6383448 orthopedic nursing
TRANSCRIPT
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MUSCULOSKELETALSYSTEM
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Review of Anatomy and
The musculo-skeletal system consistsof the muscles, tendons, bones andcartilage together with the joints
The primary function of which is toproduce skeletal movements
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Muscles
Three types of muscles eist in thebody
!" #keletal Muscles
$oluntary and striated %" &ardiac muscles
'nvoluntary and striated
(" #mooth)$isceral muscles 'nvoluntary and *+*-striated $isceral, plain muscles
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Muscle Types:2. Skeletal Muscle
accounts for at least . of body mass
aids in the formation of the smoothcontour of the bodyParts/!"! 0pimysium
Tough connective tissue covering of theentire muscle" 't binds many fascicles together"Tendon)Apponeurosis / blending of the
epimysia
!"% Perimysium 1ibrous membrane covering several
sheathed muscle fibers 1ascicles 2 are bundles of muscle fibers
covered by perimysium"
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#keletal Muscle&haracteristics/
$oluntarycontrol 3but canalso beactivated byreflees4
354 #triationsMultinucleated#hape/
&ylindrical#peed ofcontraction/$ariable
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2. Smooth Muscle 1ound mainly in the walls of hollow
visceral organs such as the
stomach, urinary bladder andrespiratory passages" propels substances along a definite
tract, or pathway, within the body"
#mooth Muscle &haracteristics/ 'nvoluntary control 3-4 #triations6 no distinct sarcomeres7ninucleated#pindle-shaped#peed of &ontraction/ slow andsustained6 does not develop an
o en debt
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#mooth muscle
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3. Cardac Muscle 1ound only in the heart 3cardiac4" 8eart 2 serves as a pump, propelling
blood into the blood vessels and to alltissues of the body"
&ardiac fibers are cushioned by smallamounts of soft connective tissue and
arranged in spiral or figure 9-shapedbundles"
&ardiac Muscle &haracteristics/ 'nvoluntary control
354 #triations Multinucleated :ranched #peed of contraction/ $ariable
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Muscle !u"cto"s:
%4 Production of
movements)locomotion(4 Maintenance of posture
4 ;oint stabilienerating heat?4 0nergy production
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Smlartes o# all Muscle Types:
c4 All muscle cells are elongated 3this
eplains the term muscle fibers4d4 Muscle contractions depends on
the types of myofilaments 3thinand thick myofilaments4
e4 Terminology 3prefied/ myo, mys,@ sarco4
#
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Mcroscopc A"atomy o#Skeletal Muscle
!" #arcolemma Plasma membrane of skeletal
muscle cells"
(" Myofibrils ong ribbon like organelles,
pushing the nuclei aside
Alternating dark 3A4 and light 3'4bands along the length of themyofibrils, give the muscle cell3as a whole4 a striated
#
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Mcroscopc A"atomy o#
(" #arcomere 1unctional unit of a muscle" These are chains of contractile
units of myofibrils"
" #arcoplasmic Reticulum #urrounds individual myofibrils
#peciali
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SA$COME$E% #u"cto"al u"t o# the muscle& e'te"ds #rom o"e (%l"e to a"other (%l"e
% ma"ly composed o# act" ) myos" myo#lame"ts
(%dsk or (%l"e * a"chors the act" myo#lame"ts
M%l"e* holds the myos" #lame"ts " place
M l Ph i l
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Muscle Physiology
Stmulato" a"d Co"tracto" o# a
S"+le Skeletal Muscle Cell{ !u"cto"al ,ropertes o# Muscle!-ers:!" 'rritability 2 ability to react and
respond to stimulus%" &ontractility 2 ability to shorten
when stimulated by adeBuatestimulus
{ The er/e Stmulus a"d Acto",ote"tal!" Motor 7nit - single motor neuron
and all of the corresponding
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#C00TA M7#&0/
M* control
0nergy is consumed during musclecontraction 2 A&T'& A&'D 3O2)
MUSCLE FATIGUE: work of muscle wit i!"#e$u"te O2 su%%l&
'e%letio! of (l&co(e! e!er(& stores
Accumul"tio! of l"ctic "ci#
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#tructure and function of theskeletal system
#keletal system consist of Aial andAppendicular skeleton"
Aial #keleton- which is composed ofbones of the skull, thora andvertebral column which forms the aisof the body"
Appedicular #keleton- consist ofbones of the upper and loweretrimities, including the hip and theshoulder"
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Two types of connective tissue found in theskeletal system
%" &artilage 2 a semi-rigid and slightly
fleible structures that plays anessential role in prenatal and childhooddevelopment of the skeleton and as asurface for the articulating ends of the
skeletal joint"
(" :ones 2 which provide the firmstructure of the skeleton and serve as
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Three types of cartilage
0lastic &artilage- &ontain some elastin ineach intracellualr substance" 3 ears4
8yaline &artilage- Pearly white, found in
the articulating ends of the bones"- form the fetal skeleton " 1ibro cartilage- has a characteristic that
are intermediate between denseconnective tissue and hyaline cartilage"
't is found in the intervertebral disks, inareas where tendons are connective tobone and in the symphysis pubis"
- ?=-9. are water"
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:one- is a connective tissue in whichthe intracellular matri has beenimpregnated with inorganic calcium
salts so that it has a great tensile andcompressible strength but is lightenough to be move by coordinated
muscle contractions"
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:+*0#
$ariously classified according to shape,location and si
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:one is made up of four major
components/ mineral 3mainly calcium and phosphorus4 matri 3collagen fibers4 osteoclasts 3bone-removing cells4 osteoblasts 3bone-producing cells4"
+steocytes 3 mature bone cells for bonemaintenance fns4
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#C00TA #E#T0M/
,E$0OSTEUM: Dense fibrous membrane covering the bone
Periosteal vessels supply bone tissue
E,0,1YS0S: Fidened area at the end of the long bone
E,0,1YSEAL ,LATE +roth 4o"e5 &artilage area in children w)c provides for
longitudinal growth of the bone A$T0CULA$ CA$T0LA6E:
Provides smooth surface over the ends of thebone to facilitate joint movement
