Musculoskeletal System

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Musculoskeletal System

  1. 1. Care of Clients with Problems Related to the Musculoskeletal System Irene M. Magbanua, RN Review Specialist St Paul University Manila
  2. 2. Review of the Anatomy and Physiology
  3. 3. Assessment :
  4. 4. Diagnostic Procedures <ul><li>Radiologic studies </li></ul><ul><li>X-rays </li></ul><ul><li>Computed tomography or CT scan </li></ul><ul><ul><li>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 </li></ul></ul>
  5. 5. Diagnostic Procedures <ul><li>Myelography </li></ul><ul><ul><li>Injection of radio opaque dye into subarachnoid space at posterior spine to determine level of disc herniation or site of tumor </li></ul></ul>
  6. 6. Diagnostic Procedures <ul><li>Arthrography </li></ul><ul><ul><li>Radioopaque or air injected into joint cavity- outlines soft tissue structure and contour of joint </li></ul></ul><ul><li>Bone scanning </li></ul><ul><ul><li>Parenteral injection of bone seeking radioactive isotope </li></ul></ul><ul><li>Electromyography </li></ul><ul><ul><li>Graphic presentation of the electrical potential of muscles </li></ul></ul>
  7. 7. Diagnostic Procedures <ul><li>Magnetic Resonance Imaging </li></ul><ul><ul><li>Noninvasive scanning technique that uses magnetism and radio frequency waves to produce cross-sectional images of body tissues on computer screen </li></ul></ul><ul><li>Arthroscopy </li></ul><ul><ul><li>Endoscopic direct visualization of joint, especially knee </li></ul></ul>
  8. 8. Diagnostic Procedures <ul><li>Arthrocentesis </li></ul><ul><ul><li>Needle aspiration of synovial fluid </li></ul></ul><ul><li>Bone Biopsy or Muscle biopsy </li></ul><ul><li>Laboratory </li></ul><ul><ul><li>Uric acid </li></ul></ul><ul><ul><li>Antinuclear antibody (ANA) for systemic Lupus Erythematosus </li></ul></ul><ul><ul><li>Complement fixation (CF) for Rheumatoid Arthritis </li></ul></ul><ul><ul><li>Calcium, Alkaline Phosphate, Phosphorus </li></ul></ul>
  9. 9. Musculo-Skeletal Therapeutic Modalities <ul><li>Reduction </li></ul><ul><ul><li>Realigning an extremity into anatomical position </li></ul></ul><ul><ul><li>Open- use of surgical methods </li></ul></ul><ul><ul><li>Closed- use of non-surgical methods; manipulation </li></ul></ul>
  10. 10. Musculo-Skeletal Therapeutic Modalities <ul><li>Immobilization </li></ul><ul><ul><li>Manual </li></ul></ul><ul><ul><li>Skin- adhesive- plaster or adhesive is applied longitudinally on the lower extremities and an elastic bandage applied in an spiral motion </li></ul></ul>
  11. 11. Musculo-Skeletal Therapeutic Modalities <ul><li>Bryant’s traction- indicated for children aged 0-3 year’s not more than 40 lbs. </li></ul><ul><ul><li>Traction is always applied on both ends </li></ul></ul><ul><li>Nursing Responsibility </li></ul><ul><ul><li>Nurse should be able to pass hand between the patient’s buttocks and mattress </li></ul></ul>
  12. 12. Bryant traction Buttocks slightly elevatated and clear of bed Knee slightly flexed
  13. 13. Musculo-Skeletal Therapeutic Modalities <ul><li>Buck’s Extension Traction </li></ul><ul><ul><li>Indicated for older patients to those weighing over 40 lbs. </li></ul></ul><ul><li>Nursing Responsibility </li></ul><ul><ul><li>Only the affected extremity is placed on traction </li></ul></ul>
  14. 14. Buck’s Extension Traction
  15. 15. Musculo-Skeletal Therapeutic Modalities <ul><li>Dunlop Traction </li></ul><ul><ul><li>Used in affectations of the upper extremities </li></ul></ul>
  16. 16. Dunlop Traction
  17. 17. Nursing Care of Clients with Adhesive Traction <ul><li>Unwrap and wrap and elastic bandage at least once a shift </li></ul><ul><li>Check skin integrity for allergic reactions to plaster </li></ul><ul><li>Note circulation, sensation and mobility of the affected extremities </li></ul>
