Presentation (Muskuloskeletal System)

8/3/2019 Presentation (Muskuloskeletal System)

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Care of Clients with ProblemsCare of Clients with Problems

Related to the MusculoskeletalRelated to the Musculoskeletal

SystemSystem

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Diagnostic ProceduresDiagnostic Procedures

1.1. Radiologic studiesRadiologic studies

b.b. X-raysX-rays

c.c. Computed tomographyComputed tomography or CT scanor CT scan – Non- invasive procedure where a body partNon- invasive procedure where a body part

can be acanned from different angles withcan be acanned from different angles withan x-raybeam and a computer calculatesan x-raybeam and a computer calculatesvarrying tissue densities and records avarrying tissue densities and records across section image on paper done tocross section image on paper done todetermine extent of fracture in difficult todetermine extent of fracture in difficult todefine areasdefine areas

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c.c. MyelographyMyelography

• Injection of radioopaque dye intoInjection of radioopaque dye into

subarachnoid space at posterior spine tosubarachnoid space at posterior spine to

determine level of disc herniation or site of determine level of disc herniation or site of tumor tumor

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2.2. ArthrographyArthrography

• Radioopaque or air injected into joint cavity- outinesRadioopaque or air injected into joint cavity- outines

soft tissue structure and contour of jointsoft tissue structure and contour of joint

2.2. Bone scanningBone scanning• Parenteral injection of bone seeking radioactiveParenteral injection of bone seeking radioactive

isotopeisotope

2.2. ElectromyographyElectromyography

• Graphic presentation of the electrical potential of Graphic presentation of the electrical potential of

musclesmuscles

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5.5. Magnetic Resonance ImagingMagnetic Resonance Imaging

• Noninvasive scanning technique that usesNoninvasive scanning technique that uses

magnetism and radiofrequency waves tomagnetism and radiofrequency waves to

produce cross-sectional images of bodyproduce cross-sectional images of bodytissues on computer screentissues on computer screen

5.5. ArthroscopyArthroscopy

• Endoscopic direct visualization of joint,Endoscopic direct visualization of joint,especially kneeespecially knee

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7.7. ArthrocentesisArthrocentesis

• Needle aspiration of synovial fluidNeedle aspiration of synovial fluid

7.7. Bone Biopsy or Muscle biopsyBone Biopsy or Muscle biopsy

8.8. LaboratoryLaboratory

a.a. Uric acidUric acid

b.b. Antinuclear antibody (ANA) for systemic LupusAntinuclear antibody (ANA) for systemic Lupus

ErythematosusErythematosus

c.c. Complement fixation (CF) for Rheumatoid ArthritisComplement fixation (CF) for Rheumatoid Arthritis

d.d. Calcium, Alkaline Phosphate, PhosphorusCalcium, Alkaline Phosphate, Phosphorus

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Musculo-Skeletal TherapeuticMusculo-Skeletal Therapeutic

ModalitiesModalities

1.1. ReductionReduction

• Realigning an extremity into anatomicalRealigning an extremity into anatomical

positionposition

a.a. Open- use of surgical methodsOpen- use of surgical methods

b.b. Closed- use of non-surgical methods;Closed- use of non-surgical methods;

manipulationmanipulation

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2.2. ImmobilizationImmobilization

ManualManual

Skin- adhesive- plaster or adhesive isSkin- adhesive- plaster or adhesive is

applied longitudinally on the lower applied longitudinally on the lower

extremeties and an elastic bamndageextremeties and an elastic bamndage

applied in an spiral motionapplied in an spiral motion

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2.2. Bryant’s traction- indicated for children agedBryant’s traction- indicated for children aged

0-3 year’s not more than 40 lbs.0-3 year’s not more than 40 lbs.

1.1.Traction is always applied on both endsTraction is always applied on both ends

Nursing Responsibility Nursing Responsibility

– Nurse should be able to pass hand between theNurse should be able to pass hand between the

patient’s buttocks and mattresspatient’s buttocks and mattress

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Bryant tractionBryant traction

Buttocks sightly

elevetated and

clear of bed

Knee slightly flexed

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Buck’s Extension TractionBuck’s Extension Traction

Indicated for older patients and to thoseIndicated for older patients and to those

weighing over 40 lbs.weighing over 40 lbs.

