Musculoskeletal Disorders Part I

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MusculoskeletalDisorders Part I
Osteoporosis Osteomyelitis Osteoarthritis Rheumato
id Arthritis Gout
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MusculoskeletalDisorders Part II
Fractures Amputations
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Manifestations of Fractures

• Pain
• Swelling
• Deformity
• Numbness
• Hematoma Formation
• Muscle spasm

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Emergency Care of Fractures

• Neurovascular Assessment
• Five Ps
• Pain
• Pulses
• Pallor
• Paralysis
• Paresthesia
• Immobilization
• Alignment
• Wound Care

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Diagnosis of Fracture

• X-ray
• Bone Scan
• Lab Studies
• CBC
• Coagulation studies

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Factors Which Promote Bone Healing

• Local
• Good emergency care and fracture setting
• Ice
• Systemic
• Ca, Vitamin D, Growth Hormone
• Adequate Blood Supply
• Young and Active
• No Infection

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Fracture Treatments

• Medications
• Surgery
• Fixation Devices
• External
• Internal
• Traction
• Casts

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Medications

• Analgesics
• Antibiotics
• Anticoagulants
• GI Meds
• Constipation
• Ulcer prevention

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Surgical Treatment

• External Fixation

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Nursing Care for External Fixation Devices

• Maintain Alignment
• Frequent Neurovascular and Skin Assessments
• Infection Prevention
• Skin care per policy

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Surgical Treatment

• Internal Fixation (ORIF)

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Nursing Care for Internal Fixation Devices

• Neurovasuclar Assessment
• PAIN
• Suture Care
• Hemovac?
• Hazards of Immobility
• Lungs, heart, bowels, legs

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Traction

• Manual

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Traction

• Bucks also called Straight Traction

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Traction

• Balanced
• Suspension

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Care of the Client in Traction

• Maintain alignment
• Let weight hang free
• Maintain ropes free
• Position client
• Skin Traction
• NO more then 6 pounds of traction per extremity

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Casts

• Immobilizes Body Part
• Note Composition
• Plaster
• Fiberglass
• Teaching
• No objects in cast
• Keep Dry
• Assess Neurovascular
• Position Sling to prevent neck injuries
• Even distribution of weight
• Alignment
• ID wrinkles in fabric
• Check skin

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Nursing Care ofClient with a Cast

• Neurovascular Checks
• Assess for Infection
• Crutch Walking
• Two Point Gait
• Four Point Gait
• Swing to Gait
• Swing through Gait

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Complications Related to Fractures

• Compartment Syndrome
• Fat Embolism Syndrome
• Deep Vein Thrombosis
• Reflex Sympathetic Dystrophy

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• Compartment Syndrome (CS)
• Fascia Lines the Compartment within the limb
• Increased pressure from hemorrhage or edema
• Pressure from cast being too tight
• Results
• Nerve, vessels, muscles are damaged

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COMPARTMENT SYNDROME
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• Fat Embolism Syndrome
• Globules of fat, released from fractured bone
• Fat mixes with platelets
• Emboli travel to lungs, brain, or other areas.
• Clotting cascade activated petechiae

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Assessment of Fat Embolism Syndrome

• Notify MD Immediately
• Dyspnea
• Confusion
• Pulmonary complications
• Pulmonary Edema
• ARDS
• Petechiae

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Treatment of Fat Embolism Syndrome

• Maintain Pulmonary Function
• Intubation
• Ventilation
• Fluid Balance
• Steroid Treatment
• Stabilize Long Bone Fractures

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• Deep Vein Thrombosis

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• Reflex Sympathetic Dystrophy

• Posttraumatic Condition
• Persistent Pain
• Hyperesthesias
• Swelling
• Skin color changes
• Temperature changes

Treatment Sympathetic Nervous System Blocking
Agent (Alpha or Beta Blocker)
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Hip Fracture
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Nursing Care of Client with Hip Fracture

• Neurovascular Assessment
• Nursing Diagnosis
• Acute Pain
• Risk for Infection
• Impaired Mobility
• Impaired Sensory Perception

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Amputations
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Amputations

• Causes
• PVD
• Trauma
• Infections
• Tumors

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Teaching PrincipalsFor Clients with an Amputation

• Wrap Stump
• Positioning of the Stump
• Stump Exercises
• Physical Activities
• Household modifications
• Referrals for Social Services

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The End