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    NurseReview.Org Musculoskeletal System NurseReview.Org Musculoskeletal System Presentation Transcript

    • MUSCULO-SKELETAL SYSTEM Nurse Licensure Examination Review
    • Review of Anatomy and Physiology
      • The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints
      • The primary function of which is to produce skeletal movements
    • Muscles
      • Three types of muscles exist in the body
      • 1. Skeletal Muscles
        • Voluntary and striated
      • 2. Cardiac muscles
        • Involuntary and striated
      • 3. Smooth/Visceral muscles
        • Involuntary and NON-striated
    • TENDONS
      • Bands of fibrous connective tissue that tie bones to muscles
    • LIGAMENTS
      • Strong, dense and flexible bands of fibrous tissue connecting bones to another bone
    • BONES
      • Variously classified according to shape, location and size
      • Functions
      • 1. Locomotion
      • 2. Protection
      • 3. Support and lever
      • 4. Blood production
      • 5. Mineral deposition
    • JOINTS
      • The part of the Skeleton where two or more bones are connected
    • CARTILAGES
      • A dense connective tissue that consists of fibers embedded in a strong gel-like substance
    • BURSAE
      • Sac containing fluid that are located around the joints to prevent friction
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle and joint function
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • 1. HISTORY
      • 2. Physical Examination
        • Perform a head to toe assessment
        • Nurses need to inspect and palpate
        • The special procedure is the assessment of joint and muscle movement
        • Usually, a tape measure and a protractor are the only instruments
    • ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM
      • Gait
      • Posture
      • Muscular palpation
      • Joint palpation
      • Range of motion
      • Muscle strength
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • LABORATORY PROCEDURES
      • 1. BONE MARROW ASPIRATION
        • Usually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia
        • Usual site is the sternum and iliac crest
        • Pre-test : Consent
        • Intratest : Needle puncture may be painful
        • Post-test : maintain pressure dressing and watch out for bleeding
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • LABORATORY PROCEDURES
      • 2. Arthroscopy
        • A direct visualization of the joint cavity
        • Pre-test : consent, explanation of procedure, NPO
        • Intra-test : Sedative, Anesthesia, incision will be made
        • Post-test : maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • LABORATORY PROCEDURES
      • 3. BONE SCAN
      • Imaging study with the use of a contrast radioactive material
      • Pre-test : Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated
      • Intra-test : IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning
      • Post-test : Increase fluid intake to flush out radioactive material
    • ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM
      • LABORATORY PROCEDURES
      • 4. DXA- Dual-energy XRAY absorptiometry
      • Assesses bone density to diagnose osteoporosis
      • Uses LOW dose radiation to measure bone density
      • Painless procedure, non-invasive, no special preparation
      • Advise to remove jewelry
    •  
    • Common musculoskeletal problems The Nursing Management
    • Nursing Management of common musculo-skeletal problems
      • PAIN
      • These can be related to joint inflammation, traction, surgical intervention
      • 1. Assess patient’s perception of pain
      • 2. Instruct patient alternative pain management like meditation, heat and cold application, TENS and guided imagery
    • Nursing Management
      • PAIN
      • 3. Administer analgesics as prescribed
        • Usually NSAIDS
        • Meperidine can be given for severe pain
      • 4. Assess the effectiveness of pain measures
    • Nursing Management
      • IMPAIRED PHYSICAL MOBILITY
      • 1. Instruct patient to perform range of motion exercises, either passive or active
      • 2. Provide support in ambulation with assistive devices
      • 3. Turn and change position every 2 hours
      • 4. Encourage mobility for a short period and provide positive reinforcements for small accomplishments
    • Nursing Management
      • SELF-CARE DEFICITS
      • 1. Assess functional levels of the patient
      • 2. Provide support for feeding problems
        • Place patient in Fowler’s position
        • Provide assistive device and supervise mealtime
