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

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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

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


Reduction/Realignment

Immobilization

Nursing care

Prevention and early detection:

complication

CONCEPTS: FRACTURES


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

Cast

Traction

External fixation

Internal fixation


CASTS


Casts

External, circumferential

Thermochemical reaction = warmth

Nursing care:

No weight bearing 24-72 hours

“flat hands”

Elevate

Neuro-vascular checks


CASTS


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

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 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 FIXATION


Traction

Pulling forces: traction + countertraction

Purpose(s):

Prevent or reduce muscle spasm

Immobilization

Reduce a fracture

Treat certain joint conditions


Types of Traction

Skin

Buck’s

Russell’s

Bryant’s (“babies cry with Bry”)‏

Skeletal

Balanced suspension

(Lewis, 1660-1661)‏


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


TRACTION


SKIN TRACTION

BUCK’S TRACTION


SKELETAL TRACTION


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

Compartment syndrome

Fat embolism

Venous thrombosis

Infection


COMPARTMENT SYNDROME

  • FACIOTOMY – wound is left open

  • If no improvement, amputation


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

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

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

ORIFvs“Total Hip”


Internal fixation = immobilization


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)‏

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

Trauma vs. Therapeutic

Immobilization: wiring, screws, plate(s)‏

Nursing care:

Airway (Cutter with client)‏

Oral hygiene

Nutrition

Communication


What can go wrong

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


Degenerative Joint Disease:Osteoarthritis

Not normal part of aging process

Cartilage destruction:

Trauma

Repetitive physical activities

Inflammation

Certain drugs (corticosteroids)‏

Genetics


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

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)‏

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

Post-operative care:

5 P’s

Observe for bleeding

Pain management

Knee: CPM

Check incision for s/s infection


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

Primary – often women postmenopause

Secondary – corticosteroids, immobility, hyperparathyroidism

Bone demineralization = decreased bone density

Fractures:

Wrist

Hip

Vertebral column


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

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 wrong

Fractures

Hip

Mandible

Degenerative joint disease

Osteoporosis

Herniated disc

Amputation


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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