Nursing Musculoskeletal(SIR TIM)

7/30/2019 Nursing Musculoskeletal(SIR TIM)

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MUSCULO-SKELETAL NURSING


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Review of Anatomy and Physiology

The musculo-skeletal system consists of the

muscles, tendons, bones and cartilage

together with the joints

The primary function of which is to produce

skeletal movements


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Muscles

Three types of muscles exist in the body

1. Skeletal Muscles

Voluntary and striated

2. Cardiac muscles

Involuntary and striated

3. Smooth/Visceral muscles Involuntary and NON-striated
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TENDONS

Bands of fibrous connective tissue that tie

bones to muscles


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LIGAMENTS

Strong, dense and flexible bands of fibrous

tissue connecting bones to another bone


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BONES

Variously classified according to shape, location and

size

Functions

1. Locomotion

2. Protection

3. Support and lever

4. Blood production

5. Mineral deposition


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JOINTS

The part of the Skeleton where two or more

bones are connected


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CARTILAGES

A dense connective tissue that consists of

fibers embedded in a strong gel-like substance
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BURSAE

Sac containing fluid that are located around

the joints to prevent friction


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ASSESMENT OF THE MUSCULO-

SKELETAL SYSTEM

The nurse usually evaluates this small

part of the over-all assessment and

concentrates on the patients posture,body symmetry, gait and muscle and

joint function


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SKELETAL SYSTEM

1. HISTORY

2. Physical Examination

Perform a head to toe assessment

Nurses need to inspect and palpate

The special procedure is the assessment of jointand muscle movement

Usually, a tape measure and a protractor are theonly instruments


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ASSESSMENT OF THE MUSCULO-

SKELETAL SYSTEM

Gait

Posture

Muscular palpation Joint palpation

Range of motion

Muscle strength


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SKELETAL SYSTEMLABORATORY PROCEDURES

1. BONE MARROW ASPIRATION

Usually involves aspiration of the marrow to diagnosediseases like leukemia, aplastic anemia

Usual site is the sternum and iliac crest

Pre-test: Consent

Intratest: Needle puncture may be painful

Post-test: maintain pressure dressing and watch out forbleeding


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SKELETAL SYSTEM

LABORATORY PROCEDURES

2. Arthroscopy

A direct visualization of the joint cavity

Pre-test: consent, explanation of procedure,NPO

Intra-test: Sedative, Anesthesia, incision willbe made

Post-test: maintain dressing, ambulation assoon as awake, mild soreness of joint for 2days, joint rest for a few days, ice applicationto relieve discomfort


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3. BONE SCAN

Imaging study with the use of a contrast radioactive material

Pre-test: Painless procedure, IV radioisotope is used, nospecial preparation,pregnancy is contraindicated

Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning

Post-test: Increase fluid intake to flush out radioactive

material


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4. DXA- Dual-energy XRAY absorptiometry

Assesses bone density to diagnose osteoporosis

Uses LOW dose radiation to measure bone density Painless procedure, non-invasive, no special

preparation

Advise to remove jewelry


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Common musculoskeletal problems

The Nursing Management


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Nursing Management of common musculo-skeletal

