6383448 Orthopedic Nursing

7/27/2019 6383448 Orthopedic Nursing

1/237

MUSCULOSKELETALSYSTEM


2/237

Review of Anatomy and

The musculo-skeletal system consistsof the muscles, tendons, bones andcartilage together with the joints

The primary function of which is toproduce skeletal movements


3/237

Muscles

Three types of muscles eist in thebody

!" #keletal Muscles

$oluntary and striated %" &ardiac muscles

'nvoluntary and striated

(" #mooth)$isceral muscles 'nvoluntary and *+*-striated $isceral, plain muscles


4/237


5/237

Muscle Types:2. Skeletal Muscle

accounts for at least . of body mass

aids in the formation of the smoothcontour of the bodyParts/!"! 0pimysium

Tough connective tissue covering of theentire muscle" 't binds many fascicles together"Tendon)Apponeurosis / blending of the

epimysia

!"% Perimysium 1ibrous membrane covering several

sheathed muscle fibers 1ascicles 2 are bundles of muscle fibers

covered by perimysium"


6/237


7/237

#keletal Muscle&haracteristics/

$oluntarycontrol 3but canalso beactivated byreflees4

354 #triationsMultinucleated#hape/

&ylindrical#peed ofcontraction/$ariable


8/237

2. Smooth Muscle 1ound mainly in the walls of hollow

visceral organs such as the

stomach, urinary bladder andrespiratory passages" propels substances along a definite

tract, or pathway, within the body"

#mooth Muscle &haracteristics/ 'nvoluntary control 3-4 #triations6 no distinct sarcomeres7ninucleated#pindle-shaped#peed of &ontraction/ slow andsustained6 does not develop an

o en debt


9/237

#mooth muscle


10/237

3. Cardac Muscle 1ound only in the heart 3cardiac4" 8eart 2 serves as a pump, propelling

blood into the blood vessels and to alltissues of the body"

&ardiac fibers are cushioned by smallamounts of soft connective tissue and

arranged in spiral or figure 9-shapedbundles"

&ardiac Muscle &haracteristics/ 'nvoluntary control

354 #triations Multinucleated :ranched #peed of contraction/ $ariable


11/237

Muscle !u"cto"s:

%4 Production of

movements)locomotion(4 Maintenance of posture

4 ;oint stabilienerating heat?4 0nergy production


12/237

Smlartes o# all Muscle Types:

c4 All muscle cells are elongated 3this

eplains the term muscle fibers4d4 Muscle contractions depends on

the types of myofilaments 3thinand thick myofilaments4

e4 Terminology 3prefied/ myo, mys,@ sarco4

#


13/237

Mcroscopc A"atomy o#Skeletal Muscle

!" #arcolemma Plasma membrane of skeletal

muscle cells"

(" Myofibrils ong ribbon like organelles,

pushing the nuclei aside

Alternating dark 3A4 and light 3'4bands along the length of themyofibrils, give the muscle cell3as a whole4 a striated

#


14/237

Mcroscopc A"atomy o#

(" #arcomere 1unctional unit of a muscle" These are chains of contractile

units of myofibrils"

" #arcoplasmic Reticulum #urrounds individual myofibrils

#peciali


15/237

SA$COME$E% #u"cto"al u"t o# the muscle& e'te"ds #rom o"e (%l"e to a"other (%l"e

% ma"ly composed o# act" ) myos" myo#lame"ts

(%dsk or (%l"e * a"chors the act" myo#lame"ts

M%l"e* holds the myos" #lame"ts " place

M l Ph i l


16/237

Muscle Physiology

Stmulato" a"d Co"tracto" o# a

S"+le Skeletal Muscle Cell{ !u"cto"al ,ropertes o# Muscle!-ers:!" 'rritability 2 ability to react and

respond to stimulus%" &ontractility 2 ability to shorten

when stimulated by adeBuatestimulus

{ The er/e Stmulus a"d Acto",ote"tal!" Motor 7nit - single motor neuron

and all of the corresponding


17/237

#C00TA M7#&0/

M* control

0nergy is consumed during musclecontraction 2 A&T'& A&'D 3O2)

MUSCLE FATIGUE: work of muscle wit i!"#e$u"te O2 su%%l&

'e%letio! of (l&co(e! e!er(& stores

Accumul"tio! of l"ctic "ci#


18/237

#tructure and function of theskeletal system

#keletal system consist of Aial andAppendicular skeleton"

Aial #keleton- which is composed ofbones of the skull, thora andvertebral column which forms the aisof the body"

Appedicular #keleton- consist ofbones of the upper and loweretrimities, including the hip and theshoulder"


19/237

Two types of connective tissue found in theskeletal system

%" &artilage 2 a semi-rigid and slightly

fleible structures that plays anessential role in prenatal and childhooddevelopment of the skeleton and as asurface for the articulating ends of the

skeletal joint"

(" :ones 2 which provide the firmstructure of the skeleton and serve as


20/237


21/237


22/237

Three types of cartilage

0lastic &artilage- &ontain some elastin ineach intracellualr substance" 3 ears4

8yaline &artilage- Pearly white, found in

the articulating ends of the bones"- form the fetal skeleton " 1ibro cartilage- has a characteristic that

are intermediate between denseconnective tissue and hyaline cartilage"

't is found in the intervertebral disks, inareas where tendons are connective tobone and in the symphysis pubis"

- ?=-9. are water"


23/237


24/237


25/237

:one- is a connective tissue in whichthe intracellular matri has beenimpregnated with inorganic calcium

salts so that it has a great tensile andcompressible strength but is lightenough to be move by coordinated

muscle contractions"


26/237

:+*0#

$ariously classified according to shape,location and si


27/237

:one is made up of four major

components/ mineral 3mainly calcium and phosphorus4 matri 3collagen fibers4 osteoclasts 3bone-removing cells4 osteoblasts 3bone-producing cells4"

