Management of Musculoskeletal Disorders[1]

8/4/2019 Management of Musculoskeletal Disorders[1]

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MANAGEMENT OFMUSCULOSKELETALCONDITIONS.

Presenter: Mrs.Qolisese


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INTRODUCTIONMS also known as thelocomotors system is an organsystem that enables movement

using the muscular andskeletal system. It provides :form,support,stability&movement to the body.


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Cont..

Problems occur to most body systemsas a result of an inactive lifestyle and the

MS is affected by prolonged immobility.

Nurses need to encourage clientmovement as much as possible-early

ambulation after illness or surgery. They

therefore need to be equipped with the

knowledge and skills to carry quality

nursing care.


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OBJECTIVES

At the end of this session the student should beable to:

Assess clients with orthopaedic problems

Identify the different types of fractures.

Discuss the nursing management of fracturepatients.

Describe the pre and post operative

management of orthopedic patients.

Design nursing care plan

Prepare discharge plan for orthopedic clients.


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Lecture Content

1. ASSESSMENT OF CLIENTS WITHORTHOPAEDIC DISORDERS

1.1 Subjective data

1.2 Objective data2. TYPES OF FRACTURES

2.1 Open

2.2 Closed2.3 Incomplete

2.4 Varieties of Fractures


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MANAGEMENT OF FRACTURES3.1 Principles of treatment

3.2 Basic Treatment techniques

3.3 Operative procedure

3.4 Nursing Care Plan

3.5 Discharge Plan


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LECTURE

Definition of Fractures: Break in the continuity of the bone.

ASSESSMENT OF PATIENTS WITH

MUSCULO SKELETAL DISORDERS.

JOINTS:

Pain

Stiffness

Swelling, heat

Limitation of movement


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Cont...

MUSCLES: Pain (cramps)

Weakness

BONES:

Pain

Deformity

Trauma (fractures, sprains, dislocations)


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Cont...

Functional Assessments (ADL) Self deficit in:

- bathing

- toileting- dressing

- grooming

- eating- communicating

- mobility aids


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Cont...

SELF CARE BEHAVIOURS

Heavy lifting

Repetitive motion to joints

Nature of exercise programs

Weight gain (recent)

OBJECTIVE DATA

EQUIPMENT NEEDED- Tape Measure

- Skin Marking Pen

- Goniometer to measure joint angles


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Cont..METHODS OF ASSESSMENT

Inspection and palpation of joints Observation of Range of Movement

Age

INSPECTION

Compare corresponding paired joints

Inspect for symmetry of structure note the sizeand contour.

Inspect the skin and the color note if there isany swelling, mass or deformity.


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cont..PALPATION

Palpate each joint including its skin fortemperature.

RANGE OF MOVEMENT

Ask for active range of movement Familiarize yourself with the type of each joint

and its normal range of motion so you canrecognize limitations.

MUSCLE TESTING

Test the strength of the prime mover musclesgroups for each joint.


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cont...CERVICAL SPINE

Inspect the alignment of head and neck

Spine straight and the head erect

SHOULDER Inspect and compare both shoulders

posteriorly and interiorly.

Check the size and contour of the joint. Test ROM (Range of movement)


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cont..

ELBOW Inspect size and contour in both flexed and

extended position

Look for any deformity Test range of movement

WRIST AND HAND

Inspect the hands and wrists on the dorsal andpalmar sides noting position, contour and shape.


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TYPES OF FRACTURE

Closed fractures no communication

Incomplete fractures whole thickness of the

bone is not broken, but it is bent.

Open fractures break in the bone

communicates with a wound in the skin.


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Varieties of FracturesTransverse

Longitudinal

Oblique and spiral

Comminuted

CompressionPathological fracture


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Principles of treatment

PURPOSE

- to establish the length, shape and alignment of

the fractured bones or joints and restore

anatomic function.

C t


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Cont...

PRINCIPLES

- patients extremity/fracture site must behandled gently.

