Unit c musculoskeletal_chpt_46 part i voice and no underline (1)

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Unit c musculoskeletal_chpt_46 part i voice and no underline (1)

  1. 1. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Chapter 46 Nursing Care Of Patients With Musculoskeletal And Connective Tissue Disorders
  2. 2. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper BONE AND SOFT TISSUE Strain DISORDERS ◆ 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
  3. 3. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Rotator cuff tear http://www.google.com/imgres? imgurl=http://www.emedx.com/emedx/diagnosis_information/diag nosis_information_image_files/shoulder_images/partial_rotator_c uff_tear-1.jpg&imgrefurl=http:// http://4.bp.blogspot.com/_zBjdOy7tPmY/SXrphxa8i0I/AAAAAAAAAl 0/Bg_G7RlMYtA/s400/shoulder-rotator-cuff.jpg
  4. 4. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  5. 5. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Carpal Tunnel Syndrome Relieve Inflammation and Rest Wrist ◆ Splint ◆ Anti-inflammatory ◆ Surgery Teach Prevention
  6. 6. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  7. 7. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Types of Fractures
  8. 8. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  9. 9. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Diagnostic Tests X-ray CT scan Hg may be obtained for patients with severe bleeding MRI may be used to assess soft tissue damage
  10. 10. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  11. 11. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Fracture Management Goals ◆ Realignment of Bone Ends ◆ Immobilization
  12. 12. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Fracture Healing PhasesSee page 994in Med/Surgbook
  13. 13. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  14. 14. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  15. 15. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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)
  16. 16. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. HopperAssessment of extremity in a cast (5 P’s) Pain Pallor Pulselessness Paresthesia PuffinessSee page1003 and 1004 for P’s related to compartment syndrome
  17. 17. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  18. 18. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Nursing care Diet should be regulated for patients in a Hip Spica cast 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 http://4.bp.blogspot.com/_NURyBgG-- referred to physical therapy for muscle RE/SO1lRUj_odI/AAAAAAAAAbQ/Y_u exercises. nEIFIouA/s1600-h/Akira-in-chair.jpg
  19. 19. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Nursing care Weight bearing usually begins with partial weight bearing. The degree of weight bearing is determined by the physician and physical therapist.
  20. 20. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Types of Skin TractionThe patientsbody providescountertraction
  21. 21. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Balanced Suspension and Skeletal TractionTractionshould be Weightcontinuous should notand weights touch thenot lifted,increased or bed anddecreased shouldunless there is hang free.a doctor’sorder to do so Check physicians orders to see how high the head of the bed can be elevated
  22. 22. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  23. 23. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper External fixation
  24. 24. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  25. 25. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper A Complication of an internal fixation is necrosis of the bone Necrosis of the bone symptoms ◆ Pain ◆ Limp while ambulating ◆ Muscle spasm
  26. 26. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  27. 27. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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.
  28. 28. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Compartment SyndromeMay also be due tocast being too tight.Patient may havesevere pain,sluggish capillaryrefilling, weakpulses andnumbness belowcast. 1.5 seconds isa normal refilling Relieved by cutting cast or fasciotomytime
  29. 29. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Bivalving CastIf windows arecut into a cast,they should betaped back inplace.Windows aremade over areasof discomfort topermit directvisualization ofthe area
  30. 30. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. HopperNursing Diagnoses for Fractures Acute Pain Impaired Physical Mobility Impaired Walking Ineffective Health Maintenance Risk for Peripheral Neurovascular Dysfunction
  31. 31. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Nursing Diagnoses Risk for Ineffective Tissue Perfusion Risk for Ineffective Skin Integrity
  32. 32. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Nursing Care for Fractures Cast Care Traction Care Pain Control Neurovascular Checks ◆ Check the extremity for color and temperature Skin Care Nutrition
  33. 33. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Palming the Cast
  34. 34. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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
  35. 35. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Patient Education Cast Care Pin Care Nutrition
  36. 36. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Complications of orthopedic surgery Shock and infection are two major complications
  37. 37. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Joint dislocation Closed reduction is usually first method attempted for dislocated joints.
  38. 38. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper 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.drfoot.c o.uk/pictures/clubf oot_braces.jpg http://www.abdn.ac.uk/~gen155/graphics/cl ubfoot.jpeg
  39. 39. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Osteomyelitis Infection of Bone acute or chronic Prevention Is Key! Fever, Redness, Heat, Pain, Swelling, Pain Long-term Antibiotic Therapy Incision and Drainage Amputation
  40. 40. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Osteomyelitis
  41. 41. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Osteomyelitis Nursing Care ◆ Medication teaching ◆ Hand Hygiene ◆ Sterile dressing changes

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