Nursing · Adult clinical nursing
The injury is treated by the surgeon; what lying still does is prevented by nurses
Fractures, back pain, worn joints and falls are among the commonest reasons anybody presents for care anywhere in the world, and road traffic injury is among the leading causes of death in young adults. But the thing that makes this a nursing subject rather than a surgical one is that most of the harm comes from lying still. Clots, chest infection, pressure damage, muscle loss, delirium and constipation are what disable and kill orthopaedic patients, and every one of them is prevented by nursing rather than by an operation. Muscle strength is lost within days of immobility and returns far more slowly, which is why a week in bed can cost an older person their independence permanently. The question in this subject is almost never whether the bone mended. It is whether the person got their life back.
Fractures, back pain, worn joints and falls are among the commonest reasons anybody presents anywhere in the world. A nurse who works in a general hospital, a health centre, a school or a home will encounter this subject constantly, whatever their declared specialty.
A bone that heals crooked but lets somebody walk may matter less than one that heals perfectly in a person who never regains the ability to stand. The question in this subject is almost never whether the tissue mended but whether the person got their life back.
Road traffic injury is among the leading causes of death in young adults worldwide, and most of it is musculoskeletal with something worse alongside. That makes this subject inseparable from trauma care rather than a quiet specialty of plasters.
A fractured hip in an older person carries a mortality within the following year that surprises people who think of it as a broken bone. It marks frailty as much as it marks trauma, and how it is nursed changes the outcome considerably.
Most of the harm that follows a musculoskeletal injury comes from lying still — clots, chest infection, pressure damage, muscle loss, confusion and constipation. The injury is treated by the surgeon; the consequences of not moving are prevented by nurses.
Bone is constantly being broken down and rebuilt, which is why it heals, why it thins when unused, and why it responds to weight-bearing by getting stronger. It is a living organ with a blood supply, not a mineral scaffold.
Blood supply, stability, and reasonable nutrition. Take away any one and healing stalls, which explains why a bone with a poor blood supply, a fracture that keeps moving, or a malnourished patient all fail to mend on schedule.
Two bone ends covered in smooth cartilage, lubricated, held by ligaments and moved by muscles across it. Damage the cartilage and the joint grinds; damage the ligaments and it gives way; lose the muscle and it becomes useless even when intact.
Strength is lost within days of immobility and takes far longer to rebuild, which is why a week in bed can cost an older person their independence permanently. This asymmetry is the single strongest argument for early mobilisation.
The major nerves and arteries of a limb lie close to the bones, which is why a fracture or a dislocation can injure them, and why every limb injury is assessed for circulation and sensation rather than only for the bone.
A fracture with a wound over it communicates with the outside, so it is an infection emergency needing urgent cleaning and antibiotics as well as fixing. Closed fractures are orthopaedic problems; open ones are urgent surgical ones.
Pain, deformity, swelling, inability to use the limb, and movement where there should be none. A person who is walking on a limb does not always have an intact bone, so an inability to bear weight matters more than an ability to.
Growing bone is softer and bends, so children sustain incomplete fractures that adults do not, and they heal considerably faster. Injuries involving the growth areas of a child's bone can affect future growth and are taken seriously.
Holding a fracture still relieves pain, prevents further injury to surrounding tissue, and allows healing. It is also why splinting before transfer is a kindness and a clinical intervention rather than a delay.
Bone unites over weeks to months depending on site, age and health, and a patient who has been given no timeframe invents one and then believes something has gone wrong. Saying how long, honestly, prevents a great deal of anxiety.
Bleeding and swelling within the tight fascial sheath around a muscle group can raise pressure until the blood supply is cut off, destroying muscle and nerve within hours. It is the orthopaedic emergency a nurse is most likely to detect first.
The earliest and most reliable sign is pain far worse than the injury should cause, worsening despite treatment, and worse on passive stretching. Waiting for absent pulses means waiting until the damage is done — pulses are frequently present until very late.
A patient complaining persistently about a cast is reporting a clinical finding. Escalating rather than reassuring, and never elevating a limb above the heart when this is suspected, are the two actions that matter.
Long bone fractures release fat into the circulation and immobility produces clots, and both present as breathlessness, confusion and low oxygen days after the injury. New confusion in a patient with a fractured femur is a respiratory event until proved otherwise.
