presentation ms ortho

8/6/2019 Presentation MS Ortho

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MUSCULOSKELETAL

SYSTEM

ALEXANDER L.

LEGION, RN, MAN-

MS (C)


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I. NURSING PROCESS

ASSESSMENT:

Health History:

Assessment of the patient with musculoskeletal

dysfunction depends on the needs of the patient andalso includes an evaluation of the effects of the

musculoskeletal problem on the patient. Concerns of

the nurse are focused on assisting the patients to

maintain: (a.) general health, (b) accomplish theiractivities of daily living, (c) manage their treatment

programs.


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Initial interview:

1. Obtain a general impression of the patients

health status.

Gather subjective data from the patient

concerning the onset of the problem and how it

has been managed.

PAIN

Most patients with diseases and traumatic

conditions or disorders of muscles, bones, andjoints experiences pain. Pain is variable, and its

assessment and management must be

individualized.


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Bone pain described as dull and deep ache in nature and

throbbing.

Muscle pain

described as soreness, or aching and isreferred to as muscle cramps.

Fracture pain sharp and piercing and is relieved by

immobilization.

Sharp pain may also result from bone infection with

muscle spasm or pressure on a sensory nerve.

Pain that increases with activity may indicate joint

sprain or muscle strain.

Steadily increasing pain progression of an infectious

process or neurovascular complications.

Radiating pain occurs in condition in which pressure is

exerted on a nerve root.


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Questions that can be asked regarding pain:

Joint Assessment: Any problem with your joints? Any pain?

Location: which joint? On one side or both sides?

Quality: what does the pain feel like?

Severity: how strong is the pain?

Onset: when did the pain started?

Timing: what time of day does the pain occur? How long

does it last? How often does it occur?

y Is the pain aggravated by movements, rest position,weather? Is the pain relieved by rest, medications,

application of heat or ice?


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y Is the pain associated with chills, fever, recent sore throat,trauma, repetitive activity?

Any stiffness in your joints?

Any swelling, heat, redness in the joints?

Any limitation of movement in any joint? Which joint?

Muscle Assessment:

Any problems in muscle, such as any pain or cramping?Which muscles?

If in calf muscles: is the pain with walking? Does it go awaywith rest?

Are your muscle aches associated fever, chills, or flu? Any weakness in muscles?

Location: where is the weakness? How long have younoticed weakness?


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y Do the muscle look smaller?

Bones: Any bone pain? Is the pain affected by movement?

Any deformity of any bone or joint? Is the deformity due to

injury or trauma? Does the deformity affect ROM?

Any accidents or trauma ever affected the bones or joints:fractures, joint stain, sprain, dislocation? Which ones?

When did this occur? What treatment was given? Any

problem or limitations now as a result?

Any back pain? In which part of the back? Is pain feltanywhere else, like shooting down leg?

y Any numbers and tingling? Any limping?


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Functional Assessment of ADLs

Bathing: turning faucets? Getting in and out of the tub?

Toileting: urinating, moving bowels, able to get self on /off toilet, wipe self?

Dressing: dong buttons, zipper, fasten opening behind

neck, pulling dress or sweater over head, pulling up pants,

tying shoes, getting shoes that fit? Grooming: shaving, brushing teeth, brushing or fixing hair,

applying make up?

Eating: preparing meals, pouring liquids, cutting up foods,

bringing food to mouth, drinking?

Mobility: walking, walking up or down stairs, getting in /

out of be, getting out of house?

Communicating: talking, using phone, writing?


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2. Concurrent health conditions and related problems, such

as familial or genetic abnormalities.

Did the patient had any past problems or injuries to the

joints, muscles or bones. What treatment was given? If the

patient had any after effect from the injury or problem?

3. History of medications used and response to pain

medication.

Developmental Hi

story:

Was there any trauma to infant during labor and delivery?

Did the baby come head first? Was there a need for forcep?


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Were the babys motor milestones achieved at about the

same time as siblings or age- mates?

Does the child have broken any bones? Any dislocations?How were these treated?

Is there any noticeable bone deformity? Spinal curvature?

Unusual shape of toes or fee? Age of onset? Did they ever

sought treatment for any of these?

