Dislocations and subluxations

Nursing Considerations-Nursing Diagnoses

Acute pain Disturbed body image Dressing self-care deficit Impaired physical mobility Ineffective peripheral tissue perfusion Risk for disuse syndrome

Nursing Considerations-Associated Nursing Procedures

Alignment and pressure-reducing devices Assessment techniques Clavicle strap application Cold application External fixation management IV bolus injection IV catheter insertion Internal fixation care and management Pain management Postoperative care Preoperative care Prosthesis care and management Pulse assessment Respiration assessment Traction, care of patient

Treatment-Medications

Anxiolytics, such as midazolam hydrochloride, lorazepam, or diazepam, in preparation for closed reduction Analgesics, such as nonsteroidal anti-inflammatory drugs or opioids (such as morphine sulfate or oxycodone hydrochloride and acetaminophen), depending on the severity of the pain Fentanyl citrate, propofol, or etomidate for procedural sedation Muscle relaxants

Overview-Causes

Congenital Paget's disease of surrounding joint tissues Trauma

Overview

Dislocation: Displacement of joint bones so that articulating surfaces totally lose contact (see Common dislocation) Subluxation: Partial displacement of articulating surfaces Possibly accompanying fractures of joints

Nursing Considerations-Nursing Interventions

Give prescribed drugs, including analgesics based on the patient's rating of pain. Provide proper positioning of the affected area; immobilize the affected area until treatment is initiated. Assist with manual reduction, as appropriate; anticipate the need for sedation prior to manual reduction. Apply ice, as ordered. Encourage ROM exercises, as ordered, for adjacent nonimmobilized joints. Provide meticulous skin care, especially to pin-site areas of skeletal traction or edges of brace or immobilizer. Prepare the patient and family for possible open reduction, if indicated, including what to expect after surgery, such as immobilization and use of traction.

Treatment-General

Immediate reduction and immobilization Manipulation Bracing or splinting Ice to reduce swelling Physical therapy Closed reduction

Assessment-Physical Findings

Joint surface fractures Deformity around the joint Change in the length of the involved extremity Impaired joint mobility Arm abduction and external rotation (anterior shoulder dislocation) Prominent olecranon with shortened forearm (posterior elbow dislocation) Point tenderness

Treatment-Activity

Limitations based on injury Active range-of-motion (ROM) exercises for adjacent joints not immobilized Isometric quadriceps setting exercises with a temporary brace as an alternative to surgery for knee dislocation

Treatment-Diet

Nothing by mouth if surgery is scheduled

Treatment-Surgery

Open reduction Skeletal traction Ligament repair

Overview-Risk Factors

Participation in contact sports

Patient Teaching-Discharge Planning

Refer the patient to a rehabilitation program or for follow-up physical therapy, if appropriate. Refer the patient for home health care if appropriate. Refer the patient for physical therapy if appropriate.

Nursing Considerations-Monitoring

Respiratory status if opioid analgesics are used Joint function Neurovascular status of involved extremity Integrity of skin Traction alignment Pin or surgical site Neurovascular status of affected extremity

Overview-Complications

Rotator cuff tears (shoulder dislocation) Avascular necrosis Bone necrosis Compartment syndrome (elbow dislocation)

Overview-Incidence

Shoulder dislocations account for more than one-third of shoulder pain in athletes under the age of 30. The shoulder is the most commonly dislocated joint, accounting for about 50% of all major joint dislocations. Hip dislocations from trauma are more common in people younger than age 35; hip dislocations from falls are more common in people older than age 65. Elbow dislocations are the second most common dislocation (after shoulders) in adults.

Overview-Pathophysiology

Trauma causes displacement of the joint. Joint structures (blood vessels, ligaments, tendons, and nerves) are damaged. Injuries may result in deposition of fracture fragments between joint surfaces, damaging surrounding structures. Joint function is impaired.

Assessment-History

Trauma or fall Extreme pain at injury site Participation in contact sports Feeling that "something popped"

Diagnostic Test Results-Imaging

X-rays confirm the diagnosis and show any associated fractures.

Patient Teaching-General

disorder; diagnosis, including tests and prognosis; and treatment, including the use of analgesics for pain and the possible need for surgery importance of immobilization until treatment is initiated need to keep the affected part immobilized for several weeks after manual reduction performance of isometric quadriceps-setting exercises, if applicable use of brace or immobilizer and care of pin sites, if appropriate signs and symptoms of complications, such as infection and neurovascular compromise, and the need to report any to the practitioner immediately assessment of neurovascular status and the need to report numbness, pain, cyanosis, and coldness of the extremity skin care measures and evaluation of skin integrity use of assistive devices, if appropriate importance of follow-up visits to evaluate healing and function.

Nursing Considerations-Expected Outcomes

identify factors that intensify pain and will modify behavior accordingly express positive feelings about self perform self-care activities at the highest level possible attain the highest degree of mobility possible within the confines of the injury show signs of adequate peripheral perfusion maintain joint ROM and muscle strength.