  18. 18. Skin- non adhesive <ul><li>Uses canvass or cloth that is applied on the patient’s skin </li></ul><ul><li>Pelvic girdle traction </li></ul><ul><ul><li>Applied like a girdle and connected to two ropes with weights that hangs at the foot part of the bed </li></ul></ul><ul><ul><li>Indicated for low back pain </li></ul></ul><ul><li>Head Halter Traction </li></ul><ul><ul><li>Applied on chin and occipital region connected to a hanger with weights that hangs at the head part of the bed </li></ul></ul><ul><ul><li>Usually indicated for cervical spine affectations </li></ul></ul>
  19. 19. Skin- non adhesive traction <ul><li>Cotrel Traction </li></ul><ul><ul><li>Combination of the head halter and pelvic traction used in scoliosis </li></ul></ul><ul><li>Russell Traction </li></ul><ul><ul><li>Permits patient to move freely in bed and permits flexion of the knee and hip joint </li></ul></ul><ul><ul><li>Buck’s extension and the knee is suspended in a sling to which a rope is attached </li></ul></ul>
  20. 20. Russell Traction
  21. 21. Nursing Care of Clients with non-adhesive traction <ul><li>Rest period are provided </li></ul>
  22. 22. Skeletal Traction <ul><li>Applied into a bone </li></ul><ul><li>Crutchfield Skeletal Traction </li></ul><ul><ul><li>Applied into the parietal; bones </li></ul></ul><ul><ul><ul><li>Indicated for cervical spine affectations </li></ul></ul></ul>
  23. 23. Crutchfield Tong
  24. 24. Skeletal Traction <ul><li>Balanced Skeletal Traction </li></ul><ul><ul><li>Applied alone or with skeletal traction to promote patient mobility </li></ul></ul>
  25. 25. Balanced Skeletal Traction
  26. 26. Principles of Care <ul><li>The patient should always be on either supine or dorsal recumbent position </li></ul><ul><li>There should always be an counteraction (patient’s weight) </li></ul><ul><li>The line of deformity should be in line with the traction </li></ul><ul><li>Traction should be continuous </li></ul><ul><li>There should be no friction within the line of traction </li></ul>
  27. 27. b. Cast- Comparison of Cast Materials Less likely to indent into skin Lighter in weight Less restrictive Does not crumble Nonabsorbent Can be immersed in water Less costly More effective for immobilizing severely displaced bones Smooth surface Does not require expensive equipment for application Advantages 7-15 mins of setting 15-30 mins for weight bearing 24-48 hours Drying time Polyester and cotton, fiberglass or plastic. Polyester and cotton is impregnated with water- activated polyurethane resin Plastic of Paris, comprised of powdered calcium sulfate crystals impregnated into the bandages Material Synthetic Plaster
  28. 28. c. Braces <ul><li>Knight-taylors </li></ul><ul><ul><li>For thoraco-lumbar affectations </li></ul></ul><ul><li>Milwaukee </li></ul><ul><ul><li>For scoliosis </li></ul></ul><ul><li>Nursing Care </li></ul><ul><ul><li>Use cotton clothing as barrier </li></ul></ul>
  29. 29. d. Fixators <ul><li>RAEF </li></ul><ul><ul><li>Roger Anderson External Fixator </li></ul></ul><ul><li>Ilizarov device </li></ul><ul><ul><li>Indicated for comminuted fractures </li></ul></ul>
  30. 30. 3. Rehabilitation <ul><li>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 </li></ul>
  31. 31. Members of the Rehabilitation team <ul><li>Patient </li></ul><ul><ul><li>Key member of health team </li></ul></ul><ul><li>Rehabilitation nurse </li></ul><ul><ul><li>Develops plan of patient care </li></ul></ul><ul><li>Physician </li></ul><ul><ul><li>Makes medical diagnosis; directs team </li></ul></ul><ul><li>Physiatrist </li></ul><ul><ul><li>Physician specialist in physical medicine </li></ul></ul><ul><li>Physical Therapist </li></ul><ul><ul><li>Teaches or supervises patient in prescribed exercise program </li></ul></ul>