History for adolescents:

Is the child involved in any sports at school or after school?

How frequently?

Does the child use any special equipment?

What is the nature of your daily warm up?

What do you do if you get hurt?


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Social History:

Information concerning the patients learning ability,

economic status, and current occupation, needed forrehabilitation and discharge planning.

Assess the patients use of tobacco, alcohol, and other

drugs to evaluate how these agents may affect patient

care. Does the patient drink alcohol or caffeinated beverages?

How much and how often?

Describe the activities during a typical day. How much time

is spent in the sunlight?

y Describe any routine exercises that the patient do.

y Describe the patients occupation.

y Describe your posture at work and at leisure.


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y Does the patient have difficulty performing normal

activities of daily living? Do they use assistive devices to

promote mobility?y How does musculoskeletal problems interfered with their

ability to interact or socialize with others? Have they

interfered with the usual sexual activity?

Psychological History:

How did you view yourself before you had this

musculoskeletal problem, and how do you view yourself

now?

Has your musculoskeletal problem added stress to your life?

Describe.


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PHYSICAL ASSESSMENT:

The extent of assessment depend on the patientsphysical complaints, health history, and physical cluesthat warrant further exploration. Mostly the assessmentfocuses on the patients ability to perform activities ofdaily living; evaluating the patients posture, gait, boneintegrity, joint function, and muscle strength and size. Inaddition, assessing the skin and neurovascular status isan important part of a complete musculoskeletalassessment.

A.POSTURE

Inspect the spinal curves and trunk symmetry fromposterior and lateral views.

Stand behind the patient and note for differences in theheight of the shoulders and iliac crest. Gluteal folds arenormally symmetric.


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Shoulder and hip symmetry as well as the line of thevertebral column are inspected with the patient erectand the patient bending forward.

Common deformities of the spine: Kyphosis an increased forward curvature of the thoracic

spine.

Lordosis or swayback, an exaggerated curvature of thelumbar spine.

Scoliosis lateral curving deviation of the spine.

B. GAIT

Gait is assessed by having the patient walk away from

the examiner for a short distance. Observe gait for smoothness and rhythm. Unsteadiness or

irregular movements are considered abnormal.


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Limping motion, most frequently caused by painful

weight bearing. Have the patient pin point the area of

discomfort, thus guiding further examination. Oneextremity is shorter than the other.

Limited joint motion may affect gait.

A variety of neurological conditions are associated with

abnormal gait such as spastic hemiparesis gait ( stroke),

steppage gait (Lower motor neuron disease ), and

shuffling gait.

C. BONE INTEGRITY

Bony skeleton is assessed for deformities and alignment.

Symmetric parts of the body are observed.

Abnormal bony growths due to bone tumors may be

observed.


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Shortened extremities, amputations, and body parts that

are not in anatomic alignment are noted.

Fracture findings may include abnormal angulation oflong bones, motion at points other than joints, and

crepitus at the point of abnormal motion.

D. JOINT FUNCTION

Inspect for size, shape, color and symmetry. Note anymasses, deformities, or muscle atrophy. Compare

bilateral joint findings.

Normally the joint moves smoothly

Evaluated by noting range of motion, deformity, stability,

and nodular formation.

Range of motion is evaluated both actively and passively.


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Test each joints ROM. Demonstrate how to move each

joint through its normal ROM, then ask the client actively

to move the joint through the same motion. Comparebilateral joint findings.

Goniometer tool used to give precise measurement of

range of motion

Palpation of the joint while it is passively moved provides

information about the integrity of the joint.

Limited range ofmotion may be a result of skeletal

deformity, joint pathology or contracture of the

surrounding muscles, tendons and joint capsules.

Effusion excessive fluid within the capsule. Joint motionis compromised or joint is painful.


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Effusion is suspected if joint is swollen and the normalbody landmarks are obscured. The most common site forjoint effusion is the knee.

Joint deformity may be caused by:

a. contracture ( shortening of surrounding joint structures)

b. dislocation ( complete separation of joint surfaces)

c. subluxation ( partial separation of articular surfaces) or

disruption of structures surrounding the joint. Snap or crack may indicate that a ligament is slipping over

a bony prominence.

