Care of client with musculoskeletal injury or disorder
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Care of client with musculoskeletal injury or disorder.

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Care of client with musculoskeletal injury or disorder

Care of client with musculoskeletal injury or disorder

http://wwwhttp://www.scribd.com/doc/9378673/musculoskeletal-dishttp://www.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005orders-care-of-client-with-fall-2005.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005


What can go wrong

What can go wrong

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


Reduction realignment immobilization nursing care prevention and early detection complication

Reduction/Realignment

Immobilization

Nursing care

Prevention and early detection:

complication

CONCEPTS: FRACTURES


Realignment reduction

Realignment=Reduction

Correct bone alignment goal: restore injured part to normal or near-normal function

Closed vs. open reduction

Open reduction = surgery


Immobilization to maintain alignment

Immobilization:to maintain alignment

Cast

Traction

External fixation

Internal fixation


Casts

CASTS


Casts1

Casts

External, circumferential

Thermochemical reaction = warmth

Nursing care:

No weight bearing 24-72 hours

“flat hands”

Elevate

Neuro-vascular checks


Casts2

CASTS


Cast client family teaching

Cast: Client/Family Teaching

Keep dry

No foreign objects in cast

No weight bearing until MD order (at least 48 hour)‏

Elevate above heart (48 hours)‏

Signs of problems to report

Pain, tingling, burning

Sores, odor


External fixation

External fixation

Metal pins inserted into bone

Pins attach to external rods

Nursing care:

Assess for s/s infection

Teach pin care: ½ H2O2+ ½ H2o

Open reduction: assess incision

Elevate

Neurovascular checks


External fixation1

EXTERNAL FIXATION


Internal fixation

Internal Fixation

Pins, plates, screws surgically inserted

Nursing care:

Assess incision site

MD orders: activity, weight bearing, ROM,

Assess s/s infection; temp. q 2-4 hours

Neurovascular checks:

5 “P’s”


Internal fixation1

INTERNAL FIXATION


Traction

Traction

Pulling forces: traction + countertraction

Purpose(s):

Prevent or reduce muscle spasm

Immobilization

Reduce a fracture

Treat certain joint conditions


Types of traction

Types of Traction

Skin

Buck’s

Russell’s

Bryant’s (“babies cry with Bry”)‏

Skeletal

Balanced suspension

(Lewis, 1660-1661)‏


Nursing concerns interventions

Nursing Concerns/Interventions

Assess neurovascular status

Assess skin (bony prominences, under elastic wraps, etc.)‏

Assess pin sites (skeletal tx)‏

Maintain correct body alignment

Weights hang freely

Hazards of immobility


Traction1

TRACTION


Skin traction

SKIN TRACTION

BUCK’S TRACTION


Skeletal traction

SKELETAL TRACTION


Nursing diagnoses

Nursing Diagnoses

Neurovascular dysfunction, risk for

Acute pain, R/T edema, muscle spasms, movement of bones

Infection, risk for

Impaired skin integrity, risk for

Impaired physical mobility


Complications of fractures

Complications of Fractures

Compartment syndrome

Fat embolism

Venous thrombosis

Infection


Compartment syndrome

COMPARTMENT SYNDROME

  • FACIOTOMY – wound is left open

  • If no improvement, amputation


Hip fracture

Hip Fracture

In 1999 (USA) hip fractures resulted in approximately 338,000 hospital admissions

Up to 25% of community-dwelling older adults who sustain hip fractures remain institutionalized for at least a year


Hip fractures

Hip Fractures

One-third of older women who fracture their hip will die within a year because of lengthy convalescence that makes them susceptible to complications, like lung and bladder infections.

The Lancet 1999;353:878-82


Fracture of hip

Fracture of hip

Types of hip fractures (Lewis pg. 1675):

Intracapsular

Capital

Subcapital

Transcervical

Extracapsular

Intertrochanteric

Subtrochanteric


Open reduction internal fixation pins screws plate s total hip endoprosthesis replace femoral head

Open reduction/internal fixation:

pins, screws, plate(s)‏

Total hip:

endoprosthesis – replace femoral head

ORIFvs“Total Hip”


Internal fixation immobilization

Internal fixation = immobilization


Nursing care

Nursing Care

Risk for peripheral neurovascular dysfunction

Pain

Impaired mobility:

Prevent thrombus

Safety

Constipation

Risk for impaired skin integrity:

Immobility

Incision


Femoral head prosthesis total hip

Femoral head prosthesis (total hip)‏

Prevent dislocation:

Do not flex > 90 degrees

No internal rotation (toes to ceiling)‏

Maintain abduction

Do not position on operative side

Patient teaching:

Precautions for 6-8 weeks

Notify dentist: prophylactic antibiotics

Lewis: pg. 1678


Fracture of mandible

Fracture of mandible

Trauma vs. Therapeutic

Immobilization: wiring, screws, plate(s)‏

Nursing care:

Airway (Cutter with client)‏

Oral hygiene

Nutrition

Communication


What can go wrong1

What can go wrong

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


Degenerative joint disease osteoarthritis

Degenerative Joint Disease:Osteoarthritis

Not normal part of aging process

Cartilage destruction:

Trauma

Repetitive physical activities

Inflammation

Certain drugs (corticosteroids)‏

Genetics


Assessment

Assessment

Location, nature, duration of pain

Joint swelling/crepitus

Joint enlargement

Deformities

Ability to perform ADL’s

Risk factors

Weight (history of obesity)‏


Nursing interventions

Nursing Interventions

Pain management

Rest with acute pain; exercise to maintain mobility

Splint or brace

Moist heat

Alternative therapies

TENS, acupuncture, therapeutic touch


Surgical management total joint arthroplasty replacement

Surgical management: total joint arthroplasty (replacement)‏

Elbow, shoulder, hip, knee, ankle, etc.

Pre-operative teaching:

“What to expect” (CPM, abduction pillow, drains, compression dressing, etc.)‏

Postoperative exercises: quad sets, glute sets, leg raises, abduction exercises

Pain management:

PCA

Use of pain scale


Total joint arthroplasty

Total Joint Arthroplasty

Post-operative care:

5 P’s

Observe for bleeding

Pain management

Knee: CPM

Check incision for s/s infection


Total joint arthroplasty1

Total Joint Arthroplasty

Postoperative Care

Prevent:

Dislocation

Skin breakdown

Venous thrombosis (DVT)‏

TED/Sequential compression

Anticoagulants

Exercises: plantar flexion, dorsiflexion, circle feet, glute & quad sets


Osteoporosis

Osteoporosis

Primary – often women postmenopause

Secondary – corticosteroids, immobility, hyperparathyroidism

Bone demineralization = decreased bone density

Fractures:

Wrist

Hip

Vertebral column


Silent disease

Silent disease

Dowager’s hump (kyphosis)‏

Pain

Compression fractures

Spontaneous fractures

X-ray can not detect until > 25% calcium in bone is lost

Diagnosis: bone density ultrasound


Interventions

Interventions

Hormone replacement

Calcium & vitamin D

Calcitonin, Fosamax, Actonel, Evista

Avoid alcohol and smoking

Daily weight bearing, sustained exercise (walking, bike)‏

Safety in home (throw rugs, pets, etc.)‏


What can go wrong2

What can go wrong

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


Location of ppt on web is below

Location of PPT on Web is below

  • http://www.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005


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