Loss of sensation, inability to move a specific muscle group, a cold pale limb or an absent pulse are recorded at the first assessment precisely so that a later change can be recognised as new. Without a baseline nobody can tell.
Plaster generates heat as it sets and then the limb swells inside it, which is why the first twenty-four hours carry the highest risk and why observation is most frequent then. A cast applied to a swelling limb becomes tight without anybody doing anything.
Keep it dry, do not push anything down inside it, keep the limb elevated as instructed, move the joints that are free, and return immediately for increasing pain, numbness, a bad smell or discharge. Written down, because it will be forgotten.
Skin at the cast edges, the heel, and any bony point is where damage occurs, and it occurs silently in a limb that cannot be felt properly. Looking and asking, rather than assuming, finds it while it is still skin rather than a wound.
Traction works only while the pull is continuous and in line, so weights must hang free, cords must run over their pulleys, and nothing is lifted off to make a bed. A traction that has been interrupted has stopped treating the fracture.
Where pins enter the skin is a direct route to bone, so the sites are inspected and kept clean, and redness, discharge or loosening is reported. Bone infection acquired this way is difficult and prolonged to treat.
An older person who fractures a hip has usually fallen for a reason, has other conditions, and may have been on the floor for hours. Treating only the bone misses the dehydration, the infection, the medicine causing dizziness, and the reason they fell.
Prolonged waiting increases pain, delirium, pressure damage, chest infection and death, which is why these operations are prioritised. A patient waiting has active nursing needs rather than a pause in their care.
Untreated pain in a hip fracture prevents breathing deeply, sitting, and standing, and therefore produces the chest infection and the immobility. Adequate analgesia here is not comfort care; it is what makes recovery physically possible.
Confusion after a hip fracture is common and is worsened by pain, dehydration, constipation, infection, unfamiliar surroundings and darkness. Most of what prevents it is nursing — hydration, glasses, hearing aids, daylight, familiar faces and sleep.
Standing and walking as early as the surgery allows reduces complications substantially. The patient who is helped up on the first day and the one who is not are frequently, a month later, two quite different people.
A worn joint that causes pain at rest and at night, and that has stopped responding to everything else, is replaced to relieve pain and restore function. It is one of the most consistently successful operations in surgery.
Infection and dislocation. Infection in a replaced joint is difficult to eradicate and may require removing the implant, which is why any subsequent wound, dental infection or skin breach is treated attentively.
Each replaced joint has movements that can dislocate it, and these are explained, demonstrated and reinforced rather than mentioned once. Sitting low, crossing the legs and twisting are the ones most often forgotten at home.
Major joint surgery in an older, temporarily immobile patient carries a substantial clot risk, which is why prevention is routine and why a swollen painful calf or sudden breathlessness afterwards is taken seriously.
A replaced joint relieves pain reliably and restores movement partially, and it does not make somebody twenty again. A patient whose expectations were never discussed can be objectively well and subjectively disappointed.
The great majority of back pain has no serious underlying cause, improves within weeks, and is made worse rather than better by rest and by extensive imaging. Reassurance with a plan is the treatment, and it is genuinely difficult to deliver convincingly.
Prolonged bed rest for back pain worsens outcomes and prolongs disability. Staying as active as the pain allows, returning to normal activity early, and building strength is the advice with the best evidence behind it.
New bladder or bowel disturbance, numbness around the buttocks and inner thighs, weakness in both legs, fever, unexplained weight loss, a history of cancer, or pain that is severe at night and unrelieved by position. Any of these converts back pain into an urgent problem.
Pressure on the spinal cord or the nerves at its base causes permanent loss if not relieved quickly, and it presents with exactly the findings above. Recognising it is a nursing skill because the patient reports it to whoever is nearest.
Fear of movement, belief that the spine is damaged, and a job that cannot be modified predict long-term disability better than any scan finding. Addressing what the person believes is treating the condition rather than avoiding it.
A compressed nerve root produces pain radiating along a predictable path with numbness or weakness in that same distribution, which is why the pattern locates the level. Pain in the arm can be entirely a neck problem and pain in the leg entirely a back one.
Nerve root pain is severe and usually improves over weeks to months as the inflammation subsides, and surgery is reserved for progressive weakness or intractable pain. Explaining the expected course is what allows somebody to endure it.
Numbness and tingling in the hand, worse at night, is extremely common and readily treatable, and is frequently endured for years. Asking about night-time hand symptoms takes seconds and finds a great deal.
