Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries PDF

Timby’s Introductory Medical- Surgical Nursing, 13e Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries Copyright Copyright © 2018 © 2022 Wolters Wolters Kluwer |·Lippincott Kluwer Health All Right...

Timby’s Introductory Medical- Surgical Nursing, 13e Chapter 62: Caring for Clients With Traumatic Musculoskeletal Injuries Copyright Copyright © 2018 © 2022 Wolters Wolters Kluwer |·Lippincott Kluwer Health All RightsWilliams Reserved& Wilkins Learning Objectives Differentiate strains, contusions, and sprains. Define joint dislocations. Discuss the nursing management of various types of sports or work- related injuries. Identify the stages of bone healing after a fracture. Describe the signs and symptoms of a fracture. Explain the nursing management for clients with various types of fractures. Discuss methods used to prevent complications associated with fractures. Discuss potential complications associated with a fractured hip. Copyright © 2022 Wolters Kluwer · All Rights Reserved Strains and Sprains #1 v Etiology: Injury to muscle or ligaments, when stretched or pulled beyond capacity v Strain: Overuse or excessive stress or overuse - results in tiny tears in muscle fiber- Three Types strains: o First degree: mild; some edema and muscle spasm, no real loss of function; pain occurs with full range of motion o Second degree: partial tearing of muscle or tendon, leading to inability to bear weight. Limited motion, and edema, muscle tenderness, muscle spasm, and bruising. o Third degree: severe muscle and/or tendon tearing, severe pain, muscle spasm, ecchymosis, edema, and loss of function. Copyright © 2022 Wolters Kluwer · All Rights Reserved Strains, Sprains, Contusions #2 v Sprain: Injuries to ligaments surrounding a joint. o Caused by twisting motion or hyperextension. Graded in same manner as strains o First Degree: Mild edema, edema, joint pain o Second Degree: Partial tearing of the ligament with joint instability, some loss of function o Third Degree: Ligaments torn or ruptured completely with possible detachment of a fragment of bone (Avolition Fracture). Hematoma, severe pain, edema and abnormal joint movement v Contusion: soft tissue resulting from blow or blunt trauma, does not involve muscle Copyright © 2022 Wolters Kluwer · All Rights Reserved  Avulsion Fracture Copyright © 2022 Wolters Kluwer · All Rights Reserved Strains and Sprains #2 v Assessment Findings: Immediate pain followed by swelling; ecchymoses; joint instability v Diagnostic Findings: physical examination; radiography; arthrography; arthroscopy v Medical and Surgical Management: RICE v Medications v Immobilization v Heat possibly later Copyright © 2022 Wolters Kluwer · All Rights Reserved Strains and Sprains cont. vNursing Management Intermittent application of cold packs for20 to 30 min for the first 24 to 48 hours. Care must be taken to avoid skin damage Compression bandage: Figure 8 Neurovascular checks every 15 min for 1-2 hours then every 30 min until stable. Client teaching of immobilization, RICE, specific to injury Copyright © 2022 Wolters Kluwer · All Rights Reserved  Dislocations/subluxation v Pathophysiology and Etiology: Ligaments supporting joint are torn, stretched, or relaxed. Usually Hip, knee, shoulder o Subluxation: partial dislocation v Assessment Findings: Dislocation o Popping” sound; sudden instability; pain; altered structural shape; limited ROM; swelling, coolness, numbness, tingling, and pale or dusky color of the distal tissue. o Risks factor: § Compartment syndrome; increased pressure in a compartment to the point that blood cannot supply the muscles and nerves with oxygen and nutrients. § Volkmann’s contracture; claw like deformity Copyright © 2022 Wolters Kluwer · All Rights Reserved Compartment Syndrome v A deep aching pain in arm or leg (lasts for few minutes) v Swelling and tightness v Numbness v Pin and needles type of pain v Visible muscle bulging v Tingling or burning sensation in the skin v Severe pain that increases with the stretching of muscles v Difficulty in moving the foot/ foot drop Copyright © 2022 Wolters Kluwer · All Rights Reserved Volkmann's Contracture Copyright © 2022 Wolters Kluwer · All Rights Reserved Dislocations/subluxation v Diagnostic Findings: radiographic, arthrography, arthroscopy v Medical and Surgical Management: manipulate, immobilize joint; surgery; bandage; cast; splint