timby/smith: introductory medical-surgical nursing, 10/e

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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 62: Caring for Clients with Traumatic Musculoskeletal Injuries

By: P.K. Williams, RN 01/31 Pg 989


20 Words To Know: 02/31 Pg 989 20 Words To Know: 02/31 Pg 989 • Avascular necrosis Avulsion fracture

• Callus Carpal tunnel syndrome

• Compartment syndrome Contusion

• Dislocation EcchymosisEpicondylitis

• Fasciotomy Fracture Ganglioncyst

• Menisectomy Palsy Rotator cuff

• Sprain Strain Subluxation

• Tendonitis Volkman’s contracture


08 Learning Objectives Pg 989 03/31 Pg 989 08 Learning Objectives Pg 989 03/31 Pg 989

• On completion of this chapter, you reader will be able to:

• 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


08 Learning Objectives, Cont: Pg 989 04/31 Pg 989 08 Learning Objectives, Cont: Pg 989 04/31 Pg 989

• 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

07/31 Pg 898


Strains, Contusions, Sprains*** 05/31 Pg 989 Strains, Contusions, Sprains*** 05/31 Pg 989

• Strain: Injury to a muscle when stretched or pulled beyond its capacity.

– [Overuse over stretching]

• Contusion: Soft tissue resulting from blow, blunt trauma.

– [Brusies = hematomas = collection of blood]

• Sprain: Injuries to ligaments surrounding a joint.

– Sudden, unusual movement

– [ wrist, elbow, knee, ankle, cervical = whiplash]

• [Avulsion Fx’s = bone attached to ligament]


Strains, Contusions, Sprains*** 02/31 Pg 989 Strains, Contusions, Sprains*** 02/31 Pg 989

• Pathophysiology, 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, Surgical Management: R.I.C.E.S.; Heat (when edema unlikely); Medications; Progressive physical therapy

• Nursing Management


Strains, Contusions, Sprains Treatment 07/31 Pg 989

Strains, Contusions, Sprains Treatment 07/31 Pg 989

• R est

• I ce

• C ompression

• E levation

• S tabalization

• Medical, Surgical Management: R.I.C.E.S.;


07/31 Pg 990


Question 08/31 Pg 989 Question 08/31 Pg 989

Is the following statement true or false?

An acronym for the appropriate management of strains, contusions, and sprains is R.I.C.E.S.

08/31 Pg 990


Answer 09/31 Pg 990

Answer 09/31 Pg 990

True.

An acronym for the appropriate management of strains, contusions, and sprains is R.I.C.E.S.

R: Rest, I: Ice, C: Compression, E: Elevation, S: Stabilization


Dislocations 10/31 Pg 990Dislocations 10/31 Pg 990

• Pathophysiology,Etiology*: Trauma

– Compartment Syndrome; Volkmann’s contracture; Complications


– “Popping” sound; Sudden instability; Pain; Altered structural shape; Limited ROM

• Diagnostic Findings: Radiographic films [ X-rays] ; Arthrography; Arthroscopy

• Medical, Surgical Management: Manipulate, immobilize joint; Surgery



Tendonitis 11/31 Pg 991 Tendonitis 11/31 Pg 991 • Pathophysiology, Etiology*: Recurrent injuries:

Epicondylitis; Ganglions; Carpal tunnel syndrome

• Assessment Findings: Signs and Symptoms - Pain; Inflammation; Sensation loss

• Diagnostic Findings: Electromyography; X-ray studies; Carpel Tunnel Syndrome: Tinel’s sign[extend]; Phalen’s sign[Flex]

• Medical, Surgical Management: Ice + heat; Rest; Well-planned exercise; NSAIDs, other medications; Splinting; Physical therapy; Surgery



Question 12/31 Pg 991 Question 12/31 Pg 991


Rest is an important facet of the medical treatment of tendonitis.


Answer 13/31 Pg 991 Answer 13/31 Pg 991

True.

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.


