MANAGEMENT OF CLIENT WITH MUSCULOSKELETAL PROBLEMS OSTEOARTHRITIS What is osteoarthritis? It is the most common type of arthritis that develops due to the deterioration of the articular cartilage. Remember articular cartilage is hyaline cartilage. When this happens it leads to bone break down because the bones within the joint start to rub upon one another. This will cause changes inside and outside of the bone. The inside of the bone will start to experience abnormal hardening (sclerosis), and the outside of the bone will experience osteophytes formation (bone spurs). What is bone cartilage? Bone cartilage is a rubbery, smooth tissue found within the joint that covers the end of each bone. It acts as a protective mechanism for movement by providing this slick surface for the bones to slide and glide during movement. In addition, it absorbs shock from movement. What happens in Osteoarthritis? The top layer of cartilage begins to breakdown and wear away. This leads to a loss of joint space within the joint, which allows the bones to grate upon each other. Therefore, there is no longer this environment that allows for easy gliding of bones during movement without friction. This leads to eroding of the bone and osteophyte formation. Furthermore, pieces of cartilage and bone can break off and float around in the joint space. All of this leads to extreme stiffness and pain. Key Points about Osteoarthritis to Remember: OA is also called degenerative joint disease and remember it is the cartilage NOT synovium. It happens and worsens overtime. It tends to most commonly occur in the hands, knees, hips, and spine (majorly the weight-bearing joints which experience a lot of stress) and it does not affect other systems in the body and it’s unsymmetrical (a patient can have OA in both correlating joints or just one). Remember RA is symmetrical….it must be found in the correlating joint. Causes: Occurs in older age 40+ Increased risk if patient has had repeated joint injuries. Jobs that are strenuous e.g nursing Overweight Genetics There is no cure. It gets worse overtime and damage can’t be reversed (cases vary mild to severe). Managed with lifestyle changes (exercise/losing weight), medication, surgery (hip/knee joint replacement or bone realignment “osteotomy’, arthroscopic). No conclusive test to diagnose OA. Must evaluate patient’s signs and symptoms and rule out other forms of arthritis such as gout, rheumatoid arthritis. X-ray imaging may be helpful (remember an x-ray ONLY shows bones, it doesn’t show cartilage) X-ray may show: sclerosis of bones, decreased joint space, osteophytes/bone fragments in the joint space, osteophytes (bone spur) formation. Signs and Symptoms of Osteoarthritis 1. Outgrowths that are bony, especially on the hands due to bone spur formation (*remember the names of the nodes and where they are found): Heberden’s Node (most common): found on the distal interphalangeal joint (joint closest to the fingernail) Bouchard’s Node: found on the proximal interphalangeal joint (middle finger joint) 2. Sunrise Stiffness (morning) LESS than 30 minutes (Remember RA is greater than 30 minutes)…pain will be the worst at the end of day from overuse than compared to morning time 3. Tenderness when touching the joint site with bony overgrowths (joints will be BONY and HARD). 4. Experience grating (crepitus) of the bones when moving/flexing joint from bones rubbing together and joint pain with activity which goes away with rest. 5. Only the joints: Asymmetrical/Uneven, limited to joints (joint site will be hard and bony, NO warmth) along with limited mobility, not system wide, no fever, fatigue or systemic inflammation just the joint). Nursing Interventions for Osteoarthritis: *Pain assessment: patient’s perception of the disease, effects of the disease on the patient’s activities of daily living, nonpharmalogical and pharmacological approaches *Therapy: physical activity may be one of the effective which may help create more lubrication to the cartilage allowing the pain and stiffness to decrease, strengthen muscles, help patient lose weight, feel better mentally Do not exercise painful, irritated joint but let it rest. *Exercise: this is the last thing most patients want to do but limiting activity and not exercising leads to more pain, increased joint damage, increased weight, and decreased mental health. Types: Low impact: walking, water aerobics Strengthen training (lifting weights which helps strengthen muscles around the joint) Range of motion exercises (ROM): improves the mobility of the joint and decreases stiffness AVOID: high impact exercise that will increase the stress on weight bearing joints, such as running/jogging, jump rope, or any type of exercise where both feet are off the ground. *Heat and cold compresses *Importance of weight loss (BMI <25) *Physical therapy and occupation therapy (using assistance devices to decrease weight bearing stress, exercise etc.), local support groups, structuring day to prevent overuse of joints. Medications: Intra-articular injections: corticosteroids…more effective