2. A contusion is a soft tissue injury produced by
blunt force, such as a blow, kick, or fall.
A strain, or a “pulled muscle,” is an injury to a
musculotendinous unit caused by overuse,
overstretching, or excessive stress
First degree Strain/Sprain
Second degreeStrain/Sprain
Third degree Strain/Sprain
3. • A sprain is an injury
to the ligaments and
supporting muscle
fibers that surround
a joint. It is caused
by a wrenching or
twisting motion.
– First degree Sprain
– Second degree Sprain
– Third degree Sprain
5. Rest
Ice
Compression
Elevation
Surgical intervention in cases of 3rd degree
damages
6. A dislocation of a
joint is a condition
in which the
articular surfaces of
the bones forming
the joint are no
longer in anatomic
contact
7. Causes are
Trauma (dislocation of a
joint of a criminology student
during a soccer game)
Congenital
Pathologic (rheumatoid
arthritis)
8. Signs and Symptoms
Signs of inflammation
change in contour of the joint,
change in the length of the extremity
loss of normal mobility, and
change in the axis of the dislocated bones.
X-rays confirm the diagnosis and reveal any
associated fracture
9. Management
Immobilization
Reduction
Pain and anti-inflammatory drugs
Muscle Relaxants
Neuro-Vascular Assessment
Range of motion Exercises after reduction
The joint is immobilized by bandages, splints, casts,
or traction and is maintained in a stable position
10. Contusions result from direct falls or blows. The
initial dull pain becomes greater, with edema and
stiffness occurring by the next day.
Sprains occur most commonly in the ankles but
may also occur in fingers and knees. Ankle sprains
account for 25% of all sports-related injuries
(Schoen, 2005). If the sprain is third-degree, the joint
becomes unstable, and surgical repair may be
required.
Strains manifest with a sharp, stabbing pain caused
by bleeding and immediate muscle spasm. Tennis
players often suffer calf muscle strains; soccer
players often experience quadriceps strains; and
swimmers, weightlifters, and tennis players often
suffer shoulder strains.
11. Tendinitis (inflammation of a tendon) is caused by
overuse and is seen in tennis players (epicondylar
tendinitis, or “tennis elbow”), runners and gymnasts
(Achilles tendinitis), and basketball players
(infrapatellar tendinitis).
Meniscal injuries of the knee occur with excessive
rotational stress.
Dislocations are seen with sports that involve throwing
or lifting.
Traumatic fractures occur with falls. Skaters and bikers
frequently suffer Colles' fractures of the wrist when they
fall on outstretched arms, and ballet dancers and track
and field athletes may experience metatarsal fractures.
Stress fractures occur with repeated bone trauma from
activities such as running,
12.
13.
14.
15.
16. A fracture is a break in the continuity of bone
and is defined according to its type and extent.
Fractures occur when the bone is subjected to
stress greater than it can absorb.
Fractures are caused by
direct blows,
crushing forces,
sudden twisting motions, and
extreme muscle contractions
It can also damage soft tissues surrounding the
injury
17. Types of fracture
complete fracture involves a break across the entire
cross-section of the bone and is frequently displaced
(removed from its normal position).
incomplete fracture (eg, greenstick fracture) involves a
break through only part of the cross-section of the bone.
comminuted fracture is one that produces several bone
fragments.
closed fracture (simple fracture) is one that does not
cause a break in the skin.
open fracture (compound, or complex, fracture) is
one in which the skin or mucous membrane wound
extends to the fractured bone
18. Open fractures are graded according to the
following criteria:
Grade I is a clean wound less than 1 cm long.
Grade II is a larger wound without extensive soft
tissue damage.
Grade III is highly contaminated, has extensive soft
tissue damage, and is the most severe.
19.
20. Pain
Loss of function
Deformity
Shortening of the extremity
Crepitus
Local swelling and discoloration
Diagnosis by symptoms and x-ray
Patient usually reports an injury to the area
21. Immobilize the body part
Splinting: joints distal and proximal to the
suspected fracture site must be supported and
immobilized
Assess neurovascular status before and after
splinting
Open fracture: cover with sterile dressing to
prevent contamination
Do not attempt to reduce the fracture
22. Reduction
Closed
Open
Immobilization: internal or external fixation
Open fractures require treatment to prevent
infection
Tetanus prophylaxis, antibiotics, and cleaning and
debridement of wound
Closure of the primary wound may be delayed to
permit edema, wound drainage, further assessment,
and debridement if needed
24. closed reduction is accomplished by bringing the
bone fragments into apposition (ie, placing the ends
in contact) through manipulation and manual
traction.
The extremity is held in the desired position while
the physician applies a cast, splint, or other device.
