3. Specific soft tissue injuries: includes the skin,
muscles, tendons, ligaments, nerves, and
blood vessels. It can occur with or without a
bony injuries.
Introduction:
4. It is a closed wound in which a ruptured
blood vessel has hemorrhaged into the
surrounding tissues. The blood may form a
hematoma if bleeding is sufficient and has
been contained. This can result from blunt
external forces or external stresses.
Definition:
5. Swelling
Discoloration (bruising)
/Ecchymosis: Bluish lesion at earliest stages of onset
Tenderness
Discomfort
6. Physical activities
Sports
Abusive relationships
Patients who takes anticoagulant therapy
Who have history of clotting disorders
(Hemophilia, Leukemia)
7. 1.Subjective data collection:
- History of present injury/chief complaint:
1. Direct blow to affected area
2. Object of contact
3. Onset of swelling, discoloration
4. Therapies initiated to relieve symptoms
- Past medical history:
Current preexisting disease/illness: (PVD, clotting factor
deficiencies, hemophilia, Leukemia).
- Medication history: (anticoagulant, anti-platelets agents)
- Family history: Hemophilia
- Allergies
- Immunization status
8. 2.Objective data collection: (Physical examination)
1. General appearance: (distress and discomfort)
2. Inspection: - skin discoloration reflecting the age of contusion
- Size
- Location (Extension of ecchymosis)
3. Palpation: - Tenderness
- Temperature
9. 1) Acute pain related to injury
2) Activity intolerance related to pain
3) Impaired skin integrity related to bleed under skin
4) Deficient knowledge
5) Risk for infection
10. Insert I.V line.
Splint extremity to protect from further injury and for pain reduction
Apply pressure dressing to decrease hemorrhage and swelling
Rest and elevate affected extremity to minimize bleeding and edema.
Apply cold packs to stimulate vasoconstriction
Administer pharmacologic therapy: (anti inflammatory, pain killers)
Educate patient:
• Rest and elevate affected extremity to minimize bleeding and
edema formation
• Apply cold packs to stimulate vasoconstriction
• Apply and remove compressive dressing
• Use physical assistive devices
12. A sprain is the stretching, separation, or
tear of a supporting ligament (fibrous tissue
that connects bones),muscle, or tendon in
the region of a joint.
A strain occurs when a muscle or tendon is
overstretched, overexerted, or separated.
13. Fist degree: Minor tear in the fibers; minimal swelling,
minor discomfort, absent or minor ecchymosis.
Second degree: Partial tear; joint intact; more severe
swelling, visible ecchymosis.
Third degree: Complete disruption of ligament; joint
may be open; minimal to severe swelling; resultant
separation of muscle from muscle, muscle from tendon,
or tendon from bone.
14. Athletes
Obesity
Not warming up before activity
Past history of sprains and strains
Falls
Twisting a limb,
Sports injuries
Over-exertion.
15. Pain increased with movement.
Swelling
Bruising
Limited ability to move the affected joint
A "pop" sound may be heard or felt in the joint
16. Subjective data collection:
1) History of present injury/chief complaint:
a) Sudden stretching, twisting, or excessive force to joint (popping
sound may be heard or felt)
b) Pain in joint (ranges from localized to severe and disabling; may be
aggravated by movement, muscle tension, weight bearing)
2) Past history:
a) Current or preexisting diseases/illness (Rheumatoid arthritis,
Steroid injections are associated with tendon rupture).
b) Injury, surgery, or problems with joint.
c) Medications.
d) Allergies.
e) Immunization status.
17. Objective data collection: (Physical examination)
a) General appearance: (Gait: possible alteration, distress/discomfort)
b) Inspection: - Swelling
- Deformity of affected area
- Ecchymosis
18. c) Palpation
1. Tenderness over affected area
2. Swelling
3. Loss of motor function,
ranging from minor to severe
4. Alteration in sensation
19. a. Acute pain related to tendon/muscle over-
stretching
b. Activity intolerance related to pain
c. Anxiety/fear related to disease
d. Deficient knowledge related to disease
e. Risk for falls/injury
f. Risk for ineffective tissue perfusion
20. - Insert I.V line.
