CH. 62 Caring for Clients With Traumatic Musculoskeletal Injuries

List 7 Complications

See Table 62-1 1. Shock 2. Fat embolism 3. Pulmonary embolism 4. Compartment syndrome 5. Delayed bone healing 6. Infection 7. Avascular necrosis

Strains, Contusions, and Sprains - Pathophysiology? - Recognizing cues? - Diagnostics? - Med & Surg management?

1. Pathophysiology and Etiology: areas subject to injury 2. Assessment Findings: Signs and Symptoms Immediate pain followed by: - swelling - ecchymoses - joint instability - Unable to sustain weight - joint may be unstable Diagnostic Findings: - physical examination: Symptoms above - radiography: larger than usual joint space - arthrography: asymmetry in the joint - arthroscopy: Trauma in the joint capsule Medical and Surgical Management: - ProtectfromfrutherinjuryRestIceCompressionEleveate\ - Ice: first 24-48 hrs - Elevate with elastic bandage + compression - Apply heat after 2 days when swelling is not increasing - Removable splint or cast - progressive physical therapy: After healing, PT begins Medications: NSAiDS (Use: Mild -moderate pain, antipyretic, antiinflammatory, rheumatoid arthritis) - C celecoxib = Celebrex - I bupfroen = Motrin - I ndomathacin = Indocin - N aproxyn = Naprosyn Side effects: Nausea, dyspepsia, constipation Contraindications: Post-op cardiac surgery (risk of cardiov. thrombosis, heart attack, stroke)

Define Strains, Contusions, and Sprains

1. Strain: injury to a muscle when stretched or pulled beyond its capacity 1st Degree: - Mild stretch (edema + muscle spasm, pain w. full ROM, no real loss of function) 2nd Degree: - Partial tear (unable to bear weight, edema, tenderness, spasm, bruising) 3rd Degree: - Severe tear (all above symptoms + loss of function) 2. Contusion: soft tissue resulting from blow or blunt trauma, does not affect musculoskeletal function (swelling, coolness, numbness, tingling, pale dusky color of disal tissue) 3. Sprain: injuries to ligaments surrounding a joint 1st Degree: - Mild stretch (edema + tenderness, pain w. full ROM) 2nd Degree: - Partial tear ( edema, pain with motion, joint instability, some loss of function) 3rd Degree: - Complete tear + possible detachment of bone fragment (avulsion fracture) - hematoma formation -> Severe pain, edema, abnormal joint movement -

A nurse is caring for a client with an intracapsular hip fracture. Identify the area where this client's fracture occurred

Explanation: - Fractures may occur in the femoral neck (intracapsular or inside the hip joint capsule) - between the trochanters (intertrochanteric-extracapsular or outside the hip joint capsule) - below the trochanters (subtrochanteric-extracapsular).

A nurse is caring for a client with an extracapsular hip fracture. Identify the area where this client's fracture occurred.

Fractures may occur in the femoral neck (intracapsular or inside the hip joint capsule), between the trochanters (intertrochanteric-extracapsular or outside the hip joint capsule), or below the trochanters (subtrochanteric-extracapsular).

Fractures Medical & Surgical Management: - Goals? - Treatment? - What are the Factors that affect healing? - Nursing 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 - Nursing Guidelines 61-1 - Table 61-1

Fractures - Pathophysiology? - Classifications? - Recognize cues? - Diagnostics?

Pathophysiology and Etiology - sudden direct force - bone weakness - bone healing process - complications Classification of fractures - type and extent See Box 62-1 Assessment Findings: Signs and Symptoms - Loss of function - deformity - false motion - crepitus - edema - spasm - tissue - nerve damage - pain Diagnostic Findings - radiography - bone scan

Fractured Hip - Pathophysiology? - Recognizing cues? - Diagnostics? - Med & Surg management? - Nurse Management?

Pathophysiology and 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 and Surgical Management: - total hip arthroplasty - hemiarthroplasty Nursing Management - (see Nursing Care Plan 61-1) - Deep vein thrombosis (Evidence-Based Practice 62-1)

Fractured Femur - Pathophysiology? - Recognizing cues? - Diagnostics? - Med & Surg management? - Nurse Management?

Pathophysiology and Etiology: - Auto accidents - falls - trauma-related multiple injuries Assessment Findings: Signs and Symptoms - Severe pain; swelling - ecchymosis - hip/knee immobility; compound fx Diagnostic Findings: - radiography Medical and Surgical Management: - traction - spica cast Nursing Management (see Nursing Guidelines 61-3)

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

- Incomplete Explanation: A greenstick fracture involves a break through only part of the cross-section of the bone.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

- "Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

- "Describe the pain and rate it on the pain scale." Explanation: The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time?

- 6 to 12 months Explanation: The course of rehabilitation following repair of a rotator cuff tear is lengthy (i.e., 6 to 12 months); functionality after rehabilitation depends on the patient's dedication to the rehabilitation regimen

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time?

- 6 to 8 weeks Explanation: Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

The surgical nurse is admitting a client from postanesthetic recovery following the client's below-the-knee amputation. The nurse recognizes the client's high risk for postoperative hemorrhage and should keep what equipment at the bedside?

- A tourniquet Explanation: Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the client's bedside so that, if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. PRBCs cannot be kept at the bedside. Vitamin K and protamine sulfate are antidotes to warfarin and heparin, but are not given to treat active postsurgical bleeding.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

- Apply ice to the fracture site. Explanation: Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

- As soon as tolerated, after a reasonable period of immobilization Explanation: Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

- Avascular necrosis may develop at the site if it is not promptly resolved. Explanation: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

- Between 24 and 48 hours Explanation: After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.)

- Checking the urine for hematuria - Palpating peripheral pulses in both lower extremities - Testing the stool for occult blood Explanation: In pelvic fracture, the nurse should palpate the peripheral pulses, especially the dorsalis pedis pulses of both lower extremities; absence of a pulse may indicate a tear in the iliac artery or one of its branches. To assess for urinary tract injury, the patient's urine is analyzed for blood.

A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?

- Client can demonstrate safe use of assistive devices. Explanation: A client should be able to use assistive devices appropriately and safely prior to discharge. Scar formation will not be complete at the time of hospital discharge. It is anticipated that the client will require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be wholly absent.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

- Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes . A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

- Compartment syndrome Explanation: The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as disseminated intravascular coagulation, carpal tunnel syndrome, or fat embolism syndrome.

A nurse admits a client who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse should plan to care for what type of fracture?

- Compound Explanation: A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse fracture occurs straight across the bone shaft.

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

- Compound Explanation: A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

- Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?

- Coughing and deep breathing with pillow splinting Explanation: Because these fractures cause pain with respiratory effort, the client tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the client cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with his or her hands, or may educate the client on using a pillow to temporarily splint the affected site.

A nurse is planning the care of a client with osteomyelitis that resulted from a diabetic foot ulcer. The client requires a transmetatarsal amputation. When planning the client's postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?

- Disturbed Body Image Explanation: Amputations present a serious threat to any client's body image. None of the other listed diagnoses is specifically associated with amputation.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

- Elevate the affected area. Explanation: Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

Which general nursing measure is used for a client with a fracture reduction?

- Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include: - administering analgesics - providing comfort measures - encouraging participation in ADLs - promoting physical mobility - preventing infection - maintaining skin integrity - preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. The nurse does not need to examine the abdomen for enlarged liver or spleen because fracture reduction treatment does not affect these organs. It is unlikely that a client with a fracture reduction will be prescribed immune-enhancing tube feeding formulas.

A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication?

- Fat embolism syndrome Explanation: Fat embolism syndrome occurs most frequently in young adults and elderly clients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include: - hypoxia - tachypnea - tachycardia - pyrexia (fever) The respiratory distress response includes: - tachypnea - dyspnea - wheezes - precordial chest pain - cough - large amounts of thick, white sputum - tachycardia Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

- Fat embolism syndrome Explanation: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome.

Which factor inhibits fracture healing?

- History of diabetes Explanation: Factors that inhibit fracture healing include: - diabetes - smoking - local malignancy - bone loss, - extensive local trauma - age greater than 40 - infection. Factors that enhance fracture healing include: - proper nutrition - vitamin D and calcium - exercise - maximum bone fragment contact - proper alignment - Immobilization of the fracture.

