Musculoskeletal Disorders

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common disorders and diseases of musculoskeletal system. includes assessment findings, treatment, diagnostic tests, etc.. Great for study!

Text of Musculoskeletal Disorders

MUSCULOSKELETAL SYSTEM DISORDERS

PYRAMID POINTS Assessment findings in a fracture Initial care of a fracture Various types of traction Nursing care of the client in traction Client education for the use of a halo device Client education related to crutch walking Client education related to the use of a cane

or walker

PYRAMID POINTS Assessment findings and interventions for

complications of a fracture Care of the client following hip pinning and hip prosthesis Care of the client following total knee replacement Treatment measures for the client with a herniated intervertebral disc Care of the client following disc surgery

PYRAMID POINTS Interventions following amputation Treatment modalities for the client with

rheumatoid arthritis Client education related to osteoporosis Client education related to gout

INJURIES STRAINS

An excessive stretching of a muscle or tendon Management involves cold and heat applications, exercise with activity limitations, antiinflammatory medications, and muscle relaxants Surgical repair may be required for a severe strain (ruptured muscle or tendon)

INJURIES SPRAINS An excessive stretching of a ligament usually caused by a twisting motion Characterized by pain and swelling Management involves rest, ice, and a compression bandage to reduce swelling and provide joint support Casting may be required for moderate sprains to allow the tear to heal Surgery may be necessary for severe ligament damage

INJURIES ROTATOR CUFF INJURIES Musculotendinous or rotator cuff of the shoulder sustains a tear usually as a result of trauma Characterized by shoulder pain and the inability to maintain abduction of the arm at the shoulder (drop arm test) Management involves nonsteroidal antiinflammatory drugs (NSAIDs), physical therapy, sling support, and ice/heat applications Surgery may be required if medical management is unsuccessful or for those who have a complete tear

FRACTURES DESCRIPTION

A break in the continuity of the bone caused by trauma, twisting as a result of muscle spasm or indirect loss of leverage, or bone decalcification and disease that result in osteopenia

TYPES OF FRACTURES CLOSED OR SIMPLE

Skin over the fractured area remains intact One side of the bone is broken and the other is bent; most commonly seen in children

GREENSTICK

TRANSVERSE The bone is fractured straight across OBLIQUE

The break extends in an oblique direction

TYPES OF FRACTURES SPIRAL The break partially encircles bone COMMINUTED The bone is splintered or crushed, with three or more fragments COMPLETE The bone is completely separated by a break into two parts INCOMPLETE A partial break in the bone

TYPES OF FRACTURES OPEN-COMPOUND

The bone is exposed to air through a break in the skin, and soft tissue injury and infection are common A part of the fractured bone is driven into another bone Bone fragments are driven inward

IMPACTED

DEPRESSED

TYPES OF FRACTURES COMPRESSION

A fractured bone compressed by other bone A fracture due to weakening of the bone structure by pathological processes, such as neoplasia or osteomalacia; also called spontaneous fracture

PATHOLOGICAL

TYPES OF FRACTURES

From Ignativicius, D. & Workman, M. (2002). Medical-surgical nursing, ed 4, Philadelphia: W.B. Saunders.

FRACTURE OF AN EXTREMITY ASSESSMENT

Pain or tenderness over the involved area Loss of function Obvious deformity Crepitation Erythema, edema, ecchymosis Muscle spasm and impaired sensation

FRACTURE OF AN EXTREMITY INITIAL CARE

Immobilize affected extremity If a compound fracture exists, splint the extremity and cover the wound with a sterile dressing

INTERVENTIONS FOR A FRACTURE Reduction Fixation Traction Casts

REDUCTION DESCRIPTION

Restoring the bone to proper alignment

REDUCTION CLOSED REDUCTION

Performed by manual manipulation May be performed under local or general anesthesia A cast may be applied following reduction

CLOSED REDUCTION

From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B. Saunders.

REDUCTION OPEN REDUCTION

Involves a surgical intervention May be treated with internal fixation devices The client may be placed in traction or a cast following the procedure

FIXATION INTERNAL FIXATION

Follows open reduction Involves the application of screws, plates, pins, or nails to hold the fragments in alignment May involve the removal of damaged bone and replacement with a prosthesis Provides immediate bone strength Risk of infection is associated with the procedure

INTERNAL FIXATION

From Browner BB et al (1992) Skeletal trauma. Philadelphia: W.B. Saunders.

