Management of Musculoskeletal Disorders[1]
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Transcript of Management of Musculoskeletal Disorders[1]
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MANAGEMENT OFMUSCULOSKELETALCONDITIONS.
Presenter: Mrs.Qolisese
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INTRODUCTIONMS also known as thelocomotors system is an organsystem that enables movement
using the muscular andskeletal system. It provides :form,support,stability&movement to the body.
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Cont..
Problems occur to most body systemsas a result of an inactive lifestyle and the
MS is affected by prolonged immobility.
Nurses need to encourage clientmovement as much as possible-early
ambulation after illness or surgery. They
therefore need to be equipped with the
knowledge and skills to carry quality
nursing care.
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OBJECTIVES
At the end of this session the student should beable to:
Assess clients with orthopaedic problems
Identify the different types of fractures.
Discuss the nursing management of fracturepatients.
Describe the pre and post operative
management of orthopedic patients.
Design nursing care plan
Prepare discharge plan for orthopedic clients.
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Lecture Content
1. ASSESSMENT OF CLIENTS WITHORTHOPAEDIC DISORDERS
1.1 Subjective data
1.2 Objective data2. TYPES OF FRACTURES
2.1 Open
2.2 Closed2.3 Incomplete
2.4 Varieties of Fractures
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MANAGEMENT OF FRACTURES3.1 Principles of treatment
3.2 Basic Treatment techniques
3.3 Operative procedure
3.4 Nursing Care Plan
3.5 Discharge Plan
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LECTURE
Definition of Fractures: Break in the continuity of the bone.
ASSESSMENT OF PATIENTS WITH
MUSCULO SKELETAL DISORDERS.
JOINTS:
Pain
Stiffness
Swelling, heat
Limitation of movement
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Cont...
MUSCLES: Pain (cramps)
Weakness
BONES:
Pain
Deformity
Trauma (fractures, sprains, dislocations)
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Cont...
Functional Assessments (ADL) Self deficit in:
- bathing
- toileting- dressing
- grooming
- eating- communicating
- mobility aids
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Cont...
SELF CARE BEHAVIOURS
Heavy lifting
Repetitive motion to joints
Nature of exercise programs
Weight gain (recent)
OBJECTIVE DATA
EQUIPMENT NEEDED- Tape Measure
- Skin Marking Pen
- Goniometer to measure joint angles
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Cont..METHODS OF ASSESSMENT
Inspection and palpation of joints Observation of Range of Movement
Age
INSPECTION
Compare corresponding paired joints
Inspect for symmetry of structure note the sizeand contour.
Inspect the skin and the color note if there isany swelling, mass or deformity.
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cont..PALPATION
Palpate each joint including its skin fortemperature.
RANGE OF MOVEMENT
Ask for active range of movement Familiarize yourself with the type of each joint
and its normal range of motion so you canrecognize limitations.
MUSCLE TESTING
Test the strength of the prime mover musclesgroups for each joint.
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cont...CERVICAL SPINE
Inspect the alignment of head and neck
Spine straight and the head erect
SHOULDER Inspect and compare both shoulders
posteriorly and interiorly.
Check the size and contour of the joint. Test ROM (Range of movement)
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cont..
ELBOW Inspect size and contour in both flexed and
extended position
Look for any deformity Test range of movement
WRIST AND HAND
Inspect the hands and wrists on the dorsal andpalmar sides noting position, contour and shape.
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TYPES OF FRACTURE
Closed fractures no communication
Incomplete fractures whole thickness of the
bone is not broken, but it is bent.
Open fractures break in the bone
communicates with a wound in the skin.
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Varieties of FracturesTransverse
Longitudinal
Oblique and spiral
Comminuted
CompressionPathological fracture
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Principles of treatment
PURPOSE
- to establish the length, shape and alignment of
the fractured bones or joints and restore
anatomic function.
C t
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Cont...
PRINCIPLES
- patients extremity/fracture site must behandled gently.
