Contusion• Hemorrhage into injured part (ecchymosis)—from rupture of small blood vessels; also associated with fractures.• Pain, swelling, and ecchymosis.• Hyperkalemia may be present with extensive contusions, resulting in destruction of body tissue and loss of blood
Strain• Hemorrhage into the muscle.• Swelling.• Tenderness.• Pain with isometric contraction.• May be associated spasm.
Sprain• Rapid swelling—due to extravasation of blood within tissues.• Pain on passive movement of joint.• Increasing pain during first few hours due to continued swelling.
• X-ray may be done to rule out fracture.• Immobilize in splint, elastic wrap, or compression dressing to support painful structures and control swelling.• Apply ice while swelling is present.• Analgesics usually include nonsteroidal anti-inflammatory drugs (NSAIDs).• Severe sprains may require surgical repair or cast immobilization.
• Elevate the affected part to reduce swelling• Maintain splint or immobilization as prescribed.• Apply cold compresses for the first several days (15-20 min at a time every few hours)—to produce vasoconstriction, decrease edema, and reduce discomfort• Do not apply ice directly to skin
• Ice may be needed for up to a week to control acute swelling• Assess neurovascular status of contused extremity every 1 to 4 hours as patients condition indicates• Instruct patient on use of pain medication as prescribed• Ensure correct use of crutches or other mobility aid with or without weight bearing, as prescribed.
• Educate on need to rest injured part for about a month to allow for healing.• Teach patient to resume activities gradually.• Teach patient to avoid excessive exercise of injured part.• Teach patient to avoid reinjury by “warming up” before exercise and stretching tendons and muscles before and after exercise.
• Complementary methods, such as acupuncture, biofeedback, and imagery, may contribute to healing by reducing anxiety and pain.
NURSING ALERTTeach patients to use PRICE at home for minor injuries: Protection—of the affected part from injury Rest—to promote healing Ice—to control swelling (do not use heat until acute swelling is relieved) Compression—with an elastic wrap or splint to control swelling and prevent stiffness, can be removed at night Elevation —above the level of the heart to reduce swelling