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Type of bone cell
+steogenic cells- 7ndifferentiatedcells that differentiate intoosteoblasts" They are found in the
periosteum, endosteum, andepiphyseal growth plate of growingbones"
+steoblasts- :one building cells thatsynthesi
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+steocytes- Mature bone cells thatfunction in the maintenance of bonematri" +steocytes also play an active
role in releasing calcium in the blood " +stroclasts- :one cells responsible for
the resorption of bone matri and the
release of calcium and phosphatefrom bone"
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#C00TA #E#T0M/
R0D :+*0 MARR+F/ 8emopoietic tissue located in the central
bone cavities"
Adults/ ribs, sternum, vertebrae, portionsof hips @ pelvic bones ong :ones filled with fatty, yellow
marrow
17*&T'+*#/ 1ormation of R:&, F:& @ platelets
Destruction of old R:& 3phagocytosis4
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:+*0 1+RMAT'+*
+##'1'&AT'+* Process by which matri 3collagen fiber @
ground substance4 is formed @ hardening
minerals are deposited on collagen fibers3give tensile strength4
0*D+&8+*DRA +steoid 3cartilage-like tissue4 is formed,
reabsorbed, @ replaced by bone '*TRAM0M:RA*+7#
:one develops within membrane 3e"g" face,skull4
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:+*0 MA'*T0*A*&0 @
R0>7AT+RE 1A&T+R# D0T0RM'*'*>:+T8 1+RMAT'+* @ R0#+RPT'+*/ !" 7e+ht%-ear"+ local stress5
%" 8tam" 9 Calctrol5promotesabsorption of calcium from >'T
(" ,arathyrod 1ormo"eregulatescalcium
" Calcto"" ) Am"o -phosphate3e"g"Alendronate G1osamaH4 increasesproduction of bone cells
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:+*0 MA'*T0*A*&0 @
!" 7e+ht%-ear"+ local stress5 #timulate bone formation @ remodelling
Prolonged bed rest/ bone losses calcium
3resorption4 @ becomes osteopenia @ weak%" olo+cally Act/e8tam" 9Calctrol5
"mou!t of C" i! *loo# *& %romoti!( "*sor%tio!
of C" from GIT F"cilit"tes mi!er"li+"tio! of osteoi# tse
'eficie!c& c"use *o!e #emi!er"li+"tio!,#eformit& fr"cture
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:+*0 MA'*T0*A*&0 @
(" ,arathyrod 1ormo"eparathormo"e5 regulates calcium in blood in part by
promoting movIt of &a from the bone C" i! *loo# - .T/ %rom%t #emi!er"li+"tio!
of te *o!e
" Calcto"" ) Am"o -phosphate3e"g"
Alendronate G1osamaH4 increasesproduction of bone cells
&alcitonin- inhibits release of calcium fromthe bone into the etracellular fluid and
reduces the renal tubular reabsorptionof
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Parathyroid hormone
Parathyroid gland
:one 2 releaseof &a and
&alciumconcentration in
the etracellular
Cidneyreabsorption of
7rinaryecretion of
Activation of$it"D
'ntestineReabsorption of
&a via activated
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:+*0 MA'*T0*A*&0 @
Estro+e" ) A"dro+e" #timulate osteoblastic activity @ inhibit PT8 Menopause)Andropause 2 C" - *o!e loss - osteo%orosis
A"dro+e"%testostero"e .romote "!"*olism *o!e m"ss 0#TR+>0*-'t appears that oestrogen
deficiency allows greater epression of thesecytokines, all of which are associated withincreased stimulation of bone resorptionwhich then leads to increased bone loss anda reduction in :MD"
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AndrogensAndrogens, like oestrogens,can directly affect and modulate bonecell function" Androgen receptors are
found on osteoblast cell lines and theycan cause osteoblast proliferation"8ypogonadal men, in common with post-menopausal women, have decreasedcalcium absorption and low vitamin D
levels" The replacement of androgenswith testosterone can correct theseabnormalities, suggesting again that sehormones are reBuired for the
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:+*0 80A'*>/ STA6E ;. 1EMATOMA !O$MAT0O )
0!LAMMAT0O Fhen bone is damaged or injured, hematoma precedes new
tissue formation in the production of new bone substance
STA6E 2. CELLULA$ ,$OL0!E$AT0O: >ranular tissue formation where :$ @ cartilage overlie the
fracture
&allus forms as minerals are deposited to organi
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:one healing
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1A&T+R# A110&T'*> T'M0
!" age
%" displacement
(" site of fracture
" nutritional level
=" blood supply to the area of injury
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;+'*T#
Permits bone tochange position @facilitate body movIt
Diarthrodial 3synovial4joint is the mostcommon type of jointin the body
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joints
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joints
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joints
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;oints
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joint
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joints
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&ART'A>0 3h li 4
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&ART'A>0 3hyaline4
A dense connective tissue that consistsof fibers embedded in a strong gel-likesubstance that cover the end of the
bone
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&ART'A>0
A$T0CULA$ CA$T0LA6E Rigid, connective, avascular tissue that
covers each bone ends
Damaged cartilage heals slowly 3lacksdirect blood suply4
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:7R#A0
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:7R#A0
#ac containing fluid that are locatedaround the joints to prevent friction
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A fibrous capsule of connective tissue
joins the % bones together
!" SYO80UM sy"o/al mem-ra"e5
ines the capsule
%" SYO80AL !LU09 #ecreted by the synovium @ decreases
friction by lubricating the joints
T0*D+*# 3aponeurosis4
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T0*D+*# 3aponeurosis4
:ands of fibrous connective tissue thattie -o"es to muscles
'>AM0*T#
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'>AM0*T#
#trong, dense and fleible bands offibrous tissue connecting -o"es toa"other -o"e
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A##0#M0*T +1 T80 M7#&7+-
The "urse usuallye/aluates ths small part
o# the o/er%all assessme"ta"d co"ce"trates o" thepate"t>s posture? -ody
symmetry? +at a"dmuscle a"d @o"t #u"cto"
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A##0#M0*T +1 T80 M7#&7+-
;. 10STO$Y 0"@ury? sur+ery? dsa-lty? "#lammatory
meta-olc co"dto"s !amlal predsposto" Le/el o# "ormal act/ty occupato"?