+steocytes 3 mature bone cells for bonemaintenance fns4


28/237


29/237

#C00TA #E#T0M/

,E$0OSTEUM: Dense fibrous membrane covering the bone

Periosteal vessels supply bone tissue

E,0,1YS0S: Fidened area at the end of the long bone

E,0,1YSEAL ,LATE +roth 4o"e5 &artilage area in children w)c provides for

longitudinal growth of the bone A$T0CULA$ CA$T0LA6E:

Provides smooth surface over the ends of thebone to facilitate joint movement


30/237

Type of bone cell

+steogenic cells- 7ndifferentiatedcells that differentiate intoosteoblasts" They are found in the

periosteum, endosteum, andepiphyseal growth plate of growingbones"

+steoblasts- :one building cells thatsynthesi


31/237

+steocytes- Mature bone cells thatfunction in the maintenance of bonematri" +steocytes also play an active

role in releasing calcium in the blood " +stroclasts- :one cells responsible for

the resorption of bone matri and the

release of calcium and phosphatefrom bone"


32/237


33/237


34/237


35/237


36/237


37/237

#C00TA #E#T0M/

R0D :+*0 MARR+F/ 8emopoietic tissue located in the central

bone cavities"

Adults/ ribs, sternum, vertebrae, portionsof hips @ pelvic bones ong :ones filled with fatty, yellow

marrow

17*&T'+*#/ 1ormation of R:&, F:& @ platelets

Destruction of old R:& 3phagocytosis4


38/237

:+*0 1+RMAT'+*

+##'1'&AT'+* Process by which matri 3collagen fiber @

ground substance4 is formed @ hardening

minerals are deposited on collagen fibers3give tensile strength4

0*D+&8+*DRA +steoid 3cartilage-like tissue4 is formed,

reabsorbed, @ replaced by bone '*TRAM0M:RA*+7#

:one develops within membrane 3e"g" face,skull4


39/237

:+*0 MA'*T0*A*&0 @

R0>7AT+RE 1A&T+R# D0T0RM'*'*>:+T8 1+RMAT'+* @ R0#+RPT'+*/ !" 7e+ht%-ear"+ local stress5

%" 8tam" 9 Calctrol5promotesabsorption of calcium from >'T

(" ,arathyrod 1ormo"eregulatescalcium

" Calcto"" ) Am"o -phosphate3e"g"Alendronate G1osamaH4 increasesproduction of bone cells


40/237

:+*0 MA'*T0*A*&0 @

!" 7e+ht%-ear"+ local stress5 #timulate bone formation @ remodelling

Prolonged bed rest/ bone losses calcium

3resorption4 @ becomes osteopenia @ weak%" olo+cally Act/e8tam" 9Calctrol5

"mou!t of C" i! *loo# *& %romoti!( "*sor%tio!

of C" from GIT F"cilit"tes mi!er"li+"tio! of osteoi# tse

'eficie!c& c"use *o!e #emi!er"li+"tio!,#eformit& fr"cture


41/237

:+*0 MA'*T0*A*&0 @

(" ,arathyrod 1ormo"eparathormo"e5 regulates calcium in blood in part by

promoting movIt of &a from the bone C" i! *loo# - .T/ %rom%t #emi!er"li+"tio!

of te *o!e

" Calcto"" ) Am"o -phosphate3e"g"

Alendronate G1osamaH4 increasesproduction of bone cells

&alcitonin- inhibits release of calcium fromthe bone into the etracellular fluid and

reduces the renal tubular reabsorptionof


42/237

Parathyroid hormone

Parathyroid gland

:one 2 releaseof &a and

&alciumconcentration in

the etracellular

Cidneyreabsorption of

7rinaryecretion of

Activation of$it"D

'ntestineReabsorption of

&a via activated


43/237

:+*0 MA'*T0*A*&0 @

Estro+e" ) A"dro+e" #timulate osteoblastic activity @ inhibit PT8 Menopause)Andropause 2 C" - *o!e loss - osteo%orosis

A"dro+e"%testostero"e .romote "!"*olism *o!e m"ss 0#TR+>0*-'t appears that oestrogen

deficiency allows greater epression of thesecytokines, all of which are associated withincreased stimulation of bone resorptionwhich then leads to increased bone loss anda reduction in :MD"


44/237

AndrogensAndrogens, like oestrogens,can directly affect and modulate bonecell function" Androgen receptors are

found on osteoblast cell lines and theycan cause osteoblast proliferation"8ypogonadal men, in common with post-menopausal women, have decreasedcalcium absorption and low vitamin D

levels" The replacement of androgenswith testosterone can correct theseabnormalities, suggesting again that sehormones are reBuired for the


45/237

:+*0 80A'*>/ STA6E ;. 1EMATOMA !O$MAT0O )

0!LAMMAT0O Fhen bone is damaged or injured, hematoma precedes new

tissue formation in the production of new bone substance

STA6E 2. CELLULA$ ,$OL0!E$AT0O: >ranular tissue formation where :$ @ cartilage overlie the

fracture

&allus forms as minerals are deposited to organi


46/237

:one healing


47/237

1A&T+R# A110&T'*> T'M0

!" age

%" displacement

(" site of fracture

" nutritional level

=" blood supply to the area of injury


48/237

;+'*T#

Permits bone tochange position @facilitate body movIt

Diarthrodial 3synovial4joint is the mostcommon type of jointin the body


49/237

joints


50/237


51/237

joints


52/237

joints


53/237

;oints


54/237

joint


55/237

joints


56/237

&ART'A>0 3h li 4


57/237

&ART'A>0 3hyaline4

A dense connective tissue that consistsof fibers embedded in a strong gel-likesubstance that cover the end of the

bone


58/237

&ART'A>0

A$T0CULA$ CA$T0LA6E Rigid, connective, avascular tissue that

covers each bone ends

Damaged cartilage heals slowly 3lacksdirect blood suply4


59/237

:7R#A0


60/237

:7R#A0

#ac containing fluid that are locatedaround the joints to prevent friction


61/237

A fibrous capsule of connective tissue

joins the % bones together

!" SYO80UM sy"o/al mem-ra"e5

ines the capsule

%" SYO80AL !LU09 #ecreted by the synovium @ decreases

friction by lubricating the joints

T0*D+*# 3aponeurosis4


62/237

T0*D+*# 3aponeurosis4

:ands of fibrous connective tissue thattie -o"es to muscles

'>AM0*T#


63/237

'>AM0*T#

#trong, dense and fleible bands offibrous tissue connecting -o"es toa"other -o"e


64/237

A##0#M0*T +1 T80 M7#&7+-

The "urse usuallye/aluates ths small part

o# the o/er%all assessme"ta"d co"ce"trates o" thepate"t>s posture? -ody

symmetry? +at a"dmuscle a"d @o"t #u"cto"