- Prepare for/assist with medical interventions
1) Ice, elevation of extremity
2) Apply splint, immobilization devices, cast
- Administer pharmacologic therapy as ordered
1) Non-narcotic analgesics
2) Narcotics
3) Non-steroidal anti-inflammatory drugs (NSAIDs)
21. c. Educate patient and significant others
1) Mnemonic RICE: Rest, Ice, Compression, Elevation
2) Rest affected joint
3) Non–weight bearing with crutches
4) Avoid use of Ice after 24hrs of injury, apply heat.
5) Compression: use elastic bandage to provide
support and help reduce swelling
6) Elevation: raise injured part to above level of heart
during the first 24 hours after injury to reduce swelling
23. Dislocation is a displacement of the bone ends
from a joint (shoulder, elbow, etc..), it’s also
called subluxations.
An untreated dislocation could cause damage to
your ligaments, nerves, or blood vessels.
24. Elderly
Child
History of recurrent dislocations
Fall
Sports injuries
25. Severe joint pain
Joint deformity/ Asymmetry
Decreased or absent ROM
Weak or absent pulse
Edema
Shortening of extremity
26. Subjective Data:
1-History or present illness/chief complaint:
- Mechanism of injury
- Position in which the victim was found ( can be
obtained from the patient or witnesses)
- Pain(PQRST)
- Associated symptoms( change in neurovascular
function and range of motion)
27. Subjective Data:
2-Past medical history: ( Anemia, Diabetes mellitus,
acute inflammatory diseases, recurrent dislocations)
3-Past surgical history: replacement joint surgeries
4-Medications taken at home(NSAIDS)
5-Personal History: Smoking, activity, weight bearing.
6- Allergy
7- Occupational status
28. Objective Data:
1- General appearance:
- Obvious deformity in affected joint
- Possible altered gait or inability to ambulate
- Moderate to severe distress/discomfort
2- Inspection:
- skin lacerations, pallor, bluish, ecchymosis, edema.
- Loss of mobility
- Extremity length discrepancy
- Abnormal position: rotation or alignment
3- Palpation:
- Reduced or absent pulse distal to injury, decreased skin
temperature, delayed capillary refill, cool or warm skin,
tenderness, deformity.
29. a) Immediate radiographs to verify dislocation
and identify any associated fractures.
b) Post-reduction radiograph after relocation.
c) Vascular studies, as indicated by physical
examination findings and history.
d) Preoperative laboratory tests if operative
relocation required.
30. Impaired physical mobility related to dislocation
manifested by limited ROM.
Anxiety related to immobility and fear of
unknown manifested by patient’s facial
expression.
Risk of hypyvolemia and shock related to trauma.
Risk for impaired skin integrity related to
improper handling of the site and impaired
mobility.
31. Maintain ABC.
Oxygen administration.
Provide venous access, administer crystalloid NSS.
Monitoring of vital signs, pain characteristics and Sensation, mobility, circulation
of the affected limb.
Prepare for/assist with medical interventions:
- Immobilize joint to prevent further injury and help relieve pain,
Elevate joint, and apply ice to reduce swelling.
- Prepare for immediate reduction/administer procedural sedation
- Assist in diagnostic test (X-ray)
Administer pharmacologic therapy as ordered (NSAIDs, narcotics)
Educate patient and significant others:
- Maintain immobilization for prescribed time frame
- Apply cold packs
- Perform neurovascular assessment and report changes
- Indications/precautions for prescribed medications
33. A fracture is a complete or incomplete break in a bone
resulting from the application of excessive force.
34. There are four types of fractures:
Closed fractures
◦ The bone doesn’t break the skin
◦ A crack or a complete separation of the
bone
Open fractures
◦ The bone punctures the skin
Depressed: Flat bone injury due to blunt trauma.
Comminuted: Two or more bone fragments.
35. There are many types of fractures:
Avulsion: insertion site bone fragment breaks away due
to forceful muscle contraction.
Spiring: twisting injury.
Oblique: linear oblique fracture.
Transverse: horizontal linear fracture.
Segmented: broken in two or more places.
36. Age
Gender( Women>Men)
Smoking
Diabetes Mellitus ( Type 1)
Family history of Hip Fracture
Drinking Alcohol in excess
Corticosteroids(steroids)
Rheumatoid Arthritis
37. Accident / trauma / Fall
Pathological (bone infection, Osteoporosis, Tumor)
Stress fractures, commonly found among
professional sports people.
