Info

midazolam (Versed)

can occur

Note: The physician usually prescribes analgesics and muscle relaxants to control the pain and prevent muscle spasms. Frequently, the patient needs muscle relaxants so that the physician can manipulate the injured structures.

Note: The physician usually prescribes analgesics and muscle relaxants to control the pain and prevent muscle spasms. Frequently, the patient needs muscle relaxants so that the physician can manipulate the injured structures.

Independent

Before reduction of the joint, direct nursing care to relieve pain and protect the joint and extremity from further injury. Maintain proper positioning and alignment to limit further injury. Accompanying soft tissue injuries are treated by RICE therapy: Rest, Ice, Compression bandage, and Elevation with or without immobilization.

The patient and family need support to cope with a sudden injury. Allow time each day to listen to concerns, discuss the patient's progress, and explain upcoming procedures. Older patients may experience depression and loss if the injury has long-term implications about their self-care.

Use social workers and advanced-practice nurses for consultation if the patient's anxiety or fear is abnormal. Immobilization involving the whole person rather than one extremity requires aggressive prevention of the hazards of immobility. Motivate and educate patients to help them prevent complications. Encourage a balanced diet that contains foods that promote healing, such as those that have protein and vitamin C. Stimulation of the affected area by isometric and isotonic exercises also helps promote healing.

• Restrictions of movement before and after reduction, level of discomfort, pain relief, neu-rovascular assessment (pain, pallor, paresthesia, paralysis, pulselessness)

• Response to treatment (open or closed procedure)

Be certain that the patient and/or family understands the importance of the prescribed rehabilitation. For children, outline the appropriate activities to maintain growth and development. Demonstrate the adaptations required for patients with casts. Discuss the need to report any changes in pain, numbness, or other signs of neurovascular compromise. Make certain the patient or parents and family understand the signs and symptoms of suture line infections if open reduction has been accomplished and that odors or drainage from a cast should have immediate attention. If antibiotics have been ordered, stress the importance of completing the course as prescribed. Discuss the potential for repeat dislocations and the need for protection during sports or other activities.

Disseminated intravascular coagulation (DIC) is a life-threatening hemostatic disarray in which bleeding and clotting occur simultaneously. It is also called consumptive coagulopathy and defibrination syndrome. The pathophysiology involves an overactivation of the clotting mechanisms with both enhanced fibrin production leading to small clots and fibrinolysis leading to enhanced bleeding. As its name implies, tiny clots accumulate in the microcirculation (capillaries) throughout the body, depleting the blood supply of its clotting factors. These microemboli interfere with blood flow and lead to ischemia and organ damage. As the clots begin to lyse, fibrin degradation products (FDPs) (which have an anticoagulant property of their own) are released. The FDPs, along with decreased levels of clotting factors in the bloodstream, lead to massive bleeding internally from the brain, kidneys, adrenals, heart, and other organs, or from any wounds and old puncture sites.

Because DIC is somewhat difficult to diagnose, the following definition may be helpful in understanding the disorder: a systemic thrombohemorrhagic coagulation disorder that is associated with well-defined clinical situations (see Causes, below) and laboratory evidence of coagulant activation, fibrinolytic activation, inhibitor consumption, and biochemical evidence of endorgan damage. Morbidity and mortality depend on the underlying disease that initiates DIC and

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