VOPP MUSCLSK TRAUM part 3

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Rehabilitation Related to Specific Fractures:

Rehabilitation Related to Specific Fractures Clavicle Use of clavicular strap or sling Exercises Limitation of activities Do not elevate arm above shoulder for approximately 6 weeks Humeral neck and shaft fractures Slings and bracing Activity limitations and pendulum exercises

Fracture of Clavicle and Immobilization Device:

Fracture of Clavicle and Immobilization Device

Prescribed Shoulder Exercises (Clavicle Fractures):

Prescribed Shoulder Exercises (Clavicle Fractures)

Immobilizers for Proximal Humeral Fractures:

Immobilizers for Proximal Humeral Fractures

Functional Humeral Brace:

Functional Humeral Brace

Rehabilitation Related to Specific Fractures:

Rehabilitation Related to Specific Fractures Elbow fractures Monitor regularly for neurovascular compromise and signs of compartment syndrome Potential for Volkmann's contracture Active exercises and ROM are encouraged to prevent limitation of joint movement after immobilization and healing (4–6 weeks for nondisplaced, casted) or after internal fixation (about 1 week) Radial, ulnar, wrist, and hand fractures Early functional rehabilitation exercises Active motion exercises of fingers and shoulder

Rehabilitation Related to Specific Fractures:

Rehabilitation Related to Specific Fractures Pelvic fractures Management depends on type and extent of fracture and associated injuries. Stable fractures are treated with a few days of bed rest and symptom management. Early mobilization reduces problems related to immobility. Hip fracture Surgery is usually done to reduce and fixate the fracture. Care is similar to that of a patient undergoing other orthopedic surgery or hip replacement surgery.

Pelvic Bones:

Pelvic Bones

Stable Pelvic Fractures:

Stable Pelvic Fractures

Unstable Pelvic Fractures:

Unstable Pelvic Fractures

Regions of the Proximal Femur:

Regions of the Proximal Femur

Examples of Internal Fixation for Hip Fractures:

Examples of Internal Fixation for Hip Fractures

Rehabilitation Related to Specific Fractures:

Rehabilitation Related to Specific Fractures Femoral shaft fractures Lower leg, foot, and hip exercises to preserve muscle function and improve circulation Early ambulation stimulates healing. Physical therapy, ambulation and weight bearing are prescribed. Active and passive knee exercises are begun as soon as possible to prevent restriction of knee movement.

Femoral Fractures:

Femoral Fractures

Nursing Process: The Care of the Patient With Fracture of the Hip—Assessment:

Nursing Process: The Care of the Patient With Fracture of the Hip—Assessment Health history and presence of concomitant problems Pain VS, respiratory status, LOC, and signs and symptoms of shock Affected extremity including frequent neurovascular assessment Bowel and bladder elimination; bowel sounds, I&O Skin condition Anxiety and coping

Nursing Process: The Care of the Patient With Fracture of the Hip—Diagnoses:

Nursing Process: The Care of the Patient With Fracture of the Hip—Diagnoses Acute pain Impaired physical mobility Impaired skin integrity Risk for impaired urinary elimination Risk for ineffective coping Risk for disturbed thought processes

Collaborative Problems and Potential Complications:

Collaborative Problems and Potential Complications Hemorrhage Peripheral neurovascular dysfunction DVT Pulmonary complications Pressure ulcers

Nursing Process: The Care of the Patient With Fracture of the Hip—Planning:

Nursing Process: The Care of the Patient With Fracture of the Hip—Planning Major goals may include relief of pain; achievement of a pain-free, functional, and stable hip; a healed wound; maintenance of normal urinary elimination pattern; use of effective coping mechanisms; remains oriented and participates in decision making; and absence of complications.

Relief of Pain:

Relief of Pain Administer analgesics as prescribed Use of Buck’s traction as prescribed Handle extremity gently Support extremity with pillows and when moving Positioning for comfort Frequent position changes Alternative pain relief methods

Prompting Physical Mobility:

Prompting Physical Mobility Maintain neutral position of hip Use trochanter rolls Maintain abduction of hip Isometric, quad-setting, and gluteal-setting exercises Use of trapeze Use of ambulatory aids Consultation with physical therapy

Nursing Process: The Care of the Patient With Fracture of the Hip—Interventions:

Nursing Process: The Care of the Patient With Fracture of the Hip—Interventions Use aseptic technique with dressing changes Avoid or minimize use of indwelling catheters Supporting coping Provide and reinforce information Encourage patient to express concerns Support coping mechanisms Encourage patient to participate in decision making and planning Consult social services or other supportive services

