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Muscle/Skeletal Rehabilitation

Muscle/Skeletal Rehabilitation. Lesson #2. Objectives. Identify the principles of rehabilitation after a fracture Describe arthroplasty and teaching for the patient in rehabilitation after a joint replacement Describe the role of the rehab nurse in fracture and arthroplasty rehabilitation

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Muscle/Skeletal Rehabilitation

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  1. Muscle/Skeletal Rehabilitation Lesson #2

  2. Objectives • Identify the principles of rehabilitation after a fracture • Describe arthroplasty and teaching for the patient in rehabilitation after a joint replacement • Describe the role of the rehab nurse in fracture and arthroplasty rehabilitation • Describe amputation rehabilitation • State the interventions by the rehab nurse that can help the patient with arthritis to improve functional abilities

  3. Few Statistics • Over 10 million people in USA have osteoporosis • 1.5 million fractures are credited to osteoporosis • 350, 000 hip fractures included • More than 70% of knee/hip replacements from osteoarthritis

  4. Prohibits Surgery • Bone infection • Severe osteoporosis • Uncontrolled medical problem

  5. DesiredPost-Fracture Rehab Outcomes • Normal position healing • Full ROM to joints around fracture • Normal strength returns • Prevent complications

  6. General Rule • A fracture will require immobilization of the joint both above and below the fracture site during the healing process

  7. Types of Fractures Muscle/Skeletal Rehab Nursing

  8. #1 Stable fracture

  9. Stable Fractures • Require very little treatment • Rehab course begins as soon as initial symptoms of fracture subside. • Perform progressive ROM exercises 3-4 days post fracture • Progressive strengthening of fracture 3rd of 4th week post fracture • Example: • Radial Head Fracture • Non displaced ulna fracture

  10. #2 Moderately stable fracture • Requires some form of immobilization yet allows movement of the joints nearest fracture

  11. #2 Moderately Stable Fracture

  12. #3 Unstable Fracture

  13. #4 Grossly Unstable Fracture • Can’t be immobilized • Requires surgical intervention • Requires plaster or fiberglass cast • May require a cast or air brace • Examples: • Hip Fractures • Femur Fractures

  14. #4 Grossly Unstable Fracture

  15. Unstable Fracture Advantages and Disadvantages Advantages Disadvantages • Early mobilization • Early return to general mobility • Sometimes early protected weight bearing • Decreased risk with spinal anesthesia • Newer smaller incisions • Increased risks w/general anesthesia (elderly) • Increased risk of infection • Risk of interference w/the natural physiology of healing process..(screws may loosen, unresolved pain)

  16. #5 Comminuted Fracture • External Fixator

  17. External Fixators • Used for complicated, very commuted and grossly unstable fractures • Usually have a lot of soft tissue damage and edema

  18. Basic Principles of Rehab post fracture • #1 All Joints not requiring immobilization should be mobilized • #2 Gait Training/weight bearing as soon as possible • #3 Mobilization of the fracture area as soon as stability has been achieved • #4 Use of Local Help Techniques for pain and muscle spasms • #5 Muscle Strengthening as soon as fracture stabilized • #6 Perform ROM Exercises • #7 Strengthening Exercises

  19. Systemic Complications of Fractures • Atelectasis and Pneumonia • Infection • GU stasis • Deep Vein Thrombosis • Fat Emboli • Pulmonary Emboli • Systemic problems of Immobility • ARDS

  20. Local Complications of Specific Fractures • Non-Union • Mal-Union • Infection-Osteomyelitis • Stiffness

  21. Surgeries • Arthroplasty • Defined • Two Goals • Candidates for surgery • Our focus: • Hip • Knee

  22. Hip Abductor Wedge

  23. Complications of Hip Dislocation • Causes • S&S of dislocation • Five “P’s” neurovascular check • Nursing responsibility • AnteriorPosterior

  24. Knee Replacement • Purpose • When? • Critical pathway • Other replacements

  25. Role of Rehab Nurse in Fractures and Arthroplasty • Routine cast care • Monitor the extremity regularly • Provide/teach skin care/pin site care • Position properly • Supervise and monitor client’s weight bearing • Perform ROM as PT directed • Provide and encourage ADL training • Monitor for systemic and local complications • Monitor and perform pain management

  26. Amputations

  27. Amputation Rehabilitation • Children do well for injuries requiring rehab • Indications for an amputation is when the limb is no longer of any use • Severe trauma • Thermal injuries • Infections • Tumors • Pain • Severe circulatory problems) • Goal with amputations

  28. Level of Amputation • Severity of soft tissue damage • Assessment • Vascularity of the tissue • Best level of function

  29. Types of Amputations

  30. Stump Healing • Care and inspection • S&S of infection • W/C support • Expected outcomes

  31. Stump Shrinking • Purpose • Dressings

  32. Preventing Contractures Principles • #1 Prevent hip flexion and external rotation of stump • #2 Promote prone position • #3 Encourage crutch walking ASAP • #4 Avoid prolong sitting in W/C, bed, chair • #5 Patient performs resistance strengthening exercises on other limb

  33. Amputee Mobility Training

  34. Problem/Complications of Amputees • Skin problems • Atrophy • Phantom Limb Sensation • Phantom Pain • Interventions • Desensitizing techniques • Alternative methods to help phantom pain • Edema • Bony overgrowths

  35. Rehab Nurse Role in Care of Amputation • Appropriate care to enable the patient to wear a prosthetic • Ensure appropriate care of stump healing/shrinking • Prevention of contractures

  36. Arthritis Rheumatoid Arthritis Osteoarthritis

  37. Arthritis Rheumatoid Osteoarthritis • Chronic/ ?autoimmune • Systemic and symmetrical • Periods of exacerbation/remission • Onset: insidious • S&S • Treatment: • Drugs, rest, Protect, change environment • Degenerative • Unknown cause • Localized and asymmetrical • Can’t function with ADLs RT pain • S&S • Treatment: Wt loss • Drugs, rest, ROM, heat, Environment changes

  38. Arthritis Problems

  39. Arthritis Rehabilitation Nurses Role • Minimize morning stiffness • Manage environment • Provide /maintain stress free environment • Encourage/support: • proper positioning • comfort measures

  40. Summary • So what did I learn? • Name one thing • How you will incorporate it into your nursing practice

  41. References http://www.sportmedstore.com/products/images/POST-OP_WOUND_CARE_FRACTURE.jpg http://www.mdguidelines.com/images/Illustrations/fr_fem_n.jpg http://nemsi.uchc.edu/images/image_wristfract1.jpg http://media.summitmedicalgroup.com/media/db/relayhealth-images/radihead.jpg http://www.drfoot.co.uk/pictures/CollesFracture.gif http://www.hmc.org.qa/mejem/sept2003/images/Figure%202%20pg%2044.jpg http://www.ossur.co.uk/library/10461&proc=6/Soft%20Humeral%20Fracture%20Brace.jpg http://www.orthosupersite.com/images/content/ot/201012/ot1210podeszwaF1.gif http://www.irishvetjournal.org/content/figures/2046-0481-62-10-663-3.gif http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/10202.jpg http://teamofmonkeys.com/html/images/a%20Ilizarov%20External%20Fixation%20at%20Bat%20Yam%20Migdal%20Zahav%20Israel%202006%20yfrimer.jpg http://www.the-hospitalist.org/SpringboardWebApp/userfiles/hosp/image/TH_2012_09_pp09_02.jpg http://www.doctortipster.com/4163-deep-venous-thrombosis-treatment-and-prophylaxis.html/lovenox http://hanyhefny.com/images/malunion.jpg

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