Nursing Responsibility Nursing Responsibility

Only the affected extremity is placedOnly the affected extremity is placedon tractionon traction

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Buck’s Extension TractionBuck’s Extension Traction

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Dunlop TractionDunlop Traction

Used in affectations of the upper Used in affectations of the upper

extremitiesextremities

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Dunlop TractionDunlop Traction

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Nursing Care of Clients withNursing Care of Clients with

Adhesive Traction Adhesive Traction

1.1. Unwrap and wrap and elastic bandage atUnwrap and wrap and elastic bandage at

least once a shiftleast once a shift

2.2. Check skin integrity for allergic reactionsCheck skin integrity for allergic reactions

to plaster to plaster

3.3. Note circulation, sensation and mobilityNote circulation, sensation and mobility

of the affected extremitiesof the affected extremities

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Skin- non adhesiveSkin- non adhesive

Uses canvass or cloth that is applied on theUses canvass or cloth that is applied on thepatient’s skinpatient’s skin

Pelvic girdle tractionPelvic girdle traction

• Applied like a girdle and connected to two ropes withApplied like a girdle and connected to two ropes withweights that hang at the foot part of the bedweights that hang at the foot part of the bed

• Indicated for low back painIndicated for low back pain

Head Halter TractionHead Halter Traction

• Applied on chin and occipital region connected to aApplied on chin and occipital region connected to ahanger with weights that hangs at the head part of thehanger with weights that hangs at the head part of thebedbed

• Usually indicated for cervical spine affectationsUsually indicated for cervical spine affectations

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Skin- non adhesive tractionSkin- non adhesive traction

Cotrel TractionCotrel Traction

• Combination of the head halter and pelvicCombination of the head halter and pelvic

traction used in scoliosistraction used in scoliosis

Russell TractionRussell Traction

• Permits patient to move freely in bed andPermits patient to move freely in bed and

permits flexion of the knee and hip jointpermits flexion of the knee and hip joint

• Buck’s extension and the knee is suspendedBuck’s extension and the knee is suspendedin a sling to which a rope is attachedin a sling to which a rope is attached

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Russell TractionRussell Traction

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Nursing Care of Clients with non-Nursing Care of Clients with non-

adhesive tractionadhesive traction

Rest period are providedRest period are provided

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Skeletal TractionSkeletal Traction

Applied into a boneApplied into a bone

Crutchfield Skeletal TractionCrutchfield Skeletal Traction

•Applied into the parietal; bonesApplied into the parietal; bones

Indicated for cervical spine affectationsIndicated for cervical spine affectations

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Crutchfield TongCrutchfield Tong

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Skeletal TractionSkeletal Traction

Balanced Skeletal TractionBalanced Skeletal Traction

• Applied alone or with skeletal traction toApplied alone or with skeletal traction to

promote patient mobilitypromote patient mobility

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Balanced Skeletal TractionBalanced Skeletal Traction

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Principles of CarePrinciples of Care

1.1. The patient should always be on either The patient should always be on either supine or dorsal recumbent positionsupine or dorsal recumbent position

2.2. The traction should always have aThe traction should always have a

counteraction (patient’s weight)counteraction (patient’s weight)3.3. The line of deformity should be in lineThe line of deformity should be in line

with the tractionwith the traction

4.4. Traction should be continuousTraction should be continuous5.5. There should be no friction within the lineThere should be no friction within the line

of tractionof traction

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b. Cast- Comparison of Cast Materialsb. Cast- Comparison of Cast MaterialsPlaster Plaster SyntheticSynthetic

MaterialMaterial Plaster of Paris, comprisedPlaster of Paris, comprisedof powdered calciumof powdered calciumsulfate crystalssulfate crystalsimpregnated into theimpregnated into thebandagesbandages

Polyester and cotton,Polyester and cotton,fiberglass or plastic.fiberglass or plastic.Polyester and cotton isPolyester and cotton isimpregnated with water-impregnated with water-activated polyurethaneactivated polyurethaneresinresin

Drying timeDrying time 24-48 hours24-48 hours 7-15 mins of setting7-15 mins of setting

15-30 mins for weight15-30 mins for weightbearingbearing

AdvantagesAdvantages Less costlyLess costly

More effective for More effective for

immobilizing severelyimmobilizing severelydisplaced bonesdisplaced bones

Smooth surfaceSmooth surface

Does not require expensiveDoes not require expensiveequipment for applicationequipment for application

Less likely to indent intoLess likely to indent intoskinskin

Lighter in weightLighter in weight

Less restrictiveLess restrictive

Does not crumbleDoes not crumble

NonabsorbentNonabsorbent

Can be immersed in water Can be immersed in water

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c. Bracesc. Braces

• Knight-taylorsKnight-taylors

• For thoraco-lumbar affectationsFor thoraco-lumbar affectations

•

MilwaukeeMilwaukee

• For scoliosisFor scoliosis

Nursing CareNursing Care• Use cotton clothing as barrier Use cotton clothing as barrier

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d. Fixatorsd. Fixators

• RAEFRAEF

• Roger Anderson External Fixator Roger Anderson External Fixator

• Ilizarov deviceIlizarov device

• Indicated for comminuted fracturesIndicated for comminuted fractures

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3. Rehabilitation3. Rehabilitation