        • Offer finger foods that can be handled by patient
        • Keep suction equipment ready
    • Nursing Management
      • SELF-CARE DEFICITS
      • 3. Assist patient with difficulty bathing and hygiene
        • Assist with bath only when patient has difficulty
        • Provide ample time for patient to finish activity
    • Musculoskeletal Modalities
      • Traction
      • Cast
    • Nursing Management
      • Traction
      • A method of fracture immobilization by applying equipments to align bone fragments
      • Used for immobilization, bone alignment and relief of muscle spasm
    • Traction
      • Skin traction
      • Skeletal traction
    • Traction
      • Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities
    •  
    •  
    • Nursing Management
      • Traction: General principles
      • 1. ALWAYS ensure that the weights hang freely and do not touch the floor
      • 2. NEVER remove the weights
      • 3. Maintain proper body alignment
      • 4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot
    • Nursing Management
      • Traction: General principles
      • 5. Observe and prevent foot drop
        • Provide foot plate
      • 6. Observe for DVT, skin irritation and breakdown
      • 7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide
    • Nursing Management
      • CAST
      • Immobilizing tool made of plaster of Paris or fiberglass
      • Provides immobilization of the fracture
    • Nursing Management
      • CAST: types
      • Long arm
      • Short arm
      • Spica
    • Casting Materials
      • Plaster of Paris
        • Drying takes 1-3 days
        • If dry, it is SHINY, WHITE, hard and resistant
      • Fiberglass
        • Lightweight and dries in 20-30 minutes
        • Water resistant
    • Nursing Management
      • CAST: General Nursing Care
      • 1. Allow the cast to dry (usually 24-72 hours)
      • 2. Handle a wet cast with the PALMS not the fingertips
      • 3. Keep the casted extremity ELEVATED using a pillow
      • 4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast
    • Nursing Management
      • CAST: General Nursing Care
      • 5. Petal the edges of the cast to prevent crumbling of the edges
      • 6. Examine the skin for pressure areas and Regularly check the pulses and skin
    • Nursing Management
      • CAST: General Nursing Care
      • 7. Instruct the patient not to place sticks or small objects inside the cast
      • 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses
    • Common Musculoskeletal conditions Nursing management
    • METABOLIC BONE DISORDERS
      • Osteoporosis
      • A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure
    • METABOLIC BONE DISORDERS
      • Osteoporosis: Pathophysiology
      • Normal homeostatic bone turnover is altered  rate of bone RESORPTION is greater than bone FORMATION  reduction in total bone mass  reduction in bone mineral density  prone to FRACTURE
    • METABOLIC BONE DISORDERS
      • Osteoporosis: TYPES
      • 1. Primary Osteoporosis- advanced age, post-menopausal
      • 2. Secondary osteoporosis- Steroid overuse, Renal failure
    • METABOLIC BONE DISORDERS
      • RISK factors for the development of Osteoporosis
      • 1. Sedentary lifestyle
      • 2. Age
      • 3. Diet- caffeine, alcohol, low Ca and Vit D
      • 4. Post-menopausal
      • 5. Genetics- caucasian and asian
      • 6. Immobility
    • METABOLIC DISORDER
      • ASSESSMENT FINDINGS
      • 1. Low stature
      • 2. Fracture
        • Femur
      • 3. Bone pain
    • METABOLIC DISORDER
      • LABORATORY FINDINGS
      • 1. DEXA-scan
        • Provides information about bone mineral density
        • T-score is at least 2.5 SD below the young adult mean value
      • 2. X-ray studies
    • METABOLIC DISORDER
      • Medical management of Osteoporosis
      • 1. Diet therapy with calcium and Vitamin D
      • 2. Hormone replacement therapy
      • 3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST
      • 4. Moderate weight bearing exercises
      • 5. Management of fractures
    • METABOLIC DISORDER
      • Osteoporosis Nursing Interventions
      • 1. Promote understanding of osteoporosis and the treatment regimen
      • Provide adequate dietary supplement of calcium and vitamin D
      • Instruct to employ a regular program of moderate exercises and physical activity
      • Manage the constipating side-effect of calcium supplements
    • METABOLIC DISORDER
      • Osteoporosis Nursing Interventions
      • Take calcium supplements with meals
      • Take alendronate with an EMPTY stomach with water