than oral: reduces the inflammation of the inflamed tendons and ligaments. Note: this is temporary relief of no more than a month or two. Glucosamine: improve symptoms and function Pain relief: topical creams, Tylenol, NSAIDs (GI bleeding/ulcers), controlled substances (opioids if severe) Rheumatoid Arthritis Rheumatoid arthritis (RA) is an autoimmune disorder that causes joint inflammation. It can also cause inflammation and damage to other tissues, including blood vessels and nerves. The immune system normally protects the body from infection, but with RA, it attacks the lining of the joints and other tissues. As a result, white blood cells enter the joint space and release enzymes that break down tissue and cartilage. Inflammation causes pain, swelling, stiffness, and loss of movement in joints. Osteoarthritis vs Rheumatoid Arthritis NOTE; There are several different types of arthritis, with two of the most common being osteoarthritis and rheumatoid arthritis. Osteoarthritis and rheumatoid arthritis differ in that osteoarthritis is caused by mechanical wear and tear on joints, whereas rheumatoid arthritis is caused by an autoimmune disorder. It’s a progressive degeneration of the protective cartilage cushion on the end of the bones resulting in bone-on-bone rubbing, causing massive pain. Osteoarthritis is the most common type of arthritis, and typically begins in an isolated joint. RA is a disease in which the immune system attacks the body, instead of defending it against intruders. As a result, it attacks the synovial membrane that encases and protects joints. Pannus Formation in Rheumatoid Arthritis Pannus (or synovial tissue proliferation) is a type of extra growth that can cause pain, swelling, and damage to the bones, cartilage, and other tissue. RA causes extra tissue growth in your joints, known as pannus. But serious, if rare, pannus formations develop only if you don’t get treatment for RA or if can’t find an effective treatment for you. Signs and Symptoms Fatigue Weight loss Morning joint stiffness Symmetrical pain and swelling in the small joints of the hands Pain, aching, or stiffness in more than one joint Investigations Synovial fluid aspiration Arthroscopy Blood tests: e.g Rheumatoid factor (RF) and Erythrocyte sedimentation rate (ESR) Pharmacotherapy The goal of pharmacotherapy in RA is to alleviate symptoms, reduce inflammation, and slow down joint damage. In addition to pharmacotherapy, physical therapy, and exercise can also be beneficial for RA clients to improve joint function and reduce pain.RA drugs include Disease-modifying antirheumatic drugs (DMARDs) e.g hydroxychloroquine, methotrexate. Corticosteroids Biologics Methotrexate for Rheumatoid Arthritis For clients with RA, use methotrexate as first-line therapy. Methotrexate is a drug that relaxes the immune system, and stops them from attacking cells. This helps reduce the inflammation that causes swollen and stiff joints in RA. It’s important to note that Methotrexate is not a painkiller. Methotrexate Side Effects Unusual bleeding or bruising Black, tarry stools Stomach pain Bleeding gums Red spots on the skin Blood in the urine, stools, or vomit Increased heartbeat Diarrhea Nausea Sores in the mouth or lips Swelling of the eyelids, face, lips, hands, feet, or lower legs Yellow eyes or skin Rheumatoid Arthritis Nursing Interventions Provide pain relief interventions, including administering analgesics and teaching clients about pain-relieving methods. Educate your clients about RA including disease progression, symptoms, medications, and self-management strategies such as exercise, diet, and stress reduction. Assess pain, joint mobility, and functional status to identify any side effects that medication may cause. Promote mobility by exercising the body, including: range of motion exercises, strength training, and cardiovascular exercise. Manage clients’ medications by ensuring they take them as prescribed and providing education about possible side effects, drug interactions, and the importance of regular follow-up with their healthcare providers. Rheumatoid Arthritis Patient Education Pain control – Assess pain levels Do NOT elevate the knees with pillows at night Exercise (low impact) e.g Swimming Heat & Cold to affected joints-Warm shower or bath before bed GOUT Gout is a type of inflammatory arthritis that can lead to significant pain and lack of mobility. It occurs when hyperuricemia (uric acid) leads to the formation of crystallized monosodium urate which gets deposited in joints, tendons and bursae, causing swelling and pain. Gout can be primary or secondary. The exact cause of primary gout is not fully understood. In most patients, gout occurs due to a decreased excretion of uric acid. In others, it occurs due to overproduction of uric acid. Both pathologies lead to elevated uric acid levels or hyperuricemia. It’s important to note, however, that hyperuricemia on its own does not cause gout. Many people have elevated urate levels and do not develop gout. Secondary gout develops as a consequence of another condition. Common