Neck pain after a road traffic collision is largely soft tissue, improves with early gentle movement, and is prolonged by collars and by inactivity. The advice runs against instinct, which is why it must be given clearly.
Pain is common and rarely urgent; progressive weakness or loss of dexterity is neither. Distinguishing the two in what a patient reports is the most useful assessment skill in this chapter.
Cartilage thins, the bone underneath reacts, the joint becomes stiff and painful and its shape changes. It is far more than simple wear: the whole joint, including the surrounding muscle, is involved.
Pain worse with use and towards the end of the day, stiffness that eases after a few minutes of moving, gradual loss of range, and creaking. Its slow onset over years is what distinguishes it at the bedside.
Strengthening the muscles around a worn joint reduces pain and improves function, and it is the intervention patients are least likely to believe in. Explaining why loading a painful joint helps is worth the time it takes.
Reducing load through a weight-bearing joint reduces pain measurably, and saying so without blame is a skill. Advice delivered as criticism is advice that ends the conversation.
A stick used in the correct hand transfers load substantially and is frequently refused because of what it signifies. Naming that openly, and framing it as a tool rather than a defeat, is what gets it used.
Inflammatory joint disease is the immune system attacking joints, affecting several symmetrically, with prolonged morning stiffness, swelling, warmth, fatigue and systemic illness. It damages joints permanently if untreated, which is why early recognition matters so much.
How long does the morning stiffness last, are the joints warm and swollen, is it symmetrical, is there fatigue and are other systems involved. Stiffness lasting more than an hour points firmly away from simple wear.
Damage occurs in the first months to years, and treatment started early prevents deformity that cannot later be undone. A person passed between services for a year has lost something that will not be recovered.
Inflammatory disease affects the eyes, lungs, skin, heart and blood, and the treatments suppress the immune system, so a person on them who develops a fever is assessed urgently rather than routinely.
Fatigue is frequently the most disabling symptom and the one least asked about. Hand function determines whether somebody can dress, cook and work, so watching them open a bottle tells you more than examining the joint does.
A joint that becomes exquisitely painful, red, hot and swollen over hours, often at the base of the big toe, is the classic picture. The severity is genuinely extreme and patients are sometimes disbelieved.
A hot swollen joint may be crystal disease or may be infected, and the two are indistinguishable at the bedside. That is why the joint is sampled, and why assuming the benign diagnosis is a serious error.
Alcohol, certain foods, dehydration, illness, surgery and some medicines, including several the person is taking for other conditions. The trigger is frequently identifiable and avoidable once somebody asks.
Recurrent attacks are associated with raised blood pressure, kidney disease and cardiovascular risk, so the person with gout warrants a broader look rather than only pain relief.
Preventing recurrence is a long-term matter and is frequently abandoned because the person feels well. Explaining that the treatment prevents rather than relieves is what makes it continue.
Bacteria in a joint destroy cartilage within days, so a hot swollen joint with fever is drained and treated urgently. A delay of days can cost the joint permanently.
Infection within bone has poor blood supply reaching it, so it requires prolonged treatment and frequently surgery. It follows open fractures, surgery, pins, foot ulcers in diabetes, and spread through the blood in children.
A child who refuses to use a limb, is febrile and is irritable has a bone or joint infection until proved otherwise. Children localise poorly, so refusal to move a limb carries more weight than where they say it hurts.
Infection around an implant hides on its surface where antibiotics reach poorly, which is why it recurs and why removing the implant is sometimes the only cure. Any wound problem after joint replacement is escalated early.
Recognising the fever with the hot joint, taking the samples before antibiotics start where that is the plan, and maintaining the long courses of treatment with the line care they require is most of what determines whether this is cured.
Ligaments connecting bones sprain, muscles and tendons strain or tear, and the immediate management is similar — protect, apply cold, compress, elevate, then move progressively. The distinction matters mainly for how long recovery takes.
Instability after a ligament injury means the joint cannot be trusted, which causes falls and further damage. It is a functional complaint that imaging may not explain and that the patient describes precisely if asked.
A tendon that has snapped produces a sudden loss of a specific movement, and these are regularly missed because the patient can still move the limb using other muscles. Testing the specific action is the only way to find it.
Tendon pain from repetitive loading recurs unless the loading changes, which means asking about the job, the sport, the tool and the technique. Treating the tendon without changing what caused it guarantees a return visit.
