95801587 Musculoskeletal Disorders

  • View
    214

  • Download
    0

Embed Size (px)

Text of 95801587 Musculoskeletal Disorders

  • 7/28/2019 95801587 Musculoskeletal Disorders

    1/53

    Musculoskeletal

    Disorders

    Prepared by:

    Wilfredo A. Dela Cerna, RN

  • 7/28/2019 95801587 Musculoskeletal Disorders

    2/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    3/53

    - 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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    4/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    5/53

    Muscle weakness

    Diagnostic Tests

    Xray

    CBC; anemia is common

    ESR elevated

    Rheumatoid factor (POSITIVE)

  • 7/28/2019 95801587 Musculoskeletal Disorders

    6/53

    Treatment

    Pharmacologic Agents

    Salicylates

    NSAIDs

    Corticosteroids

    Methotrexate

  • 7/28/2019 95801587 Musculoskeletal Disorders

    7/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    8/53

    - common sites are weight-bearing joints and terminal

    interphalangeal joints of fingers

    Clinical Manifestations

    Pain and stiffness of jointsHeberdens nodes

    Bouchards nodes

    Decreased ROM

  • 7/28/2019 95801587 Musculoskeletal Disorders

    9/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    10/53

    Diagnostic Tests

    X-ray

    Elevated ESR

    Treatment: SAME with RA

  • 7/28/2019 95801587 Musculoskeletal Disorders

    11/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    12/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    13/53

    Clinical Manifestations

    Joint pain, redness, heat,

    swelling; commonly affectedsites are great toe, ankle

    Headache

    MalaiseAnorexia

    Diagnostic Tests

    X-Ray

    Serum Uric Acid Evaluation

  • 7/28/2019 95801587 Musculoskeletal Disorders

    14/53

    Management

    Drug therapy

    ColchicineNSAIDs

    Uricosuric Agent

    Analgesics

    Diet: Low purine

    Joint rest and protection

  • 7/28/2019 95801587 Musculoskeletal Disorders

    15/53

    Nursing Interventions

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    16/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    17/53

    Clinical Manifestations

    Pain, aggravated by motion

    Loss of motionEdema on the site

    Hematoma/ discoloration

    Assymetry

    Diagnostic Tests

    X-Ray

  • 7/28/2019 95801587 Musculoskeletal Disorders

    18/53

    Management

    TractionReduction

    Application of a Casts

  • 7/28/2019 95801587 Musculoskeletal Disorders

    19/53

    Nursing Interventions

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    20/53

    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.

  • 7/28/2019 95801587 Musculoskeletal Disorders

    21/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    22/53

    Basis for Traction Usage:

    1. Patients condition2. Age

    3. Weight

    4. Skin condition

    5. Duration of traction to beapplied

    6. Purpose of traction

  • 7/28/2019 95801587 Musculoskeletal Disorders

    23/53

    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)

  • 7/28/2019 95801587 Musculoskeletal Disorders

    24/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    25/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    26/53

    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.

  • 7/28/2019 95801587 Musculoskeletal Disorders

    27/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    28/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    29/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    30/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    31/53

  • 7/28/2019 95801587 Musculoskeletal Disorders

    32/53

    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.

  • 7/28/2019 95801587 Musculoskeletal Disorders

    33/53

    Complications of Traction

    1. Pressure sores

    2. Muscle atrophy3. Weakness

    4. Contractures

    5. GI disturbances

    6. Respiratory problems

    7. Circulatory problems

    8. Osteomyelitis

  • 7/28/2019 95801587 Musculoskeletal Disorders

    34/53

    Key Nursing Diagnoses

    1. Constipation related to

    immobility2. Impaired physical mobility

    related to restrictions

    associated with traction3. Impaired tissue integrity

    related to immobility

  • 7/28/2019 95801587 Musculoskeletal Disorders

    35/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    36/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    37/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    38/53

    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

  • 7/28/2019 95801587 Musculoskeletal Disorders

    39/53

    11. Check carefully for ordersabout turning

    Bu