Nursing Considerations for Musculoskeletal Injuries

Reducing Accidents and Musculoskeletal Injuries

• Common Causes:
  • Traumatic events causing fractures, dislocations, subluxations, soft tissue injuries.
  • Accidents ranked among top 3 causes of death (ages 1-64).
• Nursing Role:
  • Educate about safety and accident prevention.
  • Encourage the use of safety equipment and compliance with safety regulations (Box 67.1).

Preventing Musculoskeletal Injuries

• General Safety Practices (Box 67.1):

  • Wear seatbelts
  • Drive within speed limits
  • Avoid distractions (e.g., texting)
  • Do not drive under influence of substances
  • Warm-up before exercise
  • Use protective equipment for sports
  • Use proper safety equipment at work

• Fall Prevention Strategies (Box 67.2):

  • Assess home and work environments for risks
  • Wear appropriate footwear (non-skid, well-fitted shoes)
  • Maintain visibility and remove hazards (e.g., rugs)

Teaching Older Adults

• Encourage regular moderate exercise for muscle strength and balance.
• Emphasize calcium and vitamin D intake for bone health.
• Key Instructions (Table 67.1):
  • Use ramps instead of stairs
  • Avoid wet or slippery surfaces
  • Use assistive devices like walkers or canes

Common Soft Tissue Injuries

• Types Include:
  • Sprains, strains, dislocations, subluxations stemming from trauma.
• Increased Incidence:
  • Associated with sports and fitness activities.

Specific Injuries and Treatments

• Sprains versus Strains:
  • Sprains: Injury to ligaments from twisting; classified by severity:
  • 1st degree: Mild, few fibers torn
  • 2nd degree: Moderate, some tearing
  • 3rd degree: Severe, complete tear
  • Strains: Excessive stretching of muscle/tendon, also graded similarly.
• Symptoms Include:
  • Pain, swelling, decreased function, bruising.

RICE Method for Injury Treatment

• Rest, Ice, Compression, Elevation:
  • Used immediately after injury to manage pain and swelling.
  • Ice reduces pain; apply for 20-30 minutes.
  • Compression bandaging helps edema.
  • Elevate above heart level to reduce swelling.

Dislocations and Subluxations

• Complete or partial joint displacement causing pain, swelling, and limited movement.
• Most Common Joints: Shoulder, elbow, knee.

Compartment Syndrome

• Increased pressure within muscles causing ischemia, most often due to fractures.
• Clinical Signs: Severe pain, paresthesia, pallor, pulselessness.

Diagnostic and Treatment Considerations

• X-rays help determine fractures or soft tissue injuries.
• Pain management and gradual rehabilitation critical for recovery.

Fracture Classification

• Open vs. Closed Fractures:
  • Open: Skin broken, bone exposed.
  • Closed: Skin intact, no exposure.
• Complete vs. Incomplete Fractures:
  • Complete: Full break through the bone shaft.
  • Incomplete: Partly across; usually due to bending forces.

Fracture Treatment Goals

• Overall Goals:
  • Anatomic realignment, immobilization, restore function.
• Interventions include:
  • Manual traction, closed or open reduction, surgical fixation.

Postoperative Care and Rehabilitation

• Regular neurovascular assessments.
• Supportive care, pain management, and early mobility.
• Monitor for signs of complications (VTE, infection).

Patient Education for Fracture Care

• Key Instructions:
  • Daily limb checks, report excessive pain, wear prescribed devices.
  • Maintain an exercise regimen for strength and mobility.
  • Adjust home environment to minimize fall risks.

Joint Surgeries: Goals and Types

• Aimed at pain relief and restoring function.
• Types include:
  • Synovectomy, osteotomy, debridement, arthroplasty.
  • Arthroplasty most common for severe OA, RA.
  • Postoperative care focuses on recovery and rehabilitation, monitoring for complications such as infection and VTE.