95801587 Musculoskeletal Disorders

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Musculoskeletal

Disorders

Prepared by:

Wilfredo A. Dela Cerna, RN


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Rheumatoid Arthritis (RA)

- chronic systemic disease

characterized by inflammatorychanges in the joints and relatedstructures

- common in women than in men- may occur at any age but thepeak is usually between 35-50

years old- IDIOPATHIC cause, said to bean autoimmune problem


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- associated with viral and bacterialinfections, lifestyle and hormonalfactors

Clinical Manifestations

Fatigue

Anorexia

Malaise

Painful joints, warm, swollen, limitedin motion, stiff in morning and period

after inactivity


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Muscle weakness

Diagnostic Tests

Xray

CBC; anemia is common

ESR elevated

Rheumatoid factor (POSITIVE)


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Treatment

Pharmacologic Agents

Salicylates

NSAIDs

Corticosteroids

Methotrexate


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Osteoarthritis

- the most common form of

arthritis- a chronic deterioration and anonsystemic disorder of the joint

cartilage and formation of areactive new bone at the marginsubchondral areas of the joints.

- IDIOPATHIC cause- associated with aging, obesityand trauma


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- common sites are weight-bearing joints and terminal

interphalangeal joints of fingers


Pain and stiffness of jointsHeberdens nodes

Bouchards nodes

Decreased ROM


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Diagnostic Tests

X-ray

Elevated ESR

Treatment: SAME with RA


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Nursing Interventions

1. Administer analgesics/ anti-

inflammatory2. Provide emotional support

3. Encourage patient to perform as

much self-care as his immobilityand pain allow.

4. Promote rest periods and

comfort


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Gout

- a disorder in the purine

metabolism; causes high levelsof uric acid in the blood and theprecipitation of urate crystals inthe joints and in the kidneys.

- more common in men than inwomen

- familial tendency


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Joint pain, redness, heat,

swelling; commonly affectedsites are great toe, ankle

Headache

MalaiseAnorexia

Diagnostic Tests

X-Ray

Serum Uric Acid Evaluation


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Management

Drug therapy

ColchicineNSAIDs

Uricosuric Agent

Analgesics

Diet: Low purine

Joint rest and protection


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1. Assess joints for pain, motion,

appearance2. Provide bed rest and joint

immobilization

3. Administer antigoutmedications as ordered.

4. Administer analgesics as

ordered.5. Increase OFI to 2000-3000ml

per day


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Fractures

- a break in the continuity of the

bone usually caused by traumaTypes

1. Open or Compound

2. Closed or Simple3. Transverse

4. Oblique

5. Spiral

6. Greenstick


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Pain, aggravated by motion

Loss of motionEdema on the site

Hematoma/ discoloration

Assymetry

Diagnostic Tests

X-Ray


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Management

TractionReduction

Application of a Casts


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1. Provide emergency care for

fractures.2. Perform a neurovascular check

on affected extremity

3. Observe for signs andsymptoms of CompartmentSyndrome.

4. Observe for signs andsymptoms of Fat embolism


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5. Encourage diet high in proteinand vitamins to promote healing.

6. Encourage fluid to preventconstipation, renal calculi andUTI.

7. Provide care for client intraction, with a casts or withopen reduction.


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TRACTIONS

- used to treat fractures,dislocations, correct or preventdeformities, improve or correct

contractures or decrease musclespasms by exerting a pullingforce on a part of the body


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Basis for Traction Usage:

1. Patients condition2. Age

3. Weight

4. Skin condition

5. Duration of traction to beapplied

6. Purpose of traction


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Types of Traction

1. Skin Traction

- 5 to 8 lbs (2.5 to 3.5 kg)

2. Skeletal Traction

- 25 to 40 lbs (11.5 to 18 kg)


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SKIN TRACTION

Types:

1. Bucks Traction- exerts straight pull on

affected extremity

- generally used to temporarilyimmobilize the leg in a clientwith a fractured hip

- shock blocks at the foot of

the bed to producecountertraction and prevent theclient from sliding down in bed


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2. Russell Traction

- knee is suspended in a sling

attached to a rope and pulley onthe Balkan Frame

- generally used to stabilize

fractures of the femoral shaftwhile client is awaiting forsurgery.


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3. Cervical Traction

- cervical head halter attached to

weights hang over head of bed- used for soft tissue damage ordegenerative disc disease of

cervical spine and to maintainalignment

- elevate the head of the bed to

produce countertraction


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4. Pelvic Traction

- pelvic girdle with extension

straps attached to ropes andweights

- used for low back pain to

reduce muscle spasms andmaintain alignment

- client in SEMI-FOWLERS with

KNEE BENT


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SKELETAL TRACTION

- traction is applied directly tothe bones using pins, wires, ortongs (Crutchfield Tongs) that

are surgically inserted.- used for fractured femur, tibia,humerus and cervical spine.


