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

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 20 Words To Know: 02/31 Pg 989 Avascular necrosisAvulsion fracture CallusCarpal tunnel syndrome Compartment syndromeContusion DislocationEcchymosisEpicondylitis FasciotomyFractureGanglioncyst MenisectomyPalsyRotator cuff SprainStrainSubluxation TendonitisVolkman’s contracture

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 12/31 Pg 991 Is the following statement true or false? Rest is an important facet of the medical treatment of tendonitis.

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. 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 16/31 Pg 993

17. 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. 17/31 Pg 993

18. 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. 18/31 Pg 993

19. 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 20/31 Pg 993 Fig: 62-1 Pg 994 Table: 62-1 Pg 995

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Fractuers: NIB 20/31 NIB

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures 21/31 Pg 994

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

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractures Radial Styloid Fx The xray belongs to 39 years old male who had a fall from height < 10ft 23/31 NIB

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins April 1, 2011 By Dr Arun Pal Singh he 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 NIBDr Arun Pal Singh April 1, 2011 By Dr Arun Pal Singh he 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 NIBDr Arun Pal Singh

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Following : preoperative xray of a child who has fracture shaft of femur 25/31 Pg NIB

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Comminuted fracturesComminuted fractures are generally as a result of direct trauma to the bone. 26/31 Pg NIB Comminuted fracturesComminuted fractures are generally as a result of direct trauma to the bone. 26/31 Pg NIB

27. 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 27/31 Pg 993

28. 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 28/31 Pg 996

29. 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 29/31 Pg 996

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Fractured Hip*** 30/31 Pg 996

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Time to NCLEX 31/31 Pg 997 End of Presentation By: P.K. Williams, RN pkwilliams@DNI.edu