problems

PAIN

These can be related to joint inflammation, traction,

surgical intervention

1. Assess patients perception of pain

2. Instruct patient alternative pain management like

meditation, heat and cold application, TENS and

guided imagery


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Nursing Management

PAIN

3. Administer analgesics as prescribed

Usually NSAIDS

Meperidine can be given for severe pain

4. Assess the effectiveness of pain measures


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Nursing Management

IMPAIRED PHYSICAL MOBILITY

1. Instruct patient to perform range of motionexercises, either passive or active

2. Provide support in ambulation with assistivedevices

3. Turn and change position every 2 hours

4. Encourage mobility for a short period and provide

positive reinforcements for small accomplishments


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Nursing Management

SELF-CARE DEFICITS

1. Assess functional levels of the patient

2. Provide support for feeding problems Place patient in Fowlers position

Provide assistive device and supervise mealtime

Offer finger foods that can be handled by patient

Keep suction equipment ready


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Nursing Management

SELF-CARE DEFICITS

3. Assist patient with difficulty bathing and

hygiene

Assist with bath only when patient has difficulty

Provide ample time for patient to finish activity


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Musculoskeletal Modalities

Traction

Cast


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Nursing Management

Traction

A method of fracture immobilization by

applying equipments to align bone fragments

Used for immobilization, bone alignment and

relief of muscle spasm


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Traction

Skin traction- Buck, Bryant

Skeletal traction-cervical,tibia, overhead armtraction


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Traction

Balanced Suspension traction

Running/Straight traction


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Traction

Pulling force exerted on bones to reduce or

immobilize fractures, reduce muscle spasm,

correct or prevent deformities


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Traction

TO decrease muscle spasms

TO reduce, align and immobilize fractures

To correct deformities


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Nursing Management

Traction: General principles

1.ALWAYS ensure that the weights hang freely and

do not touch the floor

2. NEVER remove the weights

3. Maintain proper body alignment

4. Ensure that the pulleys and ropes are properly

functioning and fastened by tying square knot


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Nursing Management


5. Observe and prevent foot drop

Provide foot plate

6. Observe for DVT, skin irritation and

breakdown

7. Provide pin care for clients in skeletal

traction- use of hydrogen peroxide


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Nursing Management


8. Promote skin integrity

Use special mattress if possible Provide frequent skin care

Assess pin entrance and cleanse the pin with

hydrogen peroxide solution

Turn and reposition within the limits of traction

Use the trapeze


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Nursing Management

CAST

Immobilizing tool made of plaster of Paris or

fiberglass

Provides immobilization of the fracture


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Nursing Management

CAST: types

1. Long arm

2. Short arm

3. Short leg

4. Long leg

5. Spica6. Body cast


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Casting Materials

Plaster of Paris

Drying takes 1-3 days

If dry, it is SHINY, WHITE, hard and resistant

Fiberglass

Lightweight and dries in 20-30 minutes

Water resistant


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Cast application

1. TO immobilize a body part in a specificposition

2. TO exert uniform compression to the

tissue

3. TO provide early mobilization ofUNAFFECTED body part

4. TO correct deformities5. TO stabilize and support unstable joints


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Nursing Management

CAST: General Nursing Care

1. Allow the cast to air dry (usually 24-72

hours)

2. Handle a wet cast with the PALMS not

the fingertips


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Nursing Management


3. Keep the casted extremity ELEVATED

using a pillow

4. Turn the extremity for equal drying. DO

NOT USE DRYER for plaster cast

Encourage mobility and range of motion

exercises


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Nursing Management


5. Petal the edges of the cast to

prevent crumbling of the edges

6. Examine the skin for pressure

areas and Regularly check thepulses and skin


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Nursing Management


7. Instruct the patient not to place

sticks or small objects inside the cast 8. Monitor for the following:pain,

swelling, discoloration, coolness,

tingling or lack of sensation and

diminished pulses


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Nursing Management


Hot spots occurring along the cast may

indicate infection under the cast


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Common Musculoskeletal

conditionsNursing management


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METABOLIC BONE DISORDERS

Osteoporosis

A disease of the bone characterized by a

decrease in the bone mass and density with a

change in bone structure


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Osteoporosis: Pathophysiology

Normal homeostatic bone turnover is

altered rate of bone RESORPTION is greater

than bone FORMATION reduction in total

bone mass reduction in bone mineral

density prone to FRACTURE


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Osteoporosis: TYPES

1. Primary Osteoporosis- advanced age,

post-menopausal

2. Secondary osteoporosis- Steroid overuse,

Renal failure


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RISK factors for the development of Osteoporosis