Crepitus grating, crackling sound or sensation, result ifirregular joint surfaces move across one another.

Surrounding joints are examined for nodule formationwhich are present on the different types of arthritis.


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E. MUSCLE STRENGTH AND SIZE

Is assessed by noting the patients ability to change

position, muscular strength and coordination, and thesize of individual muscles.

Assessment of muscle strength is done by having patient

perform certain maneuvers with and without added

resistance.

Test muscle strength by asking client to move each

extremity through its full ROM against resistance. Do this

by applying some resistance. If this is not possible, then

attempt passively to move the part through its full ROM.

If this is not possible, then inspect and feel for apalpable contraction of the muscle while the client

attempts to move it.


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Do not force the part beyond its normal range. Stop passive

motion if the client expresses discomfort or pain. Be

especially cautious with the older client when testing ROM.

When comparing bilateral strength, keep in mind that the

clients dominant side will tend to be the stronger side.

Clonus rhythmic contractions of a muscle by sudden,

forceful, sustained dorsiflexion of the foot or extension of

the wrist.

Fasciculations - involuntary twitching of muscle fiber

groups.

girth of an extremity are also being measured to monitor

increase in size due to exercise, edema or bleeding intothe muscle.


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F. SKIN

Inspect skin for edema, temperature, and color.

Palpation of the skin can reveal whether any areas arewarmer, suggesting increased perfusion of infection. Or

cooler, suggesting decreased perfusion and whether

edema is present.

G. NEUROVASCULAR STATUS

Neurologic system is responsible for coordinating the

functions of the skeleton and muscles.

It is also important to perform neurovascularassessments of patient with musculoskeletal disorders


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DIAGNOSTIC ASSESSMENTOREVALUATION

IMAGING PROCEDURES1. X-ray studies

Important in evaluating patients with musculoskeletal

disorders.

Multiple x-rays needed for full assessment of thestructure being examined.

X-ray study of the cortex of the bone reveals any

widening, narrowing or signs of irregularity.

Bone x-rays determines bone density, texture erosionand changes in bone relationships.

Joint x-rays reveal fluid, irregularity, spur formation,

narrowing and changes in joint structure.


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2. Computed Tomography

It is used to identify the location and extent of fractures in areas in

areas that are difficult to evaluate.

Shows in detail a specific plane of involved bone.

Can reveal tumors of the soft tissue.

Injuries to the ligaments or tendons.

The patient must remain still during the procedure.

3. Magnetic resonance Imaging

A non-invasive imaging technique that uses magnetic fields, radio

waves and computers to demonstrate abnormalities.

Contrast media may be injected intravenously to enhance

visualization.

Allows for detailed visualization of the internal structure.

Provides much greater contrast between the different soft tissues

than the CT Scan.


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During the procedure the patient needs to lie still for 1 to 2 hours.

4. Arthrogram

Allows visualization of the surface of the soft tissues, joint,

tendons, ligaments, muscles and cartilage that cannot be seen

through plain x-ray.

A radiographic examination of the soft tissues of the joint structuresand is used to diagnose trauma to joint capsule or ligaments.

A local anesthetic is used for the procedure.

A contrast medium or air is injected into the joint cavity, and the

joint is moved through ROM as a series of x-ray films are taken.

Interventions:

Assess the client for allergies to iodine or seafood before the

procedure


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Obtain an informed consent.

Inform the client of the need to remain as still as possible, except

when asked to reposition.

Minimize the use of the joint for 12hours after the procedure.

Instruct the client that the joint may be edematous and tender for 1 to

2 days after the procedure and may be treated with ice packs and

analgesics as prescribed.

Instruct the client that if edema and tenderness last longer than 2 days

to notify the physician.

If air was used for injection, crepitus may be felt in the joint for up to

2 days.

5. Arthroscopy An invasive procedure, in which endoscope is being inserted into the

joint through a small incision, and joint structure are being viewed on a

video monitor.

Provides an endoscopic examination of various joints.


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Articular cartilage abnormalities may be assessed, loosebodies can be removed, and the cartilage can betrimmed.