e'ercse? recreato"5
2. ,hyscal E'am"ato"
0"specto" #or +ross de#ormtes?asymmetry? sell"+? edema utrto"al status: e+ht? -ody #rame
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A##0##M0*T +1 T80
6at3Antalgic46 >enu $algum 3Cnock-Cnee4, >enu $arum 3:ow-egged4
,osture3Cyphosis)ordosis)#coliosis4
Muscular palpato" Bo"t palpato" Creptus%+rat"+
sou"d5
$a"+e o# moto" Muscle stre"+th
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Assessment 1indings
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g
< ,>s o# EU$O8ASCULA$9AMA6E
Sell"+
Loss o# #u"cto" 9e#ormty
Creptus
,
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, aaulselessulselessarestharestharalyaraly
aa
oklotheoklothe
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A##0#M0*T +1 T80 M7#&7+-
LAO$ATO$Y ,$OCE9U$ES
;. OE MA$$O7 AS,0$AT0O Usually "/ol/es asprato" o# the
marro to da+"ose dseases lkeleukema? aplastc a"ema
Usual site is the sternum and iliac crest
Pre-test: Co"se"t
Intratest: eedle pu"cture may -epa"#ul
Post-test: ma"ta" pressure dress"+a"d atch out #or -leed"+
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A##0#M0*T +1 T80 M7#&7+-
A:+RAT+RE PR+&0D7R0# %" Arthroscopy
A drect /sual4ato" o# the @o"tca/ty
Pre-test: co"se"t? e'pla"ato" o#procedure? ,O
Intra-test: Sedat/e? A"esthesa?"cso" ll -e made
Post-test: ma"ta" dress"+? am-ulato" as soo" as aake? mld sore"ess o# @o"t #or 2 days?@o"t rest #or a #e days ) ce
applcato" to rele/e dscom#ort
A##0#M0*T +1 T80 M7#&7+
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%" A$T1$OSCO,Y %&"' for pt who cannot fle K L and withinfected knee
7ses large pneumatic tourniBuet tominimi
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C*00 ART8R+#&+PE
ART8R+#&+PE
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ART8R+#&+PE
C*00 ART8R+#&+PE
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C*00 ART8R+#&+PE
#8+7D0R ART8R+#&+PE
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#8+7D0R ART8R+#&+PE
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A##0#M0*T +1 T80 M7#&7+-
LAO$ATO$Y ,$OCE9U$ES
3. OE SCA
0ma+"+ study th the use o# a co"trastradoact/e materal
Pre-test:,a"less procedure? 08radosotope s used? "o specalpreparato"?pregnancy is contraindicated
Intra-test:08 "@ecto"? 7at"+ perod o# 2hours -e#ore %ray? !luds alloed? Sup"eposto" #or sca"""+
Post-test:0"crease #lud "take to #lush outradoact/e materal
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OE SCA 2 Radioisotope injected '$3technetium, >allium, Thalium4
Adm" 'sotope !-% days before scanning*o radioactive threatsProcedure lasts (-? min*o special care after procedure0creted in 7rine @ feces0ncourage fluid
A##0#M0*T +1 T80 M7#&7+#C00TA #E#T0M
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A:+RAT+RE PR+&0D7R0#
" 9EA% 9ual%e"er+y $AYA-sorptometry
Assesses bone density to diagnoseosteoporosis
7ses LOW dose radiationto measurebone density
Painless procedure, non-invasive, no specialpreparation
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A##0#M0*T +1 T80 M7#&7+
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A##0#M0*T +1 T80 M7#&7+-
=" ray !lms: $oe"t+e"o+rams2plain ray film is common AP3Antero-posterior lateral views"
?" A$T1$O6$A,1Y/ injection of dyeor air in the joint for -ray study
" MYELO6$A,1Y:eamines spinalcord after introduction of contrastmedium
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Myelography
ART8R+>RAP8E
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ART8R+>RAP8E
Arthrography is theradiographic eamination
of a joint, after theinjection of a dye-likecontrast material and)orair, to outline the soft
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A##0#M0*T +1 T80 M7#&7+-
9" OEMUSCLE 0O,SY:'liac crestusual puncture site6 not commonlydone today
ocal anesthesia, check PT @ PTT &oagulant given %-( days before @
after procedure
Pressure dressing after
A##0#M0*T +1 T80 M7#&7+
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A##0#M0*T +1 T80 M7#&7+-
N" CT SCA:assess bone @ softtse tumors
!" M$0:to assess soft tissue andjoints with myelography >A*D+'*'7M DTPA
3DiethyleneTriamine PentaAcetic Acid4
:++D #T7D'0#/ h d
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;. ES$ Erythrocyte Sedme"tato"$ate5:
non-specific test for inflammation 1/ -%mm)hr M/ -! mm)hr
%" U$0C AC09:0levated in gout *ormal %"%- mg)dl 314 6"%-9 mg)! ml
3M4(" AA A"t%"uclear A"t%-ody5:
Measures the presence of antibodies thatdestroy the nucleus of the body tissue cells
in auto-immune disorder6 354 in about N. of clients w) #0
#jorenIs syndrome RA
:++D #T7D'0#/
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:++D #T7D'0#/
$1EUMATO09 !ACTO$ Late'!'ato"5: Determine presence of auto antibodies 3R14
found in clients with connective tissue dse 354 R1 is suggestive of RA