65/237

A##0#M0*T +1 T80 M7#&7+-

;. 10STO$Y 0"@ury? sur+ery? dsa-lty? "#lammatory

meta-olc co"dto"s !amlal predsposto" Le/el o# "ormal act/ty occupato"?

e'ercse? recreato"5

2. ,hyscal E'am"ato"

0"specto" #or +ross de#ormtes?asymmetry? sell"+? edema utrto"al status: e+ht? -ody #rame


66/237

A##0##M0*T +1 T80

6at3Antalgic46 >enu $algum 3Cnock-Cnee4, >enu $arum 3:ow-egged4

,osture3Cyphosis)ordosis)#coliosis4

Muscular palpato" Bo"t palpato" Creptus%+rat"+

sou"d5

$a"+e o# moto" Muscle stre"+th


67/237

Assessment 1indings


68/237

g

< ,>s o# EU$O8ASCULA$9AMA6E

Sell"+

Loss o# #u"cto" 9e#ormty

Creptus

,


69/237

, aaulselessulselessarestharestharalyaraly

aa

oklotheoklothe


70/237

A##0#M0*T +1 T80 M7#&7+-

LAO$ATO$Y ,$OCE9U$ES

;. OE MA$$O7 AS,0$AT0O Usually "/ol/es asprato" o# the

marro to da+"ose dseases lkeleukema? aplastc a"ema

Usual site is the sternum and iliac crest

Pre-test: Co"se"t

Intratest: eedle pu"cture may -epa"#ul

Post-test: ma"ta" pressure dress"+a"d atch out #or -leed"+


71/237


72/237

A##0#M0*T +1 T80 M7#&7+-

A:+RAT+RE PR+&0D7R0# %" Arthroscopy

A drect /sual4ato" o# the @o"tca/ty

Pre-test: co"se"t? e'pla"ato" o#procedure? ,O

Intra-test: Sedat/e? A"esthesa?"cso" ll -e made

Post-test: ma"ta" dress"+? am-ulato" as soo" as aake? mld sore"ess o# @o"t #or 2 days?@o"t rest #or a #e days ) ce

applcato" to rele/e dscom#ort

A##0#M0*T +1 T80 M7#&7+


73/237

%" A$T1$OSCO,Y %&"' for pt who cannot fle K L and withinfected knee

7ses large pneumatic tourniBuet tominimi


74/237

C*00 ART8R+#&+PE

ART8R+#&+PE


75/237

ART8R+#&+PE

C*00 ART8R+#&+PE


76/237

C*00 ART8R+#&+PE

#8+7D0R ART8R+#&+PE


77/237

#8+7D0R ART8R+#&+PE


78/237

A##0#M0*T +1 T80 M7#&7+


79/237

A##0#M0*T +1 T80 M7#&7+-

LAO$ATO$Y ,$OCE9U$ES

3. OE SCA

0ma+"+ study th the use o# a co"trastradoact/e materal

Pre-test:,a"less procedure? 08radosotope s used? "o specalpreparato"?pregnancy is contraindicated

Intra-test:08 "@ecto"? 7at"+ perod o# 2hours -e#ore %ray? !luds alloed? Sup"eposto" #or sca"""+

Post-test:0"crease #lud "take to #lush outradoact/e materal

A##0#M0*T +1 T80 M7#&7+-


80/237

OE SCA 2 Radioisotope injected '$3technetium, >allium, Thalium4

Adm" 'sotope !-% days before scanning*o radioactive threatsProcedure lasts (-? min*o special care after procedure0creted in 7rine @ feces0ncourage fluid

A##0#M0*T +1 T80 M7#&7+#C00TA #E#T0M


81/237


82/237

A##0#M0*T +1 T80 M7#&7+


83/237

A##0#M0*T +1 T80 M7#&7+-

A:+RAT+RE PR+&0D7R0#

" 9EA% 9ual%e"er+y $AYA-sorptometry

Assesses bone density to diagnoseosteoporosis

7ses LOW dose radiationto measurebone density

Painless procedure, non-invasive, no specialpreparation


84/237

A##0#M0*T +1 T80 M7#&7+


85/237

A##0#M0*T +1 T80 M7#&7+-

=" ray !lms: $oe"t+e"o+rams2plain ray film is common AP3Antero-posterior lateral views"

?" A$T1$O6$A,1Y/ injection of dyeor air in the joint for -ray study

" MYELO6$A,1Y:eamines spinalcord after introduction of contrastmedium


86/237

Myelography

ART8R+>RAP8E


87/237

ART8R+>RAP8E

Arthrography is theradiographic eamination

of a joint, after theinjection of a dye-likecontrast material and)orair, to outline the soft

