1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 62: Caring for Clients with Traumatic Musculoskeletal Injuries

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Strains, Contusions, Sprains Strain: Injury to a muscle when stretched or pulled beyond its capacity. Contusion: Soft tissue resulting from blow, blunt trauma. Sprain: Injuries to ligaments surrounding a joint.

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Strains, Contusions, Sprains 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

4. Copyright © 2010 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 R.I.C.E.S.

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Dislocations 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; Arthrography; Arthroscopy Medical, Surgical Management: Manipulate, immobilize joint; Surgery Nursing Management

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Tendonitis 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; Phalen’s sign Medical, Surgical Management: Ice + heat; Rest; Well-planned exercise; NSAIDs, other medications; Splinting; Physical therapy; Surgery Nursing Management

8. Copyright © 2010 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.

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Rotator Cuff Tear Pathophysiology, Etiology: Traumatic injury; Chronic overuse of shoulder joint Assessment Findings: Signs and Symptoms –Pain; Limited mobility Diagnostic Findings: Physical exam; Radiography; Arthrography; MRI Medical, Surgical Management: NSAIDs; Rest; Immobilization; Corticosteroid injections; Progressive exercises and stretching; Surgery Nursing Management

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Ligament, Meniscal Injuries Pathophysiology, Etiology: Traumatic injury Assessment Findings: Signs and Symptoms –Pain; Instability; Ambulatory difficulty Medical, Surgical Management –NSAIDs; Ice; Immobilization –Limited weight bearing; Progressive activity –Surgery Nursing Management

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

14. Copyright © 2010 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.

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractured Hip

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation