Chapter 43 - Management of Patients With Musculoskeletal Trauma

strain

A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A strain is characterized by inflammation, local tenderness, and muscle spasms

Comminuted fracture

A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees. An incomplete fracture involves a break through only part of the cross-section of the bone.

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? Apply a soft compression dressing. Assist the client with use of a trapeze. Maintain the internal fixator. Maintain Buck's traction.

Correct response: Maintain Buck's traction. Explanation: Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time? 2 to 4 weeks 6 to 8 weeks 10 to 12 weeks 14 to 16 weeks

Correct response: 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.

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? Volkmann's contracture Subluxation Compartment syndrome Sprain

Correct response: Subluxation Explanation: A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

fat embolism

Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

Sprains

Sprains are injuries to the ligaments surrounding a joint. A sprain would be manifested by pain and swelling; ecchymosis may appear later A sprain is the result of an injury to ligaments that is caused by a twisting motion. A second-degree sprain is an incomplete tear of the ligament that results in painful weight bearing. A third-degree sprain involves a complete ligament tear with loss of weight-bearing function.

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

Correct response: Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation

When is it advisable for the nurse to apply heat to a sprain or a contusion? Do not apply at all Immediately Only after a week After 2 days

Correct response: After 2 days Explanation: It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Correct response: Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

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? A. "Apply ice packs for the first 12 to 18 hours." B. "Apply heat packs for the first 24 to 48 hours." C. "Apply ice packs for the first 24 to 48 hours, then apply heat packs." D. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

Correct response: "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 is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? A. "I'll start with ice for the first couple of hours and then apply heat." B. "I need to stay off my ankle for at least the next 3 to 4 weeks." C. "I'll get the prescription filled for the narcotic pain reliever." D. "I'll make sure to keep my ankle elevated as much as possible."

Correct response: "I'll make sure to keep my ankle elevated as much as possible." Explanation: Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Elevating the stump for the first 24 hours Maintaining the client on complete bed rest Applying heat to the stump as the client desires Removing the pressure dressing after the first 8 hours

Correct response: Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

greenstick fracture

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.

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? I II III IV

Correct response: III Explanation: Open fractures are graded according to the following criteria (Schaller, 2012): Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage or avulsions. Grade III is highly contaminated and has extensive soft tissue damage. It may be accompanied by traumatic amputation and is the most severe.

When the patient who has experienced trauma to an extremity complains of severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the patient is likely demonstrating signs of complex regional pain syndrome. avascular necrosis of bone. a reaction to an internal fixation device. heterotrophic ossification.

Correct response: complex regional pain syndrome. Explanation: CRPS is frequently chronic and occurs most often in women. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? A. Performing passive range-of-motion (ROM) exercises on the client's legs once each shift B. Keeping a pillow between the client's legs at all times C. Turning the client from side to side every 2 hours D. Maintaining the client in semi-Fowler's position

Correct response: Keeping a pillow between the client's legs at all times Explanation: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After hip pinning, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.