Care of client with musculoskeletal injury or disorder

1. Care of client with musculoskeletal injury or disorder http://wwwhttp://www.scribd.com/doc/9378673/musculoskeletal-dishttp://www.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005orders-care-of-client-with-fall-2005.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005

2. What can go wrong Fractures Hip Mandible Degenerative joint disease Osteoporosis Herniated disc Amputation

3. Reduction/Realignment Immobilization Nursing care Prevention and early detection: complication CONCEPTS: FRACTURES

4. Realignment=Reduction Correct bone alignment goal: restore injured part to normal or near-normal function Closed vs. open reduction Open reduction = surgery

5. Immobilization:to maintain alignment Cast Traction External fixation Internal fixation

6. CASTS

7. Casts External, circumferential Thermochemical reaction = warmth Nursing care: No weight bearing 24-72 hours “flat hands” Elevate Neuro-vascular checks

8. CASTS

9. Cast: Client/Family Teaching Keep dry No foreign objects in cast No weight bearing until MD order (at least 48 hour)‏ Elevate above heart (48 hours)‏ Signs of problems to report Pain, tingling, burning Sores, odor

10. External fixation Metal pins inserted into bone Pins attach to external rods Nursing care: Assess for s/s infection Teach pin care: ½ H2O2+ ½ H2o Open reduction: assess incision Elevate Neurovascular checks

11. EXTERNAL FIXATION

12. Internal Fixation Pins, plates, screws surgically inserted Nursing care: Assess incision site MD orders: activity, weight bearing, ROM, Assess s/s infection; temp. q 2-4 hours Neurovascular checks: 5 “P’s”

13. INTERNAL FIXATION

14. Traction Pulling forces: traction + countertraction Purpose(s): Prevent or reduce muscle spasm Immobilization Reduce a fracture Treat certain joint conditions

15. Types of Traction Skin Buck’s Russell’s Bryant’s (“babies cry with Bry”)‏ Skeletal Balanced suspension (Lewis, 1660-1661)‏

16. Nursing Concerns/Interventions Assess neurovascular status Assess skin (bony prominences, under elastic wraps, etc.)‏ Assess pin sites (skeletal tx)‏ Maintain correct body alignment Weights hang freely Hazards of immobility

17. TRACTION

18. SKIN TRACTION BUCK’S TRACTION

19. SKELETAL TRACTION

20. Nursing Diagnoses Neurovascular dysfunction, risk for Acute pain, R/T edema, muscle spasms, movement of bones Infection, risk for Impaired skin integrity, risk for Impaired physical mobility

21. Complications of Fractures Compartment syndrome Fat embolism Venous thrombosis Infection

22. COMPARTMENT SYNDROME • FACIOTOMY – wound is left open • If no improvement, amputation

23. Hip Fracture In 1999 (USA) hip fractures resulted in approximately 338,000 hospital admissions Up to 25% of community-dwelling older adults who sustain hip fractures remain institutionalized for at least a year

24. Hip Fractures One-third of older women who fracture their hip will die within a year because of lengthy convalescence that makes them susceptible to complications, like lung and bladder infections. The Lancet 1999;353:878-82

25. Fracture of hip Types of hip fractures (Lewis pg. 1675): Intracapsular Capital Subcapital Transcervical Extracapsular Intertrochanteric Subtrochanteric

26. Open reduction/internal fixation: pins, screws, plate(s)‏ Total hip: endoprosthesis – replace femoral head ORIFvs“Total Hip”

27. Internal fixation = immobilization

28. Nursing Care Risk for peripheral neurovascular dysfunction Pain Impaired mobility: Prevent thrombus Safety Constipation Risk for impaired skin integrity: Immobility Incision

29. Femoral head prosthesis (total hip)‏ Prevent dislocation: Do not flex > 90 degrees No internal rotation (toes to ceiling)‏ Maintain abduction Do not position on operative side Patient teaching: Precautions for 6-8 weeks Notify dentist: prophylactic antibiotics Lewis: pg. 1678

30. Fracture of mandible Trauma vs. Therapeutic Immobilization: wiring, screws, plate(s)‏ Nursing care: Airway (Cutter with client)‏ Oral hygiene Nutrition Communication

31. What can go wrong Fractures Hip Mandible Degenerative joint disease Osteoporosis Herniated disc Amputation

32. Degenerative Joint Disease:Osteoarthritis Not normal part of aging process Cartilage destruction: Trauma Repetitive physical activities Inflammation Certain drugs (corticosteroids)‏ Genetics

33. Assessment Location, nature, duration of pain Joint swelling/crepitus Joint enlargement Deformities Ability to perform ADL’s Risk factors Weight (history of obesity)‏

34. Nursing Interventions Pain management Rest with acute pain; exercise to maintain mobility Splint or brace Moist heat Alternative therapies TENS, acupuncture, therapeutic touch

35. Surgical management: total joint arthroplasty (replacement)‏ Elbow, shoulder, hip, knee, ankle, etc. Pre-operative teaching: “What to expect” (CPM, abduction pillow, drains, compression dressing, etc.)‏ Postoperative exercises: quad sets, glute sets, leg raises, abduction exercises Pain management: PCA Use of pain scale

36. Total Joint Arthroplasty Post-operative care: 5 P’s Observe for bleeding Pain management Knee: CPM Check incision for s/s infection

37. Total Joint Arthroplasty Postoperative Care Prevent: Dislocation Skin breakdown Venous thrombosis (DVT)‏ TED/Sequential compression Anticoagulants Exercises: plantar flexion, dorsiflexion, circle feet, glute & quad sets

38. Osteoporosis Primary – often women postmenopause Secondary – corticosteroids, immobility, hyperparathyroidism Bone demineralization = decreased bone density Fractures: Wrist Hip Vertebral column

39. Silent disease Dowager’s hump (kyphosis)‏ Pain Compression fractures Spontaneous fractures X-ray can not detect until > 25% calcium in bone is lost Diagnosis: bone density ultrasound

40. Interventions Hormone replacement Calcium & vitamin D Calcitonin, Fosamax, Actonel, Evista Avoid alcohol and smoking Daily weight bearing, sustained exercise (walking, bike)‏ Safety in home (throw rugs, pets, etc.)‏

41. What can go wrong Fractures Hip Mandible Degenerative joint disease Osteoporosis Herniated disc Amputation

42. Location of PPT on Web is below • http://www.scribd.com/doc/9378673/musculoskeletal-disorders-care-of-client-with-fall-2005