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Chapter 62: Caring for Clients w/ Traumatic Musculoskeletal Injuries

front 1 Complications from this in older adults often lead to death	back 1 Hip Fractures
front 2 injury to a muscle when it is stretched or pulled beyond its capacity	back 2 Strain
front 3 soft tissue injury result from a blow or blunt trauma confined to the soft tissues and does not affect the musculoskeletal structure	back 3 Contusion
front 4 injuries to ligaments surrounding a joint result from sudden, unusual movement or stretching around a joint common w/ falls or other accidental injuries	back 4 Sprain

front 5 sprain of the cervical spine	back 5 Whiplash injury
front 6 This client presents w/ an injured area that is painful and swollen avoids full weight bearing or using the injured joint/limb ecchymosis	back 6 Strain Sprain Contusion
front 7 Medical and surgical tx for clients w/ a sprain, strain, or contusion	back 7 apply ice or chemical cool pack for the first 24-48 hours compression of an elastic bandage after 2 days when swelling is not likely to increase, heat may be used to reduce pain NSAIDs
front 8 Acronym for remembering the tx for strains, sprains, and contusions?	back 8 P: protection from further injury R: rest I: ice C: compression E: elevation

front 9 occur when the articular surfaces of a joint are no longer in contact	back 9 Dislocations
front 10 partial dislocation	back 10 Subluxation
front 11 This client presents w/: reports hearing a "popping" sound complaint that their joint just gave out, implying that joint isn't supportive and is unstable structural shape of joint is altered depression in joint's circumference ROM limited swelling, coolness, tingling, numbness, and a pale/dusky color of distal tissue	back 11 Dislocation
front 12 Medical/surgical management for clients w/ a dislocation?	back 12 pcp manipulates the joint or reduces the displace parts until they return to normal position, then immobilizes the joint w/ an elastic bandage, cast, or splint for several weeks may receive local or general anesthesia before the manipulation is performed surgery

front 13 Nursing management for clients w/ dislocations?	back 13 analgesics elevating and immobilizing the affected limb applying cold packs neurovascular assessments q 30 minutes for several hours and at least q 2-4 hours for the next 1-2 days to detect any complications (ex. compartment syndrome)
front 14 REVIEW CLIENT AND FAMILY TEACHING 62-1: PREVENTING SPORTS AND/OR WORK-RELATED INJURIES	back 14 REVIEW CLIENT AND FAMILY TEACHING 62-1: PREVENTING SPORTS AND/OR WORK-RELATED INJURIES
front 15 inflammation of a tendon caused by overuse causes are due to trauma and repeated stress ex. carpal tunnel syndrome, epicondylitis, ganglion cyst	back 15 Tendinitis
front 16 painful inflammation of the elbow	back 16 Epicondylitis

front 17 cystic mass that develops near tendon sheaths and joints of the wrist	back 17 Ganglion cyst
front 18 group of symptoms located in the carpal tunnel of the wrist	back 18 Carpal tunnel syndrome
front 19 This client reports: pain radiating down the dorsal surface of the forearm and a weak grasp	back 19 Epicondylitis
front 20 This client presents w/: pain/burning in one or both hands, which may radiate to the forearm and shoulder in severe cases pain is more prominent at night and early morning shaking the hands may reduce the pain by promoting movement of edematous fluid from the carpal canal sensation may be lost in the thumb, index, middle, and ring finger client may be unable to flex the index and middle fingers to make a fist flexion of the wrist usually causes immediate pain and numbness dx'd w/ tinel's sign and phalen sign	back 20 Carpal tunnel syndrome

front 21 test that elicits tingling, numbness, and pain for clients w/ carpal tunnel syndrome	back 21 Tinel's sign
front 22 involves having the client flex the wrist for 30 seconds to determine if pain or numbness occurs, indicating a positive sign for carpal tunnel syndrome	back 22 Phalen sign
front 23 Medical and surgical management for clients w/ tendinitis?	back 23 applications of cold and heat NSAIDs rest Carpal tunnel: rest hands and splint hands and wrist, along w/ NSAIDs
front 24 Nursing management for clients w/ tendinitis?	back 24 provide info about meds, such as taking NSAIDs w/ food show clients how to use and care for splints and perform related ROM exercises Teach client to: - rest joint in a position that reduces stress - support affect limb on pillows - apply cold packs for the first 24-48 hours to reduce pain and swelling - gradually increase joint movement - avoid working or lifting above shoulder level - perform ROM and strengthening exercises as prescribed