1. Sedentary lifestyle

2. Age

3. Diet- caffeine, alcohol, low Ca and Vit D

4. Post-menopausal

5. Genetics- caucasian and asian

6. Immobility


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METABOLIC DISORDER

ASSESSMENT FINDINGS

1. Low stature

2. Fracture

Femur

3. Bone pain


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METABOLIC DISORDER

LABORATORY FINDINGS

1. DEXA-scan

Provides information about bone mineral density

T-score is at least 2.5 SD below the young adult

mean value

2. X-ray studies


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METABOLIC DISORDER

Medical management of Osteoporosis

1. Diet therapy with calcium and Vitamin D

2. Hormone replacement therapy

3. Biphosphonates- Alendronate, risedronateproduce increased bone mass by inhibiting the

OSTEOCLAST

4. Moderate weight bearing exercises 5. Management of fractures


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METABOLIC DISORDER

Osteoporosis Nursing Interventions

1. Promote understanding of osteoporosis and thetreatment regimen

Provide adequate dietary supplement of calcium andvitamin D

Instruct to employ a regular program of moderateexercises and physical activity

Manage the constipating side-effect of calciumsupplements


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METABOLIC DISORDER


Take calcium supplements with meals

Take alendronate with an EMPTY stomach

with water

Instruct on intake of Hormonal replacement


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METABOLIC DISORDER


2. Relieve the pain

Instruct the patient to rest on a firm mattress

Suggest that knee flex ion will cause relaxation of

back muscles

Heat application may provide comfort

Encourage good posture and body mechanics

Instruct to avoid twisting and heavy lifting


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METABOLIC DISORDER


3. Improve bowel elimination

Constipation is a problem of calcium

supplements and immobility

Advise intake of HIGH fiber diet and increased

fluids


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METABOLIC DISORDER


4. Prevent injury

Instruct to use isometric exercise to

strengthen the trunk muscles

AVOID sudden jarring, bending and strenuous

lifting

Provide a safe environment

l h d h


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Juvenile rheumatoid Arthritis

Definition:

AUTO-IMMUNE inflammatory joint disorder of

UNKNOWN cause

SYSTEMIC chronic disorder of connective tissue

Diagnosed BEFORE age 16 years old

l h d h


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PATHOPHYSIOLOGY : unknown

Affected by stress, climate and genetics

Common in girls 2-5 and 9-12 y.o.


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Systemic JRA Pauci-articular Polyarticular

FEVERMILD joint pain

and swelling

Morning jointstiffness andfever

Salmon-pinkrash

IRIDOCYCLITISWeightBearing joints

Five or morejoints

Less than 4joints

Five or morejoints

Anorexia,anemia, fatigue

Very Goodprognosis

Poor prognosis

JRA


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JRA

Symptoms may decrease as child enters

adulthood

With periods of remissions and exacerbations

JRA


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JRA

Medical Management

1. ASPIRIN and NSAIDs- mainstay treatment

2. Slow-acting anti-rheumatic drugs

3. Corticosteroids


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DEGENERATIVE JOINT DISEASE


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OSTEOARTHRITIS

The most common form of degenerative joint

disorder



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OSTEOARTHRITIS

Chronic, NON-systemicdisorder of joints



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OSTEOARTHRITIS: Pathophysiology

Injury, genetic, Previous joint damage,

Obesity,Advanced age Stimulate the

chondrocytes to release chemicals

chemicals will cause cartilage

degeneration, reactive inflammation of

the synovial lining and bone stiffening



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OSTEOARTHRITIS: Risk factors

1. Increased age

2. Obesity

3. Repetitive use of joints with previous joint

damage

4. Anatomical deformity

5. genetic susceptibility



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OSTEOARTHRITIS: Assessment findings

