Care of Clients with Problems Related to the Musculoskeletal System
Diagnostic Procedures
1. b. c.
Radiologic studies X-rays Computed tomography or CT scan
Non- invasive procedure where a body part can be acanned from different angles with an x-raybeam and a computer calculates varrying tissue densities and records a cross section image on paper done to determine extent of fracture in difficult to define areas
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Diagnostic Procedures
c. Myelography Injection of radioopaque dye into subarachnoid space at posterior spine to determine level of disc herniation or site of tumor
Diagnostic Procedures
2.
Arthrography
Radioopaque or air injected into joint cavity- outines soft tissue structure and contour of joint
2.
Bone scanning
Parenteral injection of bone seeking radioactive isotope
2.
Electromyography
Graphic presentation of the electrical potential of muscles
Diagnostic Procedures
5.
Magnetic Resonance Imaging
Noninvasive scanning technique that uses magnetism and radiofrequency waves to produce cross-sectional images of body tissues on computer screen
5. Arthroscopy Endoscopic direct visualization of joint, especially knee
Diagnostic Procedures
7.
Arthrocentesis
Needle aspiration of synovial fluid
Bone Biopsy or Muscle biopsy 8. Laboratory
7.
a. Uric acid b. Antinuclear antibody (ANA) for systemic Lupus Erythematosus c. Complement fixation (CF) for Rheumatoid Arthritis d. Calcium, Alkaline Phosphate, Phosphorus
Musculo-Skeletal Therapeutic Modalities
1. Reduction Realigning an extremity into anatomical position
a. Open- use of surgical methods b. Closed- use of non-surgical methods; manipulation
Musculo-Skeletal Therapeutic Modalities
2.
Immobilization
Manual Skin- adhesive- plaster or adhesive is applied longitudinally on the lower extremeties and an elastic bamndage applied in an spiral motion
Musculo-Skeletal Therapeutic Modalities
2. Bryants traction- indicated for children aged
0-3 years not more than 40 lbs.
1.Traction is always applied on both ends
Nursing Responsibility
Nurse should be able to pass hand between the patients buttocks and mattress
Bryant traction
Knee slightly flexed
Buttocks sightly elevetated and clear of bed
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Musculo-Skeletal Therapeutic Modalities
Bucks Extension Traction Indicated for older patients and to those weighing over 40 lbs. Nursing Responsibility Only the affected extremity is placed on traction
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Bucks Extension Traction
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Musculo-Skeletal Therapeutic Modalities
Dunlop Traction Used in affectations of the upper extremities
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Dunlop Traction
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Nursing Care of Clients with Adhesive Traction
1. Unwrap and wrap and elastic bandage at
least once a shift 2. Check skin integrity for allergic reactions to plaster 3. Note circulation, sensation and mobility of the affected extremities
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Skin- non adhesive
Uses canvass or cloth that is applied on the
patients skin Pelvic girdle traction
Applied like a girdle and connected to two ropes with weights that hang at the foot part of the bed Indicated for low back pain
Head Halter Traction
Applied on chin and occipital region connected to a hanger with weights that hangs at the head part of the bed Usually indicated for cervical spine affectations
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Skin- 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 Bucks extension and the knee is suspended in a sling to which a rope is attached
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Russell Traction
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Nursing Care of Clients with nonadhesive traction
Rest period are provided
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Skeletal Traction
Applied into a bone
Crutchfield Skeletal Traction
Applied into the parietal; bones
Indicated for cervical spine affectations
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Crutchfield Tong
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Skeletal Traction
Balanced Skeletal Traction
Applied alone or with skeletal traction to promote patient mobility
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Balanced Skeletal Traction
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Principles of Care
1. The patient should always be on either 2. 3. 4. 5.
supine or dorsal recumbent position The traction should always have a counteraction (patients weight) The line of deformity should be in line with the traction Traction should be continuous There should be no friction within the line of traction
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b. Cast- Comparison of Cast Materials
Plaster Synthetic Material Plaster of Paris, comprised of powdered calcium sulfate crystals impregnated into the bandages 24-48 hours Polyester and cotton, fiberglass or plastic. Polyester and cotton is impregnated with wateractivated polyurethane resin 7-15 mins of setting 15-30 mins for weight bearing
Drying time
Advantages
Less costly Less likely to indent into skin More effective for immobilizing severely Lighter in weight displaced bones Less restrictive Smooth surface Does not crumble Does not require expensive Nonabsorbent equipment for application Can be immersed in water
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c. Braces
Knight-taylors For thoraco-lumbar affectations Milwaukee For scoliosis
Nursing Care
Use cotton clothing as barrier
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d. Fixators
RAEF Roger Anderson External Fixator Ilizarov device Indicated for comminuted fractures
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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 is capable
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Members of the Rehabilitation team
a. a. a. a. a.
