time due to:
• use proper form when exercising, or modify exercise • Decreased calcitonin
technique, increase duration of workouts slowly, o promote bone resorption & inhibit bone formation
perform daily activities in a different way
• Decreased estrogen (with aging, menopause,
Hip bursitis oophorectomy)
• overuse from running, cycling o promote bone breakdown,
• stiffness and pain around the hip joint due to o accelerate bone resorption
inflammation of bursae • Increased parathyroid hormone (PTH) with aging increase
• hip pain tends to be worse at night bone turnover and resorption
• pain in getting up from a seated position
• avoid strenuous activities, NSAIDs
• physical therapy, steroid injections
• use of cane or other assistive device
Concussion
• a TBI that occurs when the brain undergoes rapid
acceleration inside the skull due to direct hit to the head
or body
• risk for contact sports (football)
• headache, loss of consciousness, memory loss,
sleepiness, nausea, vomiting
• thorough neurological exam
• physical and mental rest
Achilles tendonitis
• inflammation that causes pain on the lower back of the
leg just above the heel
• pain, swelling, stiffness
• rest, ice, stretching, NSAIDs
• physical therapy
• special footwear and orthotics
Runner’s Knee
• patellofemoral pain syndrome
• occurs when tendons, joint lining (synovia), and / or
other soft tissues of the knee become irritated
• overuse or misaligned kneecap

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 NCM 116 PERCEPTION AND COORDINATION

TYPES
PRIMARY
• failure to develop optimal peak bone mass and low
vitamin D levels contribute to the development of
osteopenia without associated bone loss
• occurs in women after menopause, and in men later in
life

SECONDARY
• result of medications or diseases that affect bone
metabolism
• more likely for men

RISK FACTORS
• alcohol intake of 3 or more drinks daily
• current use of tobacco products
• family history
• history of bone fracture during adulthood
• inactive or sedentary lifestyle
• inadequate calcium and vitamin D intake
• low body mass index
• malabsorption disorders
• men older than 60 years of age
• women who are postmenopausal
• prescribed corticosteroids for longer than 3 months
DIAGNOSTICS
• DEXA (dual-energy x-ray absorptinometry)
• BMD studies
• FRAX (fracture risk assessment tool)
• laboratory studies
MEDICAL MANAGEMENT
• diet (calcium, vitamin D)
• vitamin D plus calcium supplements
• weight-bearing exercises
• avoid excessive alcohol intake
• quit tobacco smoking
• medications (bisphosphonates,
o estrogen agonist/antagonists,
o receptor activator of nuclear factor kappa-B ligand
(RANKL) inhibitors
NURSING CARE MANAGEMENT
• promote understanding of osteoporosis and the treatment
regimen
• relieve pain
• improve bowel elimination
• prevent injury