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Transcript of musc2
Review of the Anatomy and Physiology
kyphosis
lordosis
lordosis
scoliosis
Genu varum
Genu valgum
Diagnostic Procedures1. Radiologic studies a. X-rays b. Computed tomography or CT scan Non- invasive procedure where a body part can be scanned from different angles with an x-ray beam and a computer calculates varying tissue densities and records a cross section image on paper done to determine extent of fracture in difficult to define areas
Diagnostic Proceduresc. Myelography Injection of radio opaque dye into subarachnoid space at posterior spine to determine level of disc herniation or site of tumor
Diagnostic Procedures2.
ArthrographyRadioopaque or air injected into joint cavity- outlines soft tissue structure and contour of joint
2.
Bone scanningParenteral injection of bone seeking radioactive isotope
2.
ElectromyographyGraphic presentation of the electrical potential of muscles
Diagnostic Procedures5.
Magnetic Resonance ImagingNoninvasive scanning technique that uses magnetism and radio frequency waves to produce cross-sectional images of body tissues on computer screen
5. Arthroscopy Endoscopic direct visualization of joint, especially knee
Diagnostic Procedures7.
ArthrocentesisNeedle aspiration of synovial fluid
Bone Biopsy or Muscle biopsy 8. Laboratory7.a. Uric acid b. Antinuclear antibody (ANA) for systemic Lupus Erythematosus c. Complement fixation (CF) for Rheumatoid Arthritis d. Calcium, Alkaline Phosphate, Phosphorus
arthroscopy
Musculo-Skeletal Therapeutic Modalities1. Reduction Realigning an extremity into anatomical positiona. Open- use of surgical methods b. Closed- use of non-surgical methods; manipulation
ORIF
Musculo-Skeletal Therapeutic Modalities2.
Immobilization Manual Skin- adhesive- plaster or adhesive is applied longitudinally on the lower extremities and an elastic bandage applied in an spiral motion
Musculo-Skeletal Therapeutic Modalities2. Bryants traction- indicated for children
aged 0-3 years not more than 40 lbs.1.Traction is always applied on both ends
Nursing Responsibility Nurse should be able to pass hand between the patients buttocks and mattress
Bryant traction
Knee slightly flexed
Buttocks slightly elevatated and clear of bed
Musculo-Skeletal Therapeutic ModalitiesBucks Extension Traction Indicated for older patients to those weighing over 40 lbs. Nursing Responsibility Only the affected extremity is placed on traction
Bucks Extension Traction
Musculo-Skeletal Therapeutic ModalitiesDunlop Traction Used in affectations of the upper extremities
Dunlop Traction
Nursing Care of Clients with Adhesive Traction1. Unwrap and wrap and elastic bandage at
least once a shift 2. Check skin integrity for allergic reactions to plaster 3. Note circulation, sensation and mobility of the affected extremities
Skin- non adhesive Uses canvass or cloth that is applied on the
patients skin Pelvic girdle traction
Applied like a girdle and connected to two ropes with weights that hangs at the foot part of the bed Indicated for low back pain
Head Halter Traction Applied on chin and occipital region connected to a hanger with weights that hangs at the head part of the bed Usually indicated for cervical spine affectations
Skin- non adhesive tractionCotrel Traction Combination of the head halter and pelvic traction used in scoliosis
Russell Traction Permits patient to move freely in bed and permits flexion of the knee and hip joint Bucks extension and the knee is suspended in a sling to which a rope is attached
Russell Traction
Nursing Care of Clients with nonadhesive tractionRest period are provided
Skeletal Traction Applied into a bone
Crutchfield Skeletal Traction Applied into the parietal; bonesIndicated for cervical spine affectations
Crutchfield Tong
Skeletal TractionBalanced Skeletal Traction Applied alone or with skeletal traction to promote patient mobility
Balanced Skeletal Traction
CERVICAL HALO TRACTION
BALKAN FRAME
THOMAS SPLINT WITH PEARSON ATTACHMENT
PELVIC TRACTION
PELVIC TRACTION
Principles of Care1. The patient should always be on either 2. 3. 4. 5.
supine or dorsal recumbent position There should always be an counteraction (patients weight) The line of deformity should be in line with the traction Traction should be continuous There should be no friction within the line of traction
WINDOWING A CAST
BIVALVING A CAST
FIBER GLASS CAST
b. Cast- Comparison of Cast MaterialsPlaster Synthetic Material Plastic of Paris, comprised of powdered calcium sulfate crystals impregnated into the bandages 24-48 hours Polyester and cotton, fiberglass or plastic. Polyester and cotton is impregnated with wateractivated polyurethane resin 7-15 mins of setting 15-30 mins for weight bearing
Drying time
Advantages
Less costly Less likely to indent into skin More effective for immobilizing severely Lighter in weight displaced bones Less restrictive Smooth surface Does not crumble Does not require expensive Nonabsorbent equipment for application Can be immersed in water
c. Braces Knight-taylors For thoraco-lumbar affectations Milwaukee For scoliosis
Nursing Care Use cotton clothing as barrier
d. Fixators RAEF Roger Anderson External Fixator Ilizarov device Indicated for comminuted fractures
3. Rehabilitation Active or dynamic program aimed at
enabling an ill or disabled to achieve the highest level of physical, mental, social, and economic self-sufficiency of which he is capable
Members of the Rehabilitation teama. a. a. a. a.
