Complications from this in older adults often lead to death

Hip Fractures

injury to a muscle when it is stretched or pulled beyond its capacity

Strain

soft tissue injury result from a blow or blunt trauma

• confined to the soft tissues and does not affect the musculoskeletal structure

Contusion

injuries to ligaments surrounding a joint

• result from sudden, unusual movement or stretching around a joint
• common w/ falls or other accidental injuries

Sprain

sprain of the cervical spine

Whiplash injury

This client presents w/

• an injured area that is painful and swollen
• avoids full weight bearing or using the injured joint/limb
• ecchymosis

• Strain
• Sprain
• Contusion

Medical and surgical tx for clients w/ a sprain, strain, or contusion

• 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

Acronym for remembering the tx for strains, sprains, and contusions?

• P: protection from further injury
• R: rest
• I: ice
• C: compression
• E: elevation

occur when the articular surfaces of a joint are no longer in contact

Dislocations

partial dislocation

Subluxation

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

Dislocation

Medical/surgical management for clients w/ a dislocation?

• 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

Nursing management for clients w/ dislocations?

• 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)

REVIEW CLIENT AND FAMILY TEACHING 62-1: PREVENTING SPORTS AND/OR WORK-RELATED INJURIES

REVIEW CLIENT AND FAMILY TEACHING 62-1: PREVENTING SPORTS AND/OR WORK-RELATED INJURIES

inflammation of a tendon caused by overuse

• causes are due to trauma and repeated stress
• ex. carpal tunnel syndrome, epicondylitis, ganglion cyst

Tendinitis

painful inflammation of the elbow

Epicondylitis

cystic mass that develops near tendon sheaths and joints of the wrist

Ganglion cyst

group of symptoms located in the carpal tunnel of the wrist

Carpal tunnel syndrome

This client reports:

• pain radiating down the dorsal surface of the forearm and a weak grasp

Epicondylitis

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

Carpal tunnel syndrome

test that elicits tingling, numbness, and pain for clients w/ carpal tunnel syndrome

Tinel's sign

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

Phalen sign

Medical and surgical management for clients w/ tendinitis?

• applications of cold and heat
• NSAIDs
• rest
• Carpal tunnel: rest hands and splint hands and wrist, along w/ NSAIDs

Nursing management for clients w/ tendinitis?

• 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

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

Rotator cuff injury

Medical management for clients w/ rotator cuff injury

• NSAIDS
• pcp advises client to modify their activities and to rest the joint
• corticosteroid injections into the joint
• surgery

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

Injuries of the knee (meniscal injuries)

When the ACL or PCL tears, what may be client report?

popping sound or tearing sensation

Medical/Surgical tx for clients w/ meniscal injuries?

• 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

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

Ruptured Achilles Tendon

Medical/surgical management for ruptured achilles tendon?

• surgical repair
• client wears cast/brace 6-8 weeks post-surgery
• physical therapy

Nursing management for clients w/ a Ruptured Achilles tendon?

• teach about activity restrictions, use of ambulatory aids, and pain management
• pre and post-op surgery instructions

a break in the continuity of a bone

Fracture

a fracture in which bone has splintered into several fragments?

comminuted fracture

a fracture in which damage also involves the skin or mucous membrane

compound fracture

a fracture in which fragments are driven inward

depressed fracture

a fracture in which one side of a bone is broken and the other side is bent

greenstick fracture

fracture that remains contained; does not break the skin

simple fracture

a fracture twisting around the shaft of the bone

• seen mostly in kids

spiral fracture

s/s of a fracture

• 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

Medical and surgical management for clients w/ fractures?

the goal is to reestablish functional continuity of the bone

• traction
• open/closed reduction
• internal or external fixation
• cast application

Nursing management for clients w/ fractures:

• 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

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

Femur fracture

Medical/surgical tx for client's w/ femur fractures?

• initially, some form of traction to prevent deformities and soft tissue injury
• spica cast may be used to maintain corrected position after traction

Nursing tx for clients w/ femur fractures:

• 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

• affects the proximal end of the femur
• results from a fall
• occurs more often in older adults w/ osteoporosis

Fractured hip

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

Hip Fracture

large blood loss from subtrochanteric and intertrochanteric fractures can lead to ?

hypovolemic shock

Medical/surgical management for clients w/ hip fractures?

• surgery (hip arthroplasty; hemiarthroplasty)
• refer to chapter 61 for other tx of fractures

Nursing management for clients w/ hip fractures?

• 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

If a client has a hip prosthesis inserted, what are some nursing interventions that should be done?

• 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