A##0#M0*T +1 T80 M7#&7+


88/237

A##0#M0*T +1 T80 M7#&7+-

9" OEMUSCLE 0O,SY:'liac crestusual puncture site6 not commonlydone today

ocal anesthesia, check PT @ PTT &oagulant given %-( days before @

after procedure

Pressure dressing after

A##0#M0*T +1 T80 M7#&7+


89/237

A##0#M0*T +1 T80 M7#&7+-

N" CT SCA:assess bone @ softtse tumors

!" M$0:to assess soft tissue andjoints with myelography >A*D+'*'7M DTPA

3DiethyleneTriamine PentaAcetic Acid4

:++D #T7D'0#/ h d


90/237

;. ES$ Erythrocyte Sedme"tato"$ate5:

non-specific test for inflammation 1/ -%mm)hr M/ -! mm)hr

%" U$0C AC09:0levated in gout *ormal %"%- mg)dl 314 6"%-9 mg)! ml

3M4(" AA A"t%"uclear A"t%-ody5:

Measures the presence of antibodies thatdestroy the nucleus of the body tissue cells

in auto-immune disorder6 354 in about N. of clients w) #0

#jorenIs syndrome RA

:++D #T7D'0#/


91/237

:++D #T7D'0#/

$1EUMATO09 !ACTO$ Late'!'ato"5: Determine presence of auto antibodies 3R14

found in clients with connective tissue dse 354 R1 is suggestive of RA

The higher the antibody titer the greater thedegree of inflammation

M'*0RA M0TA:+'#M/


92/237

M'*0RA M0TA:+'#M/

!" CALC0UM/ i! osteom"l"ci",&%o%"r"t&roi#ism0 *o!e tumors, "cuteosteo%orosis,*o!e fr"cture1e"li!( %"se)

Normal: 4.5 5.8 mEq/L or 9-10.5 mg/dL 2 PHOSPHORUS: i! osteom"l"ci",

e"li!( fr"ctures, C3F, *o!e tumorNormal: 3 - 4.5 mEq/L

M7#&0 0*OEM0 T0#T#/


93/237

M7#&0 0*OEM0 T0#T#/

!" C$EAT00E ,1O,1OK0ASECK3 or CK%MM5 1/ (-!(= 7)6 M/==-! 7) 2 highest

concentration in traumatic injuries,progressive muscular dystrophy

%" ALKAL0E ,1OS,1ATASE3AP-%42 'ncreased in &ancer, PagetIs Dse @

+steomalacia" *ormal/ %-N '7)

COMMO


94/237

COMMO

MUSCULOSKELETAL ,$OLEMS

The *ursing Management

*ursing Management of common musculo-


95/237

*ursing Management of common musculoskeletal problems

;. ,A0 These can be related to joint

inflammation, traction, surgical

intervention !" Assess patientIs perception of pain

%" 'nstruct patient alternative pain

management like meditation, heatand cold application, guided imagery

*ursing Management


96/237

*ursing Management

PA'*

(" Administer analgesics as prescribed

7sually *#A'D#

Meperidine 3demerol4can be givenfor severe pain

" Assess the effectiveness of pain

measures

*ursing Management


97/237

*ursing Management

2. 0M,A0$E9 ,1YS0CAL MO0L0TY

!" 'nstruct patient to perform range ofmotion eercises, either passive oractive

%" Provide support in ambulation withassistive devices

(" Turn and change position every %

hours " 0ncourage mobility for a short period

and provide positive reinforcements forsmall accomplishments

*ursing Management


98/237

*ursing Management

3. SEL!%CA$E 9E!0C0TS !" Assess functional levels of the patient

%" Provide support for feeding problems

Place patient in 1owlerIs position Provide assistive device and supervise

mealtime

+ffer finger foods that can be handled by

patient Ceep suction eBuipment ready

*ursing Management


99/237

*ursing Management

#01-&AR0 D01'&'T#

(" Assist patient with difficulty bathingand hygiene

Assist with bath only when patient hasdifficulty

Provide ample time for patient to finishactivity


100/237

!$ACTU$ES

1racture


101/237

1racture

A break in the continuity of the boneand is defined according to its typeand etent

1racture


102/237

1racture

Severe mechanical Stress to bonebone fracture

'irect 4lows

Crusi!( forces Su##e! twisti!( motio!

E5treme muscle co!tr"ctio!


103/237


104/237

fractures


105/237

fractures


106/237

1racture


107/237

T6.ES OF F3ACTU3E

7 Clo!d "ra#$%r! &S'(PLE) Te fr"cture t"t #oes !ot c"use " *re"k i! te

ski!

2. O*!+ "ra#$%r! &CO(POUN, or CO(PLE)

Te fr"cture t"t i!8ol8es " *re"k i! te ski!9 Com*l!$! ra#$%r!i!8ol8es e!tire cross sectio!

of te *o!es

; '+#om*l!$! ra#$%r!< i!8ol8es o!l& " %ortio! of

te cross sectio! of te *o!e

1racture


108/237

1racture

T6.ES OF F3ACTU3E = Comm+%$!d "ra#$%r!

A fr"cture t"t i!8ol8es %ro#uctio! of se8er"l*o!e fr"(me!ts

> r!!+$# ra#$%r! O!e si#e is *roke! te oter si#e is *e"t

? ,!*r!!d

fr"(me!tis #ri8e! i!w"r# 1skull,f"ci"l*o!es)

T6.ES OF F3ACTU3E


109/237

T6.ES OF F3ACTU3E

@ 2ra+!r!d

4re"k str"i(t "cross te *o!e

S*ral Forms o*li$ue "!(le to te *o!e

s"ft

1racture/ A##0##M0*T


110/237

1racture/ A##0##M0*T

CL'N'CL (N'ES22'ONS:2 ."i!: imme#i"te, se8er

9 Loss of fu!ctio!

; 'eformit&0 "*!orm"l %ositio!i!( of e5tremit&= Sorte!i!(

> Cre%it"tio!: %"l%"*le or "u#i*le

? E#em"


111/237

" Paresthesia- burning or

tingling sensation 9" *umbness N" Motor weakness 1! Pulselessness" impairedcapillary re#ill time and

cyanotic s$in

1racture


112/237

1racture

ASSESSMEBT FIB'IBGS

7 ."i!