Patient Key member of health team Rehabilitation nurse Develops plan of patient care Physician Makes medical diagnosis; directs team Physiatrist Physician specialist in physical medicine Physical Therapist Teaches or supervises patient in prescribed exercise program
Members of the Rehabilitation teamf.
PsychologistHelps patient or family explore feelings
g. Occupational Therapist Helps develop skills for home and work situations g. Social Worker Assists patient and family adjust socio-economically g. Vocational Counselor Tests patients interest and aptitudes g. Rehabilitation Engineer Uses technology in designing or constructing devices to help the handicapped
Transfer and Assistive Devices1.
transferring a client from bed to stretcherstretcher must be perpendicular to bed
1.
transferring a client from bed to wheelchairthe wheelchair must be parallel to the head of the bed
1.
CanesHeight of cane is from floor to waist level Cane is held by opposite the affected extremity
Transfer and Assistive Devices4. Crutches Height of crutch is from floor to axilla minus 2 inches Patients weight is borne by the palm, of the hand and not on the axilla When going upstairs, unaffected leg first When going upstairs, affected leg first
Crutch-walking techniques
Two point gait (two alternate gait) Three point gait Four point gait Swinging crutch gaits Both legs are lifted off the ground simultaneously and swung forward while patient pushes up on crutches
Swing-to gait Lift and swing body up to crutches Swing-through gait Lift swing body beyond crutches
Exercisesa. Isometric Alternate contraction and relaxation of the muscle without moving the joint a. Done on the affected extremity b. Isotonic Range of motion exercises Done on the unaffected extremity
Heat or Cold Application in TraumaCold Application first 24 hours To decrease hemorrhage To relieve pain To reduce inflammation Heat Application After 24 hours To relieve pain from muscle spasms To reduce swelling by increasing circulation To promote healing by increasing oxygenation
4. Orthopedic Operative Proceduresa. Arthrotomy
Surgical opening into a joint a. Arthrodesis Fixation of a joint a. Spinal fusion Surgical removal of 1 or more vertebra and fusing them together
4. Orthopedic Operative Proceduresd. Hip replacement
Placement of prosthesis on the hip joint Indication Hip fracture Inability to move leg voluntarily Shortening and external rotation of the leg
Nursing Management on Hip ReplacementAvoid positioning on the operative site Maintain abduction of hip Pillows between legs Provide chair with firm, non-reclining seat and arms
Nursing Management on Hip ReplacementAvoid hip flexion beyond 60 degrees for 10 days Avoid hip flexion beyond 90 degrees from day 10 to 2 months Avoid adduction of the affected leg beyond midline for 2 months Partial weight bearing status for 2 months
TraumaContusion Injury to the soft tissue produced by blunt force
Sprain Injury to the ligamentous structures caused by wrenching or twisting Forcible hyperextension of a joint with tissue damage like whiplash injury
TraumaStrain Tearing of musculotendenous unit caused excessive stretching Dislocation Joint articulating surfaces are partially separated No longer in anatomical contact Fractures Break on continuity of bone
Nursing Assessment1. Pain Increasing until immobilized 1. Loss of function 2. Localized swelling or discoloration 3. Deformity 4. Crepitus Grating sound
General Classifications of Fractures1. Simple or closed Skin is intact over fracture site 1. Compound or open With an external wound in contact with the underlying fracture 1. Complete Entire cross section is displaced 1. Incomplete Portion of cross section undisplaced
General Classifications of Fractures1. Greenstick One side broken and other bent 1. Transverse Straight across the bone 1. Oblique Angle or slanting across the bone 1. Spiral Twisting or coils around shaft 1. Comminuted Splintered into several fragments
General Classifications of FracturesDepressed Fragments are drived-in; facial or skull Compression Fractured bone compressed by another bone; vertebra Impacted Fractured bones are pushed into each other (telescoped) Displaced Fragments are separated from fracture line Linear Fracture parallel with long axis
COMPARING ARTHRITIS Rheumatoid Etiology Autoimmune + Rh factor 35-45 women Osteoarthritis Degenerative senescence Men or more in women Gouty Metabolic or familial, purine metabolism Men over 40
Incidence
Signs and symptoms
Subcutaneaous nodules Heberdens nodule Morning stiffness Bouchards nodule Swan neck deformity Weight bearing joint (hips, wrist, spine) Symptomatic
Tophi
Areas affected Joints of hands Management Aspirin, NSAIDs Paraffin bath
Great toe
Colchicine Avoid purine diet Allopurinol