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Individuals Experiencing Musculoskeletal Disorders

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Presentation on theme: "Individuals Experiencing Musculoskeletal Disorders"— 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
Make sure you can identify these different fractures

10 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 Emergency treatment always includes assess Airway, Breathing, and Circulation first. From there, stabilizing the affected limb or area is important to prevent further tissue trauma and damage. Emergency assessment of injured area include Circulation, movement and sensation. Once a fracture location has been determined, reduction process is planned and implemented (outside of scope of RN). The reduction most often is closed, however with more complext fractures, and open or surgical reduction may be necessary. Often when the fracture is fairly simple, but surrounding muscle is resistant to reduction, persuasive force by the use of traction is implemented to assist relignment of fracture.

12 Complications Shock Fat Embolism Syndrome Compartment Syndrome
Delayed Union/Nonunion Avascular Necrosis Infection It’s important that you understand each of these complications and nursing roles related to each.

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. Further examples Risk for impaired skin integrity related to immobility and presence of cast. Ineffective therapeutic regimen management related to lack of knowledge regarding muscle atrophy, exercise program, and cast care as evidenced by questioning of longp0term effect of casting and cast care.

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 Further nursing strategies Apply ice compresses as ordered to reduce edema and provide comfort Notify physician immediately is client complains of increasing pain that is unrelieved by meds because this may indicate neurovascular impairment. Teach client the signs of peripheral neurovascular dysfunction to enable participation in care. For each of the other nursing diagnoses ( on previous slide), consider appropriate nursing interventions.

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 It is critical that you know these Do’s and Don’ts and that you could implement them into a plan for patient teaching regarding recovery from hip surgery.

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
Following cast application, monitoring for immediate complications includes assessing the 5 Ps

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 Client’s are often disappointed with the appearance of a limb following cast removal – muscle atrophy, skin condition, and even hair growth may impact their response.

26 Traction Maintain established line of pull Prevent friction of skin
Maintain counteraction Continuous (usually) Maintain correct body alignment When casting or open reduction alone are not sufficient for realigning a fracture, traction may be implemented.


28 Skin Traction Non-invasive Assess traction set-up
Assess mobility restrictions Assess Pain Assess NV status Understanding Intermittent release Patients in traction will experience an extreme limitation in movement and mobility. Nursing measures must focus on this reality.

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

30 While this may be a drawing of skin or skeletal fracture, the point of including it is to illustrate the forces involved in traction. Free hanging weights are often used to create the force needed for traction. Part of assessing the traction set-up is ensuring that weights are indeed hanging freely and not subject to interference by activity of patient or others within the room (you don’t want visitors going by and pulling on the weights or swinging them around.--- ouch!!!)

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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