Rotator Cuff Tear [Shoulder] Rotator Cuff Tear [Shoulder] • Pathophysiology, Etiology*: Traumatic injury;

Chronic overuse of shoulder joint


– Pain; Limited mobility, Can’t reach above shoulder

• Diagnostic Findings: Physical exam; Radiography; Arthrography; MRI

• Medical, Surgical Management: NSAIDs; Rest; Immobilization; Corticosteroid injections; Progressive exercises and stretching; Surgery

• Nursing Management14/31 Pg 992


Ligament, Meniscal Injuries Ligament, Meniscal Injuries

• Pathophysiology, Etiology*: Traumatic injury– Anterior ACL / Posterior PCL

Lateral Hyper-Extension

• Assessment Findings: Signs and Symptoms– Pain; Instability; Ambulatory difficulty

• Medical, Surgical Management– NSAIDs; Ice; Immobilization

– Limited weight bearing; Progressive activity

– Surgery



Ruptured Achilles TendonRuptured Achilles Tendon

• Pathophysiology, Etiology*: Trauma


– Loud pop; Severe pain; Inability to plantar flex

• Surgical Repair

– Then cast or brace

– Physical therapy



QuestionQuestion


Many clients who rupture their Achilles’ tendon report hearing a loud pop at the time of injury.

17/31 Pg 993


AnswerAnswer

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.

18/31 Pg 993


FracturesFractures

• Pathophysiology, Etiology*: Sudden direct force; Bone weakness; Bone healing process; Complications

– Classification of fractures: Type and extent


– Loss of function; Deformity; False motion; Crepitus; Edema; Spasm; Tissue, nerve damage

• Diagnostic Findings: Radiography; Bone scan

20/31 Pg 993 Fig: 62-1 Pg 994 Table: 62-1 Pg 995


Types of Fractuers: NIB 20/31 NIBTypes of Fractuers: NIB 20/31 NIB


Fractures 21/31 Pg 994Fractures 21/31 Pg 994


Comminuted Fracture :If the injury results in multiple breaks in the bone, they are visible as different fragments. These kind of fractures are called comminuted fractures 22/31 NIB

Comminuted Fracture :If the injury results in multiple breaks in the bone, they are visible as different fragments. These kind of fractures are called comminuted fractures 22/31 NIB

Comminuted Fracture :If the injury results in multiple breaks in the bone, they are visible as different fragments. These

kind of fractures are called comminuted fractures


FracturesRadial Styloid Fx

The xray belongs to 39 years old male who had a fall from height < 10ft 23/31 NIB

FracturesRadial Styloid Fx

The xray belongs to 39 years old male who had a fall from height < 10ft 23/31 NIB


April 1, 2011 By Dr Arun Pal Singhhe was brought to the hospital after complaint of increased thigh pain following fall while walking. Xray revealed the implant and a fracture in the femoral shaft around distal part of the stem.24/31 Pg NIB

April 1, 2011 By Dr Arun Pal Singhhe was brought to the hospital after complaint of increased thigh pain following fall while walking. Xray revealed the implant and a fracture in the femoral shaft around distal part of the stem.24/31 Pg NIB


Following : preoperative xray of a child who has fracture shaft of femur25/31 Pg NIB

Following : preoperative xray of a child who has fracture shaft of femur25/31 Pg NIB


Comminuted fractures are generally as a result of direct trauma to the bone.

26/31 Pg NIB

Comminuted fractures are generally as a result of direct trauma to the bone.

26/31 Pg NIB


Fractures Fractures

• Medical, 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


27/31 Pg 993


Fractured Femur Fractured Femur

• Pathophysiology, Etiology*: Trauma


– Severe pain; Swelling; Ecchymosis; Open wound or bone protrusion

• Diagnostic Findings: Radiography

• Medical, Surgical Management: Traction or external fixator; Spica cast


28/31 Pg 996


Fractured Hip Fractured Hip • Pathophysiology, Etiology*: Falls; Bone disorder;

Trauma


– Severe pain; Shortening, external rotation of leg; Blood loss; Extensive bruising; Edema; Contained bleeding

• Diagnostic Findings: Radiography

• Medical, Surgical Management: Total hip arthroplasty; Hemiarthroplasty

• Nursing Management 29/31 Pg 996


Fractured Hip*** 30/31 Pg 996Fractured Hip*** 30/31 Pg 996


Time to NCLEX31/31 Pg 997

End of PresentationBy: P.K. Williams, RN

[email protected]

timby/smith: introductory medical-surgical nursing, 10/e

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