conditions that predispose someone to gout include obesity, hypertension, diabetes, heart disease, renal disease, lymphoma, and leukemia. Nutritional factors that can lead to hyperuricemia include excess intake of high-purine foods, fructose and alcohol. This is why the disease was historically called the “disease of kings.” High-purine foods that can trigger gout include organ meats, red meat, shrimp, mussels, lobster, anchovies, sardines, beer, and hard liquor. Moderatepurine foods include oatmeal, spinach, beans and cauliflower, among others. It can also occur secondary to pharmacological treatment for other conditions. Main culprit drugs are thiazide and loop diuretics, which are often used to treat hypertension and prevent fluid volume overload in patients with heart failure. Other drugs that can lead to hyperuricemia and gout include low-dose aspirin, anti-tubercular drugs, cytotoxic chemotherapy and the immunosuppressants cyclosporine and tacrolimus. Certain individuals are at higher risk for the development of gout. This includes males, those of advanced age, postmenopausal women, and individuals from certain ethnicities such as African American, Hmong and Pacific Islanders. The four phases of gout Left untreated, gout progresses through four clinical phases. Phase 1: Asymptomatic hyperuricemia. In this phase, the patient’s urate levels are elevated, but they have no signs or symptoms of gout. Phase 2: Acute gouty arthritis. In this phase, the patient has swollen and painful joints. It is at this phase that most patients seek medical care. Phase 3: Intercritical gout. This phase can last for months up to years. The patient can be asymptomatic during this phase or have occasional flares. Phase 4: Chronic tophaceous gout. In this phase (which can occur many years after the first attack of gouty arthritis), clusters of urate crystals called tophi develop in the soft tissues, synovial membranes, cartilage and tendons. Tophi can damage bone and tissue and even lead to deformity and loss of mobility. Over time the skin over the tophi can degenerate and cause a white exudate to be released. Complications of gout In addition to physical disability and pain, gout can also lead to the formation of renal calculi, infections secondary to tophi rupture, atherosclerosis and nerve damage. Now that you understand the basics of gout, let’s dive into caring for these patients using the straight nursing latte method L: How does the patient LOOK? A patient with gout will be complaining of severe to intense pain in a joint, most often this is first noticed in the metatarsophalangeal joint. The pain usually follows a predictable pattern where it will peak within 24 hours and then gradually resolve over 7 to 10 days. Many patients report the pain starts at night. If you’re reading a chart and you see the term “podagra” this is a medical term meaning the pain is in the big toe, which is a very common site. Other sites are the knees, ankles, elbows and feet. Depending on the stage of gout, the patient may also have tophi, which can occur in many locations of the body. Common sites for tophi include the pinna of the ear, elbows, hands, knees, feet, lateral forearms, and the Achilles tendon. If a tophi has caused the overlying skin to ulcerate, a white exudate may be present. A: How do you ASSESS the patient? Key assessments are centered around the patient’s musculoskeletal status. Look for pain in the affected joints as well as ROM to understand how the condition affects the patient’s mobility and ability to perform ADLs. The pain with gout can have a significant impact on quality of life, sleep, social connections and work. It is also beneficial to perform a thorough pain assessment, utilizing a standard format such as the OPQRST format. O: Onset – When did the pain start? Did it come on suddenly or ramp up over time? The patient will often tell you the pain started in the middle of the night and came on suddenly. P: Provocation and palliation – What makes the pain worse or better? A patient with gout may state the pain is worse after eating specific foods and that antiinflammatory medications may help. Q: Quality – What is the quality of the pain? Patients with chronic gout may state the pain as a continuous dull aching pain. An acute attack may be described as sharp or even stabbing pain. R: Radiation – Does the pain radiate anywhere? The pain associated with gout is typically localized to the affected body part. S: Severity – What is the severity of the pain on a 0 to 10 scale? The patient suffering from an acute attack will report the pain as very severe. T: Time – How long ago did the pain start? An acute attack typically resolves within 10 to 14 days, so the answer will vary from patient to patient. If the patient has ulcerated skin over areas of tophi, examine the exudate for signs of infection. This includes localized erythema, warmth, pain and purulent drainage. T: What TESTS will be conducted for a patient with gout? Key tests for a patient with gout include: Serum urate level Arthrocentesis X-ray CT Scan Ultrasound: Ultrasound uses sound waves to detect the presence of tophi or urate crystals in the joints. T: What TREATMENTS are provided for a patient with gout? Treatments for gout will depend on whether the condition is acute or chronic. The goals of therapy are to stop an acute attack, reduce urate levels, and prevent future attacks from occurring. To treat an acute gout attack, both pharmacology and dietary modifications will be utilized. NSAIDs – NSAIDs are often used short-term in the treatment of gout for their anti-inflammatory properties. Corticosteroids – Corticosteroids, such as prednisone, may be used during an acute flare up. Note that corticosteroids come with unpleasant side effects such as weight gain, mood swings, hyperglycemia and hypertension. Longer term use can lead to redistribution of body fat, osteoporosis, poor skin integrity and higher risk for infection. Colchicine – Colchicine disrupts leukocyte activation to disrupt the inflammatory response to monosodium urate crystals. Its use is typically avoided in patients with hepatic or renal impairment and can cause serious hematologic adverse effects including leukopenia, thrombocytopenia, aplastic anemia and agranulocytosis. More common adverse effects are diarrhea, nausea and vomiting. Monitor your patient for colchicine toxicity which includes muscle weakness or pain, tingling in the periphery, bruising or unusual bleeding, signs of significant anemia, and severe vomiting or diarrhea. Dietary modifications – The patient should follow a low-purine diet and abstain from other triggering items such as fructose and alcohol. Non-pharmacologic therapies – These include cold therapy, elevation and immobilization in some cases. Lifestyle modifications for gout A key component of gout therapy is dietary modification. Patients will be counseled to avoid high-purine foods and to have moderate-purine foods only occasionally. They should also avoid high fructose beverages and alcohol, especially beer and hard liquor. Lifestyle modifications are aimed at reducing weight and improving mobility with exercise. Good options for a patient for gout include low-impact activities such as swimming, cycling and walking. E: How do you EDUCATE the patient? Since gout can be a chronic condition that requires careful management, education will play a key role in preventing further progression of the disease and gout flares. Teach the patient to keep a food journal. Not only can this help them adhere to dietary guidelines, it can also help them identify their specific trigger foods. Teach the patient that dehydration can worsen gout. Staying hydrated promotes uric acid excretion and helps prevent complications due to the formation of renal calculi. Teach the patient that allopurinol will not stop an acute attack, but is used long-term to prevent future attacks from occurring. Teach the patient that sometimes allopurinol can trigger an acute attack when starting therapy. This is due to crystals lodging in joints as they are made smaller. The patient may receive another medication such as an anti-inflammatory to help reduce the risk of an acute attack occurring. Teach the patient to notify their medical provider of any other medications they are taking. Some may increase the risk for hyperuricemia and increase flares of gout. And, ensure the patient understands the importance of and how to follow their treatment plan. OSTEOMYELITIS Osteomyelitis is an infection of the bone. Bones may become prone to infection from trauma, surgery, ischemia, or bacteria from surrounding tissues. Osteomyelitis can result from a systemic bacterial infection that extends to the bones (sepsis or bacteremia). This form typically affects a child’s long bones, such as the femur or humerus. Adult cases of osteomyelitis frequently involve the vertebral bones along the spinal column. Staphylococcus aureus is typically the cause of infection, while other bacteria or fungi may also be the source. A neighboring infection brought on by a traumatic accident, repeated drug injections, surgery, ulcers, or the application of a prosthetic device can cause osteomyelitis. Additionally, those with diabetes are more likely to develop ulcers in the lower extremities from impaired blood supply promoting infection. In these circumstances, the microorganism has a direct portal of entry into the compromised bone. Osteomyelitis is more likely to occur in people with compromised immune systems. Patients with sickle cell disease or HIV or those taking immunosuppressive agents like Chemotherapy or steroids are at higher risk. Depending on the cause of the infection, osteomyelitis may be acute or chronic. Signs and symptoms of osteomyelitis include: Pain in the infected area Fever Irritability Fatique Lethargy Purulent drainage Swelling and inflammation to the infected area Warmth and tenderness to the infected area Decreased range of motion to the affected area Osteomyelitis can be diagnosed through blood work, imaging and bone scans, and biopsies. Delayed or inadequate treatment may lead to worsening infection and necrosis. Loss