25. A rigid, external immobilizing device
Uses
Immobilize a reduced fracture
Correct a deformity
Apply uniform pressure to soft tissues
Provide support to stabilize a joint
Materials: nonplaster (fiberglass), plaster
26. Non-plaster
Also called fiberglass cast
Water-activated materials with the versatility of
plaster but are lighter in weight
Cool activated hardeners that bond and reach full
rigidity in minutes
Porous
Do not soften when wet
Dried with a hair dryer when wet
Used for nondisplaced fractures with minimal
swelling and for long term wear
27. Plaster
Plaster bandage are wet in cool water and applied
smoothly to the body
Exothermic reaction
Casts needs to be exposed in air to cool for 15 min
Speed of reaction varies from 15 to 20 minutes
It does not have full strength until it dries
Should be handled with palm to prevent indentation
Requires 24 to 72 hours to dry completely
A wet cast appears dull and gray, sounds dull, feels
damp and smells musty
A dry cast is shiny, sounds resonant, odorless and firm
28. Assessment
Patient’s general health
Patient’s understanding
Body part needed to be casted
Neurovascular status
Diagnosis
Deficient knowledge
Acute
Pain
Impaired physical mobility
Self care deficit
Impaired skin integrity
29.
30. Prior to cast application
Explain condition necessitating the cast
Explain purpose and goals of the cast
Describe expectations during the casting process: eg,
the heat from hardening plaster
Cast care: keep dry; do not cover with plastic
Positioning: elevation of extremity; use of slings
Hygiene
Activity and mobility
31. Explain exercises
Do not scratch or stick anything under the cast
Cushion rough edges
Report the following signs and symptoms: persistent
pain or swelling; changes in sensation, movement,
skin color, or temperature; and signs of infection or
pressure areas
Required follow-up care
Cast removal
32. Prior to casting
Perform general health assessment
Evaluate emotional status
Determine presenting signs and symptoms and
condition of the area to be casted
Knowledge
Monitor neurovascular status and the potential for
complications
34. Major goals include knowledge of the treatment regimen,
relief of pain, improved physical mobility, achievement
of maximum level of self-care, healing of any trauma-
associated lacerations and abrasions, maintenance of
adequate neurovascular function, and absence of
complications
35. Relieve pain
Elevate to reduce edema
Apply ice or cold intermittently
Implement position changes
Administer analgesics
Unrelieved pain may indicate compartment
syndrome; discomfort due to pressure may
require change of cast
Muscle setting exercises:
Patient teaching:
36. Heal skin wounds and maintain skin integrity
Treat wounds to skin before the cast is applied
Observe for signs and symptoms of pressure or
infection
Pad cast and cast edges
Patient may require tetanus booster
Maintain adequate neurovascular status
Assess circulation, sensation, and movement
Five “P’s”
Notify physician at once of signs of compromise
Elevate extremity no higher than the heart
Encourage movement of fingers or toes every hour
37. Patient with arm cast
Immobilized arm is elevated
Sling should distribute the supported to a large area
and not on the back of the neck
Watch for Volkmann’s contracture
Patient with Leg cast
Support cast on pillows above the heart level
Apply ice packs over the fracture site for 1 to 2 days
Use assistive devices like crutches when cast dries
Prevent foot drop
38. Patient with arm Body cast
Monitor for cast syndrome
Support on a firm mattress and with flexible,
waterproof pillows until the cast dries
Turn the patient to the uninjured side every 2 hours
Encourage use of a trapeze bar
Turn the patient to prone position twice daily to
drain the bronchial tree
Inspect the skin by pulling the skin taut and using a
flashlight
Massage and bath the skin by reaching under the
cast edges with the fingers
39. Patient with arm Body cast
Prevent soiling of the cast during elimination
Manage cast syndrome (superior mesenteric artery
syndrome)
40. Compartment syndrome
Pressure ulcer
Disuse syndrome
Delayed union or nonunion of fracture(s)
42. Move about as normally as possible, but avoid
excessive use of the injured extremity, and avoid
walking on wet, slippery floors or sidewalks.
Perform prescribed exercises regularly, as
prescribed.
Elevate the casted extremity to heart level frequently
to prevent swelling.
Do not attempt to scratch the skin under the cast.
This may cause a break in the skin and result in the
formation of a skin ulcer. Cool air from a hair dryer
may alleviate an itch. Do not insert objects such as
coat hangers inside the cast to scratch itching skin. If
itching persists, contact your physician.
43. Cushion rough edges of the cast with tape.
Keep the cast dry but do not cover it with plastic or
rubber, because this causes condensation, which
dampens the cast and skin. Moisture softens a
plaster cast. (A wet fiberglass cast must be dried
thoroughly with a hair dryer on a cool setting to
avoid skin burns.)
Report any of the following to the physician:
persistent pain, swelling that does not respond to
elevation, changes in sensation, decreased ability to
move exposed fingers or toes, and changes in skin
color and temperature.
