NUR102 - Chp. 62 - Caring for Clients with Traumatic Musculoskeletal Injuries

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." * Ice 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.

The nurse is caring for a client who has been diagnosed with a rotator cuff tear. What option(s) for treating this condition does the nurse identify? Select all that apply.

- Nonsteroidal anti-inflammatory drugs (NSAIDs) - Activity modification and joint rest - Arthroscopic surgery - Corticosteroid injections * As well as open acromioplasty (shoulder decompression surgery).

A client has been involved 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. Other than the bone, what physical structures could be affected by this injury?

All options are correct. * Surrounding muscle, blood vessels, & nerves.

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

Apply ice to the fracture site. * Causes vasoconstriction, helping to relieve or prevent swelling and bleeding.

A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client?

Arterial blood gases. * Subtle personality changes, restlessness, irritability, or confusion in a client who has sustained a fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism syndrome.

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. * 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.

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

Assessing the left leg. * Remember your ABCs! Airway is patent as well as Breathing. We need to check for Circulation in the affected leg.

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.

Fracture

Break in the continuity of a bone.

Ecchymosis

Bruising.

Compartment Syndrome

Buildup of pressure in the muscle; symptoms such as severe pain that develop when a tendon or nerve is compressed within a confined space.

Flexion Contracture

Chronic loss of joint motion due to structural changes in muscle, tendons, ligaments, or skin that prevents normal movement of joints. * Think "contract"ure as far as always staying tight, not being able to move because the muscles are contracted.

Volkmann Contracture

Claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm & hand.

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.

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

Comminuted.

Radiographs of a client's upper arm shows three fragments of the humeral bone. This diagnostic result suggests what type of fracture?

Comminuted. * Has more than two bone fragments.

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 (Open) Fracture. * A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture.

Which is not one of the general nursing measures employed when caring for the client with a fracture?

Cranial nerve assessment.

Avascular Necrosis

Death of bone tissue due to lack of blood supply

Palsy

Decreased sensation & movement.

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

Encourage participation in ADLs. * 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, and preparing the client for self-care.

Meniscectomy

Excision of the meniscus (performed for a torn cartilage).

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action?

Explain the risks of flexion contracture to the client. * Flexion contracture of the hip may result. * Flexion Contracture: Chronic loss of joint motion due to structural changes in muscle, tendons, ligaments, or skin that prevents normal movement of joints.

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. * Key words: "dyspnea and chest pain," which are symptoms of an embolism.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism. * S/s include: Altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae.

Comminuted Fracture

Fracture in which the bone is splintered or crushed.

Intra-Articular Fracture

Fracture that crosses a joint surface.

The type of fracture described as having one side of the bone broken and the other side bent would be:

Greenstick.

Callus

Healing mass that forms after a bone is fractured, which holds the ends of the bone together but cannot endure strain.

Which factor inhibits fracture healing?

History of diabetes. * Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection.

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. * Could result from hemorrhage.

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. * Infection that enters the body and affects the bone can lead to osteomyelitis.

Tendonitis

Inflammation of a tendon d/t overuse.

Epicondylitis

Inflammation of the epicondyle / elbow.

Sprains

Injuries to the ligaments surrounding a joint.

Dislocations

Injury in which the articular surfaces of a joint are no longer in contact.

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?

Joint manipulation and immobilization. * The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keeping a pillow between the client's legs at all times. * After open reduction with internal fixation, 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.

Ganglion Cyst

Mass that develops near tendon sheaths & joints of the wrist.

Fat Embolism Syndrome

Occurs when fat globules are released into the bloodstream. It's most commonly associated with a trauma, such as a bone fracture.

Subluxation

Partial dislocation.

Pendulum Exercises aka Circumduction Exercises

Patient leans forward and allows the affected arm to hang in abduction and rotate.

A client is involved in a motorcycle accident and injures an arm. The health care provider diagnoses the man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan developed for this client. What sequela of intra-articular fractures should the nurse describe regarding this client?

Posttraumatic arthritis. * Intra-articular fracture is a fracture that crosses a joint surface.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears. * Acromioclavicular joint pain is associated with the clavicle & shoulder.

Rotator Cuff

Shoulder joint where tears can develop from traumatic injury or chronic overuse.

Which term refers to an injury to ligaments and other soft tissues surrounding a joint?

Sprain. * Key word: "ligaments."

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

Stretched or pulled beyond its capacity.

Avulsion Fracture

Tendon or ligament pulls bone away at site of attachment.

Carpal Tunnel Syndrome

Term for a group of symptoms located in the wrist where the median nerve passes through a narrow, inelastic canal formed by the carpal bones. * Symptoms: Paresthesia in fingers, weakness when gripping objects, pain or numbness in affected hand, swollen feeling in fingers, etc.

An elite high school football player has been diagnosed and treated for a shoulder dislocation. What should the nurse emphasize during health education to facilitate the player's rejoining the team?

The importance of adhering to the prescribed treatment and rehabilitation regimen. * 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.

Contusion

Think bruising - soft tissue injury resulting from a blow or blunt trauma.

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted. * Must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse. Complete the following sentence by choosing from the lists of options. Based on the nursing assessment, the priority action the nurse should take is to... and prepare the client for...

notify the orthopedic health care provider immediately; bivalving of the cast. * Because of the risk for permanent neurovascular impairment, the nurse needs to notify the health care provider immediately so that measures can be taken to relieve pressure within the cast. To relieve pressure within the confined right lower leg, the nurse should anticipate that the cast will need to be bivalved (cut in half longitudinally).

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. * If a dislocation or subluxation (partial dislocation) is not reduced immediately, avascular necrosis (AVN) may develop.

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.

Fasciotomy

A procedure in which the fascia is cut to relieve pressure in the muscle compartment; a tx for Compartment Syndrome.

Strain

Injury to a muscle when it is stretched or pulled beyond its capacity.