1. Joint pain

2. Joint stiffness

3. Functional joint impairment limitation

The joint involvement isASYMMETRICAL

This is not systemic, there is no FEVER, no severe

swelling Atrophy of unused muscles

Usual joint are the WEIGHT bearing joints



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1. Joint pain

Caused by

Inflamed cartilage and synovium

Stretching of the joint capsule

Irritation of nerve endings



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2. Stiffness

commonly occurs in the morning after

awakening

Lasts only for less than 30 minutes

DECREASES with movement, but worsens

after increased weight bearing activitryCrepitation may be elicited



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OSTEOARTHRITIS: Diagnostic findings

1. X-ray

Narrowing of joint space

Loss of cartilage

Osteophytes

2. Blood tests will show no evidence of systemic

inflammation and are not useful



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OSTEOARTHRITIS: Medical management

1. Weight reduction

2. Use of splinting devices to support joints

3. Occupational and physical therapy

4. Pharmacologic management

Use of PARACETAMOL, NSAIDS

Use of Glucosamine and chondroitin

Topical analgesics

Intra-articular steroids to decrease inflam



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OSTEOARTHRITIS: Nursing Interventions

1. Provide relief of PAIN

Administer prescribed analgesics

Application ofheat modalities. ICE PACKS maybe used in the early acute stage!!!

Plan daily activities when pain is less severe

Pain meds before exercising



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2. Advise patient to reduce weight

Aerobic exercise

Walking

3. Administer prescribed medications

NSAIDS



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4. Position the client to prevent flexion

deformity

Use of foot board, splints, wedges and pillows

Rheumatoid arthritis


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A type of chronic systemic inflammatory

arthritis and connective tissue disorder

affecting more women (ages 35-45) than

men



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FACTORS:

Genetic

Auto-immune connective tissue disorders

Fatigue, emotional stress, cold, infection



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Pathophysiology

Immune reaction in the synovium

attracts neutrophilsreleases enzymes

breakdown of collagen irritates the

synovial liningcausing synovial

inflammation edema and pannus

formation and joint erosions and swelling



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ASSESSMENT FINDINGS

1. PAIN

2. Joint swelling and stiffness-SYMMETRICAL,

Bilateral

3. Warmth, erythema and lack of function

4. Fever, weight loss, anemia, fatigue

5. Palpation of join reveals spongy tissue

6. Hesitancy in joint movement



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ASSESSMENT FINDINGS

Joint involvement is SYMMETRICAL andBILATERAL

Characteristically beginning in the hands,wrist and feet

Joint STIFFNESS occurs early morning, lasts

MORE than 30 minutes, not relieved bymovement, diminishes as the day

progresses



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ASSESSMENT FINDINGS

Joints are swollen and warm

Painful when moved

Deformities are common in the hands and

feet causing misalignment

Rheumatoid nodules may be found in thesubcutaneous tissues



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Diagnostic test

1. X-ray

Shows bony erosion

2. Blood studies reveal (+) rheumatoidfactor, elevated ESR and CRP and ANTI-nuclear antibody

3. Arthrocentesis shows synovial fluid thatis cloudy, milky or dark yellow containingnumerous WBCand inflammatory proteins



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MEDICAL MANAGEMENT

1. Therapeutic dose of NSAIDS and Aspirin

to reduce inflammation

2. Chemotherapy with methotrexate,

antimalarials, gold therapyand steroid

3. For advanced cases- arthroplasty,

synovectomy

4. Nutritional therapy



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MEDICAL MANAGEMENT

GOLD THERAPY:

IM or Oral preparation

Takes several months (3-6) before effects

can be seen

Can damage the kidney and causes bonemarrow depression

May NOT work for all individuals



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Nursing MANAGEMENT

1. Relieve pain and discomfort

USE splints to immobilize the affected extremity

during acute stage of the disease andinflammation to REDUCE DEFORMITY

Administer prescribed medications

Suggest application ofCOLD packs during theacute phase of pain, then HEAT application as

the inflammation subsides



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Nursing MANAGEMENT

2. Decrease patient fatigue

Schedule activity when pain is lesssevere

Provide adequate periods of rests

3. Promote restorative sleep



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Nursing Management

4. Increase patient mobility

Advise proper posture and bodymechanics

Support joint in functional position

Advise ACTIVE ROME Avoid direct pressure over the joint



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Nursing Management

5. Provide Diet therapy

Patients experience anorexia, nausea andweight loss

Regular diet with caloric restrictionsbecause steroids may increase appetite

Supplements of vitamins, iron andPROTEIN



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6. Increase Mobility and prevent deformity:

