Bb Musculoskeletal Fall12

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Musculoskeletal Deficits

Kimberly Ambruso, RN, MS

NU 102

Fall 2012


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Musculoskeletal A&P

Function of bones

Protect

Stabilize

Surface for muscles

Reservoir for storage of

minerals Hematopoesis

Pediatric Differences

Musculoskeletal development of

neonates and infants is immature

better chance of

correcting or preventingfurther progression of

abnormalitiesPeriosteum:provides

nourishment to the bone.Thicker in children fasterhealing


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Musculoskeletal Assessment

X-ray

Bone scan

Electromyography

Muscle or bone biopsy

Arthroscopy


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Fractures

Common in children

Most frequently broken bone in child?

Causes:

Children

Adults

Methods of treatment different in pediatricsthan in older adult population

Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier

Inc.

Slide 4


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Types of Fractures

Compound or

open Complicated

Comminuted

Greenstick

Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier

Inc.

Slide 5


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Clinical Manifestations of

Fracture

Generalized

swelling

Pain or tenderness

Diminished

functional use

May have bruising,

severe muscularrigidity, crepitus

5 Ps of Fractures

Pain and point of tenderness

Pulsedistal to the fracture site

Pallor

Paresthesiasensation distal to

the fracture site

Paralysismovement distal tothe fracture site

Slide 6


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Cast Care

Drying time

Turn Q2hrs while

drying Handling wet cast

Elevate casted

extremity


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Cast Care

Nursing care

Skin

Pain

Neurovascular

Compartment syndrome

Eating/diet

Body image and

socialization


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Splints

Purpose:

Immobilization

Support

Allows more room forswelling

Fewer complications

Braces

Purpose:

Provide support

Control movement

Prevention of further injury


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Reduction

Open Fractures

Followed by fixation

ORIF

Closed Fractures

Dislocations

Followed by immobilization


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Traction

Traction: extended pulling force may be used to:

Provide rest for an extremity

Help prevent or improve contracture deformity

Correct a deformity

Treat a dislocation

Allow position and alignment

Provide immobilization

Reduce muscle spasms (rare in children)

Mosby items and derived items 2007,

2003 by Mosby, Inc., an affiliate of Elsevier

Inc.

Slide 12


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Traction: Essential Components

Traction: forward force produced by attaching weight

to distal bone fragment

Adjust by adding or subtracting weights

Countertraction: backward force provided by bodyweight

Increase by elevating foot of bed

Traction must be continuous Weights must hang freely



Inc.

Slide 13


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Types of Traction

Skin traction

Non-invasive

Secured by straps and

bandages Bucks: most common

Skeletal traction

Surgically inserted rods/bars

into the bone, through the

skin Serious potential for

infection


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Hip Replacement

Indications

Osteoarthritis

Rheumatoid arthritis

Trauma

Congenital abnormalities

Procedure

Titanium or cobalt ball and

socket

Socket is cemented into

acetabulum

Pre-Op

Assessing risks for

complications

Obesity

Cardiac

Age

Varicose veins

History of DVT, emboli


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Total Hip Replacement


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Hip Replacement Nursing Care

Post-op

Standard post-op

Prevention of infection

Hemodynamics

DVT prophylaxis

Wound drainage

Positioning

Abduction

Flexion rotation

Ambulation

PT begins immediately

Patient Education

Total Hip Precautions

No bending

No adduction

Hip cannot flex past 90degrees

No internal rotation

No external rotation


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Complications

Skin

Skin Breakdown

Nerve Damage

foot drop

Circulatory impairment

DVT

Skeletal

Infection

osteomyelitis

Shock

Skin Pin care

Nerve damage


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Compartment Syndrome

Increased pressure within

the muscle

lack of oxygen to thetissues

damage to blood

vessels and nerve and

muscle cells

EMERGENCY!!


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Compartment Syndrome

Remove cast!!!

Elevate extremity

Fasciotomy

Dont forget to do

neurovascular

checks!!


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Osteomyelitis

Causes:

Extension of soft-tissue

infection

Direct bonecontamination

Bloodborne spread from

another site of infection

Manifestations:

localized pain, edema,

erythema, fever, and

drainage

Interventions

Promote nutrition

vitamin C and protein

Encourage adequate hydration

Administer and monitor antibiotic

therapy


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Other Complications

Pressure Ulcers

Pressure on bony

prominence under

cast or brace Pain/tightness in area

Warm sensation in

area

Foul odor, drainage

Removal of cast

Disuse Syndrome

Resulting from immobility

Muscle atrophy

Isometric exercises

Muscle setting exercises


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Developmental Dysplasia

of the HipThe head of the femur isimproperly seated in the

acetabulum

A&P: ball and socket

More common in

caucasians, females and

first born children

Asymmetry of gluteal skin foldsupon extension of legs

Ortolanis sign

Barlows sign

Limited ROM

Lop-sided

Gait changes


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Inc.

Slide 27


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Hip Dysplasia- Manifestations


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Ortolani / Barlow


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Pavlik Harness

Maintains flexion,abduction and external

rotation

Initially worn continuously

Improper positioningavascular necrosis

Straps need adjustments at

regular intervals

Nursing care


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Hip Dysplasia Management

-Bryants Traction

Purpose

Nursing considerations-Spica Cast

-Surgery

Osteotomy, with possible

tendon release
http://jamasters.smugmug.com/photos/131807575-L.jpg


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Scoliosis

Lateral curvature of the spineand spinal rotation

Severity

Mild: 10-20 degrees Moderate: 20-40 degrees

Severe: > 40 degrees

Etiology

Idiopathic Congenital

Neuromuscular: MuscularDystrophy, CP, Spina Bifida


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Scoliosis

Assessment

Screening

Asymmetry of ribs, flanks

upon exam

Adams test

Leg length discrepancy

X-Rays on spine, thorax

Management

Mild: wait and see

Moderate: Milwaukee Brace

/ TLSO Purpose

Nursing implications

Severe: surgery

Spinal fusion

Harrington Rod

Post-op


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Milwaukee Brace


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TLSO Boston Brace



Inc.

Slide 36


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Nursing Considerations

Concerns of body image

Concerns of prolonged treatment of condition

Preoperative care

Postoperative care


2003 by Mosby Inc an affiliate of Elsevier Slide 37

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