• Active or dynamic program aimed atActive or dynamic program aimed at

enabling an ill or disabledenabling an ill or disabled to achieve theto achieve the

highest highest level level of physical, mental, social,of physical, mental, social,

and economic self-sufficiency of which heand economic self-sufficiency of which heis capableis capable

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Members of the Rehabilitation teamMembers of the Rehabilitation team

a.a. PatientPatient

• Key member of health teamKey member of health team

a.a. Rehabilitation nurseRehabilitation nurse

• Develops plan of patient careDevelops plan of patient care

a.a. PhysicianPhysician

• Makes medical diagnosis; directs teamMakes medical diagnosis; directs team

a.a. PhysiatristPhysiatrist

• Physician specialist in physical medicinePhysician specialist in physical medicinea.a. Physical TherapistPhysical Therapist

• Teaches or supervises patient in prescribed exerciseTeaches or supervises patient in prescribed exercise

programprogram

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Members of the Rehabilitation teamMembers of the Rehabilitation team

f.f. PsychologistPsychologist• Helps patient or family explore feelingsHelps patient or family explore feelings

g.g. Occupational TherapistOccupational Therapist• Helps develop skills for home and work situationsHelps develop skills for home and work situations

g.g. Social Worker Social Worker • Assists patient and family adjust socio-economicallyAssists patient and family adjust socio-economically

g.g. Vocational Counselor Vocational Counselor • Tests patient’s interest and aptitudesTests patient’s interest and aptitudes

g.g. Rehabilitation Engineer Rehabilitation Engineer • Uses technology in designing or constructingUses technology in designing or constructing

devices to help the handicappeddevices to help the handicapped

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Transfer and Assistive DevicesTransfer and Assistive Devices

1.1. transferring a client from bed to stretcher transferring a client from bed to stretcher

• stretcher must be perpendicular to bedstretcher must be perpendicular to bed

1.1. transferring a client from bed to wheelchair transferring a client from bed to wheelchair

• the wheelchair must be parallel to the head of thethe wheelchair must be parallel to the head of thebedbed

1.1. CanesCanes

• Height of cane is from floor to waist levelHeight of cane is from floor to waist level

• Cane is held by opposite the affected extremityCane is held by opposite the affected extremity

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Transfer and Assistive DevicesTransfer and Assistive Devices

4.4. CrutchesCrutches

• Height of crutch is from floor to axilla minusHeight of crutch is from floor to axilla minus

2 inches2 inches

• Patient’s weight is borne by the palm, of thePatient’s weight is borne by the palm, of the

hand and not on the axillahand and not on the axilla

• When going upstairs, unaffected leg firstWhen going upstairs, unaffected leg first

• When going upstairs, affected leg firstWhen going upstairs, affected leg first

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Crutch-walking techniquesCrutch-walking techniques

• Two point gaitTwo point gait (two alternate gait)(two alternate gait)

• Three point gaitThree point gait

• Four point gaitFour point gait

• Swinging crutch gaitsSwinging crutch gaits• Both legs are lifted off the ground simultaneously andBoth legs are lifted off the ground simultaneously and

swung forward while patient pushes up on crutchesswung forward while patient pushes up on crutches

• Swing-to gaitSwing-to gait

• Lift and swing body up to crutchesLift and swing body up to crutches• Swing-through gaitSwing-through gait

• Lift swing body beyond crutchesLift swing body beyond crutches

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ExercisesExercises

a.a. IsometricIsometric

• Alternate contraction and relaxation of theAlternate contraction and relaxation of the

muscle without moving the jointmuscle without moving the joint

a.a. Done on the affected extremityDone on the affected extremity

b.b. IsotonicIsotonic

• Range of motion exercisesRange of motion exercises

• Done on the unaffected extremityDone on the unaffected extremity

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Heat or Cold Application in TraumaHeat or Cold Application in Trauma

Cold ApplicationCold Application

• first 24 hoursfirst 24 hours

• To decreaseTo decrease

hemorrhagehemorrhage• To relieve painTo relieve pain

• To reduceTo reduce

inflammationinflammation

Heat ApplicationHeat Application

– After 24 hoursAfter 24 hours

– To relieve pain fromTo relieve pain from

muscle spasmsmuscle spasms – To reduce swelling byTo reduce swelling by

increasing circulationincreasing circulation

– To promote healing byTo promote healing by

increasingincreasingoxygenationoxygenation

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4. Orthopedic Operative4. Orthopedic Operative

ProceduresProcedures

a.a. ArthrotomyArthrotomy

– Surgical opening into a jointSurgical opening into a joint

a.a. ArthrodesisArthrodesis – Fixation of a jointFixation of a joint

a.a. Spinal fusionSpinal fusion

– Surgical removal of 1 or moreSurgical removal of 1 or more

vertebra and fusing them together vertebra and fusing them together

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4. Orthopedic Operative4. Orthopedic Operative