FIXATION EXTERNAL FIXATION

An external frame is utilized with multiple pins applied through the bone Provides more freedom of movement than with traction

EXTERNAL FIXATION

From Ignatavicius, D., Workman, M. (2002). Medical-surgical nursing, ed 3, Philadelphia: W.B. Saunders. Courtesy of Smith and Nephew, Inc., Orthopedics Division, Memphis, TN.

TRACTION DESCRIPTION

The exertion of a pulling force applied in two directions to reduce and immobilize a fracture Provides proper bone alignment and reduces muscle spasms

TRACTION IMPLEMENTATION Maintain proper body alignment Ensure that the weights hang freely and do not touch the floor Do not remove or lift the weights without a physicians order Ensure that pulleys are not obstructed and that ropes in the pulleys move freely Place knots in the ropes to prevent slipping Check the ropes for fraying

SKELETAL TRACTION DESCRIPTION Mechanically applied to the bone using pins, wires, or tongs IMPLEMENTATION Monitor color, motion, and sensation (CMS) of the affected extremity Monitor the insertion sites for redness, swelling, or drainage Provide insertion site care as prescribed

SKELETAL TRACTION

From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W.B. Saunders.

CERVICAL TONGS AND HALO FIXATION DEVICE Head and Spinal Cord Injuries

SKIN TRACTION DESCRIPTION

Traction applied by the use of elastic bandages or adhesive

SKIN TRACTION: SIDE ARM

From Monahan, F. & Neighbors, M. (1998). Medical-surgical nursing: Foundations for clinical practice, ed 2, Philadelphia: W.B. Saunders.

TYPES OF SKIN TRACTION Cervical traction Bucks traction Bryants traction Pelvic traction Russells traction

CERVICAL SKIN TRACTION Relieves muscle spasms and compression in

the upper extremities and neck Uses a head halter and a chin pad to attach the traction Use powder to protect the ears from friction rub Position the client with the head of the bed elevated 30 to 40 degrees and attach the weights to a pulley system over the head of the bed

CERVICAL SKIN TRACTION

From James, S. Ashwill, R., & Droske, S. (2002). Nursing care of children, ed 2, Philadelphia: W.B. Saunders.

HEAD HALTER TRACTION

From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensens medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

BUCKS SKIN TRACTION Used to alleviate muscle spasms; immobilizes

a lower limb by maintaining a straight pull on the limb with the use of weights A boot appliance is applied to attach to the traction Weight is attached to a pulley; allow the weights to hang freely over the edge of bed Not more than 5 pounds of weight should be applied Elevate the foot of the bed to provide the traction

BUCKS SKIN TRACTION

From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensens medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

BRYANTS AND RUSSELLS SKIN TRACTION Refer to the module entitled Pediatric

Nursing, Musculoskeletal Disorders for information related to these types of traction

PELVIC SKIN TRACTION Used to relieve low back, hip, or leg pain and

to reduce muscle spasm Apply the traction snugly over the pelvis and iliac crest and attach to the weights Use measures as prescribed to prevent the client from slipping down in bed

PELVIC SKIN TRACTION

From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensens medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

BALANCED SUSPENSION DESCRIPTION

Used with skin or skeletal traction Used to approximate fractures of the femur, tibia, or fibula Produced by a counterforce other than client

BALANCED SUSPENSION

From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensens medical-surgical nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

BALANCED SUSPENSION IMPLEMENTATION Position the client in low Fowlers, either on the side or back Maintain a 20-degree angle from the thigh to the bed Protect the skin from breakdown Provide pin care if pins are used with the skeletal traction Clean the pin sites with sterile normal saline and hydrogen peroxide or Betadine as prescribed or per agency procedure

DUNLOPS SKIN TRACTION DESCRIPTION

Horizontal traction to align fractures of the humerus; vertical traction maintains the forearm in proper alignment Nursing care is similar to Bucks traction

IMPLEMENTATION

DUNLOPS SKIN TRACTION

From Mosbys Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.

CASTS DESCRIPTION

Made of plaster or fiberglass to provide immobilization of bone