      • Instruct on intake of Hormonal replacement
    • METABOLIC DISORDER
      • Osteoporosis Nursing Interventions
      • 2. Relieve the pain
      • Instruct the patient to rest on a firm mattress
      • Suggest that knee flexion will cause relaxation of back muscles
      • Heat application may provide comfort
      • Encourage good posture and body mechanics
      • Instruct to avoid twisting and heavy lifting
    • METABOLIC DISORDER
      • Osteoporosis Nursing Interventions
      • 3. Improve bowel elimination
      • Constipation is a problem of calcium supplements and immobility
      • Advise intake of HIGH fiber diet and increased fluids
    • METABOLIC DISORDER
      • Osteoporosis Nursing Interventions
      • 4. Prevent injury
      • Instruct to use isometric exercise to strengthen the trunk muscles
      • AVOID sudden jarring, bending and strenuous lifting
      • Provide a safe environment
    • Juvenile rheumatoid Arthritis
      • Definition:
        • AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause
        • SYSTEMIC chronic disorder of connective tissue
        • Diagnosed BEFORE age 16 years old
    • Juvenile rheumatoid Arthritis
      • PATHOPHYSIOLOGY : unknown
      • Affected by stress, climate and genetics
      • Common in girls 2-5 and 9-12 y.o.
    • Juvenile rheumatoid Arthritis Poor prognosis Very Good prognosis Anorexia, anemia, fatigue Five or more joints Less than 4 joints Five or more joints Weight Bearing joints IRIDOCYCLITIS Salmon-pink rash Morning joint stiffness and fever MILD joint pain and swelling FEVER Polyarticular Pauci-articular Systemic JRA
    • JRA
      • Symptoms may decrease as child enters adulthood
      • With periods of remissions and exacerbations
    • JRA
      • Medical Management
      • ASPIRIN and NSAIDs- mainstay treatment
      • Slow-acting anti-rheumatic drugs
      • Corticosteroids
    • JRA
      • Nursing Management
      • Encourage normal performance of daily activities
      • Assist child in ROM exercises
      • Administer medications
      • Encourage social and emotional development
    • JRA
      • Nursing Management
      • During acute attack:
      • SPLINT the joints
      • NEUTRAL positioning
      • Warm or cold packs
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS
      • The most common form of degenerative joint disorder
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS
      • Chronic, NON-systemic disorder of joints
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Pathophysiology
      • Injury, genetic, Previous joint damage, Obesity , Advanced age  Stimulate the chondrocytes to release chemicals  chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Risk factors
      • 1. Increased age
      • 2. Obesity
      • 3. Repetitive use of joints with previous joint damage
      • 4. Anatomical deformity
      • 5. genetic susceptibility
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Assessment findings
      • 1. Joint pain
      • 2. Joint stiffness
      • 3. Functional joint impairment limitation
      • The joint involvement is ASYMMETRICAL
      • This is not systemic, there is no FEVER, no severe swelling
      • Atrophy of unused muscles
      • Usual joint are the WEIGHT bearing joints
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Assessment findings
      • 1. Joint pain
      • Caused by
        • Inflamed synovium
        • Stretching of the joint capsule
        • Irritation of nerve endings
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Assessment findings
      • 2. Stiffness
      • commonly occurs in the morning after awakening
      • Lasts only for less than 30 minutes
      • DECREASES with movement
      • Crepitation may be elicited
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Diagnostic findings
      • 1. X-ray
      • Narrowing of joint space
      • Loss of cartilage
      • Osteophytes
      • 2. Blood tests will show no evidence of systemic inflammation and are not useful
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Medical management
      • 1. Weight reduction
      • 2. Use of splinting devices to support joints
      • 3. Occupational and physical therapy
      • 4. Pharmacologic management
        • Use of PARACETAMOL, NSAIDS
        • Use of Glucosamine and chondroitin
        • Topical analgesics
        • Intra-articular steroids to decrease inflam
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Nursing Interventions
      • 1. Provide relief of PAIN
        • Administer prescribed analgesics
        • Application of heat modalities. ICE PACKS may be used in the early acute stage!!!
