MS Care Modalities

1. MS Care Modalities Connie K. Cupples, MS, MSN, RN

2. Care Modalities • Casts – nonplaster & plaster • Traction – Skin & skeletal • External fixation devices – pins • Open reduction with internal fixation • Artificial joint replacement – hip, knee

3. Nursing Interventions for Patient in a Cast • Pain relief – elevate the part, cold application & analgesics as ordered (unrelieved pain may indicate compartment syndrome) • Improve mobility – ROM to all immobilized joints • Promote healing of skin abrasions – clean and apply sterile dressing to areas, observe for s/s of infection

4. Nursing interventions cont’d • Maintain neurovascular function – early recognition and reporting to MD of s/s of unrelieved pain, pain on passive stretch, paresthesia, motor loss, sensory loss, coolness, pallor, slow capillary refill, sensation of tightness (may indicate compartment syndrome) • Elevate extremity no higher than heart level and call MD STAT

5. Potential Complications for Patient in a Cast • Compartment Syndrome – circulation and function are compromised • Pressure Ulcers – observe for s/s • Disuse Syndrome – muscle atrophy occurs

6. Teaching the Patient with a Cast Home Care • Mobility aids & safety • Prescribed exercise • Elevate extremity to heart level • Keep cast dry & cushion rough edges • Don’t scratch under cast • Report indicators of complications • Avoid excessive use of injured extremity • Report broken cast

7. Management of Patient in Arm Cast • Elevate immobilized arm • Sling used during ambulation • Neurovascular checks – observe for Volkmann’s contracture

8. Management of Patient in a Leg Cast • Elevate to heart level • Apply ice for 1-2 days as prescribed • Encourage recumbent position several times a day • Assess circulation and nerve function (peroneal injury may cause footdrop) • Teach use of assistive devices (transfer & ambulating) • Use of cast boot or reinforcement of cast if weight-bearing is allowed

9. Nursing Interventions with a Patient in a Body or Spica Cast • Turn q 2h to unaffected side (3-4 persons) • Prone position bid if not contraindicated • Skin care • Fracture bedpan with plastic pads • Observe for cast syndrome – psychological & physiological

10. Types of Hip Spica Casts

11. Managing Pt with Splints & Braces • Teach pt how to apply device • Neurovascular checks • Assess comfort when using device • Encourage to wear as prescribed • Refer pt for adjustments as needed

12. Nursing Interventions for Pt With an External Fixator • Pt teaching prior to application • Elevate extremity • Monitor neurovascular status q 2-4 h • Assess pin site for s/s of infection • Pin care as prescribed • Encourage isometric and active exercises • Physical therapy referral may be ordered

13. Nursing Interventions with Skin Traction • Keep leg in proper alignment • Keep traction bandage free of wrinkles • Maintain countertraction • Do not turn but assist to shift position • Measures to prevent skin breakdown • Assess for nerve pressure • Circulation checks q 1-2 h • Encourage active foot exercises

14. Nursing Interventions with a Pt in Skeletal Traction • Ensure that weights hang freely & that ropes, knots, and pulleys are correct • Maintain proper body alignment & foot in neutral position • Prevent skin breakdown • Bed changed from top to bottom • Neurovascular checks q 4h • Pin site care tid or as prescribed • Encourage exercise within therapeutic limits

15. QUESTIONS • What are three potential complications that a patient in skeletal traction may develop? • Identify nursing interventions to prevent the above complications.

16. Nursing Interventions for Pt. with Total Hip Replacement • Keep leg in abduction to prevent dislocation of the prosthesis – use abduction pillow to keep hips abducted • When turning, keep hip abducted • Turn from side to side unless surgeon orders not to turn to affected side • Teach pt to avoid flexion of affected hip • Don’t elevate HOB more than 60 degrees • Observe for s/s of dislocation

17. Teaching Pt to Avoid Hip Dislocation • Don’t cross legs • Keep knees apart • Sleep with pillow between legs • Don’t bend forward when seated • Don’t bend to pick up objects on floor • Use high-seated chair & raised toilet seat • Don’t flex hip while dressing • Use a “reaching device” to assist with activities

18. Nursing Interventions cont’d • Observe wound drainage (expect 200-500ml in 1st 24 h, 30ml or less in 48h) • Measures to prevent DVT (fluids, exercise, TEDs, SCDs, ambulate, heparin or Lovenox as ordered) • Prevent infection (antibiotics as ordered) • Teach self care to prepare for discharge • Continuity of physical therapy, use of assistive devices

19. Post-op Nursing Interventions for Pt with Total Knee Replacement • Observe dressing for bleeding/drainage • Ice as ordered • Neurovascular checks • Pain meds as ordered • Active flexion of foot q1h while awake • Observe CAC in wound suction drainage • Continuous passive motion (CPM) device • Early ambulation with knee immobilizer • Physical therapy as ordered

20. QUESTIONS • In the post-op care of the patient undergoing orthopedic surgery, name 5 potential complications for which the nurse would monitor. • Give nursing assessments and interventions to prevent these complications.

21. GOOD BYE AND GOOD LUCK • Have a blessed day! Template provided by Animationfactory.com