Lie FLAT on a firm mattress

Lie PRONE several times to prevent HIP

FLEXION contracture

Use one pillow under the head because ofrisk of dorsal kyphosis

NO Pillow under the joints because thispromotes flexion contractures



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Capsaicin Unknown mechanism

Reduces pain

Applied over the affected area Do NOT bandage the area

Side effect: burning sensation

Wash hands after application

Hot versus Cold


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Hot versus Cold

HOT Cold

Use to RELIEVE jointstiffness, pain andmuscle spasm

Use to controlinflammation and pain

After acute attack ACUTE ATTACK

OA versus RA


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OA versus RA

RA OA

Onset is early Onset is late

Chronic systemic

disease

Degenerative disease

Involves the synovium Involves the cartilages

Involved joints are

symmetrical- fingers,cervical spine

Involved joints areunilateral- weight

bearing knee, hipsspine

Malaise, fever, anemiaNo other S/SXsystemic

OA versus RA


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OA versus RA

RA OA

Joint tenderness,swelling, warmth andredness

Subcutaneous nodules

Stiffness that dimishes

Crepitus, stiffness in

the morning decreasesafter activity

Rest the joint, cold andheat modalities, ASA,NSAIDS, DMARDS

Rest the joints, Avoid

overactivity, Weightreduction, cold andwarm modalities, ASA

Gouty arthritis


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Gouty arthritis

A systemic disease caused by deposition of

uric acid crystals in the joint and body

tissues

CAUSES:

1. Primary gout- disorder of Purine

metabolism

2. Secondary gout- excessive uric acid in

the blood like leukemia


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Gouty arthritis


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Gouty arthritis

ASSESSMENT FINDINGS

1. Severe pain in the involved joints,initially the big toe

2. Swelling and inflammation of the joint 3. TOPHI- yellowish-whitish, irregular

deposits in the skin that break open and

reveal a gritty appearance 4. PODAGRA-big toe

Gouty arthritis


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Gouty arthritis

ASSESSMENT FINDINGS

5. Fever, malaise

6. Body weakness and headache

7. Renal stones

Gouty arthritis


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Gouty arthritis

DIAGNOSTIC TEST

Elevated levels of uric acid in the blood

Uric acid stones in the kidney

(+) urate crystals in the synovial fluid

Gouty arthritis


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Gouty arthritis

Medical management

1. Allopurinol- take it WITH FOOD Rash signifies allergic reaction

2. Colchicine For acute attack

3. Probenecid

For uric acid excretion

in the kidney

Gouty arthritis


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y

Nursing Intervention1. Provide a diet with LOW purine

Avoid Organ meats, aged and processed foods

STRICT dietary restriction is NOT necessary2. Encourage an increased fluid intake (2-3L/day) to

prevent stone formation

3. Instruct the patient to avoid alcohol

4. Provide alkaline ash diet to increase urinary pH

5. Provide bed rest during early attack of gout

Gouty arthritis


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y

Nursing Intervention

6. Position the affected extremity in mild flexion

7. Administer anti-gout medication and

analgesics

Fracture


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A break in the continuity of the bone and isdefined according to its type and extent

Fracture


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Severe mechanical Stress to bone bonefracture