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

- Hypovolemic Explanation: In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?

- Inadequate immobilization Explanation: Inadequate fracture immobilization can delay or prevent union. A short-term vitamin D deficiency would not likely prevent bone union. VTE is a serious complication but would not be a cause of nonunion. Similarly, bleeding would not likely delay union.

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture?

- Increase fluid intake and perform prescribed foot exercises. Explanation: Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The client should not be told to endure pain; a proactive approach to pain control should be adopted. While respiratory complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days.

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

- Infection Explanation: This client is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in death. The client is still at risk for malunion, but this risk is slight because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury but do not represent the most serious complication

Which nursing diagnosis takes highest priority for a client with a compound fracture?

- Infection related to effects of trauma Explanation: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

- Keep an elastic compression bandage on the ankle. Explanation: Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently. Rotation exercises would likely be painful.

A nurse is caring for a client who has suffered an unstable thoracolumbar fracture. What goal should the nurse prioritize during nursing care?

- Maintaining spinal alignment Explanation: Clients with an unstable fracture must have their spine in alignment at all times in order to prevent neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing skin breakdown, even though these are both valid considerations. Increased ICP is not a high risk.

A client has sustained a long bone fracture and the nurse is preparing the client's care plan. Which of the following should the nurse include in the care plan?

- Monitor temperature and pulses of the affected extremity. Explanation: The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not normally given.

Which term refers to the failure of fragments of a fractured bone to heal together?

- Nonunion Explanation: When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

- One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.

What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture?

- Place a pillow between the client's legs when turning. Explanation: Placing a pillow between the client's legs when turning prevents adduction and supports the client's legs. Administering analgesics addresses pain but does not directly protect bone remodeling and promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone positioning does not need to be maintained at all times.

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply. - Pneumonia - Necrosis of the humerus - Skin breakdown - Sepsis - Delirium

- Pneumonia - Skin breakdown - Sepsis - Delirium Explanation: - Complications in clients with hip fractures are often related to the client's age. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia can develop as a result of the anesthesia. Thromboemboli are possible, as is sepsis. Elderly clients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly client with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus.

A client was fitted with an arm cast after fracturing the humerus. Twelve hours after the application of the cast, the client tells the nurse that the injured arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

- Prepare the client for opening or bivalving of the cast. Explanation: Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. Removing or bivalving the cast is necessary to relieve pressure. Prescribing different analgesics does not address the underlying problem. Encouraging the client to move the fingers or perform range-of-motion exercises will not treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome

A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team?

- Promote the client's highest possible level of function. Explanation: The multidisciplinary rehabilitation team helps the client achieve the highest possible level of function and participation in life activities. The team is not primarily motivated by efficiency, the need for holistic care, or the need to foster the client's body image, despite the fact that each of these are valid goals.

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate?

- Provide feedback on the client's strengths and available resources. Explanation: The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity.

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply. - Regular bone density testing - A high-calcium diet - Use of falls prevention precautions - Use of corticosteroids as prescribed - Weight-bearing exercise

- Regular bone density testing - A high-calcium diet - Weight-bearing exercise - Use of falls prevention precautions Explanation: Health promotion measures after an older adult's hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

- Sprain Explanation: - A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. - Dislocation refers to the separation of joint surfaces. - Subluxation refers to partial separation or dislocation of joint surfaces. - Strain refers to a muscle pull or tear.

Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain?

- Take opioid analgesics as prescribed. Explanation: Opioid analgesics may be effective in relieving phantom pain. Heat, immobility, and elevation are not noted to relieve this form of pain.

What special elements of care should be incorporated into the care of a client in traction? Select all that apply.

- The client requires simple and direct explanations about the traction and its purpose. - The nurse points out activities that are allowed or contraindicated. - When traction is discontinued, the nurse prepares the client for further treatment, such as casting, and for the appearance of the affected area---skin and muscles.

An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education?