The higher the antibody titer the greater thedegree of inflammation
M'*0RA M0TA:+'#M/
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M'*0RA M0TA:+'#M/
!" CALC0UM/ i! osteom"l"ci",&%o%"r"t&roi#ism0 *o!e tumors, "cuteosteo%orosis,*o!e fr"cture1e"li!( %"se)
Normal: 4.5 5.8 mEq/L or 9-10.5 mg/dL 2 PHOSPHORUS: i! osteom"l"ci",
e"li!( fr"ctures, C3F, *o!e tumorNormal: 3 - 4.5 mEq/L
M7#&0 0*OEM0 T0#T#/
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M7#&0 0*OEM0 T0#T#/
!" C$EAT00E ,1O,1OK0ASECK3 or CK%MM5 1/ (-!(= 7)6 M/==-! 7) 2 highest
concentration in traumatic injuries,progressive muscular dystrophy
%" ALKAL0E ,1OS,1ATASE3AP-%42 'ncreased in &ancer, PagetIs Dse @
+steomalacia" *ormal/ %-N '7)
COMMO
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COMMO
MUSCULOSKELETAL ,$OLEMS
The *ursing Management
*ursing Management of common musculo-
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*ursing Management of common musculoskeletal problems
;. ,A0 These can be related to joint
inflammation, traction, surgical
intervention !" Assess patientIs perception of pain
%" 'nstruct patient alternative pain
management like meditation, heatand cold application, guided imagery
*ursing Management
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*ursing Management
PA'*
(" Administer analgesics as prescribed
7sually *#A'D#
Meperidine 3demerol4can be givenfor severe pain
" Assess the effectiveness of pain
measures
*ursing Management
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*ursing Management
2. 0M,A0$E9 ,1YS0CAL MO0L0TY
!" 'nstruct patient to perform range ofmotion eercises, either passive oractive
%" Provide support in ambulation withassistive devices
(" Turn and change position every %
hours " 0ncourage mobility for a short period
and provide positive reinforcements forsmall accomplishments
*ursing Management
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*ursing Management
3. SEL!%CA$E 9E!0C0TS !" Assess functional levels of the patient
%" Provide support for feeding problems
Place patient in 1owlerIs position Provide assistive device and supervise
mealtime
+ffer finger foods that can be handled by
patient Ceep suction eBuipment ready
*ursing Management
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*ursing Management
#01-&AR0 D01'&'T#
(" Assist patient with difficulty bathingand hygiene
Assist with bath only when patient hasdifficulty
Provide ample time for patient to finishactivity
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!$ACTU$ES
1racture
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1racture
A break in the continuity of the boneand is defined according to its typeand etent
1racture
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1racture
Severe mechanical Stress to bonebone fracture
'irect 4lows
Crusi!( forces Su##e! twisti!( motio!
E5treme muscle co!tr"ctio!
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fractures
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fractures
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1racture
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T6.ES OF F3ACTU3E
7 Clo!d "ra#$%r! &S'(PLE) Te fr"cture t"t #oes !ot c"use " *re"k i! te
ski!
2. O*!+ "ra#$%r! &CO(POUN, or CO(PLE)
Te fr"cture t"t i!8ol8es " *re"k i! te ski!9 Com*l!$! ra#$%r!i!8ol8es e!tire cross sectio!
of te *o!es
; '+#om*l!$! ra#$%r!< i!8ol8es o!l& " %ortio! of
te cross sectio! of te *o!e
1racture
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1racture
T6.ES OF F3ACTU3E = Comm+%$!d "ra#$%r!
A fr"cture t"t i!8ol8es %ro#uctio! of se8er"l*o!e fr"(me!ts
> r!!+$# ra#$%r! O!e si#e is *roke! te oter si#e is *e"t
? ,!*r!!d
fr"(me!tis #ri8e! i!w"r# 1skull,f"ci"l*o!es)
T6.ES OF F3ACTU3E
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T6.ES OF F3ACTU3E
@ 2ra+!r!d
4re"k str"i(t "cross te *o!e
S*ral Forms o*li$ue "!(le to te *o!e
s"ft
1racture/ A##0##M0*T
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1racture/ A##0##M0*T
CL'N'CL (N'ES22'ONS:2 ."i!: imme#i"te, se8er
9 Loss of fu!ctio!
; 'eformit&0 "*!orm"l %ositio!i!( of e5tremit&= Sorte!i!(
> Cre%it"tio!: %"l%"*le or "u#i*le
? E#em"
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" Paresthesia- burning or
tingling sensation 9" *umbness N" Motor weakness 1! Pulselessness" impairedcapillary re#ill time and
cyanotic s$in
1racture
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1racture
ASSESSMEBT FIB'IBGS
7 ."i!
Co!ti!uous "!# i!cre"ses i!se8erit&
Muscles s%"sm "ccom%"!ies te
fr"cture is " re"ctio! of te *o#& toimmo*ili+e te fr"cture# *o!e
1racture
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1racture
ASSESSMEBT FIB'IBGS
2 Lo o" "%+#$o+
A*!orm"l mo8eme!t "!#%"i! c"! result to tis
m"!ifest"tio!