Direct Blows

Crushing forces

Sudden twisting motion

Extreme muscle contraction

Fracture


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TYPES OF FRACTURE

1. Complete fracture

Involves a break across the entire cross-section

2. Incomplete fracture

The break occurs through only a part of the cross-

section


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Fracture


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TYPES OF FRACTURE

1. Closed fracture

The fracture that does not cause a break in the

skin

2. Open fracture

The fracture that involves a break in the skin


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Fracture


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TYPES OF FRACTURE

1. Comminuted fracture

A fracture that involves production of several

bone fragments

2. Simple fracture

A fracture that involves break of bone into two

parts or one

Fracture


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ASSESSMENT FINDINGS

1. Pain or tenderness over the involved area

2. Loss of function

3. Deformity 4. Shortening

5. Crepitus

6. Swelling and discoloration

Fracture


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ASSESSMENT FINDINGS

1. Pain

Continuous and increases in severity

Muscles spasm accompanies the fracture is a

reaction of the body to immobilize the

fractured bone

Fracture


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ASSESSMENT FINDINGS

2. Loss of function

Abnormal movement and pain can result to

this manifestation

Fracture


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ASSESSMENT FINDINGS

3. Deformity

Displacement, angulations or rotation of the

fragments Causes deformity

Fracture


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ASSESSMENT FINDINGS

4. Crepitus

A grating sensation produced when the bone

fragments rub each other

Fracture


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DIAGNOSTIC TEST

X-ray

Fracture


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EMERGENCY MANAGEMENT OF FRACTURE

1. Immobilize any suspected fracture

2. Support the extremity above and below when

moving the affected part from a vehicle 3. Suggested temporary splints- hard board, stick,

rolled sheets

4. Apply sling if forearm fracture is suspected or

the suspected fractured arm maybe bandaged to

the chest

Fracture


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EMERGENCY MANAGEMENT OF FRACTURE

5. Open fracture is managed by covering a

clean/sterile gauze to prevent contamination

6. DO NOT attempt to reduce the facture

Fracture


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MEDICAL MANAGEMENT

1. Reduction of fracture either open or closed,

Immobilization and Restoration of function

2. Antibiotics, Muscle relaxants such asMETHOCARBAMOL and Pain medications

Fracture


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General Nursing MANAGEMENT

For CLOSED FRACTURE

1. Assist in reduction and immobilization

2. Administer pain medication and musclerelaxants

3. teach patient to care for the cast

4. Teach patient about potential complication offracture and to report infection, poor alignment

and continuous pain

Fracture


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General Nursing MANAGEMENT

For OPEN FRACTURE

1. Prevent wound and bone infection

Administer prescribed antibiotics

Administer tetanus prophylaxis

Assist in serial wound debridement

2. Elevate the extremity to prevent edema

formation

3. Administer care of traction and cast

Fracture


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FRACTURE COMPLICATIONS

Early

1. Shock

2. Fat embolism 3. Compartment syndrome

4. Infection

5. DVT

Fracture


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FRACTURE COMPLICATIONS

Late

1. Delayed union

2. Avascular necrosis 3. Delayed reaction to fixation devices

4. Complex regional syndrome

Fracture


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FRACTURE COMPLICATIONS: Fat Embolism

Occurs usually in fractures of the long bones

Fat globules may move into the blood streambecause the marrow pressure is greater than

capillary pressure Fat globules occlude the small blood vessels of

the lungs, brain kidneys and other organs

Fracture


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Onset is rapid, within 24-72 hours

ASSESSMENT FINDINGS

1. Sudden dyspnea and respiratory distress

2. tachycardia

3. Chest pain

4. Crackles, wheezes and cough

5. Petechial rashes over the chest, axilla andhard palate

Fracture


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Nursing Management

1. Support the respiratory function

Respiratory failure is the most common cause

of death Administer O2 in high concentration

Prepare for possible intubation and ventilator

support

Fracture


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Nursing Management

2. Administer drugs

Corticosteroids Dopamine

Morphine

Fracture


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Nursing Management

3. Institute preventive measures

Immediate immobilization of fracture

Minimal fracture manipulation

Adequate support for fractured bone during turning

and positioning

Maintain adequate hydration and electrolytebalance

racture Early complication: Compartment


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Early complication: Compartment

syndrome

A complication that develops when tissue

perfusion in the muscles is less than

required for tissue viability

Fracture


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Early complication: Compartment syndrome ASSESSMENT FINDINGS