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Complications of Traction

1. Pressure sores

2. Muscle atrophy3. Weakness

4. Contractures

5. GI disturbances

6. Respiratory problems

7. Circulatory problems

8. Osteomyelitis


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Key Nursing Diagnoses

1. Constipation related to

immobility2. Impaired physical mobility

related to restrictions

associated with traction3. Impaired tissue integrity

related to immobility


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Nursing Intervention

The nurses main responsibility

includes patient teaching,maintaining traction apparatus,assessing for complications andcaring for pins in insertion sites.

Nursing Care:

1. Check traction apparatusfrequently to ensure that:

a. Ropes are aligned and weightsare hanging freely


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b. Bed in proper position

c. Line of traction is within the

long axis of the bone2. Maintain client in proper

alignment

a. Align in center of bedb. DO NOT rest affected limb

against foot of bed

3. Perform neurovascular checksto affected extremity.

4 Ob f d t


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4. Observe for and preventfootdrop

a. Provide footplate

b. Encourage plantarflexion anddorsiflexion

5. Observe for and prevent deep

venous thrombosis6. Observe for and prevent skin

irritation and breakdown

Russell Traction: popliteal areaThomas Splint: popliteal area


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Cervical: pad chin area andprotect ears

7. Provide pin care8. Assist with ADL; provide

overhead trapeze to facilitate

moving, using bedpan9. Prevent complications of

immobility

10. Encourage active ROMexercises to unaffected extremity


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11. Check carefully for ordersabout turning

Bucks Traction: client may turn tounaffected side (place pillowsbetween legs before turning)

Russell Traction: client may turnslightly from side to side withoutturning body below the waist


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CASTS

- used to immobilize a body part

Casting Materials:1. Plaster of Paris

- takes 24 72 hours to dry

- precautions must be takenuntil cast is dry to preventdents

- signs of a dry casts: SHINYWHITE, HARD, RESISTANT

t b k t d i t


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- must be kept dry since watercan ruin a plaster cast

2. Synthetic Casts (Fiberglass)- strong, lightweight; sets inabout 20 minutes

- can be dried using cast dryer orhair blowdryer on cool setting

- water-resistant; however it

must be dried thoroughly toprevent skin problem under thecast

C t D i ( Pl t C t)


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Cast Drying ( Plaster Cast)

1. Use palms of hands, NOT

FINGERTIP, to support castwhen moving or lifting client

2. Support cast on rubber or

plastic protected pillows withcloth pillowcase along length ofcast until dry

3. Turn client every 2 hours toreduce pressure and promotedrying


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4. DO NOT cover the cast until it isdry (may use fan to facilitate

drying)5. DO NOT use heat lamp or hair

dryer on plaster cast

Nursing Care for Clients with Cast:

1. Perform neurovascular checks

to area distal to cast:


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a. Report absent or diminishedpulse, cyanosis or blanching,

coldness, lack of sensation orinability to move fingers ortoes, and excessive swelling

b. Report complaints of burning,tingling or numbness

2. Note any odor from the castthat may indicate infection

3. Note any bleeding on cast in asurgical patient


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4. Check for hot spots that mayindicate inflammation under cast.

5. Instruct the patient to wiggletoes or fingers

6. Elevate the affected extremity

above the heart7. DO NOT scratch or insert foreign

objects under cast

8. Avoid eating crackers while oncasts

ASSISTIVE DEVICES fo WALKING


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ASSISTIVE DEVICES for WALKING:

1. Cane

Nursing Care: Teach client tohold cane in hand oppositeaffected extremity and to

advance cane at the same timethe affected leg is movedforward

2 Walker


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2. Walker

Nursing Care: Teach client tohold upper bars of walker at eachside, then to move the walkerforward and step into it.

3. Crutches

- when the client assumes erectposition the top of crutch mustbe 2 INCHES below the axilla,and the tip of each crutch is 6INCHES in front and sides of thefeet


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clients elbow should be


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- clients elbow should beslightly flexed when head is onhand grip

- weight should NOT be borneby the axilla.

CRUTCH GAITS:a. FOUR-POINT GAIT

- used when weight bearing is

allowed on both extremities

Ad th i ht t h


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a. Advance the right crutch

b. Step forward with left foot

c. Advance left crutchd. Step forward with right foot

b. TWO-POINT GAIT

- typical walking pattern

- an acceleration of Four-pointgait

a Step forward moving both right


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a. Step forward moving both rightcrutch and left leg simultaneously

b. Step forward moving both leftcrutch and right legsimultaneously.

c. THREE-POINT GAIT

- used when weight bearing is

permitted on one extremity only

a Advance both crutches and


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a. Advance both crutches andaffected extremity severalinches, maintaining goodbalance

b. Advance the unaffected leg tothe crutches, supporting theweight of the body on thehands.


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Date post:	03-Apr-2018
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95801587 Musculoskeletal Disorders

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