Muscle crushed or compressed for hours releases contents that damage the kidneys, so a person found collapsed on a hard floor after a long time is at risk even without a fracture. Fluid replacement and urine monitoring are the point.
Most amputations worldwide follow vascular disease and diabetes rather than trauma, which means most are potentially preventable and most patients have other serious conditions. Trauma, infection and tumour account for the remainder.
Its shape, healing, and freedom from contracture determine whether a limb can be fitted and used. Positioning, bandaging as prescribed and preventing the joint above from stiffening are therefore the definitive nursing work.
Pain felt in the missing limb is real, common, neurological, and not psychological. Dismissing it damages trust and leaves treatable pain untreated; it has specific approaches that differ from ordinary analgesia.
Losing a limb is a bereavement involving body image, work, independence and identity, and the low mood that follows is a normal response rather than a complication. Space to talk about it belongs in the care plan.
In much of the world a prosthesis is unavailable or unaffordable, and rehabilitation has to be built around crutches, a wheelchair or adaptation. Planning around what exists is more useful than describing what should.
Anybody with significant trauma, particularly to the head, or found unconscious, is managed as though the spine were injured until it can be properly assessed. Careless movement can convert a stable injury into permanent paralysis.
Log rolling with enough people, maintaining alignment, and moving on command exists to keep the spine in line. It requires numbers and a leader, and cutting corners because the ward is busy is where harm occurs.
A high spinal injury can cause low blood pressure with a slow rather than fast pulse, which looks nothing like ordinary shock and is easily misread. Recognising the combination prevents the wrong treatment.
Somebody who cannot feel or move is at immediate risk of pressure damage, urinary retention and constipation, and all three begin being managed on the first day rather than once the acute phase passes.
In established spinal cord injury, a full bladder, constipation or a skin problem below the level of injury can trigger a sudden dangerous rise in blood pressure with headache and sweating. The treatment is finding and removing the cause.
Children's bones grow from specific regions, and injury or infection there can affect future length and alignment. It is why a child's apparently minor injury near a joint is imaged and followed rather than dismissed.
A child who limps or refuses to bear weight has a cause — infection, injury, a hip disorder or a tumour — and the serious ones present exactly this way. Reassurance without assessment is how the serious ones are missed.
Several childhood hip conditions present with limp, knee pain and reduced movement at different ages, and pain felt at the knee frequently originates at the hip. Examining the hip in a child complaining of knee pain is standard for that reason.
Injuries that do not match the explanation given, that are at unusual sites, that are multiple or at different stages of healing, or that occur in a child not yet mobile, require safeguarding assessment alongside orthopaedic care.
Children put things inside casts, get them wet, and cannot describe numbness reliably, so the parents are taught what to watch for and the checks depend on looking rather than on asking.
Falls have causes — medicines, blood pressure dropping on standing, poor vision, weakness, infection, alcohol, unsafe footwear and hazards at home. Treating the injury without finding the cause guarantees the next fall.
Sedatives, blood pressure treatments, several antidepressants and anything causing dizziness raise falls risk, and stopping one unnecessary medicine can prevent more fractures than any exercise programme. It is nursing observation that identifies the candidates.
After a fall people move less, weaken further, and become more likely to fall again. Restoring confidence through supervised activity is preventive treatment rather than reassurance.
Somebody on the floor for hours develops dehydration, pressure damage, muscle breakdown, hypothermia and kidney injury. Asking how long they were down changes the assessment substantially.
Rugs, poor lighting, stairs without rails, a high bed, an inaccessible toilet at night. A home assessment prevents more injury than most of what happens in hospital, and it is frequently never arranged.
Bone thinning causes no symptoms, so the first fracture is usually the diagnosis. That makes finding it before the fracture the entire objective, which requires somebody to think of it.
Increasing age, the menopause, long-term steroids, immobility, low body weight, smoking, heavy alcohol use, poor nutrition and several chronic diseases. Most of these are known before any test is done.
A bone that breaks from a minor fall or from no identifiable injury is a fragility fracture, and it predicts further fractures strongly. Treating it as simple bad luck loses the opportunity to prevent the hip fracture that follows.
Weight-bearing activity, adequate calcium and vitamin D underpin everything else, and vitamin D comes mostly from sunlight on skin rather than from food. Deficiency is common, cheap to correct and frequently never looked for.