A biopsy may be performed during the procedure.

Intervention:

Instruct the client to fast for 8 to 12 hours before theprocedure.

Obtain an informed consent. Administer pain medication as prescribed post

procedure.

An elastic wrap should be worn for 2 to 4 days asprescribed post procedure.

Instruct the client that walking without weight bearingusually is permitted after sensation returns but to limitactivity for 1 to 4 days as prescribed following theprocedure.


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Is used diagnose metabolic bone disease and to monitor changes in

bone density with treatment.

Inform client that procedure is painless.

b. Quantitative ultrasound

Evaluates strength, density and elasticity of various bones using

ultrasound rather than radiation.

Inform client that the procedure is painless.

OTHERSTUDIES

1.Bone Scan

An imaging test used to detect increased activity in bone such as

fractures, infection, inflammation or tumors.

It detects changes in function before structural changes occur.

Radioisotope is injected intravenously and will collect in areas that

indicate abnormal bone metabolism and some fractures, if they

exist.


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The isotope is excreted in the urine and feceswithin 48 hours and is not harmful to others.

Intervention: Obtain an informed consent.

Remove all jewelry and metal objects.

Following the injection of the radioisotope, the

client must drink 32 oz of water (if notcontraindicated) to promote renal filtering of

the excess isotope.

From 1 to 3 hours after the injection, have theclient void, and then the scanning procedure areperformed. Full bladder interferes with thescanning of the pelvic bones.


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Inform the client of the need to lie supine during the

procedure and that the procedure is not painful.

No special precautions required after the procedurebecause a minimal amount of radioactivity exists in the

radioisotope.

Monitor the injection site for redness and swelling.

Encourage oral fluid intake following the procedure.

Scan is performed 2- 3 hours after the injection.

Encourage patient to drink plenty of water before the

procedure to help distribute and eliminate the isotope.

Before the scan, ask the patient to empty to empty the

bladder because full bladder interferes with scanning of

the pelvic bones.


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2. Arthrocentesis

Involves aspirating synovial fluid, blood, or pus via aneedle inserted into a joint cavity.

Medication may be instilled into the joint if necessary toalleviate inflammation.

Interventions:


Apply a compress bandage post procedure as prescribed.

Instruct the client to rest the joint for 8 to 24 hours postprocedure.

Instruct the client to notify the physician if a fever orswelling of the joint occurs.

3.Electromyography

Provides information about the electrical potential ofthe muscles.

Test is done to evaluate to evaluate muscle weakness,pain and disability


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Purpose of the procedure is to determine any abnormalityof function and to differentiate muscle and nerveproblems.

Needles are inserted into the muscle, and recording ofmuscular electrical activity are traced on the recordingpaper through an oscilloscope.

Intervention:


Instruct the client that the needle insertion isuncomfortable.

Instruct the client not to take any stimulants or sedativesfor 24 hours before the procedure.

Inform the client that slight bruising may occur at theneedle insertion sites.

4. Biopsy

Performed to determine the structure and composition ofbone marrow, bone muscle, or synovium to help diagnosespecific disease.


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Done during surgery or though aspiration or needle biopsy.

Intervention:


Monitor for bleeding, swelling, hematoma, or severe pain

Elevate the site for 24 hours following the procedure to reduceedema.

Apply ice packs as prescribed following the procedure to prevent thedevelopment of a hematoma.

Monitor for signs of infection following the procedure. Inform the client that mild to moderate discomfort is normal following

the procedure.

5. Myelogram

An x-ray exam of the spinal cord. Requires injection of dye or air into the subarachnoid space followed

by radiography to detect abnormalities of the spinal cord andvertebras.


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Provide hydration for at least 12 hours before the test.

Assess client for allergies to iodine or seafood. Premedicate for sedation as prescribed.

Post procedure Intervention

Obtain vital signs and perform neurological assess ment

frequently as prescribed If a water based dye is used, elevate the head 15 to 30

degrees for 8 hours as prescribed.

If an oil base dye is used, keep the client flat 6 to 8 hours

as prescribed.

If air is used, keep head lower than the trunk.

Encourage fluids and monitor intake and output.


