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Musculoskeletal Trauma

Musculoskeletal Trauma. Day 2 Chapter 42. Risk Factors. Elderly. Elderly Home Safety. Lighting Rugs Clutter Shoes. Soft Tissue Injury. Contusion  Ecchymosis Black & Blue Purple Brown Yellow Hematoma. Sprain. S&S Ligament injury Pain Joint Instability Edema, discoloration

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Musculoskeletal Trauma

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  1. Musculoskeletal Trauma Day 2 Chapter 42

  2. Risk Factors • Elderly

  3. Elderly Home Safety • Lighting • Rugs • Clutter • Shoes

  4. Soft Tissue Injury • Contusion  • Ecchymosis • Black & Blue • Purple • Brown • Yellow • Hematoma

  5. Sprain • S&S • Ligament injury • Pain • Joint Instability • Edema, discoloration • h pain with movement • D/T • Twisting

  6. Strain • S&S • Muscle tear • Pain • Edema • h pain with muscle contraction

  7. Dx • X-ray • MRI

  8. Tx Goal • i swelling • i pain • h rest • h healing

  9. Tx • Rest • Ice • 48 hrs • Heat • > 48 hrs • Compression dressing • Elevate

  10. Tx • Support • Knee immobilizer • Sling • Crutches • Walker

  11. Meds • NSAIDs • Analgesics • Narcotic

  12. Mr. Rayne Inspain is prescribed NSAID’s due to a grade 2-3 ankle sprain. What would you teach Mr. Inspain about this medication • Take as needed with food • Take regularly with food • Take as needed on an empty stomach • Take regularly on an empty stomach

  13. Small Group Activity • Generate a list of questions to assess John age 44 injured ankle.

  14. What are the 5 cardinal S&S of inflammation? • Pain • Redness • Swelling / edema • Loss of function • Heat

  15. Assessment • Assess • Palpate • Edema • Heat • Pain • Deformity • Crepitus

  16. Cap refill • Pulses • Mobility • Sensation

  17. Report Complications • Numbness • Tingling • Weakness • i mobility • Cool / pale

  18. Fracture • Break in the continuity of a bone.

  19. Type of Fractures Closed Open Broken skin • Intact skin

  20. Type of Fractures Comminuted Compression Crushed • Broken into many pieces

  21. Type of Fractures Impacted Depressed Pressed inward • Ends forced together

  22. Type of Fractures Spiral Greenstick Incomplete break • Twisted

  23. Fracture Healing Process • Fx • Hematoma  • Inflammatory response  • Clotting  • Phagocytosis  • Osteoblasts  • Bone Matrix • Weight bearing  • Osteocytes  • Remodeling

  24. Manifestations of Fracture • Deformity • Edema, ecchymosis • Pain • Immobility • Numbness • Crepitus • Muscle spasm

  25. Casts • Rigid external immobilizing device • Molds to the contours of the body

  26. Casts • Purpose • Immobilize • Correct deformity • Apply uniform pressure • Support

  27. Types of casts • Short arm cast

  28. Types of casts • Long-arm cast

  29. Types of casts • Short-leg cast

  30. Types of casts • Long-leg cast

  31. Types of casts • Walking cast

  32. Types of casts • Body Cast

  33. Types of casts • Shoulder-spica cast

  34. Types of casts • Hip spica cast

  35. Fiberglass Casts • Cool-water activated • Hardens in minutes • Exothermic reaction

  36. Fiberglass Casts • Light weight • Water resistant • Waterproof?

  37. Fiberglass casts – NURSING care! • Warn! This is going to get really warm – it wont burn you but it might be a little uncomfortable.

  38. Fiberglass casts – NURSING care! • Don’t dent!

  39. Waterproof Fiberglass casts – NURSING care! • Drain • Dry

  40. Plaster casts Pros + Cons - i Durability h drying time • i $ • h mold

  41. Plaster Casts • Cold water activated • Exothermic reaction • Rigid • 15-20 minutes • Fully dry • 24-72 hrs • Will plaster casts soon be a thing of the past?

  42. Plaster Cast Warning! • Do not cover while drying

  43. Splints • Indications • Not require rigid immobilization • Swelling • Skin care • Short term

  44. Splint – NURSING care • Well padded • P Circulation

  45. Braces • Indications • Support • Control movement • Prevent additional injury • Long term

  46. General Nursing Management of a Client in a Cast, Splint or Brace • Before applied: • Assessment • Holistic • Skin • Swelling • Neurovascular (5P’s) • Pain • Educate

  47. General Nursing Management of a Client in a Cast, Splint or Brace • NURSING ALERT! • A patient’s unrelieved pain must be immediately reported to the physician to avoid possible paralysis and necrosis.

  48. General Nursing Management of a Client in a Cast, Splint or Brace • Pain assessment • Elevate • Ice • Analgesic • Immobilize PAIN Pressure ulcers Compartment syndrome

  49. General Nursing Management of a Client in a Cast, Splint or Brace • NURSING ALERT! • The nurse must never ignore complaints of pain form the patient in a cast because of the possibility of problems, such as impaired tissue perfusion or pressure ulcer formation.

  50. General Nursing Management of a Client in a Cast, Splint or Brace • ROM to every joint not immobilized!

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