unit c musculoskeletal_chpt_46 part i voice and no underline (1)

Linda S. Williams / Paula D. Hopper

Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition

Chapter 46

Nursing Care Of Patients With

Musculoskeletal And Connective Tissue

Disorders



BONE AND SOFT TISSUE DISORDERS Strain

◆ Involves excessive stretching of muscle or tendon◆ May be mild, moderate, or severe (moderate strain involves a partial tear) ◆ RICE (Rest, Ice, Compression, and Elevation)

Sprain◆ Involves excessive stretching of ligaments◆ A severe sprain has torn ligaments that causes instability of the joint and often

requires surgery◆ RICE and anti-inflammatory drugs are used

Dislocation Bursitis

◆ Inflammation of the bursa◆ Treatment includes administration of salicylates and NSAIDs

Rotator Cuff Injury◆ Tendons around shoulder form rotator cuff◆ Top tendon (supraspinatus) and bursa may become impinged in the narrow space

under the acromion bone



Rotator cuff tear

http://4.bp.blogspot.com/_zBjdOy7tPmY/SXrphxa8i0I/AAAAAAAAAl0/Bg_G7RlMYtA/s400/shoulder-rotator-cuff.jpg

http://www.google.com/imgres?imgurl=http://www.emedx.com/emedx/diagnosis_information/diagnosis_information_image_files/shoulder_images/partial_rotator_cuff_tear-1.jpg&imgrefurl=http://



Carpal Tunnel Syndrome Median Nerve

Compression in Wrist’s Carpal Tunnel

Occurs with Swelling in Tunnel

Finger, Hand, Arm Pain/Numbness

Impaired mobility to hand and fingers

http://www.eorthopod.com/sites/default/files/images/hand_carpal_tunnel_anat05.jpg



Carpal Tunnel Syndrome Relieve Inflammation and Rest Wrist

◆Splint◆Anti-inflammatory◆Surgery

Teach Prevention



Fractures Break in a Bone Cause

◆Trauma◆Pathological (From Disease - most likely an

older person) Open – Breaks Skin (bone may extend through

skin)(also known as a compound fracture)

Closed – Does Not Break Skin



Types of Fractures



Signs and Symptoms Pain Decreased ROM Limb Rotation Deformity, Shortening of Limb Swelling Bruising Inability to move the arm on the injured side is a

symptom of a fractured clavicle. External rotation and shortening of the leg and

foot is a symptom of a hip fracture



Diagnostic Tests X-ray CT scan Hg may be obtained for patients with

severe bleeding MRI may be used to assess soft tissue

damage



Emergency Treatment Splint It As It Lies! Seek Medical Treatment Splint over clothing unless you need

visualize a bleeding site. Do not attempt to straighten or realign

fracture Cover protruding bone with clean cloth



Fracture Management Goals

◆Realignment of Bone Ends ◆Immobilization



Fracture Healing Phases

See page 994 in Med/Surg book



Closed Reduction Manual Realignment

◆External manipulation of the fragments and redirection the bone to its normal position

Bandages/Splints Casts Traction

◆Skin – uses pull on tapes or traction strips attached to the skin

◆Skeletal – uses wire or pins inserted in the bone with pull applied to the pin or wire



Casts An x-ray film is usually taken post

application to determine if the bone is in good alignment.

Arm slings should be positioned so that fingers are higher than elbow.

Rough edges of cast may be cushioned with tape (petaling)

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/orthopaedics/casts.html



Cast care Cast should be uncovered and exposed to the air to dry.

They may feel hot for about 10-15 minutes or up to 30 minutes.

Takes 24 to 72 hours to dry completely

Turn patient every 1-2 hours while cast is drying. 2-4 hours after cast is dry.