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Nursing Diagnosis

Acute Pain Impaired mobility

Self- care deficit

Altered Skin Integrity


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PLANNING FORHEALTH PROMOTION & MAINTENANCE /

IMPLEMENTATION

A. CAST

A cast is a rigid external immobilizing device that is

molded to the contours of the body.

Purposes:

a. to immobilize a body part in a specific position and to

apply uniform pressure on encased sot tissue.

b. to immobilize a reduced fracture.

c. to correct deformity.

d. to apply uniform pressure to underlying soft tissue or to

support and stabilize weakened joints.


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CASTING MATERIALS:

Nonplaster generally referred to as fibreglass casts. A wateractivated polyurethane materials that have the versatilityof plaster.

Lighter in weight, stronger, water resistant and durable.

Consists of an open weave, non-absorbent fabric

impregnated with cool water-activated hardeners thatbond and reach full rigid strength in minutes.

Porous, and therefore diminish skin problems. They do notsoften when wet.

When wet they are dried with a hair drier on a cool setting.Thorough drying is important to prevent skin breakdown.

They are used for non displaced fractures with minimalswelling and for long term wear.


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Plaster rolls of plaster bandage are wet in water and

applied smoothly to the body.

a crystallization reaction occurs, and heat is given off. Inform patient that the heat is given off can be

uncomfortable and there is an increasing sensation of

warmth so the patient would not become alarmed.

The crystallization process produces a rigid dressing.

Assessment:

Before the cast is applied:

1.Asses the patients general health

2.Presenting signs and symptoms.

3.Emotional status


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4. Understanding of the need for the cast

5. Condition of the body part to be immobilized.

Major goals for the patient:1. Knowledge of the treatment regimen.

The patient need information concerning the pathologicproblems and the purpose and expectations of theprescribed treatment regimen.

This knowledge promotes the patients activeparticipation in and adherence to the treatmentprogram.

It is important to prepare the patient for the applicationof the cast by describing the anticipated sights, sound

and sensations. The patients need to know what to expect during

application and that the body part will be immobilizedafter casting.


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2. Relief of pain

Carefully evaluate pain associated with musculoskeletalproblems and help determine its cause.

Most pain can be relieved by elevating the involved part.

Applying cold as prescribed.

Administer usual dosage of analgesics.

Pain associated with disease process is frequently

controlled by immobilization. Pain due to edema that is associated with trauma,

surgery, or bleeding into the tissues can be controlled byelevation and intermittent application of cold.

Pain may be indicative of complications.

Severe pain over a bony prominence warns of animpending pressure ulcer. Pain decreases whenulceration occurs


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Discomfort due to pressure on the skin may be relievedby elevation that controls edema or by positioning thatalters pressure.

3. Improved physical mobility.

Every joint that is not immobilized should be exercisedand moved through its range of motion to maintainfunction.

4.Healing of lacerations and abrasions.

5.Maintenance of Adequate Neurovascular function andAbsence of Complications.

monitors circulation, motion, sensation of the affected

extremity. Assessing the fingers or toes, of the casted extremity

and comparing them with those of the oppositeextremity.


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Normal findings: minimal swelling, minimal discomfort,

pink color, warm to touch, rapid capillary refill

response normal sensations, and ability to exercise

fingers or toes.

Early recognition of diminished circulation and nerve

function is essential to prevent loss of function.

Assessment data: unrelieved pain, pain on passive

stretch, paresthesia, motor loss, sensory loss, coolness,paleness, slow capillary refill.

6. Teaching Self Care

Instruct the patient the following:

Move about as normally as possible, but avoid excessive

use of the injured extremity and avoid walking on wet,

slippery floors or sidewalks.


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Perform prescribed exercises regularly as scheduled.

Elevate the casted extremities to heart level frequently toprevent swelling.

Do not attempt to scratch the skin under the cast. Thismay cause a break in the skin and result in the formationof a skin ulcer. Cool air from a hair dryer may alleviate anitch.

Cushion rough edges of the cast with tape.

Keep the cast dry but do not cover it with plaster orrubber, because this causes condensation, which dampensthe cast and skin. Moisture softens a plaster cast.