Vertebral fractures often occur without a memorable injury and present as back pain, loss of height and a curved upper spine. Noticing that somebody has become shorter and more stooped is a genuine clinical observation.
Cancer in bone is far more often spread from another organ than arising in the bone itself, which is why a new bone pain in somebody with a cancer history is investigated rather than attributed to age.
Bone pain from tumour is typically constant, present at rest, worse at night, and not relieved by position — which distinguishes it from mechanical pain that eases with rest. That description, taken carefully, is the referral.
A tumour weakens bone so that it fractures under normal load, and such a fracture can sometimes be anticipated and prevented by fixing the bone first. Reporting escalating pain in a weight-bearing bone is what allows that.
Cancer in bone can raise blood calcium, producing thirst, constipation, confusion and drowsiness. New confusion in somebody with bone deposits is a metabolic event to be checked rather than deterioration to be accepted.
Rare tumours arising in bone occur particularly in adolescents, presenting as persistent pain and swelling around a joint, frequently attributed to sporting injury for months. Pain that does not settle in a young person is followed up.
Pain stops people breathing deeply, coughing, sitting, standing and sleeping, and therefore causes chest infections, clots, pressure damage and delirium. Analgesia in this subject is a means of preventing complications.
A pain score recorded before treatment and not afterwards measures nothing. The second measurement is what tells you whether what you did worked, and it is the one most often omitted.
Physiotherapy, dressing changes and transfers hurt, and giving analgesia in time to be working when they happen determines whether the session achieves anything. Getting the timing right is a nursing decision.
Position, splinting, ice, heat, elevation, distraction, and simply not moving an injured limb unnecessarily all reduce pain measurably. These are available immediately and cost nothing.
Burning, shooting, electric pain with numbness responds poorly to ordinary analgesia and needs a different approach. Describing the quality of the pain rather than only its score is what identifies it.
A limb left in a comfortable flexed position stiffens there, and a contracture can end a person's ability to walk or dress. Correct positioning maintained over days is genuinely therapeutic.
Skin over bony points can be damaged in hours in somebody immobile, poorly nourished and in pain. Heels, sacrum, elbows and areas under casts or splints are where it happens, and prevention is repositioning and looking.
Moving a patient with a fracture requires support above and below the injury, enough people, and explanation first. The nurse's own back is part of the assessment, and injuries among staff in this specialty are common.
Weight-bearing instructions after surgery are specific and are frequently transmitted incorrectly. Knowing exactly what this patient is permitted to do, and confirming it rather than assuming, prevents a repeat operation.
Deep breathing, ankle movement, hydration and attention to the bowels are the unglamorous work that prevents the complications which actually kill immobile orthopaedic patients. None of it requires a prescription.
Rehabilitation is not a phase that begins after treatment; it begins at admission with positioning, movement of uninjured joints and expectation setting. Waiting until the patient is ready loses the window in which muscle is retained.
A goal of walking to the shop is worked towards; a goal of achieving a range of movement is complied with briefly. Asking what they want to be able to do produces both a better plan and better effort.
A patient told different things by the physiotherapist, the nurse and the surgeon does none of them. The nurse present at every hour is who makes the plan continuous rather than episodic.
Progress in rehabilitation is uneven, and a bad day is experienced as failure by somebody who was promised steady improvement. Saying in advance that it fluctuates prevents people from giving up.
Distance walked, stairs managed, time to stand, ability to dress. These change visibly and motivate, where a range of movement in degrees means nothing to the person doing the work.
Whether somebody manages depends on stairs, the toilet, the bed height, who else is there and how far the shops are — none of which is visible from a hospital bed. Asking in detail, early, is what prevents a readmission.
A frame, a raised seat, a rail or a commode that arrives a week after discharge is a week of a person managing unsafely. Ordering it early is a clinical priority rather than administration.
Whoever assists at home needs to be shown the transfer, the positions to avoid and what to watch for, and they are frequently absent at the moment of discharge. Arranging to catch them is worth the effort.
Increasing pain, a wound that opens or discharges, fever, a swollen painful calf, breathlessness, numbness, or a limb that changes colour. Written down, in their language, because verbal instructions at discharge are not retained.
An appointment given to somebody with no transport, no phone and no money is an appointment that will be missed and then recorded as non-attendance. Asking whether they can actually get there is part of arranging it.