1racture
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1racture
ASSESSMEBT FIB'IBGS
9 ,!"orm$
'is%l"ceme!t, "!(ul"tio!s orrot"tio! of te fr"(me!ts
1racture
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1racture
ASSESSMEBT FIB'IBGS
; Cr!*$%
A (r"ti!( se!s"tio! %ro#uce#we! te *o!e fr"(me!ts ru*e"c oter
1racture
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1racture
'IAGBOSTIC TEST
r"&
1racture
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EME3GEBC6 MABAGEMEBT OF F3ACTU3E 7 Immobilize any suspected fracture
S%**or$te e5tremit& "*o8e "!# *elow we!mo8i!( te "ffecte# %"rt from " 8eicle
Su((este# $!m*orar *l+$ "r# *o"r#, stick,rolle# seets
**l l+g if fore"rm fr"cture is sus%ecte# or tesus%ecte# fr"cture# "rm m"&*e *"!#"(e# to te
cest
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1racture
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EME3GEBC6 MABAGEMEBT:
OPEN RC2URE
7 O%e! fr"cture is m"!"(e# *& co8eri!( "
cle"!Dsterile ("u+e to %re8e!tco!t"mi!"tio!
2 'O BOT "ttem%t to re#uce te f"cture
1racture
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Ge!er"l Bursi!( MABAGEMEBT
or CLOSE, RC2URE
7 Assist i! re#uctio! "!# immo*ili+"tio!
2 A#mi!ister %"i! me#ic"tio! "!# musclerel"5"!ts
9 Te"c %"tie!t to c"re for te c"st
; Te"c %"tie!t "*out %ote!ti"l com%lic"tio!
of fr"cture "!# to re%ort i!fectio!, %oor"li(!me!t "!# co!ti!uous %"i!
G l B i MABAGEMEBT
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Ge!er"l Bursi!( MABAGEMEBT
or OPEN RC2URE
7 .re8e!t wou!# "!# *o!e i!fectio! A#mi!ister %rescri*e# "!ti*iotics A#mi!ister tet"!us %ro%&l"5is
Assist i! seri"l wou!# #e*ri#eme!t 2 Ele8"te te e5tremit& to %re8e!t e#em"
form"tio! 9 A#mi!ister c"re of tr"ctio! "!# c"st
F3ACTU3E COM.LICATIOBS
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Earl7 Sock 1/&%o8olemic Sock)
2 F"t em*olism 7st;@ rs
9 I!fectio!
; Im%"ire# Circul"tio! 1c"stDe#em")
= Com%"rtme!t s&!#rome
> e!ous St"sis trom*us form"tio!
F3ACTU3E COM.LICATIOBS
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La$! 7 'el"&e# u!io! D Bo!u!io!
2 A!(ul"tio! 1*o!e e"ls "t " #istorte# "!(le)
9 'el"&e# re"ctio! to fi5"tio! #e8ices ; Com%le5 re(io!"l s&!#rome
F3ACTU3E COM.LICATIOBS
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F3ACTU3E COM.LICATIOBS:
a$ Em6olm
Occurs usu"ll& i! fr"ctures of te lo!( *o!es
F"t (lo*ules m"& mo8e i!to te *loo# stre"m*ec"use te m"rrow %ressure is (re"ter t"!
c"%ill"r& %ressure F"t (lo*ules occlu#e te sm"ll *loo# 8essels
of te lu!(s, *r"i! ki#!e&s "!# oter or("!s
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F3ACTU3E COM.LICATIOBS: $ E 6 l
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a$ Em6olm O!set is r"%i#, witi! 2;?2 ours
SSESS(EN2 'N,'NSA. 1. Sudden dyspnea and respiratory
distress & hypoxia 2 t"c&c"r#i" 9 Cest %"i! ; Cr"ckles, wee+es "!# cou(
= .eteci"l r"ses o8er te cest, "5ill" "!#"r# %"l"te
1at embolism
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classic triad/ hypoemia6 neurologicabnormalities6 and a petechial rash"
8- 8ypoemia
*- * eurologic a-bnormalities
P- Petechial rash
1at embolism
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Assessment finding :" *eurological finding
!" &erebral emboli- freBuently present
after early stages" 9? . after therespiratory distress"
- The more common presentation iswith an acute confusional statebut
focal neurological signs, includinghemiplegia, aphasia,apraia, visualfield disturbances, and anisocoria,
1at embolism
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The characteristicpetechial rashmay bethe last componentof the triad todevelop" 't occurs in up to ?. of casesandis due to emboli
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Bursi!( M"!"(eme!t
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Bursi!( M"!"(eme!tMany studies shows that early
immobilization and fixation decreasethe incidence of pulmonarycomplication.
- Adequate fluid resuscitationtransfusion and !"# could decreasethe incidence of $%S $at embolismsyndrome '
5. S%**or$ $7! r!*ra$or "%+#$o+ 3es%ir"tor& f"ilure is te most commo!
c"use of #e"t A#mi!ister O2 i! i( co!ce!tr"tio! .re%"re for %ossi*le i!tu*"tio! "!#
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2 dm+$!r dr%g
Corticosteroi#s
'o%"mi!e
Mor%i!e
9 '+$$%$! *r!!+$! m!a%r!
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9 '+$$%$! *r!!+$! m!a%r! Imme#i"te immo*ili+"tio! of fr"cture
Mi!im"l fr"cture m"!i%ul"tio!