- provide initial medical treatment.
- equipment and personnel must be readilyavailable to treat impending/existing shockand also to control hemorrhage.
- maintain aseptic technique.
- positioning must allow adequate circulatoryand respiratory function with adequateexposure .
- patient must be comfortable.
C t
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Cont...
PRIMARY GOAL
1.UPPER EXTREMITY
- to preserve mobility.
- to restore range of movement (ROM).
2. LOWER EXTREMITY
- to restore alignment and length.
- to provide stability of the extremity for weightbearing.
C t
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Cont...
OPEN FRACTURES
- Involves soft tissue
- Several associated conditions may
arise such as:
- secondary hemorrhage.
- infection.
- severe damage to soft tissue.
- damage to blood vessels/nerves.
- ischaemic paralysis.
C t
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Cont...
BASIC TREATMENT TECHNIQUES
- Closed Reduction manipulating fragments into
position without incising the skin.
- Treatment of choice to decrease the opportunityfor infection.
- Improve results (including bone union of the
fracture)
on
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on ... EXTERNAL FIXATION:
- Provides rigid fixation and reduction with theability to manage severe soft tissue wounds.
INDICATIONS FOR EXTERNAL FIXATOR:
- Severe open fractures
- Highly comminuted closed fractures.
- arthrodesis
- infected joints
- infected non union
- fracture stabilization to protect arterial or nerve
on
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on ...- anastomosis
- major alignment and length deficits
- congenital contractures
COMPONENTS OF EXTERNAL
FIXATOR
- bone anchoring devices (e.g. threaded pins,
Kichner wires).
- longitudinal supporting devices e.g. threadedor smooth rods.
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INTERNAL FIXATION
- To correct long bones fractures
- Application of compression plates and
screws and insertion of pins, intramedullaryrods, nails or wiring.
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EXTERNAL FIXATORS
1. MANIPULATION 2. SKIN/SKELETALTRACTION
C t
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Cont...
3. THOMAS SPLINT BALANCED SUSPENSION
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4. CASTS
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Cont..
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Cont..
The use of POP calcined Gypsum plaster toimmobilize body parts
Procedure is carried out by the
doctors/physiotherapists POP hardens after it has been soaked and
applied
X-ray of the fracture is used to guide POPapplication
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Care of the Cast Expose to air for circulation & avoid sweating
Wet cast takes 24-48 hrs to dry completely
Review patients clinical record
Knowledge of the purpose
Elevate extremity & support entire length of
injured body part
Look out for sharp cast areas & pressure to
tissue
C t
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Cont Perform frequent neurovascular assessment
Palpate the cast for hot spots may indicate thepresence of underlying infection
Report any damage promptly
Cli t d f il t hi
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Client and family teachingDo not place any object in the cast
Keep cast dry if made of POPUse blow drier to dry cast made of fiber glass
Assess the injured extremity for:
Coolness
Changes in color
Increased in pain
Increased in swelling
Loss of sensation
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MANAGEMENT OF
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MANAGEMENT OF
PATIENTS WITH
FRACTURES
OPEN REDUCTION AND INTERNALFIXATION(ORIF)
Method of providing exposure of thefracture site and using pins, wire, screws, aplate and screw combination, rods or nails
to correct the fracture. Also used when close methods such as
skeletal traction fails to reduce the fractures.
PRE OPERATIVE PREPARATION
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PRE-OPERATIVE PREPARATION
Assess the clients nutritional status.
Ask the client if he/she had been treatedwith corticosteroidcould contribute tocurrent orthopedic condition.
Assess the clients general condition fromhead to toe
ensure that the patient is not
suffering from any acute infections.
Prepare the client for postoperative routine
deep breathing and coughing exercises.
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Cont..
- explain the procedure clearly to the client -
to allay anxiety.
- Allow the patient to practice on how to use
the bed pan/urinal.