of limbs may occur in severe cases. The Nursing Process Collaboration across different medical and surgical disciplines is necessary for osteomyelitis treatment to be effective. The two essential therapy components are surgery and extended antibiotics. As antibiotics only partially penetrate infected fluid collections like abscesses and injured or necrotic bone, surgical debridement of all diseased bone is frequently necessary. As a result, necrotic tissue and bone removal may be required. The nurse will administer and teach the patient about antibiotic therapy. If surgical debridement is not an option, due to the location of the infection (such as pelvic osteomyelitis), antibiotics for an extended period will be prescribed. Patients must be educated about the prolonged nature of therapy and the importance of compliance with the treatment guidelines. This helps with sufficient wound to heal and lowers the risk of recurrence. Nursing Care Plans Related to Osteomyelitis Ineffective Tissue Perfusion Ineffective tissue perfusion associated with osteomyelitis can be caused by swelling of the vessels, thrombosis, tissue destruction, oedema, and abscess formation. Nursing Diagnosis: INEFFECTIVE TISSUE PERFUSION Related to: Inflammatory reaction Thrombosis of vessels Tissue destruction Edema Abscess formation As evidenced by: Bone necrosis Continuation of the infectious process Delayed healing Pain Erythema Swelling Altered sensation in the affected area Weak peripheral pulses Expected outcomes: Patient will demonstrate improved perfusion as evidenced by decreased pain, erythema, and swelling Patient will demonstrate no signs of infection, such as fever and abscess formation Ineffective Tissue Perfusion Assessment 1. Identify the causative factors. Bone becomes vulnerable to infection with the presence of bacteria through trauma, ischemia, or the presence of foreign bodies. Assess for recent surgical procedures, fracture or open wounds. 2. Assess the extent of infection. Imaging scans like MRI or CT scans can be used before surgery to determine the severity of the infection in the affected area. 3. Assess the circulatory status. Assess the circulation in the affected area by checking for the presence of swelling, redness, warmth, pain, and peripheral pulses. 4. Assess the healing status. Heat, redness, swelling, and discomfort are the classic signs of an infection. It is crucial to determine if increases in pain, heat, edema, and erythema are associated with the inflammatory phase of wound healing or infection. Ineffective Tissue Perfusion Interventions: 1. Establish blood flow at the site. Blood circulation distributes nutrients throughout the body, aids in controlling waste production, enhances site recovery, and speeds up the healing process. Healthy blood flow across vessels, arteries, veins, and capillaries maximizes perfusion. 2. Manage chronic conditions and lifestyle factors. Diabetes, sickle cell disease, smoing, malnutrition, and more affect the revascularization of the affected area. These need to be addressed before surgical intervention. 3. Provide DVT prophylaxis. Anticoagulants should be administered as ordered to promote circulation and prevent the development of blood clots. 4. Prepare for possible surgery. Depending on the degree of vascular insufficiency, procedures to restore adequate blood flow, such as debridement or vascular surgery may be necessary. 5. Prevention through pressure ulcer prophylaxis. Patients who are immobile or bed-bound are at an increased risk of experiencing osteomyelitis due to pressure ulcers. By implementing intervention such as turning schedules and skin care, this can be prevented. Hyperthermia Hyperthermia associated with osteomyelitis can be caused by increased metabolic rate and infection. Nursing Diagnosis: Hyperthermia Related to: Increased metabolic rate Infection Inflammatory response Trauma As evidenced by: Increased body temperature Warmth to touch Flushed skin Tachypnea Expected outcomes: Patient will demonstrate core body temperature within normal limits Patient will demonstrate blood pressure, heart rate, and respiratory rate within normal limits Hyperthermia Assessment 1. Monitor the patient’s body temperature. When osteomyelitis worsens causing sepsis, fever may be very high. 2. Obtain culture and sensitivity. Wound and blood cultures should be obtained prior to antibiotic therapy. However, it is permissible to begin empiric antibiotics while awaiting C&S results. 3. Assess for other signs of infection. Monitor for symptoms of pain, redness, and warmth in the area. A bone can become infected by an infection that has spread from adjacent tissue or through the bloodstream. Hyperthermia Interventions: 1. Provide a tepid sponge bath. Tepid sponge baths lower body temperature and provide comfort to the patient. 2. Apply a cooling blanket. A cooling blanket can lower the internal body temperature by surface cooling. Monitor closely to prevent a rapid drop in body temp. 3. Initiate antibiotics. Long-term antibiotics are required for the treatment of osteomyelitis to control the infectious process. Instruct patients that antibiotic therapy may be required for weeks. 