A joint forced out of position stretches or tears the ligaments holding it, may chip the bone, and can trap or compress the nerves and vessels running beside it. It is painful, visibly deformed, and the limb cannot be used, and it is an urgent problem rather than one that waits for a routine list.
The shoulder dislocates more readily than any other joint because it trades stability for range of movement. A first dislocation in a young person carries a high chance of recurrence, and each subsequent one happens more easily, which is why the long-term plan matters as much as putting it back.
Sensation and movement in the specific distribution supplied by the nerve at risk are recorded before any attempt at reduction and again afterwards, because a deficit that appeared during the procedure needs to be distinguished from one caused by the injury. Without the first record, nobody can tell which it was, and that question matters.
An artificial joint comes out in predictable positions, which is why patients are taught the movements to avoid and why sitting low, crossing the legs and twisting are reinforced repeatedly. A patient who suddenly cannot bear weight and whose leg looks shortened or rotated after a replacement has almost certainly dislocated it.
A reduced joint is supported for a period and then progressively strengthened, because the muscles around it are what prevent it happening again. Immobilising it indefinitely produces a stiff joint, and moving it too soon produces a loose one, so the instruction given is specific and is followed exactly.
A hand does fine, coordinated work through structures packed tightly together, so an injury that looks trivial can divide a tendon or a nerve and permanently cost somebody their trade. Hand injuries are consistently under-assessed in busy departments because the wound is small and the patient is not distressed enough to prompt concern.
A patient can frequently move a finger using other muscles despite a divided tendon, so the specific action each tendon performs is tested individually against resistance. Asking somebody to wiggle their fingers and observing that they can proves very little, and it is how tendon injuries are missed for weeks.
Hands stiffen extremely quickly when immobilised and the stiffness becomes permanent, which is why joints not requiring immobilisation are moved from the first day and why elevation to reduce swelling is emphasised so heavily. A hand splinted in the wrong position for two weeks may never fully open again.
Bites, injuries from dirty machinery, and puncture wounds to the hand carry a high infection risk in a region where infection spreads along tendon sheaths rapidly and destroys function. A small wound over a knuckle sustained in a fight is treated as contaminated rather than minor, and it is a recognised trap.
Whether the person can hold a tool, fasten a button, count money or write determines how their injury actually affected their life, and watching them attempt those things reveals more than examining the wound. Recording what they can and cannot do gives the next clinician something usable.
A person with diabetes heals more slowly, becomes infected more readily, may not feel a cast pressing, and has raised glucose from the stress of injury and surgery. An orthopaedic plan built without that in it will be surprised by a wound breaking down, and their feet need looking at whatever the presenting injury was.
Somebody taking treatment to prevent clots bleeds considerably more into a fracture site and may need it managed before surgery, while stopping it carries its own risk. Establishing exactly what they take, and when they last took it, is urgent information rather than part of a routine history.
Long-term steroid treatment thins bone and skin, delays healing, and means the person cannot mount a stress response to surgery without additional cover. Each of those changes the nursing care, and the medicine is regularly discovered late because nobody asked what they take for their chest or their joints.
A confused patient cannot follow weight-bearing instructions, may not report pain, and is at high risk of both falling again and pulling at dressings. Care that depends on the patient remembering an instruction will fail, so it is built instead around supervision, familiar routine and consistent staff.
Sedatives and blood pressure treatments caused some of these falls, and continuing them unchanged after the fracture invites the next one. A review that asks whether every medicine is still needed prevents more fractures than any single operation, and it starts with an accurate list.
Recognising raised compartment pressure, the complications of immobility, hip fracture care in older people, red flags in back pain, spinal precautions, and cast and traction observation. Prioritisation questions dominate.
Waiting for absent pulses before escalating a compartment problem; elevating a limb above the heart when it is suspected; reassuring a patient who complains persistently about a cast; treating a hot joint as crystal disease without excluding infection; missing cord compression.
Pain out of proportion is escalated immediately. Assess and document circulation and sensation at baseline so change can be recognised. Mobilise early. Treat pain so that mobilising is possible. Find why they fell.
Look under the cast edges. Check the weights hang free. Ask how long they were on the floor. Time the analgesia to the physiotherapy. Confirm the weight-bearing instruction rather than assuming it.
In this subject the outcome is measured in function, and function is lost to immobility rather than to the injury. Almost everything that preserves it is nursing work done in the first few days.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
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