Care of Clients With Problems Related to the Musculoskeletal System

8/7/2019 Care of Clients With Problems Related to the Musculoskeletal System

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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 tractionindicated 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


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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


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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

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Care of Clients With Problems Related to the Musculoskeletal System