10.3 Musculoskeletal injuries and trauma

Musculoskeletal injuries can range from fractures to sprains, affecting bones, joints, and soft tissues. These injuries often result from accidents or overuse, causing pain and limiting mobility. Proper assessment and care are crucial for recovery.

Nurses play a key role in managing these injuries. From initial assessment to pain control and rehab planning, they ensure patients receive comprehensive care. Patient education on wound care, activity limits, and follow-up is also essential for optimal healing.

Common Musculoskeletal Injuries and Trauma

Common musculoskeletal injuries and trauma

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• Fractures involve a break in the continuity of a bone
  • Simple (closed) fracture occurs when the bone is broken but the skin remains intact
  • Compound (open) fracture happens when the bone is broken and the skin is pierced by the bone or by the force causing the injury
  • Common sites include the hip, wrist, vertebrae, and ankle
• Dislocations involve displacement of a bone from its normal position within a joint
  • Common sites include the shoulder, elbow, finger, and hip
• Sprains involve stretching or tearing of ligaments
  • Severity grades range from mild stretching (Grade 1) to complete tearing (Grade 3) of the ligament
  • Common sites include the ankle, knee, and wrist
• Strains involve stretching or tearing of muscles or tendons
  • Severity grades are similar to sprains
  • Common sites include the lower back, hamstring, and neck

Prioritization of nursing interventions

• Assess and maintain airway, breathing, and circulation (ABC) as the top priority
• Control bleeding and manage shock if present to prevent further complications
• Immobilize the affected area using splints, casts, or traction devices as ordered to prevent further injury
• Assess neurovascular status distal to the injury site and monitor for signs of compartment syndrome
• Administer pain medications as prescribed to manage pain and discomfort
• Assist with range of motion exercises and early mobilization as appropriate to promote healing and prevent stiffness

Pain management for musculoskeletal injuries

• Pharmacological approaches include administering analgesics as prescribed (acetaminophen, NSAIDs, opioids) while monitoring for side effects and effectiveness
• Non-pharmacological approaches involve:
  • Applying ice or cold packs to reduce swelling and pain
  • Elevating the affected limb to minimize edema
  • Encouraging deep breathing and relaxation techniques
  • Using distraction methods (music, guided imagery)
  • Providing comfortable positioning and support with pillows or foam wedges

Interdisciplinary rehabilitation planning

• Consult with physical therapists to develop individualized exercise programs focusing on improving range of motion, strength, and endurance
• Work with occupational therapists to address activities of daily living (ADLs) and adaptive equipment needs
• Coordinate with social workers to arrange for home health services or transitional care
• Communicate with physicians regarding patient progress and any complications to ensure a comprehensive approach

Patient education for post-injury care

• Wound management involves teaching proper wound care techniques, including dressing changes and signs of infection
• Immobilization devices require instruction on the correct use and care of splints, casts, or braces, as well as skin care and circulation checks for the affected area
• Activity restrictions include educating on weight-bearing limitations, the use of assistive devices (crutches, walkers), and encouraging adherence to prescribed activity levels and gradual progression
• Pain management education focuses on teaching non-pharmacological pain relief methods and the proper use of prescribed analgesics
• Follow-up care emphasizes the importance of attending follow-up appointments and physical therapy sessions to ensure proper healing and recovery