MS Care Mod Ali Ties

8/8/2019 MS Care Mod Ali Ties

1/21

MS CareModalitiesMS Care

Modalities

Connie K. Cupples, MS,MSN, RNConnie K. Cupples, MS,MSN, RN


2/21

Care ModalitiesCare Modalities

Casts nonplaster & plaster

Traction Skin & skeletal

External fixation devices pins Open reduction with internal fixation

Artificial joint replacement hip, knee

Casts nonplaster & plaster

Traction Skin & skeletal

External fixation devices pins Open reduction with internal fixation

Artificial joint replacement hip, knee


3/21

Nursing Interventions

for Patient in a Cast


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 cleanand apply sterile dressing to areas,observe for s/s of infection

Pain relief elevate the part, coldapplication & analgesics as ordered(unrelieved pain may indicate

compartment syndrome) Improve mobility ROM to all

immobilized joints

Promote healing of skin abrasions cleanand apply sterile dressing to areas,observe for s/s of infection


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Nursing interventions contdNursing interventions contd

Maintain neurovascular function earlyrecognition and reporting to MD of s/s ofunrelieved pain, pain on passive stretch,

paresthesia, motor loss, sensory loss,coolness, pallor, slow capillary refill,sensation of tightness (may indicatecompartment syndrome)

Elevate extremity no higher than heartlevel and call MD STAT

Maintain neurovascular function earlyrecognition and reporting to MD of s/s ofunrelieved pain, pain on passive stretch,

paresthesia, motor loss, sensory loss,coolness, pallor, slow capillary refill,sensation of tightness (may indicatecompartment syndrome)

Elevate extremity no higher than heartlevel and call MD STAT


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Potential Complications

for Patient in a Cast

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

Compartment Syndrome circulation andfunction 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

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

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


7/21

Management of Patient

in Arm Cast


in Arm Cast Elevate immobilized arm

Sling used during ambulation

Neurovascular checks observe forVolkmanns contracture

Elevate immobilized arm

Sling used during ambulation

Neurovascular checks observe forVolkmanns contracture


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in a Leg Cast


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

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

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

Turn q 2h to unaffected side (3-4persons)

Prone position bid if not contraindicated Skin care

Fracture bedpan with plastic pads

Observe for cast syndrome psychological & physiological


10/21

Types of Hip Spica CastsTypes of Hip Spica Casts


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Managing Pt with Splints & BracesManaging 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

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

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

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


13/21


with Skin Traction


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

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


14/21

Nursing Interventions with a Pt in

Skeletal Traction

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

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


15/21

QUESTIONSQUESTIONS

What are three potential complicationsthat a patient in skeletal traction maydevelop?

Identify nursing interventions to preventthe above complications.

What are three potential complicationsthat a patient in skeletal traction maydevelop?

Identify nursing interventions to preventthe above complications.


16/21

Nursing Interventions for Pt. with

Total Hip Replacement

Nursing Interventions for Pt. with

Total Hip Replacement Keep leg in abduction to preventdislocation of the prosthesis useabduction pillow to keep hips abducted

When turning, keep hip abducted

Turn from side to side unless surgeonorders 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

Keep leg in abduction to preventdislocation of the prosthesis useabduction pillow to keep hips abducted

When turning, keep hip abducted

Turn from side to side unless surgeonorders 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


17/21

Teaching Pt to Avoid Hip

Dislocation

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

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


18/21

Nursing Interventions contdNursing Interventions contd

Observe wound drainage (expect 200-500ml in 1st24 h, 30ml or less in 48h)

Measures to prevent DVT (fluids, exercise,TEDs, SCDs, ambulate, heparin orLovenox as ordered)

Prevent infection (antibiotics as ordered)

Teach self care to prepare for discharge Continuity of physical therapy, use of

assistive devices

Observe wound drainage (expect 200-500ml in 1st24 h, 30ml or less in 48h)

Measures to prevent DVT (fluids, exercise,TEDs, SCDs, ambulate, heparin orLovenox 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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GOOD BYE AND GOOD LUCKGOOD BYE AND GOOD LUCK

Have a blessed day! Have a blessed day!

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MS Care Mod Ali Ties