44. Note odors around the cast, stained areas, warm
spots, and pressure areas. Report them to the
physician.
Report a broken cast to the physician; do not
attempt to fix it yourself.
45.
46. Used to manage open fractures
with soft-tissue damage
Provide support for
complicated or comminuted
fractures
Reassure patient concerned by
appearance of device
Discomfort is usually minimal,
and early mobility may be
anticipated with these devices
Elevate to reduce edema
Monitor for signs and
symptoms of complications,
including infection
Provide pin care
Patient teaching
47. Nursing responsibilities
Elevate to reduce swelling
Monitor neurovascular status every two hours
Assess pin site for redness, drainage, tenderness, pain,
and loosening of the pin
Some serous drainage is expected
Clean the pin site with chlorhexidine 1 to 2 times a day
Encourage exercise as tolerated
Crusting should be left behind unless there are signs of
infection
48. The application of pulling force to a part of the body
Purposes:
Reduce muscle spasms
Reduce, align, and immobilize fractures
Reduce deformity
Increase space between opposing forces
Used as a short-term intervention until other modalities
are possible
49. All traction needs to be applied in two directions.
The lines of pull are “vectors of force.” The result
of the pulling force is between the two lines of the
vectors of force.
50. Whenever traction is applied, a counterforce must be
applied; frequently the patient’s body weight and
positioning in bed supply the counterforce
Traction must be continuous to reduce and immobilize
fractures
Skeletal traction is never interrupted
51. Weights are not removed unless intermittent traction
is prescribed
Any factor that reduces pull must be eliminated
Ropes must be unobstructed and weights must hang
freely
Knots or the footplate must not touch the foot of the
bed
55. Properly apply and maintain traction
Monitor for complications of skin
breakdown, nerve pressure, and circulatory
impairment
Inspect the skin at least 3 times a day
Palpate traction tapes to assess for tenderness
Assess sensation and movement
Assess pulses, color capillary refill, and
temperature of fingers or toes
Assess for indicators of DVT
Assess for indicators of infection
56. Promptly report any alteration in sensation or
circulation
Provide frequent back care and skin care
Regularly shift position
Special mattresses or other pressure-reduction
devices
Perform active foot and leg exercises every hour
Elastic hose, pneumatic compression hose, or
anticoagulant therapy may be prescribed
Trapeze to help with movement for patients in
skeletal traction
Pin care
Exercises to maintain muscle tone and strength
57. Assess neurovascular status and for
complications
Assess for mobility-related complications of
pneumonia, atelectasis, constipation,
nutritional problems, urinary stasis, and UTI
Assess for pain and discomfort
Assess emotional and behavioral responses
Assess coping ability
Assess thought processes
Assess knowledge
60. Major goals include understanding the treatment
regimen, reduced anxiety, maximum comfort,
maximum level of self-care within the therapeutic limits
of the traction, and absence of complications
61. Prevent skin breakdown, nerve pressure, and
circulatory impairment
Measures to reduce anxiety
Provide and reinforce information
Encourage patient participation in decision making
and in care
Encourage frequent visits (family and caregivers/
nurse) to reduce isolation
Provide diversional activities
Use assistive devices
62. Arrange consultation with/referral for physical
therapy
Prevention of atelectasis and pneumonia
Auscultate lungs every 4 to 8 hours
Encourage coughing and deep breathing
exercises
High-fiber diet
Encourage fluids
Identify and include food preferences and
encourage proper diet
63. Used to treat severe joint
pain and disability and for
repair and management of
joint fractures or joint
necrosis
Frequently replaced joints
include the hip, knee, and
fingers
Joints including the
shoulder, elbow, wrist, and
ankle may also be replaced
64. Mobility and ambulation
Patients usually begin ambulation within a day after
surgery using walker or crutches
Weight bearing as prescribed by the physician
Drain use postoperatively
Assess for bleeding and fluid accumulation
65. Prevention of infection
Infection may occur in the immediate postoperative
period (within 3 months), as a delayed infection (4
to 24 months), or due to spread from another site
(more than 2 years)
Prevention of DVT
Patient teaching and rehabilitation
66. Position the leg in abduction to prevent
dislocation of the prosthesis
Do not flex hip more than 90°
Avoid internal rotation
Provide protective positioning
Hip precautions: see Chart 67-8
67.
68.
69. Encourage active flexion exercises
Use continuous passive motion (CPM) device
70.