  32. 32. Members of the Rehabilitation team <ul><li>Psychologist </li></ul><ul><ul><li>Helps patient or family explore feelings </li></ul></ul><ul><li>Occupational Therapist </li></ul><ul><ul><li>Helps develop skills for home and work situations </li></ul></ul><ul><li>Social Worker </li></ul><ul><ul><li>Assists patient and family adjust socio-economically </li></ul></ul><ul><li>Vocational Counselor </li></ul><ul><ul><li>Tests patient’s interest and aptitudes </li></ul></ul><ul><li>Rehabilitation Engineer </li></ul><ul><ul><li>Uses technology in designing or constructing devices to help the handicapped </li></ul></ul>
  33. 33. Transfer and Assistive Devices <ul><li>transferring a client from bed to stretcher </li></ul><ul><ul><li>stretcher must be perpendicular to bed </li></ul></ul><ul><li>transferring a client from bed to wheelchair </li></ul><ul><ul><li>the wheelchair must be parallel to the head of the bed </li></ul></ul><ul><li>Canes </li></ul><ul><ul><li>Height of cane is from floor to waist level </li></ul></ul><ul><ul><li>Cane is held by opposite the affected extremity </li></ul></ul>
  34. 34. Transfer and Assistive Devices <ul><li>Crutches </li></ul><ul><ul><li>Height of crutch is from floor to axilla minus 2 inches </li></ul></ul><ul><ul><li>Patient’s weight is borne by the palm, of the hand and not on the axilla </li></ul></ul><ul><ul><li>When going upstairs, unaffected leg first </li></ul></ul><ul><ul><li>When going upstairs, affected leg first </li></ul></ul>
  35. 35. Crutch-walking techniques <ul><li>Two point gait (two alternate gait) </li></ul><ul><li>Three point gait </li></ul><ul><li>Four point gait </li></ul><ul><li>Swinging crutch gaits </li></ul><ul><ul><li>Both legs are lifted off the ground simultaneously and swung forward while patient pushes up on crutches </li></ul></ul><ul><li>Swing-to gait </li></ul><ul><ul><li>Lift and swing body up to crutches </li></ul></ul><ul><li>Swing-through gait </li></ul><ul><ul><li>Lift swing body beyond crutches </li></ul></ul>
  36. 36. Exercises <ul><li>Isometric </li></ul><ul><ul><li>Alternate contraction and relaxation of the muscle without moving the joint </li></ul></ul><ul><ul><li>Done on the affected extremity </li></ul></ul><ul><li>Isotonic </li></ul><ul><ul><li>Range of motion exercises </li></ul></ul><ul><ul><li>Done on the unaffected extremity </li></ul></ul>
  37. 37. Heat or Cold Application in Trauma <ul><li>Cold Application </li></ul><ul><ul><li>first 24 hours </li></ul></ul><ul><ul><li>To decrease hemorrhage </li></ul></ul><ul><ul><li>To relieve pain </li></ul></ul><ul><ul><li>To reduce inflammation </li></ul></ul><ul><li>Heat Application </li></ul><ul><ul><li>After 24 hours </li></ul></ul><ul><ul><li>To relieve pain from muscle spasms </li></ul></ul><ul><ul><li>To reduce swelling by increasing circulation </li></ul></ul><ul><ul><li>To promote healing by increasing oxygenation </li></ul></ul>
  38. 38. 4. Orthopedic Operative Procedures <ul><li>Arthrotomy </li></ul><ul><ul><li>Surgical opening into a joint </li></ul></ul><ul><li>Arthrodesis </li></ul><ul><ul><li>Fixation of a joint </li></ul></ul><ul><li>Spinal fusion </li></ul><ul><ul><li>Surgical removal of 1 or more vertebra and fusing them together </li></ul></ul>
  39. 39. 4. Orthopedic Operative Procedures <ul><li>Hip replacement </li></ul><ul><ul><li>Placement of prosthesis on the hip joint </li></ul></ul><ul><ul><li>Indication </li></ul></ul><ul><ul><ul><li>Hip fracture </li></ul></ul></ul><ul><ul><ul><li>Inability to move leg voluntarily </li></ul></ul></ul><ul><ul><ul><li>Shortening and external rotation of the leg </li></ul></ul></ul>