Nursing Process: The Care of the Patient With Fracture of the Hip—Interventions:

Nursing Process: The Care of the Patient With Fracture of the Hip—Interventions Orient patient to and stabilize the environment Provide for patient safety Encourage participation in self-care Encourage coughing and deep breathing exercises Ensure adequate hydration Apply TED hose or SCDs as prescribed Encourage ankle exercises Patient and family teaching

Common Sports-Related Injuries:

Common Sports-Related Injuries Contusions, strains, sprains, and dislocations Rotator cuff tears Epicondylitis Lateral and medial collateral ligament Cruciate ligament injury Meniscal injuries Rupture of Achilles tendon Fractures

Knee Ligaments, Tendons, and Menisci:

Knee Ligaments, Tendons, and Menisci

Prevention of Sports-Related Injuries:

Prevention of Sports-Related Injuries Use of proper equipment; running shoes for runners, wrist guards for skaters, and so on Effective training and conditioning specific for the person and the sport Stretching before engaging in a sport or exercise has been recommended but may not prevent injury Changes in activity and stresses should occur gradually Time to “cool down” Tune in to the body; be aware of limits and capabilities Modify activities to minimize injury and promote healing

Occupational-Related Injuries:

Occupational-Related Injuries Common injuries include strains, sprains, contusions, fractures, back injuries, tendonitis, and amputations. Prevention measures may include personnel training, proper use of equipment, availability of safety and other types of equipment (patient-lifting equipment, back belts), correct use of body mechanics, and institutional policies.

Rehabilitation of Patients With Amputation:

Rehabilitation of Patients With Amputation Amputation may be congenital or traumatic or caused by conditions such as progressive peripheral vascular disease, infection, or malignant tumor. Amputation is used to relieve symptoms, improve function, and save the person's life. The health care team needs to communicate a positive attitude to facilitate acceptance and participation in rehabilitation.

Levels of Amputation:

Levels of Amputation

Rehabilitation Needs:

Rehabilitation Needs Psychological support Prostheses fitting and use Physical therapy Vocational or occupational training and counseling Use a multidisciplinary team approach Patient teaching

Question:

Question Is the following statement true or false? Phantom limb pain is perceived in the amputated limb.

Answer:

Answer True Phantom limb pain is perceived in the amputated limb.

Nursing Process: The Care of the Patient With an Amputation—Assessment:

Nursing Process: The Care of the Patient With an Amputation—Assessment Neurovascular status and function of affected extremity or residual limb and of unaffected extremity Signs and symptoms of infection Nutritional status Concurrent health problems Psychological status and coping

Nursing Process: The Care of the Patient With an Amputation—Diagnoses:

Nursing Process: The Care of the Patient With an Amputation—Diagnoses Acute pain Impaired skin integrity Disturbed body image Grieving Self-care deficit Impaired physical mobility

Collaborative Problems and Potential Complications:

Collaborative Problems and Potential Complications Postoperative hemorrhage Infection Skin breakdown

Nursing Process: The Care of the Patient With an Amputation—Planning :

Nursing Process: The Care of the Patient With an Amputation—Planning Major goals may include relief of pain, absence of altered sensory perceptions, wound healing, acceptance of altered body image, resolution of grieving processes, restoration of physical mobility, and absence of complications.

Nursing Process: The Care of the Patient With an Amputation—Interventions:

Nursing Process: The Care of the Patient With an Amputation—Interventions Relief of pain Administer analgesic or other medications as prescribed Changing position Putting a light sand bag on residual limb Alternative methods of pain relief: distraction, TENS unit Promoting wound healing Handle limb gently Residual limb shaping

Resolving Grief and Enhancing Body Image:

Resolving Grief and Enhancing Body Image Encourage communication and expression of feelings Create an accepting, supportive atmosphere Provide support and listen Encourage patient to look at, feel, and care for the residual limb Help patient set realistic goals Help patient resume self-care and independence Referral to counselors and support groups

Achieving Physical Mobility:

Achieving Physical Mobility Proper positioning of limb; avoid abduction, external rotation and flexion Turn frequently; prone positioning if possible Use of assistive devices ROM exercises Muscle strengthening exercises “Preprosthetic care”; proper bandaging, massage, and “toughening” of the residual limb

Educating About Self-Care:

Educating About Self-Care Encourage active participation in care Continue support in rehabilitation facility or at home Focus on safety and mobility

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