front 25 This client presents w/: pain w/ movement and limited mobility of the shoulder or arm have difficulty w/ activities that involve stretching their arms above their heads pain is worse at night not able to sleep on affected side pain is the acromioclavicular joint	back 25 Rotator cuff injury
front 26 Medical management for clients w/ rotator cuff injury	back 26 NSAIDS pcp advises client to modify their activities and to rest the joint corticosteroid injections into the joint surgery
front 27 This client presents w/: a blow or twist while hyperextending the knee pain instability of the joint difficult ambulating twisting of the knee knees that 'gave away' or buckled	back 27 Injuries of the knee (meniscal injuries)
front 28 When the ACL or PCL tears, what may be client report?	back 28 popping sound or tearing sensation

front 29 Medical/Surgical tx for clients w/ meniscal injuries?	back 29 initial, immobilize joint and limit weight-bearing NSAIDs ice for first 24 hours gradual intro to activity physical rehab surgical procedures - arthrocentesis: drains any bloody fluid - meniscectomy
front 30 this happens as the client engages in activity and the calf muscle contracts suddenly, while the foot is firmly grounded in place often a loud pop client experiences severe pain and inability to plantar flex the affected foot	back 30 Ruptured Achilles Tendon
front 31 Medical/surgical management for ruptured achilles tendon?	back 31 surgical repair client wears cast/brace 6-8 weeks post-surgery physical therapy
front 32 Nursing management for clients w/ a Ruptured Achilles tendon?	back 32 teach about activity restrictions, use of ambulatory aids, and pain management pre and post-op surgery instructions

front 33 a break in the continuity of a bone	back 33 Fracture
front 34 a fracture in which bone has splintered into several fragments?	back 34 comminuted fracture
front 35 a fracture in which damage also involves the skin or mucous membrane	back 35 compound fracture
front 36 a fracture in which fragments are driven inward	back 36 depressed fracture

front 37 a fracture in which one side of a bone is broken and the other side is bent	back 37 greenstick fracture
front 38 fracture that remains contained; does not break the skin	back 38 simple fracture
front 39 a fracture twisting around the shaft of the bone seen mostly in kids	back 39 spiral fracture
front 40 s/s of a fracture	back 40 pain loss of function deformity false motion: unnatural motion occurs at the site of the fracture crepitus: grating sound of bone ends moving over one another; 'popping sound' edema spasm

front 41 Medical and surgical management for clients w/ fractures?	back 41 the goal is to reestablish functional continuity of the bone traction open/closed reduction internal or external fixation cast application
front 42 Nursing management for clients w/ fractures:	back 42 administering analgesics comfort measures assisting w/ adl's prevent constipation promoting physical mobility preventing infection preparing client for self-care review care w/ family reassure client that w/ gradual exercise and use, muscles will regain strength and tone, and joints will be flexible
front 43 a fracture that is commonly seen in automobile accidents, but may also occur in falls from ladders or gunshot wounds severe pain, swelling, and ecchymosis may be seen	back 43 Femur fracture
front 44 Medical/surgical tx for client's w/ femur fractures?	back 44 initially, some form of traction to prevent deformities and soft tissue injury spica cast may be used to maintain corrected position after traction

front 45 Nursing tx for clients w/ femur fractures:	back 45 implement measures to prevent complications of immobility and inactivity position the client in line w/ the pull exerted by the traction clean pin sites w/ a prescribed agent to prevent infection
front 46 affects the proximal end of the femur results from a fall occurs more often in older adults w/ osteoporosis	back 46 Fractured hip
front 47 Client reports: pain that increases w/ leg movement pain radiates to knee sensation of pressure in the outer aspect of the hip muscle spasms extensive bruising and swelling of the hip, groin, thigh	back 47 Hip Fracture
front 48 large blood loss from subtrochanteric and intertrochanteric fractures can lead to ?	back 48 hypovolemic shock

front 49 Medical/surgical management for clients w/ hip fractures?	back 49 surgery (hip arthroplasty; hemiarthroplasty) refer to chapter 61 for other tx of fractures
front 50 Nursing management for clients w/ hip fractures?	back 50 implement measures to prevent infection, skin breakdown, pneumonia, constipation, urinary retention, muscle atrophy, and contractures monitor wound drainage and administer antibiotics show client how to use overhead trapeze safely use trochanter rolls to maintain a neutral position
front 51 If a client has a hip prosthesis inserted, what are some nursing interventions that should be done?	back 51 ABDUCTION!!! IS KEY!: abduction pillow at all times assist the client from the bed to a chair, but chair must have an elevated seat so the client doesn't flex hips beyond 90 degrees explore ways to ensure safety in the client's room to avoid future falls and injuries