  40. 40. Nursing Management on Hip Replacement <ul><li>Avoid positioning on the operative site </li></ul><ul><li>Maintain abduction of hip </li></ul><ul><li>Pillows between legs </li></ul><ul><li>Provide chair with firm, non-reclining seat and arms </li></ul>
  41. 41. Nursing Management on Hip Replacement <ul><li>Avoid hip flexion beyond 60 degrees for 10 days </li></ul><ul><li>Avoid hip flexion beyond 90 degrees from day 10 to 2 months </li></ul><ul><li>Avoid adduction of the affected leg beyond midline for 2 months </li></ul><ul><li>Partial weight bearing status for 2 months </li></ul>
  42. 42. Trauma <ul><li>Contusion </li></ul><ul><ul><li>Injury to the soft tissue produced by blunt force </li></ul></ul><ul><li>Sprain </li></ul><ul><ul><li>Injury to the ligamentous structures caused by wrenching or twisting </li></ul></ul><ul><ul><li>Forcible hyperextension of a joint with tissue damage like whiplash injury </li></ul></ul>
  43. 43. Trauma <ul><li>Strain </li></ul><ul><ul><li>Tearing of musculotendenous unit caused excessive stretching </li></ul></ul><ul><li>Dislocation </li></ul><ul><ul><li>Joint articulating surfaces are partially separated </li></ul></ul><ul><ul><li>No longer in anatomical contact </li></ul></ul><ul><li>Fractures </li></ul><ul><ul><li>Break on continuity of bone </li></ul></ul>
  44. 44. Nursing Assessment <ul><li>Pain </li></ul><ul><ul><li>Increasing until immobilized </li></ul></ul><ul><li>Loss of function </li></ul><ul><li>Localized swelling or discoloration </li></ul><ul><li>Deformity </li></ul><ul><li>Crepitus </li></ul><ul><ul><li>Grating sound </li></ul></ul>
  45. 45. General Classifications of Fractures <ul><li>Simple or closed </li></ul><ul><ul><li>Skin is intact over fracture site </li></ul></ul><ul><li>Compound or open </li></ul><ul><ul><li>With an external wound in contact with the underlying fracture </li></ul></ul><ul><li>Complete </li></ul><ul><ul><li>Entire cross section is displaced </li></ul></ul><ul><li>Incomplete </li></ul><ul><ul><li>Portion of cross section undisplaced </li></ul></ul>
  46. 46. General Classifications of Fractures <ul><li>Greenstick </li></ul><ul><ul><li>One side broken and other bent </li></ul></ul><ul><li>Transverse </li></ul><ul><ul><li>Straight across the bone </li></ul></ul><ul><li>Oblique </li></ul><ul><ul><li>Angle or slanting across the bone </li></ul></ul><ul><li>Spiral </li></ul><ul><ul><li>Twisting or coils around shaft </li></ul></ul><ul><li>Comminuted </li></ul><ul><ul><li>Splintered into several fragments </li></ul></ul>
  47. 47. General Classifications of Fractures <ul><li>Depressed </li></ul><ul><ul><li>Fragments are drived-in; facial or skull </li></ul></ul><ul><li>Compression </li></ul><ul><ul><li>Fractured bone compressed by another bone; vertebra </li></ul></ul><ul><li>Impacted </li></ul><ul><ul><li>Fractured bones are pushed into each other (telescoped) </li></ul></ul><ul><li>Displaced </li></ul><ul><ul><li>Fragments are separated from fracture line </li></ul></ul><ul><li>Linear </li></ul><ul><ul><li>Fracture parallel with long axis </li></ul></ul>
  48. 48. Colchicine Avoid purine diet Allopurinol Symptomatic Aspirin, NSAIDs Paraffin bath Management Great toe Weight bearing joint (hips, wrist, spine) Joints of hands Areas affected Tophi Heberden’s nodule Bouchard’s nodule Subcutaneaous nodules Morning stiffness Swan neck deformity Signs and symptoms Men over 40 Men or more in women 35-45 women Incidence Metabolic or familial, purine metabolism Degenerative senescence Autoimmune + Rh factor Etiology Gouty Osteoarthritis Rheumatoid COMPARING ARTHRITIS

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