Individuals Experiencing Musculoskeletal Disorders

1
Individuals Experiencing Musculoskeletal Disorders

• NURS 2016

2

• Musculoskeletal Includes
• Bones
• Joints
• Muscles
• Tendons
• Ligaments
• Bursae
• Complications include
• Trauma
• Contusion
• Strain
• Sprain
• Joint dislocation subluxation avascular
  necrosis

3
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

4
Musculoskeletal Trauma

• Initial Assessment
• Circulation
• Movement
• Sensation

5
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

6
Treatment strains, sprains, contusions

• Rest
• Ice
• Compression
• Elevate

7
Joint Dislocations

• Subluxation is a partial dislocation of the
  articulating surfaces
• Medical Management is immobilization
• Nursing Management
• provide comfort
• neurovascular status
• protect joint

8
Fractures

• Break in the continuity of the bone

9
Fractures Break in the continuity of the bone
10
Clinical Manifestations

• Clinical manifestations
• Pain
• Loss of function
• Deformity
• False motion
• Shortening
• Crepitus
• Swelling discoloration

11
Management

• Emergency Management stabilize limb(affected
  area)
• Reduction
• Closed
• Open
• Traction

12
Complications

• Shock
• Fat Embolism Syndrome
• Compartment Syndrome
• Delayed Union/Nonunion
• Avascular Necrosis
• Infection

13
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

14
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.

15
Nursing Process Interventions

• Expected Outcome normal neurovascular
  examination
• Nursing Strategies
• Assess for SS 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

16
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.

17
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

18
Joint Replacement

• Arthroplasty replacement of all parts of the
  joint
• Contributing factors to joint replacement
• Pain
• Osteoarthritis
• Rheumatoid arthritis
• Trauma
• Congenital deformity

19
Joint Replacement Cont

• Joints frequently replaced
• Hip
• Knee
• Finger
• Joints sometimes replaced
• Shoulder
• Elbow
• Wrist
• Ankle

20
Special considerations with Hip
Fractures/Repair/Replacement

• Do NOT
• Force flexion gt90
• 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

21
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

22
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

23
5 P Assessment

• Pain
• Pallor
• Pulselessness
• Paresthesia
• Paralysis

24
Unexpected Outcomes of Casting

• Malunion
• Osteomyelitis
• Pressure ulcer
• Muscle weakness
• Cold extremity
• Skin irritation
• Unable to perform cast care

25
Post Removal

• Observe underlying skin colour, temp, integrity
• Assess clients verbal and nonverbal responses
• Explain exercise plan and demonstrate exercises
• Skin care

26
Traction

• Maintain established line of pull
• Prevent friction of skin
• Maintain counteraction
• Continuous (usually)
• Maintain correct body alignment

27
(No Transcript)
28
Skin Traction

• Non-invasive
• Assess traction set-up
• Assess mobility restrictions
• Assess Pain
• Assess NV status
• Understanding Intermittent release

29
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

30
(No Transcript)
31
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

32
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

33
AmputationStump Dressing

• Promote healing
• Residual limb shaping for prosthesis fitting
• Control edema
• Gentle handling
• Aseptic technique
• Closed rigid or soft dressing

34
(No Transcript)