Chapter 63
Nursing Management
Musculoskeletal Trauma
and Orthopedic Surgery
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Soft Tissue Injuries
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Sprains and Strains

Sprains and strains

Sprain - injury to tendinoligamentous
structures surroundin the joint

Strain - excessive stretching of a
muscle and its fascial sheath

Nursing implementation
• Health promotion
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Sprains and Strains

Sprains and strains

Nursing implementation
• Acute intervention
• RICE
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Dislocation and Subluxation

Dislocation


Severe injury of the ligamentous structures hat
surround the joint; results in complete
displacement of articular surfaces of the joint
Subluxation

Refers to partial or incomplete displacement
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Dislocation and Subluxation

Clinical Manifestations


Deformity, pain, loss of function
Collaborative management

Orthopedic emergency - require reduction
• Risk of avascular necrosis
 Pain management
 Protection of injured join
 Rehabilitation once reduced
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Fig. 63-1
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Bursitis

Inflammation of the bursae

Clinical manifestations

Management
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Fractures

A disruption or break in the continuity of
the structure of the bone

Classifications

Type (see fig 63-6)
 Communication or noncommunication with
the external environment: Open vs Closed
 Anatomic location of the involved bone
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Fig. 63-6
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Fig. 63-7
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Fig. 63-8
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Fractures

Clinical Manifestations

History - mechanism of injury
 Pain
 Decreased function
 Inability to bear weight
 Deformity
 Ecchymosis
 Edema
 Crepitation
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Factors Affecting Fracture
Healing






Age
Initial displacement
Blood supply to the area
Immobilization
Infection
hormones
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Fractures (cont'd)

Collaborative care

Fracture reduction
• Closed reduction - nonsurgical
• Open reduction - surgical
• Traction
 Skin
traction
 Skeletal
traction
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Fig. 63-10
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Fractures (cont'd)

Collaborative care (cont'd)

Fracture immobilization
• Casts
 Types of casts
 Injuries to the lower extremity
• External fixation
• Internal fixation
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Fig. 63-12
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Fig. 63-13
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Fig. 63-14
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Fractures (cont'd)

Collaborative care (cont'd)


Drug therapy
• Pain mgmt
• Muscle relaxants
• Tetanus booster
Nutritional therapy
• Protein
• Vitamins (B C D)
• Calcium
• Adequate fluid intake
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Nursing Management
Fractures

Nursing assessment
 Neurovascular assessment

Nursing diagnoses
 Impaired physical mobility
 Risk for infection
 Risk for peripheral neurovascular dysfunction
 Acute Pain
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Nursing Management
Fractures

Planning



Have physiologic healing with no associated complications
Obtain satisfactory pain relief
Achieve maximum rehabilitation potential
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Nursing Management
Fractures (cont'd)

Nursing implementation (cont'd)
 Acute intervention
• Preoperative management
 Immobilization
 Assistive devices that will be used
 Expected activity limitations after surgery
 Assure patients their needs will be met
 Assure patients pain medication will be
available
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Nursing Management
Fractures (cont'd)

Nursing implementation (cont'd)
 Acute Intervention
• Postoperative management
• Monitor vitals
• Frequent neurovascular assessments of
affected extremity
• Minimize pain and discomfort through
proper alignment and positioning
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Nursing Management
Fractures (cont'd)

Nursing implementation (cont'd)
 Acute Intervention
• Postoperative management
• Monitor limitations in movement
• Carefully observe dressings or casts for
bleeding or drainage
• Significant ↑ in size of drainage area
should be reported
• Measure and assess patency of system
and volume of drainage
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Nursing Management
Fractures (cont'd)

Nursing Implementatjon

Other measures
• Prevention of constipation
• DVT prophylaxis
• Movement as able to prevent cardiopulmonary
deconditioning
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Nursing Management
Fractures (cont'd)

Nursing Implementatjon

Traction
• Pin care
• Monitor skin for breakdowin
• Correct alignment
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Nursing Management
Fractures (cont'd)

Nursing implementation (cont'd)

Ambulatory and home care
• Cast care
• Psychosocial problems
• Ambulation
• Assistive devices
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Complications of Fractures

Infection



High risk with open fractures
May require debridement,
antibiotics
Risk of osteomyelitis
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Complications of Fractures

Compartment syndrome


A condition in which elevated intracompartmental
pressure within a confined myofascial
compartment compromises the neurovascular
function of tissues within that space
Manifestations
• 6 Ps
• Pain
Pallor
• Paresthesia
Paralysis
• Pressure
Pulselessness
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Complications of Fractures

Compartment syndrome




Prompt recognition
NO ice, elevation
Remove constricting dressings
Surgical decompression
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Fig. 63-15
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Complications of
Fractures (cont'd)

Fat embolism syndrome



Highest risk with long bone fractures
Characterized by the presence of systemic fat
globules from fractures that are distributed into the
tissues and organs after a traumatic skeletal injury
Manifestations - often rapid onset
• Often respiratory distress
• Neurologic changes
• Fever
• Petechiae
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Complications of
Fractures (cont'd)

Fat embolism syndrome



Prevention
Early identification
Supportive care
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Types of Fractures
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Colles’ Fracture
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Fracture of the Humerus
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Fig. 63-16
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Fracture of the Pelvis
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Fracture of the Hip



Refers to a fracture of the proximal third of the femur
Manifestations
 Pain
 Edema
 External rotation
 Shortening of the affected extremity
Surgical management is the preferred treatment
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Fig. 63-17
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Fig. 63-18
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Nursing Management
Hip Fracture

Nursing implementation

Preoperative management
• Pain management - may include analgesics and
Buck’s traction
• Preoperative teaching
• Consideration of comorbid conditions
• Frequent repositioning to prevent immobility
complications
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Nursing Management
Hip Fracture

Nursing implementation

Postoperative management
• Monitor VS/, I/O
• CMS assessment
• Prevention of respiratory complication
• Prevention of DVT
• Pain management
• Proper alignment
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Nursing Management
Hip Fracture

Nursing implementation

Postoperative management
• Mobility
• Monitor for complication
• Hip prosthesis management
 Table
63-11
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Gerontologic Considerations
Hip Fracture
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Femoral Shaft Fracture
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Stable Vertebral Fractures
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