Chapter 43: Management of Patients With Musculoskeletal Trauma

Explain the difference bwt contusions, stains and sprains.

1. Contusions- soft tissues due to blunt force; normally heal within 1-2 weeks 2. Strains= damage from over use or stretching 3.Sprains= injuries to the ligaments surround muscle fibers; normally due to twisting

Why may a pt receive a bone graft?

1. Joint stabilization 2. Defect filling 3. Stimulation of bone healing

A client presents to the emergency department with an open fracture. What is the first action the nurse should take?

Cover the exposed bone with sterile dressing; to help control bleeding and pt risk for infection

A fracture is termed pathologic when the fracture

occurs through an area of diseased bone.

A nurse advises a patient with a casted femur fracture to check for signs of a fat embolism. She tells the patient that the onset of symptoms for FES occur:

12 to 48 hours after injury

A pt has a above knee amputation completed. What does the nurse need to keep at the bedside?

A large tourniquet in case site starts to bleed

Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate?

Administer medication, as ordered, for the reported discomfort. *even though the pt is having phantom limb pain; this is not an excuse to deny them pain medication

An elderly lady has fallen. On examination her left leg is externally rotated, adducted and slighter shorter than her right. What needs to be done?

An abductor pillow needs to be placed bwt her legs; she likely had a hip fracture *these pillows restrict movement so pt cannot cross their legs and lead to further dislocation of the joint *Log-roll these pt

A pt phoned into a nursing call center asking what should they do after they fell and twisted their ankle. What do you recommend?

Care of Sprains and Strains: RICE! R:rest I:ice C:compression E:elevation *Cold pack 20-30 min for the first 24-48hr (vasoconstriction to reduce inflammation) *Use heat after acute inflame to vasodilator and help heal *Start ROM and POM in 2-5 days

Which of the following type of fracture is associated with osteoporosis?

Compression: a fracture in which bone has been compressed by the pt's own weight (commonly seen in vertebra)

A pt sustained a hip fracture a couple of hours ago. The pt now has asymmetrical swelling, redness and pain in lower limbs. What likely happened to this pt?

DVT

Pt with a fracture is happy that his broken limb has been re-set and casted. He now states he is no longer at risk of developing new other complications. Correct his thinking.

Delayed complications with fractures: Infection; Avascular Necrosis Fracture Blisters Delayed/non/mal- union, Reactions to internal fixation devices, Complex regional pain syndrome (CRPS) Sympathetic nervous alterations, Muscle wasting, Heterotopic ossification (bone over growth)

What would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

Hypotension, tachycardia, low urine production, mental confusion, pallor, dizziness, fainting, weakness

A pt with a fracture has started to have alterations of character. What nursing action needs to be completed?

Immediate Arterial Blood Gasses studies bc showing signs of fat embolism syndrome other s/s: hypoxemia, petechial rash, personality changes, restlessness, irritability or confusion

429. A 78-year-old client is in the emergency department following involvement in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

Immobilization

A trauma pt is c/o of back pain. Why is this concerning?

In cases of trauma it is likely large amounts of muscle damage was sustained by the pt. In turn, they are high risk of developing hyperkalemia (K lives inside of cells and a crap ton of it has just been "freed") and Rhabdomylosis. The pt is c/o of back pain which is a key s/s of rhabdo; they could be having kidney damage

You have been completing neuro/vas checks on a pt c a arm cast. The pt is now on the call light c/o of pain which worsens with passive movement . What is you next course of action?

Pt likely developing compartment syndrome (displaying key s/s). 1. Check distal pulses 2. No, Attempt to dopple the pulse 3. Still no, keep extremity AT heart level and bivalve/ open the cast *if did not have cast: fasciotomy

A pt comes to the clinic c/o of acute pain and decreased mobility of their foot. Upon examination, the foot is shorter than the other and is waywardly positioned. What likely happened to the pt's foot?

The pt foot was traumatically dislocated s/s: acute pain, change in positioning of the joint, shortening of the extremity, deformity and decreased mobility

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture (acute compartment syndrome) *common with a supracondylar fracture of the humerus which happens bc of antecubital swelling from brachial artery drainage

A dr is considered about causing compartment syndrome to a toddler who broke his wrist. The dr carefully applies a fiberglass cast to the toddler. The toddler is placed under your cares and the cast slides off. What is the best nursing action?

When cast/elastic dressings inadvertently come off the nurse must immediately wrap the residual limb with a elastic compression bandage to prevent excessive edema which will delay healing. Next the dr/surgeon should be notified so pt can be re-casted

A pt with skeletal traction is at greatest risk for developing what?

infection; pins are placed into bone through skin creating a direct path for bacteria