4. Instruct on symptoms. Teach the patient and family that if fever, chills, warmth to the skin, or skin flushing is observed that the body is attempting to fight off infection and to seek immediate assistance. Acute Pain Acute pain associated with osteomyelitis can be caused by inflammation and tissue necrosis. Nursing Diagnosis: ACUTE PAIN Related to: Inflammation Tissue necrosis As evidenced by: Verbalization of pain Tenderness with palpation Guarding behaviors Facial grimacing Increased vital signs Expected outcomes: Patient will be able to verbalize relief from pain Patient will verbalize a decrease in pain scale from pain relief measures Patient will demonstrate adequate rest and comfort as evidenced by vital signs within expected limits Acute Pain Assessment 1. Assess the pain scale of the patient. The pain scale is a measurable element that the nurse can use to better understand the severity of pain. 2. Determine the pain characteristics. Pain in osteomyelitis is localized pain and tenderness of the affected area. 3. Assess for nonverbal signs of pain. Nonverbal signs of pain include guarding the affected site, facial grimacing, self-focus, and changes in vital signs. Acute Pain Intervention 1. Reposition as needed. Repositioning and turning can decrease the stimulation of the pain and pressure receptors. 2. Administer pain medication as prescribed. Mild or moderate pain may be controlled with non-steroidal antiinflammatory drugs (NSAIDs). More severe pain or pain related to debridement or surgical intervention may require oral or IV opioid medications. 3. Elevate or immobilize the site. Elevation or splinting of an extremity may improve pain by increasing circulation. 4. Collaborate with physical and occupational therapists. Physical and occupational therapists assist in pain management through exercise, stretching, and other techniques. 5. Anticipate referral to a pain specialist. Osteomyelitis and its treatment can be very painful and prolonged. Acute pain can turn into Chronic pain depending on the severity and pain tolerance of the patient, which may need a referral to a pain specialist. SPRAIN AND STRAIN A SPRAIN is a complete or incomplete tear in the supporting ligaments surrounding a joint. Common locations include the ankle, knee, wrist, thumb, shoulder, neck and lower back. A STRAIN is an overstretching injury to a muscle or tendon. Commonly affected areas are the groin, calf, shoulder, and back muscles, and the Achilles tendons. Risk Factors SPRAIN Wrenching or twisting motion that disrupts the stabilizing action of ligaments. STRAIN From excessively vigorous movement in understretched or overstretched muscles and tendons. Pathophysiology The affected ligament is unable to stabilize the joint when the client is applying weight and attempting to mobilize the affected joint. The blood vessels may be ruptured and edema produced Assessment/Clinical Manifestations/Signs And Symptoms SPRAINS Pain and discomfort, especially on joint movement Edema, possibly ecchymoses Decreased joint motion and function Feeling of joint looseness with severe sprain STRAINS Pain Edema Ecchymoses developing several days after injury Acute strain – pain may be sudden, severe, incapacitating. Chronic strain – gradual onset of soreness and tenderness Laboratory and diagnostic study findings Radiographs are commonly done to rule out fracture or dislocation. Medical Management Treatment of strains and sprains consists of resting and elevating the affected part, applying cold and using a compression bandage. The acronym RICE – Rest, Ice, Compression, Elevation is helpful for remembering treatment intervention. Rest prevents additional injury and promotes healing. If the sprain is severe (torn muscle fibers and disrupted ligaments), surgical repair or cast immobilization may be necessary so that the joint will not lose its stability. After the acute inflammatory stage (24 to 48 hours after injury), heat may be applied intermittently (for 15 to 30 minutes four times a day) to relieve spasm and to promote vasodilation, absorption and repair. Splinting may be used to prevent reinjury. Nursing Diagnosis Acute pain Impaired mobility Risk for injury Nursing Management 1. Provide nursing care for a client who sustains a sprain Elevate or immobilize the affected joint, and apply ice packs immediately Assist with tape, splint or cast application, as necessary Prepare the client with a severe sprain for surgical repair or reattachment, if indicated. 2. Provide nursing care for a client’s suffering muscle or tendon strain. Instruct the client to allow the muscle or tendon to rest and repair itself by avoiding use for approximately week and then by progressing activity gradually until healing is complete. Teach appropriate stretching exercises to be performed after healing to help prevent reinjury. Prepare the client for surgical repair in severe injury. 3. Administer prescribed medications, which may include nonopioid analgesics.
