Nurs2016MusculoskeletalLecture
Download
Report
Transcript Nurs2016MusculoskeletalLecture
Individuals Experiencing
Musculoskeletal Disorders
NURS 2016
Musculoskeletal Includes:
Bones
Joints
Muscles
Tendons
Ligaments
Bursae
Complications include:
Trauma
Contusion
Strain
Sprain
Joint dislocation: subluxation &
avascular necrosis
Musculoskeletal Disorders
Low Back Pain
Most is self-limiting and will improve on its own with
time
Sciatica
Osteoporosis
Bone density loss
Small frame, non obese women
Osteomyelitis
Bone infection
Septic Arthritis
Joint infection
Musculoskeletal Trauma
Initial Assessment
Circulation
Movement
Sensation
Contusions, Strains, and
Sprains
Contusion is a soft tissue injury
Strain is a pulled muscle from
overuse, overstretching, or
excessive stress
Sprain is an injury to ligaments
surrounding a joint
Treatment: strains, sprains,
contusions
Rest
Ice
Compression
Elevate
Joint Dislocations
Subluxation is a partial dislocation of
the articulating surfaces
Medical Management is
immobilization
Nursing Management
provide comfort
neurovascular status
protect joint
Fractures
Break in the continuity of the bone
Fractures: Break in the continuity of the
bone
Clinical Manifestations
Clinical manifestations
Pain
Loss of function
Deformity
False motion
Shortening
Crepitus
Swelling & discoloration
Management
Emergency Management: stabilize
limb
(affected area)
Reduction
Closed
Open
Traction
Complications
Shock
Fat Embolism Syndrome
Compartment Syndrome
Delayed Union/Nonunion
Avascular Necrosis
Infection
Nursing Process: Fracture
Assessment
Objective Data: assess clinical
manifestations for fx.
Subjective Data
Health Info: past hx, meds, surgery
Functional: motion, weakness, spasm,
pain, tingling
Nursing Process: Planning
Nursing Diagnosis
Risk for peripheral neurovascular
dysfunction related to nerve compression
Acute pain, evidenced by pain descriptors,
guarding, crying, related to edema,
movement of bone fragments, and muscle
spasms.
Risk for infection related to disruption of
skin integrity and presence of
environmental pathogens secondary to
open fracture.
Nursing Process: Interventions
Expected Outcome: normal neurovascular
examination
Nursing Strategies
Assess for S&S peripheral neurovascular
dysfunction
Unrelieved pain or pain on passive
movement
Paresthesias, cool, pallor, diminished pulses
Elevate extremity above level of heart to
reduce edema by promoting venous return
The Patient with a Hip Fracture
Surgical repair is preferred method of
treatment.
Intra capsular Fx (head and neck of femur):
endoprothesis
Extracapsulr Fx (trochanteric): nails, plates,
intramedullary devices.
Nursing Management for both is the same.
Nursing Interventions
Relieving Pain
Promoting Hip Function & Stability
Promoting Wound Healing
Promoting Normal Urinary Elimination
Patterns
Promoting Skin Integrity
Promoting Effective Coping Mechanisms
Promoting Patient Orientation &
Participation in Decision Making
Monitoring & Preventing Potential
Complications
Joint Replacement
Arthroplasty: replacement of all parts
of the joint
Contributing factors to joint
replacement:
Pain
Osteoarthritis
Rheumatoid arthritis
Trauma
Congenital deformity
Joint Replacement Cont’
Joints frequently replaced:
Hip
Knee
Finger
Joints sometimes replaced:
Shoulder
Elbow
Wrist
Ankle
Special considerations with Hip
Fractures/Repair/Replacement
Do
NOT
Force flexion >90
Force adduction
Force internal rotation
Cross legs
Put footwear on
without assistive
device before 8 weeks
Sit on chair without
arms to aid in raising
to stand
DO
Use elevated toilet
seat
Place chair inside
shower or tub
Use pillow between
legs when on side
Keep hip in neutral
position
Notify surgeon if
severe pain, deformity
or loss of function
Continued Strategies for Hip
Repair/Replacements
Provide abduction pillow to prevent adduction
Monitor and manage complications
Neurovascular
DVT
Pulmonary
Skin
Bladder control
Delayed complications: infection, nonunion,
avascular necrosis, fixation device problems.
Monitor drainage from site (hemovacs)
200 -400ml of drainage is common in first day
Cast Application
Analgesic: admin ordered analgesic
Skin preparation: clean, dry
Support body part during application
Monitor smoothness of cast material
Position limp on pillow to dry,
elevated above heart.
Position client comfortably - q2hr
Prepare for discharge
5 P Assessment
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Unexpected Outcomes of
Casting
Malunion
Osteomyelitis
Pressure ulcer
Muscle weakness
Cold extremity
Skin irritation
Unable to perform cast care
Post Removal
Observe underlying skin: colour,
temp, integrity
Assess client’s verbal and nonverbal
responses
Explain exercise plan and
demonstrate exercises
Skin care
Traction
Maintain established line of pull
Prevent friction of skin
Maintain counteraction
Continuous (usually)
Maintain correct body alignment
Skin Traction
Non-invasive
Assess traction setup
Assess mobility
restrictions
Assess Pain
Assess NV status
Understanding
Intermittent
release
Skeletal Traction
Traction is external and internal (via
pins, wires, nails)
Similar care principles as skin
traction.
Continuous
Pin Care
Inspect pins every 8 hours at minimum
Principles of Traction
Weights or traction never removed
unless ordered
Patient must be in proper alignment
Ropes unobstructed
Weights hang free
Knots or other devices not hung-up
on pulleys or bedframe
Amputation
Levels: determined by
Circulation and function at most distal end that will
heal
Complications: hemorrhage, infection, skin
breakdown, joint contracture and phantom pain
Rehabilitation: multidisciplinary
Nursing Management
relieving pain
minimizing altered sensory perception
promoting wound healing
enhancing body image
self-care
Amputation
Stump Dressing
Promote healing
Residual limb shaping for prosthesis
fitting
Control edema
Gentle handling
Aseptic technique
Closed rigid or soft dressing