- provide initial medical treatment.

- equipment and personnel must be readilyavailable to treat impending/existing shockand also to control hemorrhage.

- maintain aseptic technique.

- positioning must allow adequate circulatoryand respiratory function with adequateexposure .

- patient must be comfortable.

C t


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Cont...

PRIMARY GOAL

1.UPPER EXTREMITY

- to preserve mobility.

- to restore range of movement (ROM).

2. LOWER EXTREMITY

- to restore alignment and length.

- to provide stability of the extremity for weightbearing.

C t


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Cont...

OPEN FRACTURES

- Involves soft tissue

- Several associated conditions may

arise such as:

- secondary hemorrhage.

- infection.

- severe damage to soft tissue.

- damage to blood vessels/nerves.

- ischaemic paralysis.

C t


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Cont...

BASIC TREATMENT TECHNIQUES

- Closed Reduction manipulating fragments into

position without incising the skin.

- Treatment of choice to decrease the opportunityfor infection.

- Improve results (including bone union of the

fracture)

on


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on ... EXTERNAL FIXATION:

- Provides rigid fixation and reduction with theability to manage severe soft tissue wounds.

INDICATIONS FOR EXTERNAL FIXATOR:

- Severe open fractures

- Highly comminuted closed fractures.

- arthrodesis

- infected joints

- infected non union

- fracture stabilization to protect arterial or nerve

on


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on ...- anastomosis

- major alignment and length deficits

- congenital contractures

COMPONENTS OF EXTERNAL

FIXATOR

- bone anchoring devices (e.g. threaded pins,

Kichner wires).

- longitudinal supporting devices e.g. threadedor smooth rods.


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INTERNAL FIXATION

- To correct long bones fractures

- Application of compression plates and

screws and insertion of pins, intramedullaryrods, nails or wiring.


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EXTERNAL FIXATORS

1. MANIPULATION 2. SKIN/SKELETALTRACTION

C t


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Cont...

3. THOMAS SPLINT BALANCED SUSPENSION


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4. CASTS


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Cont..


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Cont..

The use of POP calcined Gypsum plaster toimmobilize body parts

Procedure is carried out by the

doctors/physiotherapists POP hardens after it has been soaked and

applied

X-ray of the fracture is used to guide POPapplication


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Care of the Cast Expose to air for circulation & avoid sweating

Wet cast takes 24-48 hrs to dry completely

Review patients clinical record

Knowledge of the purpose

Elevate extremity & support entire length of

injured body part

Look out for sharp cast areas & pressure to

tissue

C t


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Cont Perform frequent neurovascular assessment

Palpate the cast for hot spots may indicate thepresence of underlying infection

Report any damage promptly

Cli t d f il t hi


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Client and family teachingDo not place any object in the cast

Keep cast dry if made of POPUse blow drier to dry cast made of fiber glass

Assess the injured extremity for:

Coolness

Changes in color

Increased in pain

Increased in swelling

Loss of sensation


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MANAGEMENT OF


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MANAGEMENT OF

PATIENTS WITH

FRACTURES

OPEN REDUCTION AND INTERNALFIXATION(ORIF)

Method of providing exposure of thefracture site and using pins, wire, screws, aplate and screw combination, rods or nails

to correct the fracture. Also used when close methods such as

skeletal traction fails to reduce the fractures.

PRE OPERATIVE PREPARATION


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PRE-OPERATIVE PREPARATION

Assess the clients nutritional status.

Ask the client if he/she had been treatedwith corticosteroidcould contribute tocurrent orthopedic condition.

Assess the clients general condition fromhead to toe

ensure that the patient is not

suffering from any acute infections.

Prepare the client for postoperative routine

deep breathing and coughing exercises.


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Cont..

- explain the procedure clearly to the client -

to allay anxiety.

- Allow the patient to practice on how to use

the bed pan/urinal.

- Explain to the patient to expect casts and

external fixiator post operatively.