Assess CMS (Circulation, movement, sensitivity)

Assess CWCM every 1-2 hours. Color, warmth, circulation, movement. See Box 46.2 page 997 for nursing interventions (Med/Surg book)



Assessment of extremity in a cast (5 P’s)

Pain Pallor Pulselessness Paresthesia PuffinessSee page1003 and 1004 for P’s related to compartment syndrome



Nursing care Inspect exposed skin daily Bath the toes and fingers of part that is in a

cast Massage the skin under the edges of the

cast Range-of-motion exercises for moveable

body parts



Nursing care Diet should be regulated for patients in a

hip spica cast to prevent excessive weight gain

A well balanced diet is recommended for patients in a cast

After a cast is removed there may be an exudate of dead skin and secretions from glands. This may be gently washed with mild soap and warm water. Then apply lotion

Atrophy of muscles is common for patients with casts. They should be referred to physical therapy for muscle exercises.

http://4.bp.blogspot.com/_NURyBgG--RE/SO1lRUj_odI/AAAAAAAAAbQ/Y_unEIFIouA/s1600-h/Akira-in-chair.jpg

Hip Spica cast



Nursing care Weight bearing usually begins with partial

weight bearing. The degree of weight bearing is determined by the physician and physical therapist.



Types of Skin Traction

The patients body provides countertraction



Balanced Suspension and Skeletal Traction

Traction should be continuous and weights not lifted, increased or decreased unless there is a doctor’s order to do so

Weight should not touch the bed and should hang free.

Check physicians orders to see how high the head of the bed can be elevated



Fracture Management Open Reduction With Internal Fixation External Fixation

◆May be required for complex or comminuted fractures

http://upload.wikimedia.org/wikipedia/commons/9/9f/External_Fixator.JPG



External fixation



Internal fixation

1.Involves and open reduction

2.Uses material such as pins, nails, rods, and wires

3.Goal is to immobilize and strengthen the bone



A Complication of an internal fixation is necrosis of the bone

Necrosis of the bone symptoms◆Pain◆Limp while ambulating◆Muscle spasm



Complications Of Fractures Nonunion or delayed union Neurovascular compromise or nerve damage Hemorrhage Infection (especially for compound fractures) Thromboembolitic Complications Acute Compartment Syndrome Fat Embolism Syndrome (chest pain, petechiae, and

dyspnea) (fat from yellow bone marrow goes to lungs) Vomitus may be aspirated when jaws are wired. The wire

may need to be cut



Post Fracture nursing care Weight bearing on an extremity is

determined by the physician. Unless the physician orders otherwise,

increased fluids should be taken by patients who are immobile for long periods of time.



Compartment Syndrome

May also be due to cast being too tight.Patient may have severe pain, sluggish capillary refilling, weak pulses and numbness below cast. 1.5 seconds is a normal refilling time

Relieved by cutting cast or fasciotomy



Bivalving Cast If windows are cut into a cast, they should be taped back in place.Windows are made over areas of discomfort to permit direct visualization of the area



Nursing Diagnoses for Fractures Acute Pain Impaired Physical Mobility Impaired Walking Ineffective Health Maintenance Risk for Peripheral Neurovascular

Dysfunction



Nursing Diagnoses Risk for Ineffective Tissue Perfusion Risk for Ineffective Skin Integrity



Nursing Care for Fractures Cast Care Traction Care Pain Control Neurovascular Checks

◆Check the extremity for color and temperature

Skin Care Nutrition



Palming the Cast



Nursing Care Self Care Deficits Psychosocial After an open reduction to an extremity, the

extremity should be somewhat elevated to prevent edema.

To turn a patient with a fractured leg with an internal fixation device, the nurse should place a pillow lengthwise between the legs, and keep the affected leg straight while turning the body in one movement



Patient Education Cast Care Pin Care Nutrition



Complications of orthopedic surgery

Shock and infection are two major complications



Joint dislocation Closed reduction is usually first method

attempted for dislocated joints.



Talipes equinovarus A form of bilateral clubfoot It is seen twice as often in boys than girls It is caused by having had abnormal pressure on

the feet in the uterus May be treated with a Dennis Browne splint

http://www.abdn.ac.uk/~gen155/graphics/clubfoot.jpeg

http://www.drfoot.co.uk/pictures/clubfoot_braces.jpg



Osteomyelitis Infection of Bone acute or chronic Prevention Is Key! Fever, Redness, Heat, Pain, Swelling, Pain Long-term Antibiotic Therapy Incision and Drainage Amputation



Osteomyelitis



Osteomyelitis Nursing Care

◆Medication teaching◆Hand Hygiene◆Sterile dressing changes

unit c musculoskeletal_chpt_46 part i voice and no underline (1)

Health & Medicine

medical surgical nursing

williams paula

edition linda

medical treatment splint

hopper bone

hopper fractures

hopper chapter

hopper fracture manageme