A#e$u"te su%%ort for fr"cture# *o!e #uri!( tur!i!"!# %ositio!i!(
M"i!t"i! "#e$u"te r"tio! "!# electrol&te*"l"!ce
0arly complication/ Compartme"t sy"drome
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A complication that develops when
tissue perfusion in the muscles is lessthan reBuired for tissue viability
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&+MPARTM0*T #E*DR+M0
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Muscles, nerves, vessels arerestricted to confined space3myofascial compartment4 within an
etremity 0T'++>E/
Decreased &ompartment si
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0arly complication/ Compartme"t sy"drome
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ASSESSMET !0906S !" Pain- Deep, throbbing and
U%&'LI'(') pain by opioids d)t reduction in the si
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Arterial compression may not occur6
pulses may be 354 2 3early4 :listers
&an result in permanent damage in a
short time 3?-9 hrs4 PAR0#T80#'A- first sign
P7#00##*0## - late sign
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Medical and *ursing
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Medical and *ursingmanagement/
!" Assess freBuently theneurovascular status of the
casted etremity%" 'levate the e*tremity
above the level o# the heart
(" Assist in cast removal and
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Sur+cal Treatme"t 'f surgery is reBuired to relieve the
pressure, the physician will make an
incision and cut open the skin andfascia covering the affectedcompartment" This reduces thepressure in the compartment" The
skin incision is surgically repairedwhen swelling recedes" #ometimes askin graft may be needed"
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RI# '* M>MT +1 1RA&T7R0
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!" R0&+>*'T'+* of presence offracture
%" R0D7&T'+*/
&losed Reduction 3manipulation4 +pen Reduction 3+R'1 2 surgery4
Traction
RI# '* M>MT +1 1RA&T7R0
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(" R0T0*T'+* &ast
Traction
:races ) splints
:andage
" R08A:''TAT'+* 2 restoration tonormal fn Falker
&rutches &ane
&A*0#
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C
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#hould be usedon the sideopposite theaffected leg
&ane 5 Affectedleg movetogether
&anes
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8andle should be always level ofclients greater trochanter "
&lients elbow should be fle at a !=-
( degrees angle 'nstruct the client to hold the cane -?
inches on the side of the client"
FAC0R#
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'1T the walker @place it appro" % ft"in front
>ain balance beforemoving walkerforward again
:alance provides
stability @ eBual wt"bearing
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PR+#T80#'#
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U, 70T1 T1E 6OO99O7 70T1 T1E A9
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0"dcato":Feakness in both legs or poor coordination
SeDue"ce:
1-Le#t crutch"+-right #oot"
,-right crutch"
-le#t #oot! .hen repeat!
Ad/a"ta+es:Provides ecellent stabilty as there are always three points in
contact with the ground 9sad/a"ta+es:
#low walking speed
0"dcato":'nability to bear weight on one leg 3fractures pain
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'nability to bear weight on one leg" 3fractures, pain,amputations4
,atter" SeDue"ce:
1-move both crutches and+- the /ea$er lo/er limb #or/ard! .hen bear all
your /eight do/n through the crutches
,- move the stronger or una##ected lo/er limb#or/ard! &epeat!
Ad/a"ta+es:0liminates all weight bearing on the affected leg"
9sad/a"ta+es:
0"dcato":F k i b h l di i
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Feakness in both legs or poor coordination"
,atter" SeDue"ce:1-Le#t crutch and right #oot together"then the +-right crutch and le#t #oottogether! &epeat!
Ad/a"ta+es:1aster than the four point date"
9sad/a"ta+es:&an be difficult to learn the attern"
0"dcato"s:P ti t ith k f b th l t iti
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Patients with weakness of both lower etremities"
,atter" SeDue"ce:Advance both crutches #or/ard then" /hile
bearing all /eight do/n through bothcrutches" s/ing both legs #or/ard at thesame time to 0not past the crutches!
Ad/a"ta+e:
0asy to learn" 9sad/a"ta+e:
0"dcato"s:
'nability to fully bear weight on both legs 3fractures
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'nability to fully bear weight on both legs" 3fractures,pain, amputations4
,atter" SeDue"ce:Advance both crutches #or/ard then" /hilebearing all /eight do/n through both crutches"s/ing both legs #or/ard at the same time pastthe crutches!
Ad/a"ta+e:1astest gait pattern of all si"
9sad/a"ta+e/
TRA7MAT'& &+*D'T'+*#/
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!. COTUS0O2 soft tissue injuryproduce by blunt force, blow, kick or fall
#)#/
a" hemorrhage 3ecchymosis4 ruptured:$
b" pain @ swelling
COTUS0O
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M+mt:
;. ele/ate a##ected part
2. cold compress to dm"sh edema;st2=15
3. apply pressure -a"da+e toreduce sell"+
=. apply heat to a##ected area a#ter< hrs to promote a-sorpto".