71. Routine preoperative assessment
Hydration status
Medication history
Possible infection
Ask specifically about colds, dental problems,
urinary tract infections, other infections within 2
weeks
Knowledge
Support and coping
72. Pain
Vital signs, including respirations and breath
sounds
Level of consciousness
Neurovascular status and tissue perfusion
Signs and symptoms of bleeding: wound
drainage
Mobility and understanding of mobility
restrictions
Bowel sounds and bowel elimination
Urinary output
Signs and symptoms of complications: DVT or
infection
73. Acute pain
Risk for peripheral neurovascular dysfunction
Risk for ineffective therapeutic regimen
management
Impaired physical mobility
Risk for situational low self-esteem and/or
disturbed body image
74. Hypovolemic shock
Atelectasis
Pneumonia
Urinary retention
Infection
Thromboembolism: DVT or PE
Constipation or fecal impaction
75. Major goals preoperatively and postoperatively
include the relief of pain, adequate neurovascular
function, health promotion, improved mobility, and
positive self-esteem
Postoperative goals include the absence of
complications
76. Administration of medications
Patient-controlled analgesia (PCA)
Other medications
Medicate before planned activity and ambulation
Use alternative methods of pain relief
Repositioning, distraction, guided imagery, etc.
Specific individualized strategies to control
pain
Use ice or cold
Elevation
Immobilization
77. Implement muscle setting and ankle- and calf-
pumping exercises
Take measures to ensure adequate nutrition and
hydration
Large amounts of milk should not be given to
orthopedic patients on bed rest
Provide skin care measures including frequent
turning and positioning
Follow physical therapy and rehabilitation
programs
Encourage the patient to set realistic goals and
perform self-care care within limits of the
therapeutic regimen
78. Prevent atelectasis and pneumonia
Encourage coughing and deep breathing exercises
Use incentive spirometry
Constipation
Monitor bowel function
Provide hydration
Encourage early mobilization
Use stool softeners
Patient teaching: see Chart 67-11
79.
80. Decreased muscle strength and tone, decreased
in muscle size
Decreased joint mobility and flexibility
Limited endurance and activity intolerance
Bone demineralization
Lack of coordination and altered gait
Decreased ventilatory effort and increased
respiratory secretions, atelectasis, respiratory
congestion
81. Increased cardiac workload, orthostatic
hypotention, venous thrombosis
Impaired circulation and skin breakdown
Decreased appetite and constipation
Urinary stasis and infection
Altered sleep patterns, pain, depression, anger
and anxiety
82. Correct body alignment is important to prevent
undue strains on joints, muscles, tendons, and
ligaments while maintaining balance
Maintaining balance involves keeping the spine
in vertical alignment, body weight close to the
center of gravity, and feet spread for a broad
base of support
83. Using the body’s major muscle groups and
natural levers and fulcrums allows for
coordinated movement to avoid
musculoskeletal strain and injury
Assess the situation before acting sothat you
can plan to use good body mechanics
Use the large muscle groups in the legs to
provide force for movement. Keep the back
straight with hips and knees bent. Slide, roll,
push or pull rather than lift an object
84. Perform work at the appropriate height for
your position, close to your center of gravity
Use mechanical lifts and/or assistance to ease
the movement
85. Assess the patient. Know the patient’s medical
diagnosis, capabilities, and any movement not
allowed. Put in place braces or any device the
patient wears before helping from bed
Assess the patient’s ability to assist with
planned movement. Patients should be
encouraged to assist on their own transfer.
Encouraging the patient to perform tasks that
are within their capabilities promotes
independence. Eliminating or reducing
unnecessary tasks by the nurse reduces the risk
for injury
86. Assess the patient’s ability to understand
instruction and cooperate with the staff to
achieve the movement
Ensure enough staff is available and present
to safely move the patient
Assess the area for clutter, accessibility to
the patient and availability of devices.
Remove obstacle that may make moving
and lifting inconvenient
87. Decide which equipment to use. Handling aids
should be used whenever possible to help
reduce risk of injury to patients and nurse
Plan carefully what you will do before moving
or lifting a patient. Assess the mobility of the
attached equipments. You may injure the
patient or yourself if you have not planned
well. If necessary, enlist the support of another
nurse. Communicate the plan with the staff
and patient to ensure coordination
88. Explain to the patient what you plan to do.
Then use what abilities the patient has to
assist you. This often decreases the effort
required & injury
If the patient is in pain, administer the
prescribed analgesic sufficiently in advance
of the transfer to allow the patient
participate in the move comfortably
Elevate the bed to a point comfortable and
safe to you
89. Lock the wheels of the bed, wheelchair or
stretcher so that they do not slide while you are
moving the patient.
Be sure that the patient is in good body
alignment while being moved and lifted to
protect the patient from strain
Support the patient’s body well. Avoid
grabbing and holding an extremity by its
muscles
Avoid friction on the patient’s skin during
moving. Use drawsheet if available
90. Move your body and the body of the patient
in a smooth rhythmic motion. Avoid jerky
movements
Use mechanical devices in moving the
patient. Make sure that you are
knowledgeable on how it is being used
Assure equipments meets weight
requiremnts and weight capacities