        • Plan daily activities when pain is less severe
        • Pain meds before exercising
    • DEGENERATIVE JOINT DISEASE
      • OSTEOARTHRITIS: Nursing Interventions
      • 2. Advise patient to reduce weight
        • Aerobic exercise
        • Walking
      • 3. Administer prescribed medications
        • NSAIDS
    • Rheumatoid arthritis
      • A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more women (ages 35-45) than men
    • Rheumatoid arthritis
      • FACTORS:
      • Genetic
      • Auto-immune connective tissue disorders
      • Fatigue, emotional stress, cold, infection
    • Rheumatoid arthritis
      • Pathophysiology
      • Immune reaction in the synovium  attracts neutrophils  releases enzymes  breakdown of collagen  irritates the synovial lining  causing synovial inflammation edema and pannus formation and joint erosions and swelling
    • Rheumatoid arthritis
      • ASSESSMENT FINDINGS
      • 1. PAIN
      • 2. Joint swelling and stiffness- SYMMETRICAL, Bilateral
      • 3. Warmth, erythema and lack of function
      • 4. Fever , weight loss, anemia , fatigue
      • 5. Palpation of join reveals spongy tissue
      • 6. Hesitancy in joint movement
    • Rheumatoid arthritis
      • ASSESSMENT FINDINGS
      • Joint involvement is SYMMETRICAL and BILATERAL
      • Characteristically beginning in the hands, wrist and feet
      • Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement, diminishes as the day progresses
    • Rheumatoid arthritis
      • ASSESSMENT FINDINGS
      • Joints are swollen and warm
      • Painful when moved
      • Deformities are common in the hands and feet causing misalignment
      • Rheumatoid nodules may be found in the subcutaneous tissues
    • Rheumatoid arthritis
      • Diagnostic test
      • 1. X-ray
        • Shows bony erosion
      • 2. Blood studies reveal (+) rheumatoid factor, elevated ESR and CRP and ANTI-nuclear antibody
      • 3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory proteins
    • Rheumatoid arthritis
      • MEDICAL MANAGEMENT
      • 1. Therapeutic dose of NSAIDS and Aspirin to reduce inflammation
      • 2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid
      • 3. For advanced cases- arthroplasty, synovectomy
      • 4. Nutritional therapy
    • Rheumatoid arthritis
      • MEDICAL MANAGEMENT
      • GOLD THERAPY:
      • IM or Oral preparation
      • Takes several months (3-6) before effects can be seen
      • Can damage the kidney and causes bone marrow depression
    • Rheumatoid arthritis
      • Nursing MANAGEMENT
      • 1. Relieve pain and discomfort
      • USE splints to immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE DEFORMITY
      • Administer prescribed medications
      • Suggest application of COLD packs during the acute phase of pain, then HEAT application as the inflammation subsides
    • Rheumatoid arthritis
      • Nursing MANAGEMENT
      • 2. Decrease patient fatigue
      • Schedule activity when pain is less severe
      • Provide adequate periods of rests
      • 3. Promote restorative sleep
    • Rheumatoid arthritis
      • Nursing Management
      • 4. Increase patient mobility
      • Advise proper posture and body mechanics
      • Support joint in functional position
      • Advise ACTIVE ROME
    • Rheumatoid arthritis
      • Nursing Management
      • 5. Provide Diet therapy
      • Patients experience anorexia, nausea and weight loss
      • Regular diet with caloric restrictions because steroids may increase appetite
      • Supplements of vitamins, iron and PROTEIN
    • Rheumatoid arthritis
      • 6. Increase Mobility and prevent deformity:
      • Lie FLAT on a firm mattress
      • Lie PRONE several times to prevent HIP FLEXION contracture
      • Use one pillow under the head because of risk of dorsal kyphosis
      • NO Pillow under the joints because this promotes flexion contractures
    • Hot versus Cold ACUTE ATTACK After acute attack Use to control inflammation and pain Use to RELIEVE joint stiffness, pain and muscle spasm Cold HOT
    • Gouty arthritis