v Nursing Management (see Table 60-3 and Client and Family Teaching 62-1) o ROM and strengthening exercises. o Prevention of injury during athletic activities o RICE o Neurovascular checks o Monitor for compartment syndrome Copyright © 2022 Wolters Kluwer · All Rights Reserved Tendonitis v Pathophysiology and Etiology: trauma and repeated stress: o Recurrent injuries: o Epicondylitis: Tennis elbow o Ganglion cyst: mass develop snear tendon sheaths and joints of the wrist o Carpal tunnel syndrome (repetitive motion) v Assessment Findings: pain, inflammation, sensation loss. tenderness, v Diagnostic Findings: Electromyography; x-ray studies; o Carpal tunnel syndrome: Tinel’s sign - Phalen’s sign Copyright © 2022 Wolters Kluwer · All Rights Reserved Ganglion cyst Copyright © 2022 Wolters Kluwer · All Rights Reserved Tinel’s sign and Phalen sign Tinel’s sign Phalen sign + for carpal tunnel Copyright © 2022 Wolters Kluwer · All Rights Reserved Tendinitis v Nursing Management: o Information about medication (NASIDS) o ROM exercises, ADL or job responsibilities o Comfort measures: rest, elevate, ice o Shake hands to reduce pain – fluid from carpal tunnel v Medical and Surgical Management: ice + heat; rest; well-planned exercise; NSAIDs, other medications; splinting; physical therapy; surgery o Surgical intervention may be necessary to repair tears and ruptures. Or physical therapy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Rest is an important facet of the medical treatment of tendonitis. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 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 © 2022 Wolters Kluwer · All Rights Reserved Extremity Injuries: Rotator Cuff Tear vPathophysiology and Etiology: Traumatic injury; chronic overuse of shoulder joint v Assessment Findings: o Pain; limited mobility, arm weakness, deformity v Diagnostic Findings: physical examination, radiography, arthrography, MRI v Medical and Surgical Management: NSAIDs, rest, immobilization, corticosteroid injections, progressive exercises and stretching, surgery to repair tear v Nursing Management; Teaching, manage pain, prepare for possible surgery, assess ROM, sling or brace v rotor cuff repair Copyright © 2022 Wolters Kluwer · All Rights Reserved Rotator cuff Injury Copyright © 2022 Wolters Kluwer · All Rights Reserved Rotator Cuff Repair v Arthroscopic tendon repair: reattach the tendon to the bone arthroscopically v Open tendon repair: a larger incision is used to repair and reattach the tendon v Removal of bone spur: excess bone is removed and tendons are repaired, through a small incision v Tendon transfer: replace torn tendons with a nearby tendon— open procedure v Shoulder replacement: referred to as reverse shoulder arthroplasty; the socket portion of the artificial joint is placed on the humerus, and the ball part of the joint is placed on the scapula Copyright © 2022 Wolters Kluwer · All Rights Reserved Extremity Injuries: Ligament and Meniscal Injuries v Pathophysiology and Etiology: traumatic injury anterior cruciate ligament (ACL) posterior cruciate ligament PCL) of the knee that provide stability v Assessment Findings: o Pain; instability; ambulatory difficulty, click or popping v Medical and Surgical Management: MRI o NSAIDs, ice, immobilization (brace o Limited weight bearing; progressive activity o Surgery, arthroscopy, arthrocentesis, meniscectomy o Physical therapy 3 to 12 month v Nursing Management; depends on injury, RICE, brace Copyright © 2022 Wolters Kluwer · All Rights Reserved Meniscal Injury Copyright © 2022 Wolters Kluwer · All Rights Reserved Extremity Injuries: Ruptured Achilles Tendon v Pathophysiology and Etiology: Secondary to trauma v Assessment Findings: Signs and Symptoms o Loud pop; severe pain; inability to plantar flex v Surgical Repair o Then cast or brace 6 to 8 weeks o Physical therapy v Nursing Management (see Nursing Care Plan 61-1) o Client undergoing orthoepic surgery pg. 1133 Copyright © 2022 Wolters Kluwer · All Rights Reserved Achilles Tendon Copyright © 2022 Wolters Kluwer · All Rights Reserved Fractures #1 v Pathophysiology and Etiology: sudden direct force; bone weakness; bone healing process; complications o Classification of fractures: type and extent o See Box 62-1 √ v Assessment Findings: o Immediately after fracture muscles spasm and are flaccid o Loss of function; deformity; false motion; crepitus; edema; nerve