Stra"s
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E'cess/e stretch"+ o# a muscle orte"do"
*ursing management/
;. 0mmo-l4e a##ected part
2. Apply cold packs "tally? the" heat
packs3. Lmt @o"t act/ty
=. Adm"ster SA09s a"d muscle
#prains
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0cessive stretching of the '>AM0*T#
urs"+ ma"a+eme"t
!" 'mmobili
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00
E
e
le/at
ompress
c
Musculoskeletal Modalities
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Tracto"Cast
*ursing Management
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Tracto" A method of fracture immobili
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Sk" tracto" 2 applied at thesurface of skin @ soft tissue @indirectly to the bone using adhesiveelastic bandage @ spreader" ma" lbs
3e"g" :ryant, Russel Traction4
Skeletal tracto" 2 applied directly
to the bone using wire, pins, tongs"ma" lbs" 3e"g" 8alo pelvic,&rutchfield tong traction4
Traction
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*on-adhesive traction
#kin
tracti
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:ryants traction &ervical traction
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Position clients/ low fowlers positionMaintain % degree angle at the thighto bedProtect the skin from break downProvide pin care if pin is used with theskeletal traction
:alance suspension traction
'*D'&AT'+*#)P7RP+#0#/
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1or immobiliive support to reduce pain @ musclespasm
To reduce fracture
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0"dcato"s #or Tracto" reduction, immobilisation @ alignment
of fractures
relieve muscle spasm @ pain prevent further soft tissue damage
to promote rest
ne
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R7##0I# TRA&T'+*
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RussellIs traction
&ommonly used to stabili
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:7&CI# 0T0*#'+* TRA&T'+*
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-'s used to alleviate muscle spasm andimmobili
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DunlopIs traction
Description/ 8ori
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8alo vest&ervical traction
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*ursing Management
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Traction/ >eneral principles!"ALWA2S ensure that the /eights
hang #reely and do not touch the#loor
%" %'('& remove the /eights(" Maintain proper body alignment 3dorsal
recumbent4
" 0nsure that the pulleys and ropes areproperly functioning and fastened bytying s3uare $not
*ursing Management
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Traction/ >eneral principles=" +bserve and prevent foot drop
Provide foot plate
?" +bserve for D$T, skin irritation andbreakdown
" Provide pin care for clients in skeletaltraction
0T0R*A 1'AT+R D0$'&0
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0ternal frame with a lot of pins"Provide more freedom compare to traction"
'nternal fiator
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Provide immediate bonestrength but risk for infection"
Traction/ >eneral principles9" 1or every traction, there is
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always a counter traction 2 useshock blocks6 use half ringThomas splint
N" The line of pull must be in linewith deformity
!" 1riction should be eliminated
*ursing Management
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&A#T 'mmobili
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'MM+:''OAT'+* PR0$0*T'+*)&+RR0&T'+* +1
D01+RM'TE
#7PP+RT +:TA'*'*> A 8+D +1 A 'M: T+
#0R$0 A# M+D0 1+R MAC'*>ART'1'&'A 'M:
*ursing Management
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&A#T/ types!"T$UK
Minerva &ast, Ri
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M0E$8A CAST SCOL0OS0S $ACE
:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#
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SCOL0OS0S $ACE
&astingMaterials
Plaster of Paris
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Plaster of Paris
9ry"+ takes ;%3 days
0# dry? t sS10Y? 710TE?
hard a"dreso"a"t.
1iberglass
L+hte+ht a"d
dres " 2%3m"utes
&8ARA&T0R'#T' +1 >++D&A#T/
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Fhite, shiny +dorless
ight in wt
*ot too tight
*ot too loose
Resonant on
percussion
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*ursing Management
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CAST: 6e"eral urs"+ Care ;. Allo the cast to dry usually
2=%F2 hours5
+! 4andle a /et cast /ith the
PAL5S"ot the #"+ertps 3. Keep the casted e'tremty
ELE8ATE9 us"+ a pllo
=. Tur" the e'tremty #or eDualdry"+. Use lo cool drer.
CAST: 6e"eral urs"+ Care
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G. ,etalcutt"+ theed+es5 the ed+es o# thecast to pre/e"t crum-l"+
o# the ed+es
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F. 0"struct the pate"t "otto place stcks or smallo-@ects "sde the cast
H. Mo"tor #or the #ollo"+:pain" s/elling"discoloration" coolness"
tingling or lac$ o# sensation
CAST: 6e"eral urs"+ CareN" Observe #or signs o# plaster sore:
itchiness)burning sensation sever pain
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itchiness)burning sensation, sever pain,
rise of temp, disturbed sleep,restlessness, offensive odor,discharges3windowing-eposing a tight
area to relieve edema)pain, petalling4!" Observe #or signs o# cast
syndrome: prolonged *)$, repeatedvomiting, abd"distention, vague
abd"pain, 3-4bowel sound
PA#T0R &A#T #AF
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#pecific 1ractures/
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&+0I# 1RA&T7R0 Distal radius
P0$'& 1RA&T7R0/
1reB in elderly &an cause intra abd injury and urinary
tract injury
Turn pt only on specific orders
10, !$ACTU$E &ommon in elderly women
Cl"cal ma"#estato":
0ternal rotation @ adduction of affected
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0ternal rotation @ adduction of affectedetremity
#hortening of the length of the affectedetremiety
#evere pain @ tenderness
Treatme"t:
'nitially- :uckIs traction
#urgery
A1T0R #7R>0RE
*eurovascular check
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Position/ PR0$0*T 10'+*ADD7&T'+* @ '*T0R*A R+TAT'+* Do not adduct past neutral position
Maintain in abducted position with A-frame pillow or pillows between legs
Avoid fleion of hip of more than Ndegrees
Prevent internal or eternal rotation byusing sandbags, pillows, trochanter rolls
After surgery
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0treme eternal rotationaccompanied by severe Pain ---displaced hip prosthesis
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Amputation
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Etolo+y a"d pathophysolo+y !" Refers to the removal of a body
part as a result of trauma or
surgical intervention
%" *ecessitated by/
a" Malignant tumor
b" Trauma
c" Acute arterial insufficiency
