Unit c musculoskeletal_chpt_46 part i voice and no underline (1)
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Transcript of 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
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Linda S. Williams / Paula D. Hopper
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
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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://
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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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
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Carpal Tunnel Syndrome Relieve Inflammation and Rest Wrist
◆Splint◆Anti-inflammatory◆Surgery
Teach Prevention
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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
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Types of Fractures
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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
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Diagnostic Tests X-ray CT scan Hg may be obtained for patients with
severe bleeding MRI may be used to assess soft tissue
damage
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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
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Fracture Management Goals
◆Realignment of Bone Ends ◆Immobilization
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Fracture Healing Phases
See page 994 in Med/Surg book
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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
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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
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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)
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Assessment of extremity in a cast (5 P’s)
Pain Pallor Pulselessness Paresthesia PuffinessSee page1003 and 1004 for P’s related to compartment syndrome
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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
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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
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Nursing care Weight bearing usually begins with partial
weight bearing. The degree of weight bearing is determined by the physician and physical therapist.
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Types of Skin Traction
The patients body provides countertraction
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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
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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
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External fixation
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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
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A Complication of an internal fixation is necrosis of the bone
Necrosis of the bone symptoms◆Pain◆Limp while ambulating◆Muscle spasm
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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
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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.
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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
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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
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Nursing Diagnoses for Fractures Acute Pain Impaired Physical Mobility Impaired Walking Ineffective Health Maintenance Risk for Peripheral Neurovascular
Dysfunction
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Nursing Diagnoses Risk for Ineffective Tissue Perfusion Risk for Ineffective Skin Integrity
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Nursing Care for Fractures Cast Care Traction Care Pain Control Neurovascular Checks
◆Check the extremity for color and temperature
Skin Care Nutrition
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Palming the Cast
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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
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Patient Education Cast Care Pin Care Nutrition
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Complications of orthopedic surgery
Shock and infection are two major complications
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Joint dislocation Closed reduction is usually first method
attempted for dislocated joints.
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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
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Osteomyelitis Infection of Bone acute or chronic Prevention Is Key! Fever, Redness, Heat, Pain, Swelling, Pain Long-term Antibiotic Therapy Incision and Drainage Amputation
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Osteomyelitis
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Osteomyelitis Nursing Care
◆Medication teaching◆Hand Hygiene◆Sterile dressing changes