- Explain to the patient to expect casts and
external fixiator post operatively.
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POSTOPERATIVE MANAGEMENT
- Position in bed.
- Maintain a patent airway
- Close monitoring of vital signs- Administer warm humidified oxygen (3-5 litres)
for adult.
-Pain management
- Encourage deep breathing and coughingexercises
- Keep the fractured limb in line with his/her body.
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Cont
- close monitoring of the wound drain- Keep an accurate record of the intake and output
- Patients personal hygiene.
- Encourage the patient to exercise his/her limbsto avoid complications (in bed)
- Administer medications as prescribed
- Provide high protein diet.
- Encourage the patient to drink a lot of fluids.
Care of the traction
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Care of the traction
Skeletal traction:
Never remove the weight Maintain the line of pull
Center the client on the bed
Ensure the the weight hangs freely
Not touching the floor
Ensure that nothing is lying on or obstructing the
ropes.
Knots at the end of the rope should not touch the
pulleys
on
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on Frequent skin assessment to include pin care
policy
Report signs of infection
Assess the need for analgesics
Neurovascular assessment Assess for common complications of immobility
including:
Formation of renal calculi DVTParalytic ileus-Loss of appetite
Pneumonia-client and family knowledge
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Skin traction
Frequently assess skin for evidence of pressure,
shearing or pending breakdown
Protect pressure sites with padding
Protect dressing as indicated
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COMPLICATIONS
- compartment syndrome
- Shock
- Atelectasis/pneumonia
- Osteomylitis
- Wound infections
- Deep venous thrombosis
- Fat embolism
- Thrombo embolism
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NURSING MANAGEMENT
- Assessment
- Nursing Diagnosis
- Objectives- Nursing Interventions
- Evaluation
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PATIENT EDUCATION/DISCHARGE PLAN
- Teach the client activities that minimizes developmentof complication
- Educate the client to be compliant to medication
- Encourage the client to eat a lot of healthy food- Teach the patient some signs and symptoms of
orthopaedic complications.
- Advise the patient to report to the nearest hospital
should he experience symptoms
- Continue with the exercise he was taught
- Follow up
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NURSING CARE PLAN
*Must be preparedNURSING DIAGNOSIS OBJECTIVES NURSING
INTERVENTION
EVALUATION
Risk for peripheral
neurovascular
dysfunction'se.g. compartment
syndrome
Has normal
neurovascular
examination
Assess for signs
and symptoms of
peripheralneurovascular
dysfunction such
as pain,
discoloration etc.
Elevate extremity
above heart to
reduce edema
Apply ice
compression
Patients is
free from
peripheralneurovascular
dysfunction
cont
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cont..Anxiety
Anxiety Patients will
verbalize
concerns
Explain the
procedure to
the client
Encourage
verbalizationof feelings.
Encourage
patient and
familyparticipation
Patient relax
and able to
verbalize
feelings/conc
erns.
Cont
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Cont...Pain management
Pain due toinjury
Relieve pain Position theinjured limb
in align with
body
Avoid
unnecessary
movement of
the limbAdminister
prescribed
medication
Pain relieved
C
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Cont..Infection
Risk ofinfection
related to
disrupt skin
integrity
No woundinfection
Assess pinsite and
aseptic
dressing
technique
Send wound
swabs for
culture andsensitivity
Vital signs
Pressure
No evidenceof wound
infection
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OTHER COMMON TYPES OF
FRACTURES
COLLES FRACTURE Fracture distal radiumcommon with adults.
FRACTURE OF THE HUMERUS involves theshaft of the humerus.
FRACTURE PELVIS can be life threateningdepends on the mechanism of injury.
FRACTURE OF THE TIBIA vulnerable to injurybecause it lacks anterior muscle covering.
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AMPUTATION
NURSING MANAGEMENT:
- Assessment most important part to assess isthe vascular and neurological status.