Amputation Therapeutc "ter/e"to"s
!" :elow-the-knee amputation 3:CA4common in peripheral
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common in peripheral
vascular disease6 facilitates successfuladaptation to prosthesis
because of retained knee function
%" Above-the-knee amputation 3ACA4necessitated by trauma or
etensive disease
(" 7pper etremity amputation usuallynecessitated by severe
trauma, malignant tumors, or congenital
Amputation
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Assessme"t !" *eurovascular status of involved
etremity
%" 8istory to determine
a" &ausative factors b" 8ealth problems that can compromise
recovery
(" &lientQs understanding of the etent ofthe surgery
" &lientQs coping skills
Q
Amputation
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Assessme"t !" *eurovascular status of involved
etremity
%" 8istory to determine
a" &ausative factors b" 8ealth problems that can compromise
recovery
(" &lientQs understanding of the etent ofthe surgery
" &lientQs coping skills
Q
Amputation ,la"""+0mpleme"tato"
!" Provide care preoperatively
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a" 'nitiation of eercises to strengthen musclesof etremities in
preparation for crutch walking
b" &oughing and deep-breathing eercises
c" 0motional support for anticipated alterationin body image
%" Monitor vital signs and stump dressing forsigns of hemorrhage
(" 0levate stump for !% to % hours to decreaseedema6 remove
pillow after this time to promote functional
Amputation " Provide stump care
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a" Maintain elastic bandage to shrink and shapestump in
preparation for prosthesis
b" Fhen wound is healed, wash stump daily,
avoiding the use of oils, which may causemaceration
c" Apply pressure to end of stump withprogressively firmer surfaces to toughen stump
d" 0ncourage client to move the stump
e" Place the client with a lower etremityamputation in a prone position twice daily to
$heumatod Arthrts
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0tiology and pathophysiology !" &hronic disease characteri
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&linical findings !" #ubjective
a" 1atigue
b" Malaise c" ;oint pain
d" #tiffness after periods of inactivity,particularly in the morning
e" Paresthesia f" Anoreia
Rheumatoid arthritis
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+bjective
a" Anemia
b" Feight loss
c" ;oint inflammation and deformity
d" #ubcutaneous nodules
e" 0levated sedimentation rate
f" ow-grade fever
g" Presence of rheumatoid factors in serumidentified by late fiation test
h" Positive &-reactive protein and antinuclearantibod A*A tests
Rheumatoid arthritis
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Therapeutic interventions !" &orticosteroids, antiinflammatories,
analgesics, immunosuppressive drugs6 aspirin is drug
of choice followed by the addition of
nonsteroidal antiinflammatory drugs andthen gold or penicillamine, an oral chelatingagent6 corticosteroids are reserved foracute inflammation, if possible
%" Physiotherapy to minimi
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" Application of heat or cold6 paraffindips of affected etremity for
relief of joint pain by providinguniform heat
=" Plasmapheresis may be used whenthe disease is advanced
Rheumatoid arthritis
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Assessme"t !" 8istory of onset and progression of
symptoms, noting degree to
which pain interferes with normalactivities
%" 1amily history of rheumatoidarthritis
(" >eneral physical health
" &oping skills
Rheumatoid arthritis
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,la"""+0mpleme"tato" !" Administer analgesics and other
medications as ordered %" Teach the client to take medications as
ordered and observe foraspirin toicity
3tinnitus, bleeding4 and other adverseeffects of medications
(" Apply heat and cold as ordered6 heatparaffin to !%=o to !%No 1 3=%o to =o &4
" Promote rest and position to ease jointpains =" Provide for range-of-motion eercises up
to the point of pain,
Rheumatoid arthritis
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?" 0mphasi
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!!" 0ncourage diet rich in nutrient-densefoods such as fruits, vegetables, wholegrains, and legumes to improve andmaintain nutritional status and compensatefor nutrient interactions of corticosteroid
and other treatment medications 9. E/aluato"Outcomes !" 0periences a reduction in pain %" &ompletes activities of daily living using
supportive devices as needed (" Accepts life-style consistent with abilities " Maintains or improves range of motion of
involved joints
Osteoarthrts9e+e"erat/e Bo"t
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0tiology and pathophysiology !" 0tiology relates to wear and tear ofjoints6 predisposing factors
include obesity, aging, and jointtrauma
%" A degeneration and atrophy of thecartilages and calcification of
the ligaments
(" Primarily affects weight-bearingjoints, spine, and hands
Osteoarthrts
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&linical findings !" #ubjective a" Pain after eercise b" #tiffness of joints
%" +bjective a" 8eberdenQs and :ouchardQs nodes
symmetrically occurring on fingers 3bony hypertrophy4
b" Decreased range of motion c" &repitus when joint is moved
Osteoarthrts
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Therapeutic interventions !" Feight reduction in instances of
obesity
%" ocal heat to affected joints
(" Medications to reduce symptoms,such as analgesics, antiinflammatoryagents, and steroids
" 0ercise of affected etremities
Osteoarthrts
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=" #urgical intervention a" #ynovectomy/ removal of the enlarged
synovial membrane before bone and cartilage destruction
occurs
b" Arthrodesis/ fusion of a joint performedwhen the joint
surfaces are severely damaged6 this leavesthe client with no
range of motion of the affected joint c" Reconstructive surgery/ replacement of a
badly damaged
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Assessme"t !" 8istory for risk factors such as
obesity, trauma, athletic
involvement, and occupation
%" ;oints, noting evidence ofdeformities, inflammation, and muscle
atrophy
(" 0tent of range of motion ofinvolved joints
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,la"""+0mpleme"tato" !" Assist client in activities that reBuire usingaffected joints6 allow for rest periods
%" Maintain functional alignment of joints (" Attempt to relieve the clientQs discomfort and
edema by the use of medications or theapplication of heat as ordered " Allow client ample time to verbali
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" Provide care for the client reBuiring jointreplacement 3see *ursing &are of &lientswith 1ractures of the 8ips4
9" Refer client and family to the Arthritis1oundation
9. E/aluato"Outcomes !" Reports a reduction in pain %" &ompletes activities of daily living using
supportive devices as needed