View
214
Download
0
Category
Preview:
Citation preview
8/7/2019 Care of Clients With Problems Related to the Musculoskeletal System
1/3
Care of Clients with Problems Related to the MusculoskeletalSystem
Diagnostic Procedures 1. Radiologic studies a. X- rays b. Computed tomography or CT scan
Non- invasive procedure where a body part can be acanned fromdifferent angles with an x-raybeam and a computer calculatesvarrying tissue densities and records a cross section image on
paper done to determine extent of fracture in difficult to defineareas
c. Myelography Injection of radioopaque dye into
subarachnoid space at posterior spine todetermine level of disc herniation or site of tumor
2. A rthrography Radioopaque or air injected into joint cavity-
outines soft tissue structure and contour of joint
3. B one scanning Parenteral injection of bone seekingradioactive isotope
4. E lectromyography Graphic presentation of the electrical potential
of muscles
5. Magnetic Resonance Imaging Noninvasive scanning technique that uses
magnetism and radiofrequency waves toproduce cross-sectional images of body tissueson computer screen
6. A rthroscopy Endoscopic direct visualization of joint,especially knee
7. A rthrocentesis Needle aspiration of synovial fluid
8. B one B iopsy or Muscle biopsy
Laboratory Uric acid Antinuclear antibody ( ANA) for systemic Lupus
Erythematosus Complement fixation (CF ) for Rheumatoid
Arthritis Calcium, Alkaline Phosphate, Phosphorus
Musculo-Skeletal Therapeutic Modalities
1. Reduction Realigning an extremity into anatomical
position O pen- use of surgical methods Closed- use of non-surgical methods;
manipulation
2. Immobilization Manual Skin- adhesive- plaster or adhesive is applied
longitudinally on the lower extremeties and anelastic bamndage applied in an spiral motion
3. Bryant s traction- indicated for children aged 0-3 year snot more than 40 lbs.
Traction is always applied on both ends
N ursing Responsibility Nurse should be able to pass hand between the patient s buttocksand mattress
B uck s Ex tension TractionIndicated for older patients and to those weighing over 40 lbs.
N ursing Responsibility O nly the affected e x tremity is placed on traction
Dunlop TractionUsed in affectations of the upper extremities
N ursing Care of Clients with Adhesive Traction
1. Unwrap and wrap and elastic bandage at least once ashift
2. Check skin integrity for allergic reactions to plaster3. Note circulation, sensation and mobility of the affected
extremitiesSkin- non adhesive
Uses canvass or cloth that is applied on the patient s skin
Pelvic girdle traction Applied like a girdle and connected to two
ropes with weights that hang at the foot partof the bed
Indicated for low back pain
H ead H alter Traction Applied on chin and occipital region connected
to a hanger with weights that hangs at thehead part of the bed
Usually indicated for cervical spine affectationsSkin- non adhesive traction
Cotrel Traction Combination of the head halter and pelvic
traction used in scoliosis
Russell Traction Permits patient to move freely in bed and
permits flexion of the knee and hip joint
Buck s extension and the knee is suspended ina sling to which a rope is attached
N ursing Care of Clients with non-adhesive traction Rest period are provided
Skeletal Traction Applied into a bone
Crutchfield Skeletal Traction Applied into the parietal; bones
Indicated for cervical spine affectations
8/7/2019 Care of Clients With Problems Related to the Musculoskeletal System
2/3
Crutchfield TongSkeletal TractionBalanced Skeletal Traction
Applied alone or with skeletal traction topromote patient mobility
Principles of Care1. The patient should always be on either supine or dorsal
recumbent position2. The traction should always have a counteraction
(patient s weight ) 3. The line of deformity should be in line with the traction4. Traction should be continuous5. There should be no friction within the line of traction6.
