Musculoskeletal Disorders Part I

1. MusculoskeletalDisorders Part I

3. Manifestations of Fractures Pain Swelling Deformity Numbness Hematoma Formation Muscle spasm

4. Emergency Care of Fractures Neurovascular Assessment Five Ps Pain Pulses Pallor Paralysis Paresthesia Immobilization Alignment Wound Care

5. Diagnosis of Fracture X-ray Bone Scan Lab Studies CBC Coagulation studies

6. Factors Which Promote Bone Healing Local Good emergency care and fracture setting Ice Systemic Ca++, Vitamin D, Growth Hormone Adequate Blood Supply Young and Active No Infection

7. Fracture Treatments Medications Surgery Fixation Devices External Internal Traction Casts

8. Medications Analgesics Antibiotics Anticoagulants GI Meds Constipation Ulcer prevention

9. Surgical Treatment External Fixation Page 1197 Simplest form of treatment Frame connected to pins that are inserted perpendicular to the long axis of the bone. Pins inserted above and below the fracture line Fixators increases independence while maintaining immobilization! Page 1197 Simplest form of treatment Frame connected to pins that are inserted perpendicular to the long axis of the bone. Pins inserted above and below the fracture line Fixators increases independence while maintaining immobilization!

10. Nursing Care for External Fixation Devices Maintain Alignment Frequent Neurovascular and Skin Assessments Infection Prevention Skin care per policy

11. Surgical Treatment Internal Fixation (ORIF)

12. Nursing Care for Internal Fixation Devices Neurovasuclar Assessment PAIN Suture Care Hemovac? Hazards of Immobility Lungs, heart, bowels, legs

13. Traction Manual Page 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bonePage 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bone

14. Traction Bucks also called Straight Traction Page 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bonePage 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bone

15. Traction Balanced Suspension Page 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bonePage 1199 Manual traction the hand applies the pullling Straight traction: Bucks is the most common type of straight traction Balanced Suspension: Involves more then one force or pull Skeletal is the placement of pins into the bone

16. Care of the Client in Traction Maintain alignment Let weight hang free Maintain ropes free Position client Skin Traction NO more then 6 pounds of traction per extremity

17. Casts Immobilizes Body Part Note Composition Plaster Fiberglass Teaching No objects in cast Keep Dry Assess Neurovascular Position Sling to prevent neck injuries Even distribution of weight Alignment ID wrinkles in fabric Check skin Page 1200Page 1200

18. Nursing Care ofClient with a Cast Neurovascular Checks Assess for Infection Crutch Walking Two Point Gait Four Point Gait Swing to Gait Swing through Gait www.davidlnelson.md/Fractures_in_general.htm Crutches Two point: crutch on one side advances with opposite foot Four Point: Each point is advanced seperately Swing to gait: both crutches are advanced together followed by the lifting of the limb to the same place Swing through gait. Patient swings body past the crutches www.davidlnelson.md/Fractures_in_general.htm Crutches Two point: crutch on one side advances with opposite foot Four Point: Each point is advanced seperately Swing to gait: both crutches are advanced together followed by the lifting of the limb to the same place Swing through gait. Patient swings body past the crutches

19. Complications Related to Fractures Compartment Syndrome Fat Embolism Syndrome Deep Vein Thrombosis Reflex Sympathetic Dystrophy

20. Compartment Syndrome (CS) Fascia Lines the Compartment within the limb Increased pressure from hemorrhage or edema Pressure from cast being too tight Results Nerve, vessels, muscles are damaged

21. COMPARTMENT SYNDROME www.embbs.com/aem/armstab1.html Page 1202www.embbs.com/aem/armstab1.html Page 1202

22. Fat Embolism Syndrome Globules of fat, released from fractured bone Fat mixes with platelets Emboli travel to lungs, brain, or other areas. Clotting cascade activated = petechiae

23. Assessment of Fat Embolism Syndrome Notify MD Immediately Dyspnea Confusion Pulmonary complications Pulmonary Edema ARDS Petechiae

24. Treatment of Fat Embolism Syndrome Maintain Pulmonary Function Intubation Ventilation Fluid Balance Steroid Treatment Stabilize Long Bone Fractures

25. Deep Vein Thrombosis Done by Dr. Rogers in previous lectureDone by Dr. Rogers in previous lecture

26. Reflex Sympathetic Dystrophy

27. Hip Fracture

28. Nursing Care of Client with Hip Fracture Neurovascular Assessment Nursing Diagnosis Acute Pain Risk for Infection Impaired Mobility Impaired Sensory Perception Prevention/Teaching Self Study p. 1207 – 1208 Prevention/Teaching Self Study p. 1207 – 1208

29. Amputations

30. Amputations Causes PVD Trauma Infections Tumors

31. Teaching PrincipalsFor Clients with an Amputation Wrap Stump Positioning of the Stump Stump Exercises Physical Activities Household modifications Referrals for Social Services

32. The End