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POSTOPERATIVE MANAGEMENT

- Position in bed.

- Maintain a patent airway

- Close monitoring of vital signs- Administer warm humidified oxygen (3-5 litres)

for adult.

-Pain management

- Encourage deep breathing and coughingexercises

- Keep the fractured limb in line with his/her body.


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Cont

- close monitoring of the wound drain- Keep an accurate record of the intake and output

- Patients personal hygiene.

- Encourage the patient to exercise his/her limbsto avoid complications (in bed)

- Administer medications as prescribed

- Provide high protein diet.

- Encourage the patient to drink a lot of fluids.

Care of the traction


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Care of the traction

Skeletal traction:

Never remove the weight Maintain the line of pull

Center the client on the bed

Ensure the the weight hangs freely

Not touching the floor

Ensure that nothing is lying on or obstructing the

ropes.

Knots at the end of the rope should not touch the

pulleys

on


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on Frequent skin assessment to include pin care

policy

Report signs of infection

Assess the need for analgesics

Neurovascular assessment Assess for common complications of immobility

including:

Formation of renal calculi DVTParalytic ileus-Loss of appetite

Pneumonia-client and family knowledge


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Skin traction

Frequently assess skin for evidence of pressure,

shearing or pending breakdown

Protect pressure sites with padding

Protect dressing as indicated


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COMPLICATIONS

- compartment syndrome

- Shock

- Atelectasis/pneumonia

- Osteomylitis

- Wound infections

- Deep venous thrombosis

- Fat embolism

- Thrombo embolism


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NURSING MANAGEMENT

- Assessment

- Nursing Diagnosis

- Objectives- Nursing Interventions

- Evaluation


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PATIENT EDUCATION/DISCHARGE PLAN

- Teach the client activities that minimizes developmentof complication

- Educate the client to be compliant to medication

- Encourage the client to eat a lot of healthy food- Teach the patient some signs and symptoms of

orthopaedic complications.

- Advise the patient to report to the nearest hospital

should he experience symptoms

- Continue with the exercise he was taught

- Follow up


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NURSING CARE PLAN

*Must be preparedNURSING DIAGNOSIS OBJECTIVES NURSING

INTERVENTION

EVALUATION

Risk for peripheral

neurovascular

dysfunction'se.g. compartment

syndrome

Has normal

neurovascular

examination

Assess for signs

and symptoms of

peripheralneurovascular

dysfunction such

as pain,

discoloration etc.

Elevate extremity

above heart to

reduce edema

Apply ice

compression

Patients is

free from

peripheralneurovascular

dysfunction

cont


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cont..Anxiety

Anxiety Patients will

verbalize

concerns

Explain the

procedure to

the client

Encourage

verbalizationof feelings.

Encourage

patient and

familyparticipation

Patient relax

and able to

verbalize

feelings/conc

erns.

Cont


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Cont...Pain management

Pain due toinjury

Relieve pain Position theinjured limb

in align with

body

Avoid

unnecessary

movement of

the limbAdminister

prescribed

medication

Pain relieved

C


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Cont..Infection

Risk ofinfection

related to

disrupt skin

integrity

No woundinfection

Assess pinsite and

aseptic

dressing

technique

Send wound

swabs for

culture andsensitivity

Vital signs

Pressure

No evidenceof wound

infection


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OTHER COMMON TYPES OF

FRACTURES

COLLES FRACTURE Fracture distal radiumcommon with adults.

FRACTURE OF THE HUMERUS involves theshaft of the humerus.

FRACTURE PELVIS can be life threateningdepends on the mechanism of injury.

FRACTURE OF THE TIBIA vulnerable to injurybecause it lacks anterior muscle covering.


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AMPUTATION

NURSING MANAGEMENT:

- Assessment most important part to assess isthe vascular and neurological status.

