DA

Musculoskeletal

Core Concepts

  • Functional ability, infection, mobility, pain, perfusion, safety are the priority nursing focuses in musculoskeletal disorders.

  • Nurses must be able to:

    • Recognize fracture signs & complications.

    • Perform neurovascular checks (5 Ps).

    • Anticipate and prevent complications like compartment syndrome, infection, and delayed healing.

Clinical Manifestations of Fractures

1. Bruising

  • Discoloration distal to injury from blood leakage into tissue.

  • Nursing note: Reassure patient — normal process, will resolve.

2. Crepitation

  • Crunching or grating sensation from bone fragments.

  • Significance: May increase risk of nonunion if excessive movement occurs.

3. Deformity

  • Abnormal alignment or contour.

  • Classic sign of fracture.

4. Edema & Swelling

  • From bleeding or tissue disruption.

  • Risk: Can impair circulation & nerves → compartment syndrome.

5. Loss of Function

  • Inability to use limb due to bone/joint disruption.

  • Requires proper management for restoration of mobility.

6. Muscle Spasm

  • Reflex contraction after injury.

  • Risk: Can worsen displacement.

7. Pain & Tenderness

  • Caused by spasm, nerve pressure, and movement of bone fragments.

  • Nursing note: Splint and immobilize to decrease pain.

Diagnostic Tests

  • X-ray – primary test, shows alignment and fracture.

  • CT – detailed imaging (complex fractures).

  • MRI – soft tissue and occult fractures.

Types of Fractures

  1. Open vs Closed

    • Open: Skin broken → bone exposed. Infection risk.

    • Closed: Skin intact.

  2. Displaced vs Nondisplaced

    • Displaced: Ends separated, out of position.

    • Nondisplaced: Fragments aligned.

  3. Complete vs Incomplete

    • Complete: Break goes fully through bone.

    • Incomplete: Partial break, e.g., greenstick fracture in children.

Emergency & Nursing Management

Emergency Care Priorities

  • Immobilize fracture (splints, traction if ordered).

  • Cover open wounds with sterile dressing.

  • Do not attempt to realign bones unless trained.

  • Neurovascular checks = essential (before & after immobilization).

Nursing Assessments

Cardiovascular

  • Reduced/absent pulses distal to injury.

  • Delayed capillary refill, cool skin.

Neurovascular (“5 Ps”)

  • Pain (out of proportion, unrelieved by meds).

  • Pallor (skin pale or bluish).

  • Pulselessness (late sign).

  • Paresthesia (numbness, tingling).

  • Paralysis (loss of movement).

General

  • Apprehension, guarding, restricted function.

Skin

  • Pallor, coolness, bruising, edema, lacerations.

Musculoskeletal

  • Abnormal angulation or deformity.

Complications to Monitor

  • Compartment Syndrome:

    • Increased pressure in closed muscle compartment → impaired circulation.

    • S/S: Severe pain unrelieved by opioids, paresthesia, pulselessness (late).

    • Treatment: Remove restrictive dressings/casts, fasciotomy.

  • Infection:

    • Open fractures → osteomyelitis risk.

  • Fat Embolism Syndrome (FES):

    • Fat globules enter bloodstream after long bone/pelvic fracture.

    • S/S: Respiratory distress, petechiae on chest/axilla, neuro changes.

  • DVT/PE:

    • Immobility → clot formation.

    • Prevention: Early mobilization, anticoagulants, compression devices.

  • Delayed union/nonunion:

    • Bone fails to heal correctly.

Testable NCLEX Points

  • Neurovascular checks = priority.

  • Compartment syndrome hallmark: Pain not relieved by opioids.

  • Immobilization: Splint joints above and below fracture.

  • Open fracture priority: Prevent infection (cover with sterile dressing).

  • Fat embolism hallmark: Petechiae on chest/axilla + hypoxemia.

  • Cast care:

    • Keep dry, no objects inside.

    • Monitor circulation.

  • Traction: Maintain alignment, weights free-hanging, assess skin.