Co!ti!uous "!# i!cre"ses i!se8erit&

Muscles s%"sm "ccom%"!ies te

fr"cture is " re"ctio! of te *o#& toimmo*ili+e te fr"cture# *o!e

1racture


113/237

1racture

ASSESSMEBT FIB'IBGS

2 Lo o" "%+#$o+

A*!orm"l mo8eme!t "!#%"i! c"! result to tis

m"!ifest"tio!

1racture


114/237

1racture

ASSESSMEBT FIB'IBGS

9 ,!"orm$

'is%l"ceme!t, "!(ul"tio!s orrot"tio! of te fr"(me!ts

1racture


115/237

1racture

ASSESSMEBT FIB'IBGS

; Cr!*$%

A (r"ti!( se!s"tio! %ro#uce#we! te *o!e fr"(me!ts ru*e"c oter

1racture


116/237

1racture

'IAGBOSTIC TEST

r"&

1racture


117/237

EME3GEBC6 MABAGEMEBT OF F3ACTU3E 7 Immobilize any suspected fracture

S%**or$te e5tremit& "*o8e "!# *elow we!mo8i!( te "ffecte# %"rt from " 8eicle

Su((este# $!m*orar *l+$ "r# *o"r#, stick,rolle# seets

**l l+g if fore"rm fr"cture is sus%ecte# or tesus%ecte# fr"cture# "rm m"&*e *"!#"(e# to te

cest


118/237

1racture


119/237

EME3GEBC6 MABAGEMEBT:

OPEN RC2URE

7 O%e! fr"cture is m"!"(e# *& co8eri!( "

cle"!Dsterile ("u+e to %re8e!tco!t"mi!"tio!

2 'O BOT "ttem%t to re#uce te f"cture

1racture


120/237

Ge!er"l Bursi!( MABAGEMEBT

or CLOSE, RC2URE

7 Assist i! re#uctio! "!# immo*ili+"tio!

2 A#mi!ister %"i! me#ic"tio! "!# musclerel"5"!ts

9 Te"c %"tie!t to c"re for te c"st

; Te"c %"tie!t "*out %ote!ti"l com%lic"tio!

of fr"cture "!# to re%ort i!fectio!, %oor"li(!me!t "!# co!ti!uous %"i!

G l B i MABAGEMEBT


121/237

Ge!er"l Bursi!( MABAGEMEBT

or OPEN RC2URE

7 .re8e!t wou!# "!# *o!e i!fectio! A#mi!ister %rescri*e# "!ti*iotics A#mi!ister tet"!us %ro%&l"5is

Assist i! seri"l wou!# #e*ri#eme!t 2 Ele8"te te e5tremit& to %re8e!t e#em"

form"tio! 9 A#mi!ister c"re of tr"ctio! "!# c"st

F3ACTU3E COM.LICATIOBS


122/237

Earl7 Sock 1/&%o8olemic Sock)

2 F"t em*olism 7st;@ rs

9 I!fectio!

; Im%"ire# Circul"tio! 1c"stDe#em")

= Com%"rtme!t s&!#rome

> e!ous St"sis trom*us form"tio!



123/237

La$! 7 'el"&e# u!io! D Bo!u!io!

2 A!(ul"tio! 1*o!e e"ls "t " #istorte# "!(le)

9 'el"&e# re"ctio! to fi5"tio! #e8ices ; Com%le5 re(io!"l s&!#rome



124/237

F3ACTU3E COM.LICATIOBS:

a$ Em6olm

Occurs usu"ll& i! fr"ctures of te lo!( *o!es

F"t (lo*ules m"& mo8e i!to te *loo# stre"m*ec"use te m"rrow %ressure is (re"ter t"!

c"%ill"r& %ressure F"t (lo*ules occlu#e te sm"ll *loo# 8essels

of te lu!(s, *r"i! ki#!e&s "!# oter or("!s


125/237

F3ACTU3E COM.LICATIOBS: $ E 6 l


126/237

a$ Em6olm O!set is r"%i#, witi! 2;?2 ours

SSESS(EN2 'N,'NSA. 1. Sudden dyspnea and respiratory

distress & hypoxia 2 t"c&c"r#i" 9 Cest %"i! ; Cr"ckles, wee+es "!# cou(

= .eteci"l r"ses o8er te cest, "5ill" "!#"r# %"l"te

1at embolism


127/237

classic triad/ hypoemia6 neurologicabnormalities6 and a petechial rash"

8- 8ypoemia

*- * eurologic a-bnormalities

P- Petechial rash

1at embolism


128/237

Assessment finding :" *eurological finding

!" &erebral emboli- freBuently present

after early stages" 9? . after therespiratory distress"

- The more common presentation iswith an acute confusional statebut

focal neurological signs, includinghemiplegia, aphasia,apraia, visualfield disturbances, and anisocoria,

1at embolism


129/237

The characteristicpetechial rashmay bethe last componentof the triad todevelop" 't occurs in up to ?. of casesandis due to emboli


130/237

Bursi!( M"!"(eme!t


131/237

Bursi!( M"!"(eme!tMany studies shows that early

immobilization and fixation decreasethe incidence of pulmonarycomplication.

- Adequate fluid resuscitationtransfusion and !"# could decreasethe incidence of $%S $at embolismsyndrome '

5. S%**or$ $7! r!*ra$or "%+#$o+ 3es%ir"tor& f"ilure is te most commo!

c"use of #e"t A#mi!ister O2 i! i( co!ce!tr"tio! .re%"re for %ossi*le i!tu*"tio! "!#


132/237

2 dm+$!r dr%g

Corticosteroi#s

'o%"mi!e

Mor%i!e

9 '+$$%$! *r!!+$! m!a%r!


133/237

9 '+$$%$! *r!!+$! m!a%r! Imme#i"te immo*ili+"tio! of fr"cture

Mi!im"l fr"cture m"!i%ul"tio!

