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8/8/2019 Ch 54: Musculoskeletal Trauma (per Amendolair)
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Chapter 54Interventions for Clients
with MusculoskeletalTrauma
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Osteoblast
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Acute Compartment
Syndrome
Serious condition in which
increased pressure within one or
more compartments causes
massive compromise of circulation
to the area
Prevention of pressure buildup of
blood or fluid accumulation
Pathophysiologic changes
sometimes referred to as ischemia-
edema cycle
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Emergency Care
Within 4 to 6 hr after the onset of
acute compartment syndrome,
neuromuscular damage is
irreversible; the limb can become
useless within 24 to 48 hr.
Monitor compartment pressures.(Continued)
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Emergency Care (Continued)
Fasciotomy may be performed to
relieve pressure.
Pack and dress the wound after fasciotomy.
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Other Complications of
Fractures (Continued)
Infection
Ischemic necrosis
Fracture blisters, delayed union,nonunion, and malunion
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Musculoskeletal Assessment
Change in bone alignment
Alteration in length of extremity
Change in shape of bonePain upon movement
Decreased ROM
CrepitationEcchymotic skin
(Continued)
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Musculoskeletal Assessment(Continued)
Subcutaneous emphysema with
bubbles under the skin
Swelling at the fracture site
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Special Assessment
Considerations
For fractures of the shoulder and
upper arm, assess client in sitting
or standing position.
Support the affected arm to
promote comfort.
For distal areas of the arm, assess
client in a supine position.
For fracture of lower extremities
and pelvis, client is in supine
position.
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Risk for Peripheral
Neurovascular Dysfunction
Interventions include:
Emergency care: assess for
respiratory distress, bleeding and
head injury
Nonsurgical management: closed
reduction and immobilization with a
bandage, splint, cast, or traction
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Procedures for Nonunion
Electrical bone stimulation
Bone grafting
Bone banking
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Upper Extremity Fractures
Fractures include those of the:
Clavicle
Scapula
Humerus
Olecranon
Radius and ulna
Wrist and hand
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Herbert
Screws
scaphoid
fracture
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Fractures of the Hip
Intracapsular or extracapsular
Treatment of choice: surgical
repair, when possible, to allow theolder client to get out of bed
Open reduction with internal
fixation
Intramedullary rod, pins, a
prosthesis, or a fixed sliding plate
Prosthetic device
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Lower Extremity Fractures
Fractures include those of the:
Femur
Patella
Tibia and fibula
Ankle and foot
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Fractures of the Pelvis
Associated internal damage the
chief concern in fracture
management of pelvic fractures
Non±weight-bearing fracture of the
pelvis
Weight-bearing fracture of the
pelvis
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Compression Fractures of the
Spine
Most are associated with osteoporosis rather
than acute spinal injury.
Multiple hairline fractures result when bone
mass diminishes.(Continued)
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Compression Fractures of the
Spine (Continued)
Nonsurgical management includes
bedrest, analgesics, and physical
therapy.
Minimally invasive surgeries are
vertebroplasty and kyphoplasty, in
which bone cement is injected.
(Continued)
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Amputations
Surgical amputation
Traumatic amputation
Levels of amputationComplications of amputations:
hemorrhage, infection, phantom
limb pain, problems associatedwith immobility, neuroma, flexion
contracture
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phantom pain
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Management of Pain
Phantom limb pain must be
distinguished from stump pain
because they are managed differently.
Recognize that this pain is real and
interferes with the amputee¶s activities
of daily living.
(Continued)
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Management of Pain (Continued)
Some studies have shown that
opioids are not as effective for
phantom limb pain as they are for
residual limb pain.
Other drugs include intravenous
infusion calcitonin, beta blockers,
anticonvulsants, andantispasmodics.
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Exercise After Amputation
ROM to prevent flexion
contractures, particularly of the hip
and knee
Trapeze and overhead frame
Firm mattress
Prone position every 3 to 4 hours
Elevation of lower-leg residual limb
controversial
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Prostheses
Devices to help shape
and shrink the residual
limb and help client
readapt
Wrapping of elastic
bandages
Individual fitting of theprosthesis; special
care
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What Kindof fracture
is this?
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What Kind of fracture is this?
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Impaired Physical Mobility
Interventionsinclude:Use of crutches to
promote mobility
Use of walkers and canesto promote mobility
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Imbalanced Nutrition: Less Than
Body Requirements
Interventions include:
Diet high in protein, calories, and
calcium, supplemental vitamins B and
C
Frequent small feedings and
supplements of high-protein liquids
Intake of foods high in iron
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Casts (Continued)
Cast care and client education
Cast complications: infection,
circulation impairment, peripheralnerve damage, complications of
immobility
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Traction
Application of a pulling force to the
body to provide reduction,
alignment, and rest at that site
Types of traction: skin, skeletal,
plaster, brace, circumferential
(Continued)
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Traction (Continued)
Traction care:
Maintain correct balance between
traction pull and countertraction force
Care of weights
Skin inspection
Pin care
Assessment of neurovascular status