- Nursing Diagnosis
- disturbed body image related to amputationand impaired mobility
- impaired skin integrity
- Objectives- Nursing Intervention
- Evaluation
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TYPES OF JOINT SURGERY
1. Synovectomy removal of sinovial fluids
2. Osteotomy removing or adding a wedge or
slice of bone to change alignment and shift
weighting bearing, thereby correcting deformity
and relieving pain.
3. Debridement removal of degenerative debris
such as loose bodies, osteophytes, joint debris
and degenerated menisci.
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ARTHROPLASTY
Reconstruction or replacement of a joint
Hip arthroplasty (tha)
- relief of pain
- improve function
Knee Arthroplasty (TKA)
- unremitting pain and stability as a result ofsevere destructive deterioration of the knee joint.
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Cont
Finger Joint Arthroplastry
- device used to help restore function in
fingers.
Elbow and Shoulder Arthroplastry
COMPLICATIONS
- infection- deep venous thrombosis
Cont..
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Cont..
NURSING MANAGEMENT
- Assess
- Nursing Diagnosis- Objectives
- Nursing Intervention
- Evaluation
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PATIENT TEACHING/DISCHARGE PLAN
- Assess home environment for safety reason
- Social support must also be assessed
- Rehabilitation services elderly
- Educate the patient and relatives on how to look
after the patient at home.
- Teach the patient/relative on when and howoften to take medications.
C t
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Cont
- Continue with his/her exercises
- Encourage the patient to eat nutritious/highprotein food
- To drink a lot of water.
- Teach the client some signs and symptoms ofcomplications.
- Advise him/her to report to the nearest health
centre/hospital if developing signs andsymptoms.
- Follow up clinic
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OTHER COMMON CONDITIONS
- Osteomylitis severe infection of the above.
- Multiple myeloma malignant neoplasms of
plasma cells
- Osteogenic sarcoma neoplasm of the bone
- Osteoclastoma destructive tumor that arises in
the calcellous ends of long bones in young
adults.
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NURSING CARE OF CLIENTS WITH
MS TRAUMA
SOFT TISSUE TRAUMA
Sprain.
Soft tissue trauma is treated with measures thatdecrease swelling and alleviates pain.
Severe sprains may require surgery
A splint to rest the injured area
Apply ice for the 1st 24-48hrs then apply heat
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CONT
Elevate the injured extremity to or above the
heart to increase venous return and decrease
swellingAnkle sprains-use air cast
Knee injury knee immobilizer
A sling for an upper extremity
Physiotherapy -rehabilitation
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Cont
The pain that result from soft tissue trauma is
due primarily to the injury to the muscles or
ligaments and secondarily to bleeding andedema at the injury site
Teach the client the ACRONYM RICE
R-Rest I-Ice
C-Compression
E-Evaluation/Elevation
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Cont..
Rest-allows the injured muscle or ligaments to
heal
Ice-cold causes vasoconstriction and decreasesthe pooling of blood in the injured area
Ice also numbs the tenderness
Compression-ice bandage compression dressingcan decrease the formation of edema /decrease
pain
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Cont..
Elevation/evaluation-elevating the extremity
promotes venous return, decreases edema-
decreases pain.Continuous evaluation of the effectiveness of the
procedure
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Dislocation and Subluxation
Nursing diagnosis and intervention focuses on:
Relieving pain
Correcting the dislocation
Preventing complication e.g. neurovascular
compromise
N l A t
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Neurovascular AssessmentMonitor neurovascular by assessing:
Painincreased
Pulses decreased or absent
PallorskinParalysis inability to move a body
part/extremity
Paresthesia numbness/tingling/pins/needles
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Reference List
Brown, D., and Edwards, H., (2005) Pages 1636 1708) Lewiss Medical Surgical Nursing
Assessment and Management of Clinical
Problems Elsevier Marrickville Australia
Jarvis, C., (1996) Pocket Companion for
Physical Examination and Health AssessmentWB Saunders USA.
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