WEEK 6 - MUSCULOSKELETAL CONDITIONS

Explain how to conduct a Neurovascular Assessment on a patient experiencing a traumatic soft tissue injury and identify the relevant observations of concern

THE ASSESSMENT (5 P’S)

1. PAIN - assessing for pain level

2. PULSE (CIRCULATION) - checking the presence and quality of the distal pulse and compare the strength to the uninjured limb.

3. PALLOR (CIRCULATION) - Observe the color of the skin, nails and capillary refill time

4. PARASTHESIA (SENSATION) - ask the patient if they can experience any numbness, tingling, or ‘pins and needles’ 

5. PARALYSIS (MOTION) - assess motor function by asking the patient to move the joints distal to the injury. E.g.  finger or toes 

State and describe the four (4) stages of bone healing.

1. HEMATOMA FORMATION - INFLAMMATORY PHASE: few hr to days

• hematoma (a large blood clot) seals the gap and serves as a temporary scaffolding —> platlets + inflammatory cells released —→ triggering acute inflammatory response = localised pain and swelling.

2. GRANULATION TISSUE - SOFT CALLUS FORMATION: 4 days - 3 weeks

• hematoma is replaced by granulation tissue (fibrocartilage and soft woven bone). —> forms soft callus —> bridges the fracture gap but is not yet stable

3. CALLUS OSSIFICATION - HARDING OF CALLUS:

• soft callus is gradually hardened —> more stable and bony union visible on X-ray. allowing the bone to withstand gentle stress.

4. CONSOLIDATION AND REMODELING:

• long-term process involves osteoclasts resorbing the bulky access callus —> the woven bone is replaced by organised, mature lamellar bone. —> bone gradually reshapes to its original structure and strength.

Identify the different types of fractures.

• classification by skin integrity - either simple (closed) or compound (open)

• classification by fracture line/shape - transverse, oblique, spiral, comminuted, impacted, greenstick and Avulsion

• classification by displacement- displaced and non-displaced

• other specific type - pathologic, stress (fatigue), compression

Describe the priority nursing assessments and interventions you would implement when a person has experienced a traumatic fracture.

PRIORITY AX:

1. primary survey - ABCs and vital signs

2. Neurovascular Ax - 5 P’s

3. Fracture site Ax - Inspection, temperature

PRIORITY INTERVENTION:

1. pain management and comfort - immobilisation, analgesia or elevation and cold.

2. preventing complications - open fracture care (infection), monitoring, preparation for surgery

Explain the potential complications of long bone fractures and identify the associated priority nursing assessments.

POTENTIAL COMPLICATIONS OF LONG BONE FRACTURE 

1. VASCULAR AND NEUROLOGICAL COMPROMISE:

• vascular injury 

• nerve injury 

2. COMPARTMENT SYNDROME 

• irreversible muscle and nerve damage within hours.

3. SYSTEMATIC COMPLICATION (LIFE-THREATENING)

• Hemorrhage/ hypovolemic shock 

• fat embolism syndrome (FES)

4. DELAYED/ CHRONIC COMPLICATION 

• delayed union or nonunion - delayed healing or fails to heal altogether. 

• osteomyelitis - infection of the bone

Describe the priority nursing assessments and interventions you would implement when a person has experienced an acute soft tissue injury. 

PRIORITY AX

1. NEUROVASCULAR AX - 5 P’s

2. PAIN AND INJURY SITE AX - pain, inspection, functioning 

PRIORITY INTERVENTION

1. PAIN AND SWELLING MANAGEMENT - RICE and analgesia 

2. SAFETY AND EDUCATION 

Explain the key preoperative and postoperative instructions you would provide a patient who requires surgery for a bone fracture.

PREOPERATIVE INSTRUCTIONS:

• NPO status and ceased meds

• Pain and swelling management - immobilization and RICE

• infection control - antibiotics, hygiene

POSTOPERATIVE INSTRUCTIONS;

• pain management - meds and ice and elevation

• neurovascular monitoring - 5 p’s

• wound and dressing care - clean and dry, sutures and staples

• mobility and rehabilitation - weight bearing status, physical therapy

• signs of complications - monitor for SOB, DVT, fat embolism 

Describe the purpose of a Primary Survey Assessment.

To rapidly identify and manage immediate, life-threatening injuries and conditions injuries

• life before limb - interventions target fatal conditions like airways over broken bones

• sequential prioritisation - ABCDE

• rapid identification - to move on to treatment

Identify the components of a Primary Survey.

AIRWAY - jaw -thrust maneuver 

BREATHING - high-fowler supplemental oxygen

CIRCULATION - control massive external bleeding immediately 

DISABILITY - identify and treat immediate causes of altered Loss of consciousness. E.G. hypoglycemia, severe hypoxia 

EXPOSURE AND ENVIRONMENT - cover the pt with warm blankets to prevent hypothermia

In developing a care plan for a patient with an open reduction and internal fixation of an open fracture of the tibia, a priority nursing diagnosis/problem identification is? 

risk of infection related to disruption of skin integrity

A patient has just arrived in the emergency department after sustaining multiple injuries in a fall from the roof of a house. What is the immediate care priority for the patient?

Maintain a patent airway

During the primary assessment of a trauma victim, the nurse determines that the patient has a patent airway. The next assessment the nurse makes includes?

the status of the patient’s respirations