38. Pain
Deformity
Inability to use the injured part
Swelling
Loss of movement
Cracking sound of the fractured bone
local bruising
localized tenderness
39. Subjective Data:
1-History or present illness/chief complaint:
- Mechanism of injury
- Position in which the victim was found ( can be
obtained from the patient or witnesses)
- Pain(PQRST)
40. 2-Past medical history: ( Anemia, Diabetes
mellitus, bone tumor, osteoporosis)
3-Past surgical history: (example: hip
replacement, internal bone reduction)
4-Medications taken at home: (corticosteroids)
5-Personal History: Smoking, activity, alcohol.
6- Allergy
7- Occupational status
41. Objective Data:
1- General appearance:
-Level of consciousness, vital signs, odor.
-Gait intolerance
2- Inspection:
- skin lacerations, pallor, bluish, ecchymosis, edema.
- Loss of mobility
- Extremity length discrepancy (deformity)
- Abnormal position: rotation or alignment
- Open fracture: presense of bleeding, protruded bone, wound)
3- Palpation:
- Reduced or absent pulse distal to injury, decreased skin
temperature, delayed capillary refill, cool or warm skin,
tenderness, deformity, crepitus
43. Acute Pain related to fracture, soft tissue
injury and muscle spasm.
Impaired physical mobility related to fracture
Risk for Infection related to opening in the
skin in an open fracture
Deficit Knowledge related to the occuring
disease.
44. Maintain ABC. (Stop bleeding if open fracture).
Oxygen administration.
Provide venous access, administer crystalloid NSS, blood.
Monitoring of vital signs, pain characteristics and Sensation, mobility, circulation
of the affected limb.
Prepare for/assist with medical interventions:
- Immobilize joint to prevent further injury and help relieve pain,
Elevate joint, and apply ice to reduce swelling.
- Prepare for immediate cast insertion or surgery.
- Prepare for wound dressing in case of open fracture (wound)
Administer pharmacologic therapy as ordered (NSAIDs, narcotics)
Educate patient and significant others:
- Maintain immobilization for prescribed time frame
- Apply cold packs
- Perform neurovascular assessment and report changes
- Indications/precautions for prescribed medications
46. Traumatic amputations is the accidental severing of
some or all of a body part.
A complete amputation totally detaches a
limb or appendage from the rest of the body.
In a partial amputation, some soft tissue remains att
ached to the site.
47. Accidents with lawnmowers, automobiles, motorcyles
Power tools
Farm equipment.
Sharp objects such as knives or blades
Crushing injuries are the more common cause of traumatic
amputations.
48. Blood loss may be massive or minimal
Patients who lose little blood and have less severe injuries sometimes feel more
pain than patients who bleed heavily and whose injuries are life-threatening.
Tingling
Itching
Numbness
Pain in the amputated area.
49. a. Subjective data collection:
1) History of present injury/chief complaint:
(Mechanism of injury, time of injury, pain)
2) Past medical history:(peripheral vascular disease, bleeding
disorders)
3) Medications
4) Allergies
5) Immunization status
6) Personal History(smoking: nicotine is potent vasoconstrictor and
decreases healing; patient is generally advised to abstain from
smoking)
50. b. Objective data collection:
General appearance:
(moderate to severe discomfort)
Inspection:
(1) Stump: viability of blood vessels, nerves, other tissue
(2) Amount and type of contamination
(3) Estimate of blood loss
51. a) CBC with differential
b) Type and cross match
c) Radiographs of stump and amputated part
52. Acute pain related to amputation
Fluid volume deficit related to blood loss.
Impaired physical mobility related to loss of a
limb evidenced by decreased muscle strength.
Situational self esteem related to amputation.
Risk for infection.
Risk for ineffective tissue perfusion.
53. Maintain ABC. (Stop bleeding).
Oxygen administration.
Provide venous access, administer crystalloid NSS,
blood transfusion.
Monitoring of vital signs,I/O, attach patient to monitor.
Prepare for/assist with medical interventions:
- Endotracheal intubation, Foley and NG insertion.
- Prepare for immediate surgery.
- Aseptic technique in wound dressing.
- Preserve the amputated part in clean cold bag.
Administer pharmacologic therapy as ordered (NSAIDs,
narcotics, Antibiotics, Tetanus immunization)