Patient Key member of health team Rehabilitation nurse Develops plan of patient care Physician Makes medical diagnosis; directs team Physiatrist Physician specialist in physical medicine Physical Therapist Teaches or supervises patient in prescribed exercise program
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Members of the Rehabilitation team
f.
Psychologist
Helps patient or family explore feelings
g. Occupational Therapist Helps develop skills for home and work situations g. Social Worker Assists patient and family adjust socio-economically g. Vocational Counselor Tests patients interest and aptitudes g. Rehabilitation Engineer Uses technology in designing or constructing devices to help the handicapped
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Transfer and Assistive Devices
1.
transferring a client from bed to stretcher
stretcher must be perpendicular to bed
1.
transferring a client from bed to wheelchair
the wheelchair must be parallel to the head of the bed
1.
Canes
Height of cane is from floor to waist level Cane is held by opposite the affected extremity
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Transfer and Assistive Devices
4. Crutches Height of crutch is from floor to axilla minus 2 inches Patients weight is borne by the palm, of the hand and not on the axilla When going upstairs, unaffected leg first When going upstairs, affected leg first
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Crutch-walking techniques
Two point gait (two alternate gait) Three point gait Four point gait Swinging crutch gaits
Both legs are lifted off the ground simultaneously and swung forward while patient pushes up on crutches
Swing-to gait Lift and swing body up to crutches Swing-through gait Lift swing body beyond crutches
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Exercises
a. Isometric Alternate contraction and relaxation of the muscle without moving the joint a. Done on the affected extremity b. Isotonic Range of motion exercises Done on the unaffected extremity
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Heat or Cold Application in Trauma
Cold Application first 24 hours To decrease hemorrhage To relieve pain To reduce inflammation
Heat Application After 24 hours To relieve pain from muscle spasms To reduce swelling by increasing circulation To promote healing by increasing oxygenation
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4. Orthopedic Operative Procedures
a. Arthrotomy
Surgical opening into a joint a. Arthrodesis Fixation of a joint a. Spinal fusion Surgical removal of 1 or more vertebra and fusing them together
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4. Orthopedic Operative Procedures
d. Hip replacement
Placement of prosthesis on the hip joint
Indication Hip fracture Inability to move leg voluntarily Shortening and external rotation of the leg
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Nursing Management on Hip Replacement
Avoid positioning on the operative site Maintain abduction of hip Pillows between legs Provide chair with firm, non-reclining seat and arms
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Nursing Management on Hip Replacement
Avoid hip flexion beyond 60 degrees for 10 days Avoid hip flexion beyond 90 degrees from day 10 to 2 months Avoid adduction of the affected leg beyond midline for 2 months Partial weight bearing status for 2 months
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Trauma
Contusion
Injury to the soft tissue produced by blunt force
Sprain
Injury to the ligamentous structures caused by wrenching or twisting Forcible hyperextension of a joint with tissue damage like whiplash injury
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Trauma
Strain Tearing of musculotendenous unit caused excessive stretching Dislocation Joint articulating surfaces are partially separated No longer in anatomical contact Fractures Break on continuity of bone
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Nursing Assessment
1. Pain Increasing until immobilized 1. Loss of function 2. Localized swelling or discoloration 3. Deformity 4. Crepitus Grating sound
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General Classifications of Fractures
1. Simple or closed Skin is intact over fracture site 1. Compound or open With an external wound in contact with the underlying fracture 1. Complete Entire cross section is displaced 1. Incomplete Portion of cross section undisplaced
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General Classifications of Fractures
1. Greenstick One side broken and other bent 1. Transverse Straight across the bone 1. Oblique Angle or slanting across the bone 1. Spiral Twisting or coils around shaft 1. Comminuted Splintered into several fragments
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General Classifications of Fractures
Depressed Fragments are drived-in; facial or skull Compression Fractured bone compressed by another bone; vertebra Impacted Fractured bones are pushed into each other (telescoped) Displaced Fragments are separated from fracture line Linear Fracture parallel with long axis
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COMPARING ARTHRITIS Rheumatoid Etiology Autoimmune + Rh factor 35-45 women Osteoarthritis Degenerative senescence Men or more in women Gouty Metabolic or familial purine metabolism Men over 40
Incidence
Signs and symptoms
Subcutaneaous nodules Heberdens nodule Morning stiffness Swan neck deformity Weight bearing joint Symptomatic
Tophi
Areas affected Joints of hands Management Aspirin, NSAIDs Paraffin bath
Great toe
Colchicine Avoid purine diet Allopurinol
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