Cast- Comparison of Cast Materials
Braces Knight-taylors
For thoraco-lumbar affectations Milwaukee
For scoliosisN ursing Care
Use cotton clothing as barrier
Fixators RAEF Roger Anderson External Fixator
Ilizarov device Indicated for comminuted fractures
3. Rehabilitation Active or dynamic program aimed at enabling an ill or
disabled to achieve the highest level of physical, mental,social, and economic self-sufficiency of which he iscapable
Members of the Rehabilitation teama. Patient
Key member of health teamb. Rehabilitation nurse
D evelops plan of patient carec. Physician
Makes medical diagnosis; directs teamd. Physiatrist
Physician specialist in physical medicinee. Physical Therapist
Teaches or supervises patient in prescribedexercise program
Members of the Rehabilitation team
f. Psychologist H elps patient or family explore feelings
g. O ccupational Therapist H elps develop skills for home and work
situationsh. Social Worker
Assists patient and family adjust socio-economically
i. V ocational Counselor Tests patient s interest and aptitudes
j. Rehabilitation E ngineer Uses technology in designing or constructing
devices to help the handicapped
Transfer and Assistive D evices1. transferring a client from bed to stretcher
stretcher must be perpendicular to bed2. transferring a client from bed to wheelchair
the wheelchair must be parallel to the head of the bed
3. Canes H eight of cane is from floor to waist level Cane is held by opposite the affected
extremity
Transfer and Assistive D evices4. Crutches
H eight of crutch is from floor to axilla minus 2inches
Patient s weight is borne by the palm, of thehand and not on the axilla
W hen going upstairs, unaffected leg first W hen going upstairs, affected leg first
Crutch-walking techniques Two point gait (two alternate gait ) Three point gait F our point gait
Swinging crutch gaits Both legs are lifted off the groundsimultaneously and swung forward whilepatient pushes up on crutches
Swing - to gait Lift and swing body up to crutches
Swing - through gait Lift swing body beyond crutches
Exercisesa. Isometric
Alternate contraction and relaxation of themuscle without moving the joint
D one on the affected extremityb. Isotonic Range of motion exercises
D one on the unaffected extremity
H eat or Cold Application in TraumaCold A pplication
first 24 hours To decrease hemorrhage To relieve pain To reduce inflammation
H eat A pplication After 24 hoursTo relieve pain from muscle spasmsTo reduce swelling by increasing circulationTo promote healing by increasing oxygenation
4. O rthopedic O perative Proceduresa. A rthrotomy
Surgical opening into a jointa. A rthrodesis
Fixation of a jointa. Spinal fusion
Surgical removal of 1 or more vertebra and fusing them together
8/7/2019 Care of Clients With Problems Related to the Musculoskeletal System
3/3
4. O rthopedic O perative Proceduresd. H ip replacement
Placement of prosthesis on the hip joint
Indication H ip fractureInability to move leg voluntarilyShortening and external rotation of the leg
Nursing Management on Hip Replacement
Avoid positioning on the operative siteMaintain abduction of hipPillows between legsProvide chair with firm, non-reclining seat and arms
Nursing Management on Hip Replacement Avoid hip flexion beyond 60 degrees for 10 daysAvoid hip flexion beyond 90 degrees from day 10 to 2 monthsAvoid adduction of the affected leg beyond midline for 2 monthsPartial weight bearing status for 2 months
Trauma
Contusion
Injury to the soft tissue produced by blunt force
SprainInjury to the ligamentous structures caused by wrenching ortwistingForcible hyperextension of a joint with tissue damage likewhiplash injury
Strain Tearing of musculotendenous unit caused excessive stretching
Dislocation Joint articulating surfaces are partially separatedNo longer in anatomical contact
Fractures Break on continuity of bone
N ursing Assessment 1. Pain- Increasing until immobilized1. Loss of function2. Localized swelling or discoloration3. D eformity4. Crepitus - Grating sound
General Classifications of FracturesSimple or closedSkin is intact over fracture site
Compound or openW ith an external wound in contact with the underlying fracture
CompleteEntire cross section is displaced
IncompletePortion of cross section undisplaced
General Classifications of FracturesGreenstick
O ne side broken and other bent
Transverse Straight across the bone
O blique Angle or slanting across the bone
Spiral Twisting or coils around shaft
Comminuted Splintered into several fragments
General Classifications of Fractures
D epressedFragments are drived-in; facial or skull
CompressionFractured bone compressed by another bone; vertebra
ImpactedFractured bones are pushed into each other (telescoped )
D isplacedFragments are separated from fracture line
LinearFracture parallel with long axis
Recommended