The document discusses diagnostic procedures, therapeutic modalities, and surgical procedures for musculoskeletal problems including fractures, arthritis, and joint replacements. It covers imaging tests, traction methods, casting materials, braces, exercises, and postoperative nursing care considerations. Rehabilitation approaches are also outlined along with assistive devices, classifications of injuries, and guidelines for managing common conditions like gout and osteoarthritis.

1. Care of Clients with Problems Related to the Musculoskeletal System Irene M. Magbanua, RN Review Specialist St Paul University Manila

2. Review of the Anatomy and Physiology

3. Assessment :

4. Diagnostic Procedures Radiologic studies X-rays 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

5. Diagnostic Procedures Myelography Injection of radio opaque dye into subarachnoid space at posterior spine to determine level of disc herniation or site of tumor

6. Diagnostic Procedures Arthrography Radioopaque or air injected into joint cavity- outlines soft tissue structure and contour of joint Bone scanning Parenteral injection of bone seeking radioactive isotope Electromyography Graphic presentation of the electrical potential of muscles

7. Diagnostic Procedures Magnetic Resonance Imaging Noninvasive scanning technique that uses magnetism and radio frequency waves to produce cross-sectional images of body tissues on computer screen Arthroscopy Endoscopic direct visualization of joint, especially knee

8. Diagnostic Procedures Arthrocentesis Needle aspiration of synovial fluid Bone Biopsy or Muscle biopsy Laboratory Uric acid Antinuclear antibody (ANA) for systemic Lupus Erythematosus Complement fixation (CF) for Rheumatoid Arthritis Calcium, Alkaline Phosphate, Phosphorus

9. Musculo-Skeletal Therapeutic Modalities Reduction Realigning an extremity into anatomical position Open- use of surgical methods Closed- use of non-surgical methods; manipulation

10. Musculo-Skeletal Therapeutic Modalities Immobilization Manual Skin- adhesive- plaster or adhesive is applied longitudinally on the lower extremities and an elastic bandage applied in an spiral motion

11. Musculo-Skeletal Therapeutic Modalities Bryant’s traction- indicated for children aged 0-3 year’s not more than 40 lbs. Traction is always applied on both ends Nursing Responsibility Nurse should be able to pass hand between the patient’s buttocks and mattress

12. Bryant traction Buttocks slightly elevatated and clear of bed Knee slightly flexed

13. Musculo-Skeletal Therapeutic Modalities Buck’s Extension Traction Indicated for older patients to those weighing over 40 lbs. Nursing Responsibility Only the affected extremity is placed on traction

14. Buck’s Extension Traction

15. Musculo-Skeletal Therapeutic Modalities Dunlop Traction Used in affectations of the upper extremities

16. Dunlop Traction

17. Nursing Care of Clients with Adhesive Traction Unwrap and wrap and elastic bandage at least once a shift Check skin integrity for allergic reactions to plaster Note circulation, sensation and mobility of the affected extremities

18. Skin- non adhesive Uses canvass or cloth that is applied on the patient’s 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

19. Skin- non adhesive traction Cotrel 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 Buck’s extension and the knee is suspended in a sling to which a rope is attached

20. Russell Traction

21. Nursing Care of Clients with non-adhesive traction Rest period are provided

22. Skeletal Traction Applied into a bone Crutchfield Skeletal Traction Applied into the parietal; bones Indicated for cervical spine affectations

23. Crutchfield Tong

24. Skeletal Traction Balanced Skeletal Traction Applied alone or with skeletal traction to promote patient mobility

25. Balanced Skeletal Traction

26. Principles of Care The patient should always be on either supine or dorsal recumbent position There should always be an counteraction (patient’s 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

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. c. Braces Knight-taylors For thoraco-lumbar affectations Milwaukee For scoliosis Nursing Care Use cotton clothing as barrier

29. d. Fixators RAEF Roger Anderson External Fixator Ilizarov device Indicated for comminuted fractures

30. 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

31. Members of the Rehabilitation team 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

32. Members of the Rehabilitation team Psychologist Helps patient or family explore feelings Occupational Therapist Helps develop skills for home and work situations Social Worker Assists patient and family adjust socio-economically Vocational Counselor Tests patient’s interest and aptitudes Rehabilitation Engineer Uses technology in designing or constructing devices to help the handicapped

33. Transfer and Assistive Devices transferring a client from bed to stretcher stretcher must be perpendicular to bed transferring a client from bed to wheelchair the wheelchair must be parallel to the head of the bed Canes Height of cane is from floor to waist level Cane is held by opposite the affected extremity

34. Transfer and Assistive Devices Crutches Height of crutch is from floor to axilla minus 2 inches Patient’s 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

35. 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

36. Exercises Isometric Alternate contraction and relaxation of the muscle without moving the joint Done on the affected extremity Isotonic Range of motion exercises Done on the unaffected extremity

37. Heat or Cold Application in Trauma Cold 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

38. 4. Orthopedic Operative Procedures Arthrotomy Surgical opening into a joint Arthrodesis Fixation of a joint Spinal fusion Surgical removal of 1 or more vertebra and fusing them together

39. 4. Orthopedic Operative Procedures Hip replacement Placement of prosthesis on the hip joint Indication Hip fracture Inability to move leg voluntarily Shortening and external rotation of the leg

40. Nursing Management on Hip Replacement Avoid positioning on the operative site Maintain abduction of hip Pillows between legs Provide chair with firm, non-reclining seat and arms

41. Nursing Management on Hip Replacement Avoid 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

42. Trauma Contusion 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

43. Trauma Strain 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

44. Nursing Assessment Pain Increasing until immobilized Loss of function Localized swelling or discoloration Deformity Crepitus Grating sound

45. General Classifications of Fractures Simple or closed Skin is intact over fracture site Compound or open With an external wound in contact with the underlying fracture Complete Entire cross section is displaced Incomplete Portion of cross section undisplaced

46. General Classifications of Fractures Greenstick One side broken and other bent Transverse Straight across the bone Oblique Angle or slanting across the bone Spiral Twisting or coils around shaft Comminuted Splintered into several fragments

47. General Classifications of Fractures Depressed 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

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