damage; pain v Diagnostic Findings: radiography; bone scan o Stop think and Respond 62-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Stages of Bone Healing v Immediately after a bone fracture, blood seeps into the area, and a hematoma (blood clot) forms. v After 1 week, osteoblasts form as the clot retracts. After about 3 weeks, a procallus forms and stabilizes the fracture. (a cell that secretes the matrix for bone formation) v A callus with bone cells forms in 6 to 12 weeks. In 3 to 4 months, osteoblasts begin to remodel the fracture site. v If the fractured bone has been accurately aligned during healing, remodeling will be complete in about 12 months. v Delayed healing nonunion infection and avascular necrosis death of bone from insufficient blood supply Copyright © 2022 Wolters Kluwer · All Rights Reserved Process of Bone Healing Copyright © 2022 Wolters Kluwer · All Rights Reserved Complications of Fractures v Shock: hypovolemic r/t blood loss Table 62-1 v Pulmonary embolism (PE). A clot to the lung after surgery to repair fractures, especially in the legs v Compartment syndrome; tissue swelling o Fasciotomy (surgical incision of fascia and separation of muscles) v Fat embolism: Fat globules released from pelvis or long bones. Form with platelets to form emboli in lungs or brain o Monitor clients for symptoms of respiratory distress and cerebral disturbances 48- 72 hours. Copyright © 2022 Wolters Kluwer · All Rights Reserved Fractures #2 vMedical and Surgical Management o Goal: reestablish functional continuity of the bone o Treatment: traction, closed or open reduction, internal or external fixation, cast application o Factors: location, severity of fracture; age, overall client physical condition vNursing Management o Nursing Guidelines 61-1 o Treat and monitor for complications o Casting, comfort measures, restrictions RICE Copyright © 2022 Wolters Kluwer · All Rights Reserved Fractured Femur v Pathophysiology and Etiology: Auto accidents, falls; trauma-related multiple injuries v Assessment Findings: o Severe pain; swelling; ecchymosis; hip/knee immobility; compound fx v Diagnostic Findings: radiography v Medical and Surgical Management: traction; spica cast v Nursing Management: Neurovascular, analgesics, comfort measures, mobility, cast Copyright © 2022 Wolters Kluwer · All Rights Reserved Fractures v Transverse fracture. The break is a straight horizontal line. v Oblique fracture. The break has an angled line. v Spiral fracture. The break has a line that encircles the shaft like the stripes on a barber pole or candy cane. v Comminuted fracture. The bone is broken into three or more pieces. v Compound fracture. Bone fragments are sticking out through the skin. v Open fracture. A wound penetrates down to the broken bone. Copyright © 2022 Wolters Kluwer · All Rights Reserved Reduction of Injury Copyright © 2022 Wolters Kluwer · All Rights Reserved Fractured Hip v Pathophysiology and Etiology: falls; bone disorder; trauma v Assessment Findings: Signs and Symptoms o Severe pain; shortening, external rotation of leg; blood loss; extensive bruising; edema; contained bleeding v Diagnostic Findings: radiography v Medical and Surgical Management: total hip arthroplasty; hemiarthroplasty Hip fracture v Nursing Management: wound care, pain management, prevent dislocation, ambulation o Deep vein thrombosis (Evidence-Based Practice 62-1) Copyright © 2022 Wolters Kluwer · All Rights Reserved Anatomy of Hip Copyright © 2022 Wolters Kluwer · All Rights Reserved Hip Fracture Copyright © 2022 Wolters Kluwer · All Rights Reserved Complications vSee Table 62-1 o Shock o Fat embolism o Pulmonary embolism - DVT o Compartment syndrome o Delayed bone healing o Infection o Avascular necrosis Copyright © 2022 Wolters Kluwer · All Rights Reserved  Safety If your bedroom and bathroom are on the upper floor, set up a temporary sleeping space and portable commode on the first floor so you don’t need to climb steps. Eliminate things you might trip over, such as loose cords and throw rugs. Install handrails in your bathtub or shower and near your toilet. Put railings on both sides of the stairs. Make sure your home has lots of light by adding more or brighter light bulbs. Keep items you use often in cabinets you can reach easily without using a step stool. Copyright © 2022 Wolters Kluwer · All Rights Reserved QUESTIONS ??? Copyright © 2022 Wolters Kluwer · All Rights Reserved