Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Strains, Contusion, and Sprains Strain: injury to a muscle when stretched or pulled beyond its capacity Contusion: soft tissue resulting from blow or blunt trauma Sprain: injuries to ligaments surrounding a joint

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Strains, Contusions, and Sprains—(cont.) Pathophysiology and Etiology: areas subject to injury Assessment Findings: Signs and Symptoms –Immediate pain followed by swelling; ecchymoses; joint instability Diagnostic Findings: physical examination; radiography; arthrography; arthroscopy Medical and Surgical Management: RICES, heat (when edema unlikely), medications, progressive physical therapy Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? An acronym for the appropriate management of strains, contusions, and sprains is RICES.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: An acronym for the appropriate management of strains, contusions, and sprains is RICES. R: Rest, I: Ice, C: Compression, E: Elevation, S: Stabilization

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Dislocations Pathophysiology and Etiology: trauma –Compartment syndrome; Volkmann’s contracture; complications Assessment Findings: Signs and Symptoms –“Popping” sound; sudden instability; pain; altered structural shape; limited ROM Diagnostic Findings: radiographic films, arthrography, arthroscopy Medical and Surgical Management: manipulate, immobilize joint; surgery Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Tendonitis Pathophysiology and Etiology: recurrent injuries: epicondylitis; ganglions; carpal tunnel syndrome Assessment Findings: Signs and Symptoms: pain, inflammation, sensation loss Diagnostic Findings: electromyography; x-ray studies; carpal tunnel syndrome: Tinel’s sign, Phalen’s sign Medical and Surgical Management: ice + heat; rest; well-planned exercise; NSAIDs, other medications; splinting; physical therapy; surgery Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Rest is an important facet of the medical treatment of tendonitis.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Rest is an important facet of the medical treatment of tendonitis. Resting the affected tendon is the first necessary step in medical management. Without rest, other treatment modalities will have little success.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Rotator Cuff Tear Pathophysiology and Etiology: traumatic injury; chronic overuse of shoulder joint Assessment Findings: Signs and Symptoms –Pain; limited mobility Diagnostic Findings: physical exam, radiography, arthrography, MRI Medical and Surgical Management: NSAIDs, rest, immobilization, corticosteroid injections, progressive exercises and stretching, surgery Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligament and Meniscal Injuries Pathophysiology and Etiology: traumatic injury Assessment Findings: Signs and Symptoms –Pain; instability; ambulatory difficulty Medical and Surgical Management –NSAIDs, ice, immobilization –Limited weight bearing; progressive activity –Surgery Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Ruptured Achilles Tendon Pathophysiology and Etiology: trauma Assessment Findings: Signs and Symptoms –Loud pop; severe pain; inability to plantar flex Surgical Repair –Then cast or brace –Physical therapy Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Rationale: Many clients who rupture their Achilles tendon report hearing a loud pop at the time of injury.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Many clients who rupture their Achilles tendon report hearing a loud pop at the time of injury. This report is often the significant symptom accompanied with severe pain.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures Pathophysiology and Etiology: sudden direct force; bone weakness; bone healing process; complications –Classification of fractures: type and extent Assessment Findings: Signs and Symptoms –Loss of function; deformity; false motion; crepitus; edema; spasm; tissue, nerve damage Diagnostic Findings: radiography; bone scan

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Bone Healing Immediately after a bone fracture, blood seeps into the area, and a hematoma (blood clot) forms. After 1 week, osteoblasts form as the clot retracts. After about 3 weeks, a procallus forms and stabilizes the fracture. A callus with bone cells forms in 6 to 12 weeks. In 3 to 4 months, osteoblasts begin to remodel the fracture site. If the fractured bone has been accurately aligned during healing, remodeling will be complete in about 12 months.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures—(cont.) Medical and Surgical Management –Goal: reestablish functional continuity of the bone –Treatment: traction, closed or open reduction, internal or external fixation, cast application –Factors: location, severity of fracture; age, overall client physical condition Nursing Management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Complications Shock Fat embolism Pulmonary embolism Compartment syndrome Delayed bone healing Infection Avascular necrosis

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractured Hip Pathophysiology and Etiology: falls; bone disorder; trauma Assessment Findings: Signs and Symptoms –Severe pain; shortening, external rotation of leg; blood loss; extensive bruising; edema; contained bleeding Diagnostic Findings: radiography Medical and Surgical Management: total hip arthroplasty; hemiarthroplasty Nursing Management