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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 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 • h pain with movement • D/T • Twisting
Strain • S&S • Muscle tear • Pain • Edema • h pain with muscle contraction
Dx • X-ray • MRI
Tx Goal • i swelling • i pain • h rest • h healing
Tx • Rest • Ice • 48 hrs • Heat • > 48 hrs • Compression dressing • Elevate
Tx • Support • Knee immobilizer • Sling • Crutches • Walker
Meds • NSAIDs • Analgesics • Narcotic
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
Small Group Activity • Generate a list of questions to assess John age 44 injured ankle.
What are the 5 cardinal S&S of inflammation? • Pain • Redness • Swelling / edema • Loss of function • Heat
Assessment • Assess • Palpate • Edema • Heat • Pain • Deformity • Crepitus
Cap refill • Pulses • Mobility • Sensation
Report Complications • Numbness • Tingling • Weakness • i mobility • Cool / pale
Fracture • Break in the continuity of a bone.
Type of Fractures Closed Open Broken skin • Intact skin
Type of Fractures Comminuted Compression Crushed • Broken into many pieces
Type of Fractures Impacted Depressed Pressed inward • Ends forced together
Type of Fractures Spiral Greenstick Incomplete break • Twisted
Fracture Healing Process • Fx • Hematoma • Inflammatory response • Clotting • Phagocytosis • Osteoblasts • Bone Matrix • Weight bearing • Osteocytes • Remodeling
Manifestations of Fracture • Deformity • Edema, ecchymosis • Pain • Immobility • Numbness • Crepitus • Muscle spasm
Casts • Rigid external immobilizing device • Molds to the contours of the body
Casts • Purpose • Immobilize • Correct deformity • Apply uniform pressure • Support
Types of casts • Short arm cast
Types of casts • Long-arm cast
Types of casts • Short-leg cast
Types of casts • Long-leg cast
Types of casts • Walking cast
Types of casts • Body Cast
Types of casts • Shoulder-spica cast
Types of casts • Hip spica cast
Fiberglass Casts • Cool-water activated • Hardens in minutes • Exothermic reaction
Fiberglass Casts • Light weight • Water resistant • Waterproof?
Fiberglass casts – NURSING care! • Warn! This is going to get really warm – it wont burn you but it might be a little uncomfortable.
Fiberglass casts – NURSING care! • Don’t dent!
Waterproof Fiberglass casts – NURSING care! • Drain • Dry
Plaster casts Pros + Cons - i Durability h drying time • i $ • h mold
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?
Plaster Cast Warning! • Do not cover while drying
Splints • Indications • Not require rigid immobilization • Swelling • Skin care • Short term
Splint – NURSING care • Well padded • P Circulation
Braces • Indications • Support • Control movement • Prevent additional injury • Long term
General Nursing Management of a Client in a Cast, Splint or Brace • Before applied: • Assessment • Holistic • Skin • Swelling • Neurovascular (5P’s) • Pain • Educate
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.
General Nursing Management of a Client in a Cast, Splint or Brace • Pain assessment • Elevate • Ice • Analgesic • Immobilize PAIN Pressure ulcers Compartment syndrome
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.
General Nursing Management of a Client in a Cast, Splint or Brace • ROM to every joint not immobilized!