- The importance of adhering to the prescribed treatment and rehabilitation regimen Explanation: Clients who have experienced sports-related injuries are often highly motivated to return to their previous level of activity. Adherence to restriction of activities and gradual resumption of activities need to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not necessarily have to be taken in the absence of pain. If healing is complete, the client does not likely have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.

True or False? An acronym for the appropriate management of strains, contusions, and sprains is RICES.

- True Rationale: An acronym for the appropriate management of strains, contusions, and sprains is RICES. R: Rest I: Ice C: Compression E: Elevation S: Stabilization

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse should organize care for a:

- contusion. Explanation: A contusion is a soft tissue injury that results in bleeding into soft tissues, creating a hematoma and ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a "muscle pull" from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in anatomic contact. Because the injury is not at the site of a joint, the client has not experienced a sprain, strain, or dislocation.

Which is not one of the general nursing measures employed when caring for the client with a fracture? - cranial nerve assessment - administering analgesics - providing comfort measures - assisting with ADLs

- cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

- immobilization Explanation: Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. In addition to the regular postoperative assessments prescribed by policy, what assessment does the nurse complete every 30 minutes for several hours?

- neurovascular Explanation: The nurse should perform neurovascular assessments every 30 minutes for several hours, and then at least every 2 to 4 hours for the next 1 or 2 days to detect complications.

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"?

- stretched or pulled beyond its capacity Explanation: A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

Describe the 4 Stages of Bone Healing

1. Immediately after a bone fracture, blood seeps into the area, and a hematoma (blood clot) forms. 2. After 1 week, osteoblasts form as the clot retracts. After about 3 weeks, a procallus forms and stabilizes the fracture. 3. A callus with bone cells forms in 6 to 12 weeks. In 3 to 4 months, osteoblasts begin to remodel the fracture site. 4. If the fractured bone has been accurately aligned during healing, remodeling will be complete in about 12 months.

List and describe the 4 Specific injuries to upper & lower extremities

1. Tendinitis (inflammation of tendon by overuse/stress) Examples: Carpal tunnel (median nerve compressed, transverse carpal ligament), Epicondylitis (elbow), ganglion cyst (near tendon sheath+ joint) Signs & Symptoms: - Pain + Inflammation - Elbow: radiating pain of forearm + weak grasp) - Ganglion Cyst: pain + tenderness - Carpal tunnel: pain + burning at night + unable to make a fist with middle or index finger, shaking hands reduces pain Diagnostics: - X-ray - Carpal: Electromyography (electrical stimulates nerve) - Tinel Sign (press & patient feels static= +) - Phalen sign (flex wrists together, 30 sec = numbness = +) Medical/Surgical procedure: - Cold or heat - Exercises - Rest - Epicondylitis: Splint - Ganglionic Cyst: aspirate - Carpal: Splint + Rest Medications: (take with food) - Steroidal antinflammatory - Injections: corticosteroids, NSAiDs, analgesics 2. Rotator Cuff Tear (Tear 1 or all 4 muscles by overuse/trauma) 3. Ligament & Meniscal Injuries (result from trauma) 4. Ruptured Achilles Tendon (calf muscle contracts suddenly while foot is still grounded)

Dislocations: joint no longer in contact Subluxation: Partial dislocation - Pathophysiology? - Recognizing cues? - Diagnostics? - Med & Surg management? - Nurse Management?

Pathophysiology and Etiology: Injury can disrupt the blood supply - trauma - Compartment syndrome (tendon/nerve constricted) - Volkmann's contracture (compartment syndrome in upper extremity = clawlike deformity) - complications (lack of collage in helping stagwe= instability) Assessment Findings: Signs and Symptoms - "Popping" sound - sudden instability "joint gave out" - pain from trauma - altered structural shape, shorter leg, rotates externally - limited ROM Diagnostic Findings: - radiographic films: intact yet malpositioned bones - arthrography/arthroscopy: damage to other structures in joint capsule Medical and Surgical Management: - Manipulate (adminster anesthesthetics before) - Immobilize joint (elastic bandage, cast, splint - several weeks) - Surgery Nursing Management - Administer Analgesics - Elevate + immobilize + cold packs - Neuro check x 30 min. first several hrs, then x 2-4 hrs for 1 to 2 days