A#e$u"te su%%ort for fr"cture# *o!e #uri!( tur!i!"!# %ositio!i!(

M"i!t"i! "#e$u"te r"tio! "!# electrol&te*"l"!ce

0arly complication/ Compartme"t sy"drome


134/237

A complication that develops when

tissue perfusion in the muscles is lessthan reBuired for tissue viability


135/237

&+MPARTM0*T #E*DR+M0


136/237

Muscles, nerves, vessels arerestricted to confined space3myofascial compartment4 within an

etremity 0T'++>E/

Decreased &ompartment si


137/237

0arly complication/ Compartme"t sy"drome


138/237

ASSESSMET !0906S !" Pain- Deep, throbbing and

U%&'LI'(') pain by opioids d)t reduction in the si


139/237

Arterial compression may not occur6

pulses may be 354 2 3early4 :listers

&an result in permanent damage in a

short time 3?-9 hrs4 PAR0#T80#'A- first sign

P7#00##*0## - late sign


140/237

Medical and *ursing


141/237

Medical and *ursingmanagement/

!" Assess freBuently theneurovascular status of the

casted etremity%" 'levate the e*tremity

above the level o# the heart

(" Assist in cast removal and


142/237


143/237


144/237

Sur+cal Treatme"t 'f surgery is reBuired to relieve the

pressure, the physician will make an

incision and cut open the skin andfascia covering the affectedcompartment" This reduces thepressure in the compartment" The

skin incision is surgically repairedwhen swelling recedes" #ometimes askin graft may be needed"


145/237

RI# '* M>MT +1 1RA&T7R0


146/237

!" R0&+>*'T'+* of presence offracture

%" R0D7&T'+*/

&losed Reduction 3manipulation4 +pen Reduction 3+R'1 2 surgery4

Traction

RI# '* M>MT +1 1RA&T7R0


147/237

(" R0T0*T'+* &ast

Traction

:races ) splints

:andage

" R08A:''TAT'+* 2 restoration tonormal fn Falker

&rutches &ane

&A*0#


148/237

C


149/237

#hould be usedon the sideopposite theaffected leg

&ane 5 Affectedleg movetogether

&anes


150/237

8andle should be always level ofclients greater trochanter "

&lients elbow should be fle at a !=-

( degrees angle 'nstruct the client to hold the cane -?

inches on the side of the client"

FAC0R#


151/237

'1T the walker @place it appro" % ft"in front

>ain balance beforemoving walkerforward again

:alance provides

stability @ eBual wt"bearing


152/237

PR+#T80#'#


153/237


154/237


155/237


156/237

U, 70T1 T1E 6OO99O7 70T1 T1E A9


157/237


158/237

0"dcato":Feakness in both legs or poor coordination

SeDue"ce:

1-Le#t crutch"+-right #oot"

,-right crutch"

-le#t #oot! .hen repeat!

Ad/a"ta+es:Provides ecellent stabilty as there are always three points in

contact with the ground 9sad/a"ta+es:

#low walking speed

0"dcato":'nability to bear weight on one leg 3fractures pain


159/237

'nability to bear weight on one leg" 3fractures, pain,amputations4

,atter" SeDue"ce:

1-move both crutches and+- the /ea$er lo/er limb #or/ard! .hen bear all

your /eight do/n through the crutches

,- move the stronger or una##ected lo/er limb#or/ard! &epeat!

Ad/a"ta+es:0liminates all weight bearing on the affected leg"

9sad/a"ta+es:

0"dcato":F k i b h l di i


160/237

Feakness in both legs or poor coordination"

,atter" SeDue"ce:1-Le#t crutch and right #oot together"then the +-right crutch and le#t #oottogether! &epeat!

Ad/a"ta+es:1aster than the four point date"

9sad/a"ta+es:&an be difficult to learn the attern"

0"dcato"s:P ti t ith k f b th l t iti


161/237

Patients with weakness of both lower etremities"

,atter" SeDue"ce:Advance both crutches #or/ard then" /hile

bearing all /eight do/n through bothcrutches" s/ing both legs #or/ard at thesame time to 0not past the crutches!

Ad/a"ta+e:

0asy to learn" 9sad/a"ta+e:

0"dcato"s:

'nability to fully bear weight on both legs 3fractures


162/237

'nability to fully bear weight on both legs" 3fractures,pain, amputations4

,atter" SeDue"ce:Advance both crutches #or/ard then" /hilebearing all /eight do/n through both crutches"s/ing both legs #or/ard at the same time pastthe crutches!

Ad/a"ta+e:1astest gait pattern of all si"

9sad/a"ta+e/

TRA7MAT'& &+*D'T'+*#/


163/237

!. COTUS0O2 soft tissue injuryproduce by blunt force, blow, kick or fall

#)#/

a" hemorrhage 3ecchymosis4 ruptured:$

b" pain @ swelling

COTUS0O


164/237

M+mt:

;. ele/ate a##ected part

2. cold compress to dm"sh edema;st2=15

3. apply pressure -a"da+e toreduce sell"+

=. apply heat to a##ected area a#ter< hrs to promote a-sorpto".

Stra"s


165/237

E'cess/e stretch"+ o# a muscle orte"do"

*ursing management/

;. 0mmo-l4e a##ected part

2. Apply cold packs "tally? the" heat

packs3. Lmt @o"t act/ty

=. Adm"ster SA09s a"d muscle

#prains


166/237

0cessive stretching of the '>AM0*T#

urs"+ ma"a+eme"t

!" 'mmobili


167/237

00

E

e

le/at

ompress

c

Musculoskeletal Modalities


168/237

Tracto"Cast

*ursing Management


169/237

Tracto" A method of fracture immobili


170/237

Sk" tracto" 2 applied at thesurface of skin @ soft tissue @indirectly to the bone using adhesiveelastic bandage @ spreader" ma" lbs

3e"g" :ryant, Russel Traction4

Skeletal tracto" 2 applied directly

to the bone using wire, pins, tongs"ma" lbs" 3e"g" 8alo pelvic,&rutchfield tong traction4