- Nursing Diagnosis

- disturbed body image related to amputationand impaired mobility

- impaired skin integrity

- Objectives- Nursing Intervention

- Evaluation


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TYPES OF JOINT SURGERY

1. Synovectomy removal of sinovial fluids

2. Osteotomy removing or adding a wedge or

slice of bone to change alignment and shift

weighting bearing, thereby correcting deformity

and relieving pain.

3. Debridement removal of degenerative debris

such as loose bodies, osteophytes, joint debris

and degenerated menisci.


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ARTHROPLASTY

Reconstruction or replacement of a joint

Hip arthroplasty (tha)

- relief of pain

- improve function

Knee Arthroplasty (TKA)

- unremitting pain and stability as a result ofsevere destructive deterioration of the knee joint.


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Cont

Finger Joint Arthroplastry

- device used to help restore function in

fingers.

Elbow and Shoulder Arthroplastry

COMPLICATIONS

- infection- deep venous thrombosis

Cont..


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Cont..

NURSING MANAGEMENT

- Assess

- Nursing Diagnosis- Objectives

- Nursing Intervention

- Evaluation


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PATIENT TEACHING/DISCHARGE PLAN

- Assess home environment for safety reason

- Social support must also be assessed

- Rehabilitation services elderly

- Educate the patient and relatives on how to look

after the patient at home.

- Teach the patient/relative on when and howoften to take medications.

C t


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Cont

- Continue with his/her exercises

- Encourage the patient to eat nutritious/highprotein food

- To drink a lot of water.

- Teach the client some signs and symptoms ofcomplications.

- Advise him/her to report to the nearest health

centre/hospital if developing signs andsymptoms.

- Follow up clinic


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OTHER COMMON CONDITIONS

- Osteomylitis severe infection of the above.

- Multiple myeloma malignant neoplasms of

plasma cells

- Osteogenic sarcoma neoplasm of the bone

- Osteoclastoma destructive tumor that arises in

the calcellous ends of long bones in young

adults.


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NURSING CARE OF CLIENTS WITH

MS TRAUMA

SOFT TISSUE TRAUMA

Sprain.

Soft tissue trauma is treated with measures thatdecrease swelling and alleviates pain.

Severe sprains may require surgery

A splint to rest the injured area

Apply ice for the 1st 24-48hrs then apply heat


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CONT

Elevate the injured extremity to or above the

heart to increase venous return and decrease

swellingAnkle sprains-use air cast

Knee injury knee immobilizer

A sling for an upper extremity

Physiotherapy -rehabilitation


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Cont

The pain that result from soft tissue trauma is

due primarily to the injury to the muscles or

ligaments and secondarily to bleeding andedema at the injury site

Teach the client the ACRONYM RICE

R-Rest I-Ice

C-Compression

E-Evaluation/Elevation


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Cont..

Rest-allows the injured muscle or ligaments to

heal

Ice-cold causes vasoconstriction and decreasesthe pooling of blood in the injured area

Ice also numbs the tenderness

Compression-ice bandage compression dressingcan decrease the formation of edema /decrease

pain


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Cont..

Elevation/evaluation-elevating the extremity

promotes venous return, decreases edema-

decreases pain.Continuous evaluation of the effectiveness of the

procedure


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Dislocation and Subluxation

Nursing diagnosis and intervention focuses on:

Relieving pain

Correcting the dislocation

Preventing complication e.g. neurovascular

compromise

N l A t


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Neurovascular AssessmentMonitor neurovascular by assessing:

Painincreased

Pulses decreased or absent

PallorskinParalysis inability to move a body

part/extremity

Paresthesia numbness/tingling/pins/needles


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Reference List

Brown, D., and Edwards, H., (2005) Pages 1636 1708) Lewiss Medical Surgical Nursing

Assessment and Management of Clinical

Problems Elsevier Marrickville Australia

Jarvis, C., (1996) Pocket Companion for

Physical Examination and Health AssessmentWB Saunders USA.


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Management of Musculoskeletal Disorders[1]

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Transcript of Management of Musculoskeletal Disorders[1]