ProceduresProcedures

d.d. Hip replacementHip replacement

– Placement of prosthesis on the hipPlacement of prosthesis on the hip joint joint

– IndicationIndication

Hip fractureHip fracture

Inability to move leg voluntarilyInability to move leg voluntarily

Shortening and external rotation of Shortening and external rotation of the legthe leg

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Nursing Management on HipNursing Management on Hip

Replacement Replacement

Avoid positioning on the operative siteAvoid positioning on the operative site

Maintain abduction of hipMaintain abduction of hip

Pillows between legsPillows between legsProvide chair with firm, non-recliningProvide chair with firm, non-reclining

seat and armsseat and arms

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Nursing Management on HipNursing Management on Hip

Replacement Replacement

Avoid hip flexion beyond 60 degreesAvoid hip flexion beyond 60 degreesfor 10 daysfor 10 days

Avoid hip flexion beyond 90 degreesAvoid hip flexion beyond 90 degreesfrom day 10 to 2 monthsfrom day 10 to 2 months

Avoid adduction of the affected legAvoid adduction of the affected legbeyond midline for 2 monthsbeyond midline for 2 months

Partial weight bearing status for 2Partial weight bearing status for 2monthsmonths

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TraumaTrauma

ContusionContusion

– Injury to the soft tissue produced byInjury to the soft tissue produced by

blunt forceblunt force

SprainSprain

– Injury to the ligamentous structuresInjury to the ligamentous structures

caused by wrenching or twistingcaused by wrenching or twisting – Forcible hyperextension of a joint withForcible hyperextension of a joint with

tissue damage like whiplash injurytissue damage like whiplash injury

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TraumaTrauma

StrainStrain

– Tearing of musculotendenous unit causedTearing of musculotendenous unit caused

excessive stretchingexcessive stretching

DislocationDislocation – Joint articulating surfaces are partiallyJoint articulating surfaces are partially

separatedseparated

– No longer in anatomical contactNo longer in anatomical contactFracturesFractures

– Break on continuity of boneBreak on continuity of bone

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Nursing Assessment Nursing Assessment

1.1. PainPain

– Increasing until immobilizedIncreasing until immobilized

1.1. Loss of functionLoss of function2.2. Localized swelling or discolorationLocalized swelling or discoloration

3.3. DeformityDeformity

4.4. CrepitusCrepitus

– Grating soundGrating sound

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G l Cl ifi ti f



General Classifications of General Classifications of

FracturesFractures1.1. Simple or closedSimple or closed

– Skin is intact over fracture siteSkin is intact over fracture site

1.1. Compound or openCompound or open

– With an external wound in contact with theWith an external wound in contact with theunderlying fractureunderlying fracture

1.1. CompleteComplete

– Entire cross section is displacedEntire cross section is displaced1.1. IncompleteIncomplete

– Portion of cross section undisplacedPortion of cross section undisplaced

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G l Cl ifi i fG l Cl ifi ti f



General Classifications of General Classifications of

FracturesFracturesDepressedDepressed – Fragments are drived-in; facial or skullFragments are drived-in; facial or skull

CompressionCompression – Fractured bone compressed by another bone;Fractured bone compressed by another bone;

vertebravertebraImpactedImpacted – Fractured bones are pushed into each other Fractured bones are pushed into each other

(telescoped)(telescoped)

DisplacedDisplaced

– Fragments are separated from fracture lineFragments are separated from fracture lineLinear Linear – Fracture parallel with long axisFracture parallel with long axis

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COMPARING ARTHRITISCOMPARING ARTHRITIS



RheumatoidRheumatoid OsteoarthritisOsteoarthritis GoutyGouty

EtiologyEtiology AutoimmuneAutoimmune

+ Rh factor + Rh factor

DegenerativeDegenerative

senescencesenescence

Metabolic or Metabolic or familial purinefamilial purinemetabolismmetabolism

IncidenceIncidence 35-45 women35-45 women Men or more inMen or more inwomenwomen

Men over 40Men over 40

Signs andSigns andsymptomssymptoms Subcutaneaous nodules

Subcutaneaous nodules

Morning stiffnessMorning stiffness

Swan neck deformitySwan neck deformity

Heberdens noduleHeberdens nodule

TophiTophi

Areas affectedAreas affected Joints of handsJoints of hands Weight bearing jointWeight bearing joint Great toeGreat toe

ManagementManagement Aspirin, NSAIDsAspirin, NSAIDs

Paraffin bathParaffin bath

SymptomaticSymptomatic ColchicineColchicine

Avoid purine dieAvoid purine diet

AllopurinolAllopurinol

Presentation (Muskuloskeletal System)

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