Traction


171/237

*on-adhesive traction

#kin

tracti


172/237

:ryants traction &ervical traction


173/237

Position clients/ low fowlers positionMaintain % degree angle at the thighto bedProtect the skin from break downProvide pin care if pin is used with theskeletal traction

:alance suspension traction

'*D'&AT'+*#)P7RP+#0#/


174/237

1or immobiliive support to reduce pain @ musclespasm

To reduce fracture


175/237

0"dcato"s #or Tracto" reduction, immobilisation @ alignment

of fractures

relieve muscle spasm @ pain prevent further soft tissue damage

to promote rest

ne


176/237

R7##0I# TRA&T'+*


177/237


178/237

RussellIs traction

&ommonly used to stabili


179/237

:7&CI# 0T0*#'+* TRA&T'+*


180/237

-'s used to alleviate muscle spasm andimmobili


181/237


182/237

DunlopIs traction

Description/ 8ori


183/237


184/237

8alo vest&ervical traction


185/237


186/237

*ursing Management


187/237

Traction/ >eneral principles!"ALWA2S ensure that the /eights

hang #reely and do not touch the#loor

%" %'('& remove the /eights(" Maintain proper body alignment 3dorsal

recumbent4

" 0nsure that the pulleys and ropes areproperly functioning and fastened bytying s3uare $not

*ursing Management


188/237

Traction/ >eneral principles=" +bserve and prevent foot drop

Provide foot plate

?" +bserve for D$T, skin irritation andbreakdown

" Provide pin care for clients in skeletaltraction

0T0R*A 1'AT+R D0$'&0


189/237


190/237


191/237


192/237

0ternal frame with a lot of pins"Provide more freedom compare to traction"

'nternal fiator


193/237

Provide immediate bonestrength but risk for infection"

Traction/ >eneral principles9" 1or every traction, there is


194/237

always a counter traction 2 useshock blocks6 use half ringThomas splint

N" The line of pull must be in linewith deformity

!" 1riction should be eliminated

*ursing Management


195/237

&A#T 'mmobili


196/237

'MM+:''OAT'+* PR0$0*T'+*)&+RR0&T'+* +1

D01+RM'TE

#7PP+RT +:TA'*'*> A 8+D +1 A 'M: T+

#0R$0 A# M+D0 1+R MAC'*>ART'1'&'A 'M:

*ursing Management


197/237

&A#T/ types!"T$UK

Minerva &ast, Ri


198/237

M0E$8A CAST SCOL0OS0S $ACE

:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#:+DE :RA&0#


199/237

SCOL0OS0S $ACE

&astingMaterials

Plaster of Paris


200/237

Plaster of Paris

9ry"+ takes ;%3 days

0# dry? t sS10Y? 710TE?

hard a"dreso"a"t.

1iberglass

L+hte+ht a"d

dres " 2%3m"utes

&8ARA&T0R'#T' +1 >++D&A#T/


201/237

Fhite, shiny +dorless

ight in wt

*ot too tight

*ot too loose

Resonant on

percussion


202/237


203/237

*ursing Management


204/237

CAST: 6e"eral urs"+ Care ;. Allo the cast to dry usually

2=%F2 hours5

+! 4andle a /et cast /ith the

PAL5S"ot the #"+ertps 3. Keep the casted e'tremty

ELE8ATE9 us"+ a pllo

=. Tur" the e'tremty #or eDualdry"+. Use lo cool drer.

CAST: 6e"eral urs"+ Care


205/237

G. ,etalcutt"+ theed+es5 the ed+es o# thecast to pre/e"t crum-l"+

o# the ed+es


206/237

F. 0"struct the pate"t "otto place stcks or smallo-@ects "sde the cast

H. Mo"tor #or the #ollo"+:pain" s/elling"discoloration" coolness"

tingling or lac$ o# sensation

CAST: 6e"eral urs"+ CareN" Observe #or signs o# plaster sore:

itchiness)burning sensation sever pain


207/237

itchiness)burning sensation, sever pain,

rise of temp, disturbed sleep,restlessness, offensive odor,discharges3windowing-eposing a tight

area to relieve edema)pain, petalling4!" Observe #or signs o# cast

syndrome: prolonged *)$, repeatedvomiting, abd"distention, vague

abd"pain, 3-4bowel sound

PA#T0R &A#T #AF


208/237

#pecific 1ractures/


209/237

&+0I# 1RA&T7R0 Distal radius

P0$'& 1RA&T7R0/

1reB in elderly &an cause intra abd injury and urinary

tract injury

Turn pt only on specific orders

10, !$ACTU$E &ommon in elderly women

Cl"cal ma"#estato":

0ternal rotation @ adduction of affected


210/237

0ternal rotation @ adduction of affectedetremity

#hortening of the length of the affectedetremiety

#evere pain @ tenderness

Treatme"t:

'nitially- :uckIs traction

#urgery

A1T0R #7R>0RE

*eurovascular check


211/237

Position/ PR0$0*T 10'+*ADD7&T'+* @ '*T0R*A R+TAT'+* Do not adduct past neutral position

Maintain in abducted position with A-frame pillow or pillows between legs

Avoid fleion of hip of more than Ndegrees

Prevent internal or eternal rotation byusing sandbags, pillows, trochanter rolls

After surgery


212/237

0treme eternal rotationaccompanied by severe Pain ---displaced hip prosthesis


213/237


214/237


215/237

Amputation


216/237

Etolo+y a"d pathophysolo+y !" Refers to the removal of a body

part as a result of trauma or

surgical intervention

%" *ecessitated by/

a" Malignant tumor

b" Trauma

c" Acute arterial insufficiency

Amputation Therapeutc "ter/e"to"s

!" :elow-the-knee amputation 3:CA4common in peripheral


217/237

common in peripheral

vascular disease6 facilitates successfuladaptation to prosthesis

because of retained knee function

%" Above-the-knee amputation 3ACA4necessitated by trauma or

etensive disease

(" 7pper etremity amputation usuallynecessitated by severe

trauma, malignant tumors, or congenital

Amputation


218/237

Assessme"t !" *eurovascular status of involved

etremity

%" 8istory to determine

a" &ausative factors b" 8ealth problems that can compromise

recovery

(" &lientQs understanding of the etent ofthe surgery

" &lientQs coping skills

Q

Amputation


219/237

Assessme"t !" *eurovascular status of involved

etremity

%" 8istory to determine

a" &ausative factors b" 8ealth problems that can compromise

recovery

(" &lientQs understanding of the etent ofthe surgery

" &lientQs coping skills

Q

Amputation ,la"""+0mpleme"tato"

