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Individuals Experiencing Musculoskeletal Disorders NURS 2016.

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Presentation on theme: "Individuals Experiencing Musculoskeletal Disorders NURS 2016."— Presentation transcript:

1 Individuals Experiencing Musculoskeletal Disorders NURS 2016

2  Musculoskeletal Includes: Bones Joints Muscles Tendons Ligaments Bursae  Complications include: Trauma Contusion Strain Sprain Joint dislocation: subluxation & avascular necrosis

3 Musculoskeletal Disorders  Low Back Pain Most is self-limiting and will improve on its own with time Sciatica  Osteoporosis Bone density loss Small frame, non obese women  Osteomyelitis Bone infection  Septic Arthritis Joint infection

4 Musculoskeletal Trauma Initial Assessment Circulation Movement Sensation

5 Contusions, Strains, and Sprains  Contusion is a soft tissue injury  Strain is a pulled muscle from overuse, overstretching, or excessive stress  Sprain is an injury to ligaments surrounding a joint

6 Treatment: strains, sprains, contusions  Rest  Ice  Compression  Elevate

7 Joint Dislocations  Subluxation is a partial dislocation of the articulating surfaces  Medical Management is immobilization  Nursing Management provide comfort neurovascular status protect joint

8 Fractures  Break in the continuity of the bone

9 Fractures: Break in the continuity of the bone

10 Clinical Manifestations  Clinical manifestations Pain Loss of function Deformity False motion Shortening Crepitus Swelling & discoloration

11 Management  Emergency Management: stabilize limb (affected area)  Reduction Closed Open Traction

12 Complications  Shock  Fat Embolism Syndrome  Compartment Syndrome  Delayed Union/Nonunion  Avascular Necrosis  Infection

13 Nursing Process: Fracture Assessment  Objective Data: assess clinical manifestations for fx.  Subjective Data Health Info: past hx, meds, surgery Functional: motion, weakness, spasm, pain, tingling

14 Nursing Process: Planning Nursing Diagnosis  Risk for peripheral neurovascular dysfunction related to nerve compression  Acute pain, evidenced by pain descriptors, guarding, crying, related to edema, movement of bone fragments, and muscle spasms.  Risk for infection related to disruption of skin integrity and presence of environmental pathogens secondary to open fracture.

15 Nursing Process: Interventions Expected Outcome: normal neurovascular examination Nursing Strategies  Assess for S&S peripheral neurovascular dysfunction Unrelieved pain or pain on passive movement Paresthesias, cool, pallor, diminished pulses  Elevate extremity above level of heart to reduce edema by promoting venous return

16 The Patient with a Hip Fracture  Surgical repair is preferred method of treatment.  Intra capsular Fx (head and neck of femur): endoprothesis  Extracapsulr Fx (trochanteric): nails, plates, intramedullary devices. Nursing Management for both is the same.

17 Nursing Interventions  Relieving Pain  Promoting Hip Function & Stability  Promoting Wound Healing  Promoting Normal Urinary Elimination Patterns  Promoting Skin Integrity  Promoting Effective Coping Mechanisms  Promoting Patient Orientation & Participation in Decision Making  Monitoring & Preventing Potential Complications

18 Joint Replacement  Arthroplasty: replacement of all parts of the joint  Contributing factors to joint replacement: Pain Osteoarthritis Rheumatoid arthritis Trauma Congenital deformity

19 Joint Replacement Cont’  Joints frequently replaced: Hip Knee Finger  Joints sometimes replaced: Shoulder Elbow Wrist Ankle

20 Special considerations with Hip Fractures/Repair/Replacement Do NOT  Force flexion >90  Force adduction  Force internal rotation  Cross legs  Put footwear on without assistive device before 8 weeks  Sit on chair without arms to aid in raising to stand DO  Use elevated toilet seat  Place chair inside shower or tub  Use pillow between legs when on side  Keep hip in neutral position  Notify surgeon if severe pain, deformity or loss of function

21 Continued Strategies for Hip Repair/Replacements Provide abduction pillow to prevent adduction Monitor and manage complications  Neurovascular  DVT  Pulmonary  Skin  Bladder control  Delayed complications: infection, nonunion, avascular necrosis, fixation device problems. Monitor drainage from site (hemovacs)  ml of drainage is common in first day

22 Cast Application  Analgesic: admin ordered analgesic  Skin preparation: clean, dry  Support body part during application  Monitor smoothness of cast material  Position limp on pillow to dry, elevated above heart.  Position client comfortably - q2hr  Prepare for discharge

23 5 P Assessment  Pain  Pallor  Pulselessness  Paresthesia  Paralysis

24 Unexpected Outcomes of Casting  Malunion  Osteomyelitis  Pressure ulcer  Muscle weakness  Cold extremity  Skin irritation  Unable to perform cast care

25 Post Removal  Observe underlying skin: colour, temp, integrity  Assess client’s verbal and nonverbal responses  Explain exercise plan and demonstrate exercises  Skin care

26 Traction  Maintain established line of pull  Prevent friction of skin  Maintain counteraction  Continuous (usually)  Maintain correct body alignment


28 Skin Traction Non-invasive  Assess traction set- up  Assess mobility restrictions  Assess Pain  Assess NV status  Understanding Intermittent release

29 Skeletal Traction  Traction is external and internal (via pins, wires, nails)  Similar care principles as skin traction.  Continuous  Pin Care Inspect pins every 8 hours at minimum


31 Principles of Traction  Weights or traction never removed unless ordered  Patient must be in proper alignment  Ropes unobstructed  Weights hang free  Knots or other devices not hung-up on pulleys or bedframe

32 Amputation  Levels: determined by Circulation and function at most distal end that will heal  Complications: hemorrhage, infection, skin breakdown, joint contracture and phantom pain  Rehabilitation: multidisciplinary  Nursing Management relieving pain minimizing altered sensory perception promoting wound healing enhancing body image self-care

33 Amputation Stump Dressing  Promote healing  Residual limb shaping for prosthesis fitting  Control edema  Gentle handling  Aseptic technique  Closed rigid or soft dressing


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