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

1. 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

2. 20 Words To Know: 02/31 Pg 989 • Avascular necrosis Avulsion fracture • Callus Carpal tunnel syndrome • Compartment syndrome Contusion • Dislocation Ecchymosis Epicondylitis • Fasciotomy Fracture Ganglioncyst • Menisectomy Palsy Rotator cuff • Sprain Strain Subluxation • Tendonitis Volkman’s contracture

3. 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

4. 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

5. 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]

6. 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

7. 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.; • Nursing Management 07/31 Pg 990

8. 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

9. 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

10. Dislocations 10/31 Pg 990 • Pathophysiology,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 [ X-rays] ; Arthrography; Arthroscopy • Medical, Surgical Management: Manipulate, immobilize joint; Surgery • Nursing Management

11. 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 • Nursing Management

12. Question 12/31 Pg 991 Is the following statement true or false? Rest is an important facet of the medical treatment of tendonitis.

13. 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.

14. Rotator Cuff Tear [Shoulder] • Pathophysiology, Etiology*: Traumatic injury; Chronic overuse of shoulder joint • Assessment Findings: Signs and Symptoms • 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 Management 14/31 Pg 992

15. 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 • Nursing Management 15/31 Pg 992

16. Ruptured Achilles Tendon • Pathophysiology, 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 16/31 Pg 993

17. Question Is the following statement true or false? Many clients who rupture their Achilles’ tendon report hearing a loud pop at the time of injury. 17/31 Pg 993

18. 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. 18/31 Pg 993

19. Fractures • Pathophysiology, 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 20/31 Pg 993 Fig: 62-1 Pg 994 Table: 62-1 Pg 995

20. Types of Fractuers: NIB 20/31 NIB

21. Fractures 21/31 Pg 994

22. 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 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

23. FracturesRadial StyloidFx The xray belongs to 39 years old male who had a fall from height < 10ft23/31 NIB

24. 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

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

26. Comminuted fractures are generally as a result of direct trauma to the bone.26/31 Pg NIB

27. 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 • Nursing Management 27/31 Pg 993

28. Fractured Femur • Pathophysiology, Etiology*: Trauma • Assessment Findings: Signs and Symptoms • Severe pain; Swelling; Ecchymosis; Open wound or bone protrusion • Diagnostic Findings: Radiography • Medical, Surgical Management: Traction or external fixator; Spica cast • Nursing Management 28/31 Pg 996

29. Fractured Hip • Pathophysiology, 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, Surgical Management: Total hip arthroplasty; Hemiarthroplasty • Nursing Management 29/31 Pg 996

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

31. Time to NCLEX 31/31 Pg 997 End of Presentation By: P.K. Williams, RN pkwilliams@DNI.edu