1. Pain- Deep, throbbing and UNRELIEVED pain by

opiods Pain is due to reduction in the size of the muscle

compartment by tight cast

Pain is due to increased mass in the compartmentby edema, swelling or hemorrhage

Fracture


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Early complication: Compartment syndrome

ASSESSMENT FINDINGS

2. Paresthesia- burning or tingling sensation

3. Numbness

4. Motor weakness

5. Pulselessness, impaired capillary refill time

and cyanotic skin

Fracture


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Early complication: Compartmentsyndrome

Medical and Nursing management

1. Assess frequently the neurovascularstatus of the casted extremity

2. Elevate the extremity above the level ofthe heart

3. Assist in cast removal and FASCIOTOMY

Strains


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Excessive stretching of a muscle or tendon

Nursing management

1. Immobilize affected part 2. Apply cold packs initially, then heat packs

3. Limit joint activity

4. Administer NSAIDs and muscle relaxants

Sprains


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Excessive stretching of the LIGAMENTS

Nursing management

1. Immobilize extremity and advise rest

2. Apply cold packs initially then heat packs

3. Compression bandage may be applied to

relieve edema

4. Assist in cast application

5. Administer NSAIDS

Herniated disk


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Occurs when all or part of the nucleuspulposus forces through the weakened or

torn outer ring (annulus pulposus

Herniated disk


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Impingement on the spinal nerves will resultto BACK PAIN

Herniated disk


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Causes

1. Trauma

2. Strain

3. Joint degeneration

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ASSESSMENT findings

1. Severe lower BACK PAIN that may radiate to

the buttocks or legs and feet

2. Motor and sensory loss in the area suppliedby the compressed nerves

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DIAGNOSIS of Herniated disk

1. Straight leg raising test

(+) leg pain

2. LeSegues test

90 degrees knee and thigh (-) DTR

3. XR

4. CT

5. MRI

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Nursing Implementation

1. Provide complete BED rest for several

days

2. Advise heat application over the area to

lessen pain and muscle spasm

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3. Provide exercise on bed

4. Assist in pelvic traction application

5. Provide the drugs as ordered

Aspirin

DiazepamMuscle relaxant

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6. Provide care for laminectomy

Laminectomy


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Removal of the spinal lamina to stabilize thevertebral joint and

Removal of the protruding disk

Usually accompanied by insertion of metal

plates

Laminectomy


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Pre-operatively Routine pre-operative care

Remind the patient that he should lie non his

BACK after the operation Monitor for worsening of symptoms

Use anti-embolic stocking

Encourage ROME Coordinate with the PT

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Pre-operatively Fluids to prevent renal stones

Incentive spirometry

Maintain on BED rest

Laminectomy


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POST-operatively Maintain BED rest

VERY IMPORTANT : LOG ROLLING TECHNIQUE to

turn Never lie on PRONE

HEMOVAC drainage system= check tubing for

kinks, record amount, report colorless moisture

in dressing

Provide straight BACKED chair for LIMITED sitting

ONLY

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HOME CARE AVOID sitting for a prolonged period of time

AVOID twisting, bending at the waist

Sleep on BACK Proper weight to PREVENT lordosis

Amputation


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Nursing InterventionsPost-operative care: after amputation

Elevate stump for the FIRST 24 HOURS to

minimize edema and promote venousreturn

Place patient on PRONE position after 24

hours

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Nursing Interventions

Post-operative care: after amputation

Assess skin for bleeding and hematoma

Wrap the extremity with elastic bandage

Documents

Nursing Musculoskeletal(SIR TIM)