      • A systemic disease caused by deposition of uric acid crystals in the joint and body tissues
      • CAUSES:
      • 1. Primary gout- disorder of Purine metabolism
      • 2. Secondary gout- excessive uric acid in the blood like leukemia
    •  
    •  
    • Gouty arthritis
      • ASSESSMENT FINDINGS
      • 1. Severe pain in the involved joints, initially the big toe
      • 2. Swelling and inflammation of the joint
      • 3. TOPHI- yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty appearance
      • 4. PODAGRA
    • Gouty arthritis
      • ASSESSMENT FINDINGS
      • 5. Fever, malaise
      • 6. Body weakness and headache
      • 7. Renal stones
    • Gouty arthritis
      • DIAGNOSTIC TEST
      • Elevated levels of uric acid in the blood
      • Uric acid stones in the kidney
    • Gouty arthritis
      • Medical management
      • 1. Allupurinol- take it WITH FOOD
              • Rash signifies allergic reaction
      • 2. Colchicine
          • For acute attack
    • Gouty arthritis
      • Nursing Intervention
      • 1. Provide a diet with LOW purine
      • Avoid Organ meats, aged and processed foods
      • STRICT dietary restriction is NOT necessary
      • 2. Encourage an increased fluid intake (2-3L/day) to prevent stone formation
      • 3. Instruct the patient to avoid alcohol
      • 4. Provide alkaline ash diet to increase urinary pH
      • 5. Provide bed rest during early attack of gout
    • Gouty arthritis
      • Nursing Intervention
      • 6. Position the affected extremity in mild flexion
      • 7. Administer anti-gout medication and analgesics
    • Fracture
      • A break in the continuity of the bone and is defined according to its type and extent
    • Fracture
      • Severe mechanical Stress to bone  bone fracture
      • Direct Blows
      • Crushing forces
      • Sudden twisting motion
      • Extreme muscle contraction
    • Fracture
      • TYPES OF FRACTURE
      • 1. Complete fracture
        • Involves a break across the entire cross-section
      • 2. Incomplete fracture
        • The break occurs through only a part of the cross-section
    •  
    • Fracture
      • TYPES OF FRACTURE
      • 1. Closed fracture
        • The fracture that does not cause a break in the skin
      • 2. Open fracture
        • The fracture that involves a break in the skin
    •  
    • Fracture
      • TYPES OF FRACTURE
      • 1. Comminuted fracture
        • A fracture that involves production of several bone fragments
      • 2. Simple fracture
        • A fracture that involves break of bone into two parts or one
    • Fracture
      • ASSESSMENT FINDINGS
      • 1. Pain or tenderness over the involved area
      • 2. Loss of function
      • 3. Deformity
      • 4. Shortening
      • 5. Crepitus
      • 6. Swelling and discoloration
    • Fracture
      • ASSESSMENT FINDINGS
      • 1. Pain
      • Continuous and increases in severity
      • Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone
    • Fracture
      • ASSESSMENT FINDINGS
      • 2. Loss of function
      • Abnormal movement and pain can result to this manifestation
    • Fracture
      • ASSESSMENT FINDINGS
      • 3. Deformity
      • Displacement, angulations or rotation of the fragments Causes deformity
    • Fracture
      • ASSESSMENT FINDINGS
      • 4. Crepitus
      • A grating sensation produced when the bone fragments rub each other
    • Fracture
      • DIAGNOSTIC TEST
      • X-ray
    • Fracture
      • EMERGENCY MANAGEMENT OF FRACTURE
      • 1. Immobilize any suspected fracture
      • 2. Support the extremity above and below when moving the affected part from a vehicle
      • 3. Suggested temporary splints- hard board, stick, rolled sheets
      • 4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest
    • Fracture
      • EMERGENCY MANAGEMENT OF FRACTURE
      • 5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination
      • 6. DO NOT attempt to reduce the facture
    • Fracture
      • MEDICAL MANAGEMENT
      • 1. Reduction of fracture either open or closed, Immobilization and Restoration of function