Report any of the following to the physician: persistentpain, swelling that does not respond to elevation, changes

in sensation, decreased ability to move exposed fingers ortoes, and changes in skin color and temperature.

Note odors around the cast, stained areas, warm spots,and pressure areas. Report them to the physician.


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TRACTION

Is the application of a pulling force to a part of the

body. It must be applied in the correct direction andmagnitude to obtain its therapeutic effects. Traction is

used primarily as a short term intervention until other

modalities (such as external or internal fixation.) are

possible. Traction means that a pulling force is applied to

a part of the body or an extremity where countertractionpulls in the opposite direction.

Purposes:

1. To prevent / correct deformities2. Relieve pain

3. Relieve muscle spasm

4.Reduce / immobilize / align fractures


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PrinciplesofEffective Traction

Counter traction must be used to achieve effectivetraction. Usually the patients body weight and bed

position adjustments supply the needed countertraction. Traction must be continuous to be effective in reducing

and immobilizing fractures.

Weights are not removed unless intermittent traction is

prescribed. Any factor that might reduce the effective pull or alter its

resultant line of pull must be eliminated. the patient must be in good body alignment in the center of the

bed when traction is applied.

Weights must hang free and not rest on the bed or floor.


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TypesofTraction

1. Skin Traction

A direct application of pulling force on a skinadherent that is attached to the skin to maintain a steadypull. It is often a temporary measure used to beforesurgery or to reduce muscle spasm. It should be removedand reapplied at least once a day. It also can be used foran extended period of time and is removed and reappliedintermittently as prescribed by the physician. The amountof weight applied must not exceed the tolerance of theskin. No more than 2 to 3.5 kg of traction can be used onan extremity.

2. Skeletal Traction

Skeletal traction is applied directly to the bone. Thismethod of traction is used occasionally to treat fracturesof the femur, tibia and cervical spine.


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The traction is applied directly to the bone by use of ametal pin or wire that is inserted through the bone distalto the fracture, avoiding nerves, blood vessels, muscles,

tendons, and joints.

Nursing Interventions:

1. Promoting Understanding of the Treatment Regimen.

2. Reducing Anxiety3. Maintaining Position

Patients body in traction must maintain proper alignmentto promote an effective line of pull.

Position the patients foot accordingly to prevent foot

drop.4. Preventing Skin Breakdown

Protect the clients elbows and heel and inspect it for

pressure areas.


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Suspend a trapeze overhead within easy reach of thepatient. This apparatus helps the patient to move about inbed and to move on and off the bedpan.

Specific pressure points are assessed for redness and skinbreakdown.

If patient is not permitted to turn on one side or the other,the nurse must make a special effort to provide back careand to keep the bed dry and free of crumbs and wrinkles.

5. Monitoring Neurovascular Status

Neurovascular status of the immobilized extremity isassessed at least every hour initially and then every 4 hours

Instruct the patient to report any changes in sensation or

movement immediately so they can be promptly evaluated. Encourage the patient to do active flexion extension

ankle exercises and isometric contraction of the calfmuscles 10 times an hour while awake to decrease venousstasis.


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6. Providing Pin Site Care

Assess pin site and drainage for signs of infection such asredness, tenderness and purulent drainage.

Wound in pin insertion needs attention to avoid infection. Initially the site is covered with a sterile dressing.

The nurse must keep the area clean.

Slight serous oozing at pin site is expected, but crustingshould be prevented.

7. Promoting Exercise

Encourage the patient to exercise within the therapeuticlimit of the traction, to assist maintain muscle strength,muscle tone and promoting circulation.

Active exercises include pulling up on the trapeze, flexingand extending the feet, range of motion, and weightresistance exercises for non-involved joints


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8. Achieving a Maximum level of Comfort

Special mattress or mattress overlays designed to minimizethe development of pressure ulcers may be placed on the

bed before traction is applied. The nurse can relieve pressure on dependent body parts by

turning and positioning the patient for comfort within thelimit of the traction and by making sure the bed linensremain wrinkle free and dry.

