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8/22/2019 Bb Musculoskeletal Fall12
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Musculoskeletal Deficits
Kimberly Ambruso, RN, MS
NU 102
Fall 2012
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Musculoskeletal A&P
Function of bones
Protect
Stabilize
Surface for muscles
Reservoir for storage of
minerals Hematopoesis
Pediatric Differences
Musculoskeletal development of
neonates and infants is immature
better chance of
correcting or preventingfurther progression of
abnormalitiesPeriosteum:provides
nourishment to the bone.Thicker in children fasterhealing
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Musculoskeletal Assessment
X-ray
Bone scan
Electromyography
Muscle or bone biopsy
Arthroscopy
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Fractures
Common in children
Most frequently broken bone in child?
Causes:
Children
Adults
Methods of treatment different in pediatricsthan in older adult population
Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 4
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Types of Fractures
Compound or
open Complicated
Comminuted
Greenstick
Mosby items and derived items 2007,2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 5
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Clinical Manifestations of
Fracture
Generalized
swelling
Pain or tenderness
Diminished
functional use
May have bruising,
severe muscularrigidity, crepitus
5 Ps of Fractures
Pain and point of tenderness
Pulsedistal to the fracture site
Pallor
Paresthesiasensation distal to
the fracture site
Paralysismovement distal tothe fracture site
Slide 6
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Cast Care
Drying time
Turn Q2hrs while
drying Handling wet cast
Elevate casted
extremity
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Cast Care
Nursing care
Skin
Pain
Neurovascular
Compartment syndrome
Eating/diet
Body image and
socialization
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Splints
Purpose:
Immobilization
Support
Allows more room forswelling
Fewer complications
Braces
Purpose:
Provide support
Control movement
Prevention of further injury
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Reduction
Open Fractures
Followed by fixation
ORIF
Closed Fractures
Dislocations
Followed by immobilization
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Traction
Traction: extended pulling force may be used to:
Provide rest for an extremity
Help prevent or improve contracture deformity
Correct a deformity
Treat a dislocation
Allow position and alignment
Provide immobilization
Reduce muscle spasms (rare in children)
Mosby items and derived items 2007,
2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 12
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Traction: Essential Components
Traction: forward force produced by attaching weight
to distal bone fragment
Adjust by adding or subtracting weights
Countertraction: backward force provided by bodyweight
Increase by elevating foot of bed
Traction must be continuous Weights must hang freely
Mosby items and derived items 2007,
2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 13
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Types of Traction
Skin traction
Non-invasive
Secured by straps and
bandages Bucks: most common
Skeletal traction
Surgically inserted rods/bars
into the bone, through the
skin Serious potential for
infection
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Hip Replacement
Indications
Osteoarthritis
Rheumatoid arthritis
Trauma
Congenital abnormalities
Procedure
Titanium or cobalt ball and
socket
Socket is cemented into
acetabulum
Pre-Op
Assessing risks for
complications
Obesity
Cardiac
Age
Varicose veins
History of DVT, emboli
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Total Hip Replacement
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Hip Replacement Nursing Care
Post-op
Standard post-op
Prevention of infection
Hemodynamics
DVT prophylaxis
Wound drainage
Positioning
Abduction
Flexion rotation
Ambulation
PT begins immediately
Patient Education
Total Hip Precautions
No bending
No adduction
Hip cannot flex past 90degrees
No internal rotation
No external rotation
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Complications
Skin
Skin Breakdown
Nerve Damage
foot drop
Circulatory impairment
DVT
Skeletal
Infection
osteomyelitis
Shock
Skin Pin care
Nerve damage
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Compartment Syndrome
Increased pressure within
the muscle
lack of oxygen to thetissues
damage to blood
vessels and nerve and
muscle cells
EMERGENCY!!
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Compartment Syndrome
Remove cast!!!
Elevate extremity
Fasciotomy
Dont forget to do
neurovascular
checks!!
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Osteomyelitis
Causes:
Extension of soft-tissue
infection
Direct bonecontamination
Bloodborne spread from
another site of infection
Manifestations:
localized pain, edema,
erythema, fever, and
drainage
Interventions
Promote nutrition
vitamin C and protein
Encourage adequate hydration
Administer and monitor antibiotic
therapy
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Other Complications
Pressure Ulcers
Pressure on bony
prominence under
cast or brace Pain/tightness in area
Warm sensation in
area
Foul odor, drainage
Removal of cast
Disuse Syndrome
Resulting from immobility
Muscle atrophy
Isometric exercises
Muscle setting exercises
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Developmental Dysplasia
of the HipThe head of the femur isimproperly seated in the
acetabulum
A&P: ball and socket
More common in
caucasians, females and
first born children
Asymmetry of gluteal skin foldsupon extension of legs
Ortolanis sign
Barlows sign
Limited ROM
Lop-sided
Gait changes
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Mosby items and derived items 2007,
2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 27
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Hip Dysplasia- Manifestations
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Ortolani / Barlow
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Pavlik Harness
Maintains flexion,abduction and external
rotation
Initially worn continuously
Improper positioningavascular necrosis
Straps need adjustments at
regular intervals
Nursing care
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Hip Dysplasia Management
-Bryants Traction
Purpose
Nursing considerations-Spica Cast
-Surgery
Osteotomy, with possible
tendon release
http://jamasters.smugmug.com/photos/131807575-L.jpg8/22/2019 Bb Musculoskeletal Fall12
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Scoliosis
Lateral curvature of the spineand spinal rotation
Severity
Mild: 10-20 degrees Moderate: 20-40 degrees
Severe: > 40 degrees
Etiology
Idiopathic Congenital
Neuromuscular: MuscularDystrophy, CP, Spina Bifida
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Scoliosis
Assessment
Screening
Asymmetry of ribs, flanks
upon exam
Adams test
Leg length discrepancy
X-Rays on spine, thorax
Management
Mild: wait and see
Moderate: Milwaukee Brace
/ TLSO Purpose
Nursing implications
Severe: surgery
Spinal fusion
Harrington Rod
Post-op
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Milwaukee Brace
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TLSO Boston Brace
Mosby items and derived items 2007,
2003 by Mosby, Inc., an affiliate of Elsevier
Inc.
Slide 36
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Nursing Considerations
Concerns of body image
Concerns of prolonged treatment of condition
Preoperative care
Postoperative care
Mosby items and derived items 2007,
2003 by Mosby Inc an affiliate of Elsevier Slide 37