      • 2. Antibiotics, Muscle relaxants and Pain medications
    • Fracture
      • General Nursing MANAGEMENT
      • For CLOSED FRACTURE
      • 1. Assist in reduction and immobilization
      • 2. Administer pain medication and muscle relaxants
      • 3. teach patient to care for the cast
      • 4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain
    • Fracture
      • General Nursing MANAGEMENT
      • For OPEN FRACTURE
      • 1. Prevent wound and bone infection
      • Administer prescribed antibiotics
      • Administer tetanus prophylaxis
      • Assist in serial wound debridement
      • 2. Elevate the extremity to prevent edema formation
      • 3. Administer care of traction and cast
    • Fracture
      • FRACTURE COMPLICATIONS
      • Early
      • 1. Shock
      • 2. Fat embolism
      • 3. Compartment syndrome
      • 4. Infection
      • 5. DVT
    • Fracture
      • FRACTURE COMPLICATIONS
      • Late
      • 1. Delayed union
      • 2. Avascular necrosis
      • 3. Delayed reaction to fixation devices
      • 4. Complex regional syndrome
    • Fracture
      • FRACTURE COMPLICATIONS: Fat Embolism
      • Occurs usually in fractures of the long bones
      • Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure
      • Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs
    • Fracture
      • FRACTURE COMPLICATIONS: Fat Embolism
      • Onset is rapid, within 24-72 hours
      • ASSESSMENT FINDINGS
      • 1. Sudden dyspnea and respiratory distress
      • 2. tachycardia
      • 3. Chest pain
      • 4. Crackles, wheezes and cough
      • 5. Petechial rashes over the chest, axilla and hard palate
    • Fracture
      • FRACTURE COMPLICATIONS: Fat Embolism
      • Nursing Management
      • 1. Support the respiratory function
      • Respiratory failure is the most common cause of death
      • Administer O2 in high concentration
      • Prepare for possible intubation and ventilator support
    • Fracture
      • FRACTURE COMPLICATIONS: Fat Embolism
      • Nursing Management
      • 2. Administer drugs
      • Corticosteroids
      • Dopamine
      • Morphine
    • Fracture
      • FRACTURE COMPLICATIONS: Fat Embolism
      • Nursing Management
      • 3. Institute preventive measures
      • Immediate immobilization of fracture
      • Minimal fracture manipulation
      • Adequate support for fractured bone during turning and positioning
      • Maintain adequate hydration and electrolyte balance
    • Fracture
      • Early complication: Compartment syndrome
      • A complication that develops when tissue perfusion in the muscles is less than required for tissue viability
    • Fracture
      • Early complication: Compartment syndrome
      • ASSESSMENT FINDINGS
      • 1. Pain- Deep, throbbing and UNRELIEVED pain by opiods
      • Pain is due to reduction in the size of the muscle compartment by tight cast
      • Pain is due to increased mass in the compartment by edema, swelling or hemorrhage
    • Fracture
      • Early complication: Compartment syndrome
      • ASSESSMENT FINDINGS
      • 2. Paresthesia- burning or tingling sensation
      • 3. Numbness
      • 4. Motor weakness
      • 5. Pulselessness, impaired capillary refill time and cyanotic skin
    • Fracture
      • Early complication: Compartment syndrome
      • Medical and Nursing management
      • 1. Assess frequently the neurovascular status of the casted extremity
      • 2. Elevate the extremity above the level of the heart
      • 3. Assist in cast removal and FASCIOTOMY
    • Strains
      • Excessive stretching of a muscle or tendon
      • Nursing management
      • 1. Immobilize affected part
      • 2. Apply cold packs initially, then heat packs
      • 3. Limit joint activity
      • 4. Administer NSAIDs and muscle relaxants
    • Sprains
      • Excessive stretching of the LIGAMENTS
      • Nursing management
      • 1. Immobilize extremity and advise rest
      • 2. Apply cold packs initially then heat packs
      • 3. Compression bandage may be applied to relieve edema
      • 4. Assist in cast application
      • 5. Administer NSAIDS
    • End of Musculoskeletal