# A nurse is caring for a client who sustained a shoulder dislocation during a basketball game. The client's shoulder has been successfully reduced and is now in a sling. What is the most important nursing intervention to prevent complications?

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## 문제

A nurse is caring for a client who sustained a shoulder dislocation during a basketball game. The client's shoulder has been successfully reduced and is now in a sling. What is the most important nursing intervention to prevent complications?

## 보기

1. Apply ice continuously for the first 48 hours to reduce swelling
2. Encourage gentle range-of-motion exercises as prescribed to prevent joint stiffness **✔ 정답**
3. Keep the arm completely immobilized for 2-3 weeks to ensure proper healing
4. Administer pain medication only when the client requests it

**정답: 2**

## 해설

Gentle, prescribed range-of-motion exercises prevent joint stiffness and adhesive capsulitis after shoulder dislocation reduction. Other options are less critical: ice reduces swelling but isn't the most important, complete immobilization risks stiffness, and pain medication should be scheduled, not PRN.

## 심화 해설

Understanding the Priority After Shoulder Reduction

Following a successful closed reduction of a traumatic anterior shoulder dislocation, the primary nursing concern shifts from acute injury management to preventing recurrence and restoring function. The pathology involves the stretching or tearing of the glenohumeral capsule and ligaments, particularly the anterior-inferior labrum, which leaves the joint inherently unstable. For a young, active client, the risk of re-dislocation is exceptionally high.

Analysis of Interventions

The goal of conservative management, as evaluated in the Cochrane review, is to balance healing of damaged soft tissues with the prevention of complications like adhesive capsulitis (frozen shoulder) and muscle atrophy.

- **Option 1: Apply ice continuously for the first 48 hours.** While cryotherapy is beneficial for analgesia and vasoconstriction in the immediate post-injury phase, it is a comfort measure, not the most critical intervention for preventing long-term complications after reduction. Continuous application also carries a risk of cold injury to the skin.

- **Option 2: Encourage gentle range-of-motion exercises as prescribed.** This is the correct priority. Evidence from conservative management protocols emphasizes that prolonged, complete immobilization in internal rotation does not reduce the rate of re-dislocation and may actually contribute to joint stiffness and functional delay. Early, controlled mobilization, typically starting with pendulum exercises and passive range-of-motion within a protected range, is crucial to maintain capsular elasticity and prevent the debilitating complication of a frozen shoulder.

- **Option 3: Keep the arm completely immobilized for 2-3 weeks.** This approach is outdated. The systematic review indicates that traditional long-term immobilization in a sling is not superior to shorter periods of immobilization followed by early rehabilitation in preventing re-dislocation. In fact, it can lead to significant stiffness, especially in the older adult population, and delays return to function in active individuals.

- **Option 4: Administer pain medication only when the client requests it.** This is a reactive rather than proactive pain management strategy. For optimal recovery and participation in prescribed exercises, pain should be managed around the clock initially, not solely based on client request, to prevent peaks in pain that inhibit movement.

Integrating the Evidence into Practice

The most important nursing intervention to prevent complications is to facilitate a structured rehabilitation program that begins with prescribed, gentle range-of-motion exercises. The evidence supports that conservative management after closed reduction should prioritize early mobilization over rigid, prolonged immobilization to minimize the risk of joint stiffness and promote functional recovery, without increasing the risk of re-dislocation. The nurse's role is to educate the client on the specific, prescribed exercises, ensuring they understand the critical balance between protecting the repair and preventing a frozen shoulder. The client should be taught to perform pendulum swings and passive range-of-motion within the limits set by the provider, understanding that this active approach is a cornerstone of preventing long-term disability[1].References (research sources)

- [1]Conservative management following closed reduction of traumatic anterior dislocation of the shoulderResearch articleNigel Hanchard, Lorna Goodchild, Lucksy Kottam (2014) · DOI: 10.1002/14651858.cd004962.pub3

## 임상 시나리오

Post-Reduction Shoulder Dislocation CareBalancing Joint Protection with Early Mobilization
The priority after successful closed reduction is to prevent adhesive capsulitis and muscle atrophy. Evidence shows that prolonged complete immobilization in internal rotation does not reduce redislocation rates.

Initiate gentle range-of-motion exercises as prescribed, typically starting with pendulum exercises within the first week. The goal is to maintain joint mobility without stressing the healing anterior capsule.

CautionAvoid aggressive external rotation and abduction early on, as these positions stress the torn anterior-inferior labrum and can cause re-dislocation. Ice should be applied intermittently, not continuously, to prevent cold injury.

## 핵심 개념

- **Adhesive Capsulitis** — Also known as frozen shoulder; a complication of prolonged immobilization characterized by pain and progressive stiffness in the glenohumeral joint.
- **Closed Reduction** — A non-surgical procedure to manipulate the dislocated humeral head back into the glenoid fossa.
- **Pendulum Exercises** — Early, gentle range-of-motion exercises where the patient bends forward and allows the arm to swing freely, initiating mobilization without active muscle contraction.

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