Interventions for Musculoskeletal Injury Complications

Nursing interventions for fractures are based on the cause and location of injury and the patient’s overall condition. Immediate Management Includes: Treat life-threatening injuries first. If unresponsive, assess airway, breathing, and circulation. If responsive, take actions to prevent possible secondary organ damage including providing oxygen and IV fluids. Control external bleeding with direct pressure or sterile pressure dressing and elevation of the extremity. With labored, shallow breathing, patient's are at risk for respiratory compromise. Administering oxygen inhalation is a priority nursing intervention to promote tissue perfusion and oxygenation.

Secondary Management Includes: Assess neurovascular and cardiovascular condition distal to injury before and after splinting. Notify provider immediately of signs of tissue ischemia or compromised neurovascular status. Elevate injured limb if possible. Do not attempt to straighten fractured or dislocated joints. Do not manipulate protruding bone ends. Apply ice packs to affected area. Mark location of pulses to facilitate repeat assessment.

Collaborative Management: Assess neurovascular and cardiovascular condition distal to injury before and after splinting. Notify provider immediately of signs of tissue ischemia or compromised neurovascular status. Elevate injured limb if possible. Do not attempt to straighten fractured or dislocated joints. Do not manipulate protruding bone ends. Apply ice packs to affected area. Mark location of pulses to facilitate repeat assessment.

Ongoing Management Includes: Assess vital signs, level of consciousness, O2 saturation, neurovascular condition, pain. Assess for compartment syndrome characterized by excessive pain, pain with passive stretch of the affected extremity muscles, pallor, edema, and paresthesia (with late signs of paralysis and pulselessness). Assess for signs of fat embolism (dyspnea, chest pain, temperature elevation). Rib Fractures: Assess for Hemoptysis = bloody sputum, a sign of lung trauma that indicates respiratory compromise & Low oxygen saturation. The nurse should check the oxygen saturation in a patient with rib fractures; this could indicate potential lung damage.

Interventions for Muscle Atrophy

Isometric exercises: strength exercise type - Tightening or tensing of muscles without moving body parts.  Uses the bodies own weight, resistance bands, or everyday objects such as doorknobs or towels. Performing a plank is one type of full-body isometric exercise that uses just your body weight and no equipment. Ex.) Yoga, Pilates

Interventions for Contractures

Contractors are the shortening and hardening of muscles, tendons, or other tissue. These often lead to deformities and rigidity of joints.

Interventions include frequent position changes, correct body alignment, active and passive range of motion, and stretching of tendons and ligaments.

Interventions for Plantar-Fexion

Persistent plantar-flexion leads to a shortened Achilles tendon. It also may be caused by peroneal nerve palsy. Interventions include ambulation, gait training, splinting, and use of a boot.

Therapeutic Measures

Apply ice to the fracture site for first 24 hours. Check with health care provider before getting fiberglass cast wet. Dry cast thoroughly if inadvertently exposed to water. Elevate extremity above level of heart for first 48 hours. Move joints above and below cast. Use hair dryer on cool setting for itching inside the cast. Keep appointment to have fracture and cast checked. Remain non-weight bearing on new cast for 48 hours unless otherwise instructed by health care provider.