!" Provide care preoperatively


220/237

a" 'nitiation of eercises to strengthen musclesof etremities in

preparation for crutch walking

b" &oughing and deep-breathing eercises

c" 0motional support for anticipated alterationin body image

%" Monitor vital signs and stump dressing forsigns of hemorrhage

(" 0levate stump for !% to % hours to decreaseedema6 remove

pillow after this time to promote functional

Amputation " Provide stump care


221/237

a" Maintain elastic bandage to shrink and shapestump in

preparation for prosthesis

b" Fhen wound is healed, wash stump daily,

avoiding the use of oils, which may causemaceration

c" Apply pressure to end of stump withprogressively firmer surfaces to toughen stump

d" 0ncourage client to move the stump

e" Place the client with a lower etremityamputation in a prone position twice daily to

$heumatod Arthrts


222/237

0tiology and pathophysiology !" &hronic disease characteri


223/237

&linical findings !" #ubjective

a" 1atigue

b" Malaise c" ;oint pain

d" #tiffness after periods of inactivity,particularly in the morning

e" Paresthesia f" Anoreia

Rheumatoid arthritis


224/237

+bjective

a" Anemia

b" Feight loss

c" ;oint inflammation and deformity

d" #ubcutaneous nodules

e" 0levated sedimentation rate

f" ow-grade fever

g" Presence of rheumatoid factors in serumidentified by late fiation test

h" Positive &-reactive protein and antinuclearantibod A*A tests



225/237

Therapeutic interventions !" &orticosteroids, antiinflammatories,

analgesics, immunosuppressive drugs6 aspirin is drug

of choice followed by the addition of

nonsteroidal antiinflammatory drugs andthen gold or penicillamine, an oral chelatingagent6 corticosteroids are reserved foracute inflammation, if possible

%" Physiotherapy to minimi


226/237

" Application of heat or cold6 paraffindips of affected etremity for

relief of joint pain by providinguniform heat

=" Plasmapheresis may be used whenthe disease is advanced



227/237

Assessme"t !" 8istory of onset and progression of

symptoms, noting degree to

which pain interferes with normalactivities

%" 1amily history of rheumatoidarthritis

(" >eneral physical health

" &oping skills



228/237

,la"""+0mpleme"tato" !" Administer analgesics and other

medications as ordered %" Teach the client to take medications as

ordered and observe foraspirin toicity

3tinnitus, bleeding4 and other adverseeffects of medications

(" Apply heat and cold as ordered6 heatparaffin to !%=o to !%No 1 3=%o to =o &4

" Promote rest and position to ease jointpains =" Provide for range-of-motion eercises up

to the point of pain,



229/237

?" 0mphasi


230/237

!!" 0ncourage diet rich in nutrient-densefoods such as fruits, vegetables, wholegrains, and legumes to improve andmaintain nutritional status and compensatefor nutrient interactions of corticosteroid

and other treatment medications 9. E/aluato"Outcomes !" 0periences a reduction in pain %" &ompletes activities of daily living using

supportive devices as needed (" Accepts life-style consistent with abilities " Maintains or improves range of motion of

involved joints

Osteoarthrts9e+e"erat/e Bo"t


231/237

0tiology and pathophysiology !" 0tiology relates to wear and tear ofjoints6 predisposing factors

include obesity, aging, and jointtrauma

%" A degeneration and atrophy of thecartilages and calcification of

the ligaments

(" Primarily affects weight-bearingjoints, spine, and hands

Osteoarthrts


232/237

&linical findings !" #ubjective a" Pain after eercise b" #tiffness of joints

%" +bjective a" 8eberdenQs and :ouchardQs nodes

symmetrically occurring on fingers 3bony hypertrophy4

b" Decreased range of motion c" &repitus when joint is moved

Osteoarthrts


233/237

Therapeutic interventions !" Feight reduction in instances of

obesity

%" ocal heat to affected joints

(" Medications to reduce symptoms,such as analgesics, antiinflammatoryagents, and steroids

" 0ercise of affected etremities

Osteoarthrts


234/237

=" #urgical intervention a" #ynovectomy/ removal of the enlarged

synovial membrane before bone and cartilage destruction

occurs

b" Arthrodesis/ fusion of a joint performedwhen the joint

surfaces are severely damaged6 this leavesthe client with no

range of motion of the affected joint c" Reconstructive surgery/ replacement of a

badly damaged


235/237

Assessme"t !" 8istory for risk factors such as

obesity, trauma, athletic

involvement, and occupation

%" ;oints, noting evidence ofdeformities, inflammation, and muscle

atrophy

(" 0tent of range of motion ofinvolved joints


236/237

,la"""+0mpleme"tato" !" Assist client in activities that reBuire usingaffected joints6 allow for rest periods

%" Maintain functional alignment of joints (" Attempt to relieve the clientQs discomfort and

edema by the use of medications or theapplication of heat as ordered " Allow client ample time to verbali


237/237

" Provide care for the client reBuiring jointreplacement 3see *ursing &are of &lientswith 1ractures of the 8ips4

9" Refer client and family to the Arthritis1oundation

9. E/aluato"Outcomes !" Reports a reduction in pain %" &ompletes activities of daily living using

supportive devices as needed

Date post:	13-Apr-2018
Category:	Documents
Upload:	maria-visitacion
View:	267 times
Download:	4 times

6383448 Orthopedic Nursing

Documents