9. Achieving Maximum Self Care

The nurse helps the patient to eat, bathe, dress, andtoilet. Convenient arrangement of items such astelephone, tissues, water and assistive devices mayfacilitate self care.

Nurse and patient can creatively develop a routine thatmaximizes the patients independence.


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10. Attaining Maximum Mobility with Traction

Encourage the patient to exercise the muscles and jointsthat are not in traction to guard against their

deterioration.

11. Monitoring and Managing Potential Complications

a. Pressure Ulcers

- examine frequently the patients skin for evidence

of pressure paying more attention to bony prominences.- reposition patient frequently and use protectivedevices to relieve pressure such as elbow protector.

- if a pressure ulcer develops the nurse consults withthe physician.

b. Pneumonia

- auscultate the patients lung every 4 to 8 hours todetermine respiratory status.


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- teach the client deep breathing and coughing

exercises to aid in fully expanding the lungs and

moving pulmonary secretions.

- if a respiratory problem develops, prompt institution

of prescribed therapy is needed.

c. Constipation and Anorexia

- a diet high in fiber and fluids may help to stimulate

gastric motility.

- therapeutic measures such as stool softeners,

laxatives, suppositories and enemas.

- identify and include patients food preference within

the prescribed therapeutic diet.


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d. Urinary Stasis and Infection

- monitor the patients fluid intake.

- teach the patient to consume adequate amounts offluid and to void every 3 to 4 hours.

- Notify the physician if the patient exhibits signs and

symptoms of urinary tract infection.


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Types of Cast

Short Leg Cast- From foot to below knee

- Fracture of the foot,

ankle,

or distal tibia or fibula.- severe sprain or strain

- postoperative

immobilization following

open reduction andinternal fixation


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Abduction boots

- Feet to below kneeor upper thigh

- Postoperative

immobilization

following hip abductorrelease

- Maintain abduction


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Unilateral Hip Spica cast

- Entire leg and trunkto waist or nipple line

- Fracture of the femur

- Postoperative

immobilization

- Correction of deformity

such as congenital

soft tissue injury

following dislocationof the hip


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Bilateral long leg Hip Spica Cast

-

Entire leg bilaterally towaist or nipple line

- Fractures of femur,

acetabulum, or pelvis

- Postoperative

immobilization


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Short Leg Hip Spica Cast

- Knees or thighs bilaterally

to waist or nipple line

- Developmental dysplastic

hip


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Short Arm Cast

-

Hand to below elbow

- Fracture of the hand

or wrist.

- Postoperative

immobilization


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Long Arm Cast

- Hand to Upper Arm

- Fracture of the forearm,

elbows or humerus.

- Postoperative

immobilization


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Shoulder Spica Cast

- Trunk and Shoulder,

arm and hand

- Shoulder dislocation

- Soft tissue injury to the

shoulder

- Postoperative

immobilization


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Types of Traction

1.Cervical Traction- Used for fractures or dislocation of cervical or high thoracic

vertebrae


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Halo Vest

- Fractures or dislocation of cervical or high thoracic

vertebrae


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Bryants Traction

- Used for femur fractures and congenital hip dislocation

- Used in children younger than 3 years old, weighing less

than 30 lbs.

- Applied bilaterally with hips flexed 45 degrees and legs in

extension.


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Bucks Traction

- Used for hip and knee contracture and immobilization of

hip fractures.

- This form of skin traction to the lower limb provides for

straight pull through a single pulley attached to a crossbar

at the foot of the bed.

- The limb in traction lies parallel to the bed. The foot of the

bed is routinely elevated to provide counter traction and tokeep the patient from being pulled down to the foot of the

bed.

- In Buck's extension traction, the patient is usually not

allowed to turn and must remain flat on his back


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Dunlop skeletal traction

- An orthopedic mechanism that helps immobilize the upper

arm in the treatment of contracture or supracondylar

fracture of the elbow. The mechanism uses a system of

traction weights, pulleys, and ropes and may be

accompanied by skin traction. Dunlop skeletal traction is

usually applied unilaterally but may also be applied

bilaterally.

l d


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Balanced Traction

- Used for femur fractures. Hip and knee contracture and for

postoperative positioning and immobilization.


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presentation ms ortho

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