MS Care Modalities

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MS Care Modalities

• Connie K. Cupples, MS, MSN, RN

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Care Modalities

• Casts nonplaster plaster
• Traction Skin skeletal
• External fixation devices pins
• Open reduction with internal fixation
• Artificial joint replacement hip, knee

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Nursing Interventions for Patient in a Cast

• Pain relief elevate the part, cold application
  analgesics as ordered (unrelieved pain may
  indicate compartment syndrome)
• Improve mobility ROM to all immobilized joints
• Promote healing of skin abrasions clean and
  apply sterile dressing to areas, observe for s/s
  of infection

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Nursing interventions contd

• Maintain neurovascular function early
  recognition and reporting to MD of s/s of
  unrelieved pain, pain on passive stretch,
  paresthesia, motor loss, sensory loss, coolness,
  pallor, slow capillary refill, sensation of
  tightness (may indicate compartment syndrome)
• Elevate extremity no higher than heart level and
  call MD STAT

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Potential Complications for Patient in a Cast

• Compartment Syndrome circulation and function
  are compromised
• Pressure Ulcers observe for s/s
• Disuse Syndrome muscle atrophy occurs

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Teaching the Patient with a Cast Home Care

• Mobility aids safety
• Prescribed exercise
• Elevate extremity to heart level
• Keep cast dry cushion rough edges
• Dont scratch under cast
• Report indicators of complications
• Avoid excessive use of injured extremity
• Report broken cast

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Management of Patient in Arm Cast

• Elevate immobilized arm
• Sling used during ambulation
• Neurovascular checks observe for Volkmanns
  contracture

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Management of Patient in a Leg Cast

• Elevate to heart level
• Apply ice for 1-2 days as prescribed
• Encourage recumbent position several times a day
• Assess circulation and nerve function (peroneal
  injury may cause footdrop)
• Teach use of assistive devices (transfer
  ambulating)
• Use of cast boot or reinforcement of cast if
  weight-bearing is allowed

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Nursing Interventions with a Patient in a Body or
Spica Cast

• Turn q 2h to unaffected side (3-4 persons)
• Prone position bid if not contraindicated
• Skin care
• Fracture bedpan with plastic pads
• Observe for cast syndrome psychological
  physiological

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Types of Hip Spica Casts
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Managing Pt with Splints Braces

• Teach pt how to apply device
• Neurovascular checks
• Assess comfort when using device
• Encourage to wear as prescribed
• Refer pt for adjustments as needed

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Nursing Interventions for Pt With an External
Fixator

• Pt teaching prior to application
• Elevate extremity
• Monitor neurovascular status q 2-4 h
• Assess pin site for s/s of infection
• Pin care as prescribed
• Encourage isometric and active exercises
• Physical therapy referral may be ordered

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Nursing Interventions with Skin Traction

• Keep leg in proper alignment
• Keep traction bandage free of wrinkles
• Maintain countertraction
• Do not turn but assist to shift position
• Measures to prevent skin breakdown
• Assess for nerve pressure
• Circulation checks q 1-2 h
• Encourage active foot exercises

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Nursing Interventions with a Pt in Skeletal
Traction

• Ensure that weights hang freely that ropes,
  knots, and pulleys are correct
• Maintain proper body alignment foot in neutral
  position
• Prevent skin breakdown
• Bed changed from top to bottom
• Neurovascular checks q 4h
• Pin site care tid or as prescribed
• Encourage exercise within therapeutic limits

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QUESTIONS

• What are three potential complications that a
  patient in skeletal traction may develop?
• Identify nursing interventions to prevent the
  above complications.

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Nursing Interventions for Pt. with Total Hip
Replacement

• Keep leg in abduction to prevent dislocation of
  the prosthesis use abduction pillow to keep
  hips abducted
• When turning, keep hip abducted
• Turn from side to side unless surgeon orders not
  to turn to affected side
• Teach pt to avoid flexion of affected hip
• Dont elevate HOB more than 60 degrees
• Observe for s/s of dislocation

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Teaching Pt to Avoid Hip Dislocation

• Dont cross legs
• Keep knees apart
• Sleep with pillow between legs
• Dont bend forward when seated
• Dont bend to pick up objects on floor
• Use high-seated chair raised toilet seat
• Dont flex hip while dressing
• Use a reaching device to assist with activities

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Nursing Interventions contd

• Observe wound drainage (expect 200-500ml in 1st
  24 h, 30ml or less in 48h)
• Measures to prevent DVT (fluids, exercise, TEDs,
  SCDs, ambulate, heparin or Lovenox as ordered)
• Prevent infection (antibiotics as ordered)
• Teach self care to prepare for discharge
• Continuity of physical therapy, use of assistive
  devices

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Post-op Nursing Interventions for Pt with Total
Knee Replacement

• Observe dressing for bleeding/drainage
• Ice as ordered
• Neurovascular checks
• Pain meds as ordered
• Active flexion of foot q1h while awake
• Observe CAC in wound suction drainage
• Continuous passive motion (CPM) device
• Early ambulation with knee immobilizer
• Physical therapy as ordered

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QUESTIONS

• In the post-op care of the patient undergoing
  orthopedic surgery, name 5 potential
  complications for which the nurse would monitor.
• Give nursing assessments and interventions to
  prevent these complications.

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GOOD BYE AND GOOD LUCK

• Have a blessed day!

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