Transcript Interventions for Clients with MusculoSkeletal Trauma

Interventions for Clients with
Musculoskeletal Trauma
Mona Garrett
NURS 210
Names of Fractures
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Closed (simple) or Open (complex)
Complete or incomplete
Stable (non-displaced), Unstable (displaced)
Can be classified by fracture line - Oblique,
Transverse, Spiral
Can be classified by type of fracture Greenstick, Comminuted, Compression
By anatomical location - intertrochanter,
subtrochanter, femoral neck
Assessment of Fractures
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S/S: Pain, lack of function or false
motion, extremity shortening, crepitus
(grating), local edema and discoloration
Diagnosis: Xray, CT, bone scan, MRI
Emergency treatment: Immobilize
Check neurovascular status
Cover if open
Do not attempt to reduce
Phases of Fracture Healing
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Inflammatory phase - hematoma forms
between the fractured bone ends and around
the bone surfaces; vasodilation and edema
Reparative phase
Osteoblasts promote formation of new bone
Callus is formed
Remodeling
Excess callus is removed
New bone laid down along fracture line
Complications of Fracture
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Compartment Syndrome
Unrelieved pain; decreased nv status
Treatment: Fasciotomy
Shock
Hemorrhage related to fracture or surgery
Fat Emboli
Usually 24-48 hours post injury
Occlusion of small blood vessels by fat
S/S: Altered mental status, respiratory
distress, tachycardia, tachypnea, petechiae
Complications of Fracture
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DVT - best treatment is prevention
Infection
Open fracture > closed fracture
Can lead to osteomyelitis
Delayed union or nonunion
Prolonged healing beyond usual time
R/T inadequate immobilization or
nutrition, infection, necrosis, age,
immunosuppression
Treatment of Fractures
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Casts or splints - immobilize injured bones
and promote healing
External fixation - pins inserted
perpendicular to long axis of bone above and
below the fracture site
Open Reduction Internal Fixation (ORIF)
- fracture reduced and hardware (wires, pins,
screws, plates) applied to immobilize bone
Traction - manual, skin, skeletal
Nursing Care
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Assess for the 5 P’s
Pain, pulse, paresthesia, pallor, paralysis
Pain management
Impaired physical mobility
At risk for DVT, pneumonia, constipation
Potential for infection
Pin care and/or dressing changes
Patient teaching
Cast care, pin care, infection control, meds
Amputations
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Partial or total removal of a body part
PVD major cause of lower extremity
amputation due to diabetes, smoking,
HTN
Trauma major cause of upper extremity
amputation (MVA or machinery)
Open (guillotine) or Closed (flap)
Complications: Hemorrhage, delayed
healing, phantom limb pain, contracture
Soft Tissue Trauma
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Sprain - injury to a ligament caused by a
twisting motion
Strain - excessive stretching of muscle or
tendon; also called “pulled muscle”
Treatment depends on degree of injury
RICE
Longer immobilization for 2nd degree
Surgery for chronic instability in 3rd degree
Complex Regional Pain
Syndrome
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Also called Reflex Sympathetic Dystrophy
Occurs after musculoskeletal trauma
S/S: Persistent pain, swelling, hyperesthesia
Treatment: Analgesics, early PT, muscle
relaxants, antidepressants, nerve block, TENS
(transcutaneous electrical nerve stimulation)
Joint Dislocation or
Subluxation
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Dislocation - separation of contact between
two bones of a joint
Subluxation - partial dislocation
S/S: Pain, change in shape of joint, change
in length of extremity, immobility
Treatment:
Manual traction with conscious sedation
Immobility of joint with bed rest or cast
Rehabilitation
Surgery for recurrent problem
Developmental Dysplasia of
Hip
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Congenital dislocation of the hip
S/S: Asymmetrical gluteal & thigh folds
Limited hip abduction
Apparent shortening of femur
Treatment: Most successful prior to 2 mos
Pavlik harness for infant 0-6 months
Casting 6-18 months
Surgery Older child