Musculoskeletal Disorders Flashcards Preview

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Flashcards in Musculoskeletal Disorders Deck (65)
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1

Health Assessment

• Chief complaint, onset, duration and manifestations
• Effects on function – ADL’s
• Precipitatingfactors
• Pain – 5th vital sign
• Inspect and palpate bones/ joints deformity, tenderness, swelling, warmth and ROM
• Gait, posture, sitting, ability to walk
• Muscle strength

2

Diagnostic Tests

• Xray
• CT
• MRI
• Bone density
• Bone Scan
• Arthroscopy & arthrocentesis
• Blood Work: Calcium, phosphate, alkaline phosphate, Uric acid, RF

3

Preventing Trauma

Prevention is key
Teach importance of using safety equipment
Older client
- At highest risk for falls
- Safety in the home

4

Soft Tissue Trauma: Nursing Care, Assessment

- Mechanism of injury
- Protective devices
- Pain assessment
- Inspection for redness, swelling, deformity
- Range of motion
- Palpation for warmth, tenderness, crepitus

5

Soft Tissue Trauma: Nursing Care; Decrease Swelling and Pain (PRICE)

To decrease swelling and pain
- PRICE
• Protect
• Rest
• Ice
• Compression
• Elevation
- Heat after several days
- NSAIDs
• Impaired physical mobility

6

Soft Tissue Trauma: Nursing Care, Teaching

- Promote comfort
- Prevent further injury
- Allow healing

7

Joint Trauma: Nursing Care

• Assessment of pain,neuromuscular status
• Traction to maintain alignment
• Implement care to prevent complications of immobility
• Teaching
- Immobilization recommendations
- Skin care
- Pain control
- Rehabilitation exercises

8

Dislocations

• Manual traction to reduce dislocation
• Narcotics
• Musclerelaxants
• Conscious sedation to control pain and manipulate the joint back into place

9

Fractures: Nursing Care

• Needs prompt treatment
• Goal of treatment:
- Anatomic realignment of bone fragments (reduction)
- Immobilization to maintain alignment
Restoration of normal function

10

Fractures: Emergency Care

• Immobilize before moving client
• Joint above and below
• Check pulse, colour, movement, sensation before splinting
• Sterile dressing for open wounds

11

Nursing Management: Nursing Assessment

Brief history of the accident
Mechanism of injury
Special emphasis focused on assessment of the region distal to the site of injury

12

Fractures: Nursing Care, Assessment; Neurovascular

Pain
Pulses
Sensation
Skin color
Temperature
Motion
Edema
Motor Function

13

Collaborative Care: Fracture Reduction; Closed Reduction, Open Reduction

Closed reduction
Non‐surgical, manual realignment casts
Open reduction
Correction of bone alignment through a surgical incision

14

Casts

• Rigid device to immobilize bones and promote healing
• Plaster or fiber glass
• Joints above and below fracture
• Type of cast depends on type of fracture

15

Collaborative Care: Fracture Immobilization; Traction

Application of a pulling force to an injured part of the body while counter traction pulls in the opposite direction
Prevent or reduce pain and muscle spasm Immobilization
Reduction
Treat a pathological condition
Prevent deformity

16

Traction

• Manual
• Skin
• Skeletal
• Straight
• Balanced suspension

17

Collaborative Care: Fracture Immobilization; Internal/ External Fixation

Internal Fixation
- ORIF
- Pins, plates, intramedullary rods, and screws
- Surgically inserted at the time of realignment
External fixation
- Metallic device composed of pins that are inserted into the bone and attached to external rods

18

Fractures: Other Interventions

• Analgesics
• NSAIDs
• Parenteral pain medications
• Stool softeners
• Anti‐ulcerdrugs
• Electrical bone stimulation

19

Fractures: Nursing Care

• Pain
• Impaired Mobility
• Risk for Ineffective Tissue Perfusion
• Evaluate effectiveness
- Pain control
- Safety and mobility
- Tissue perfusion

20

Fractures: Teaching, Risk for Falls

Teaching
- Care at home
- Safety assessment
- Ambulation with Assistive devices
• Risk for falls
- Fall prevention
- High risk for hip fractures
• Decreased bone mass and muscle strength
• Slowed reflexes
• Medications affecting cognition and balance
• Osteoporosis

21

Hip Fracture

• Break in the femur at the head, neck, or trochanter regions
- Intracapsular
- Extracapsular
• Pain, shortening, and external rotation of the affected lower extremity

22

Hip Fracture

• Buck’s traction
• ORIF
• Arthroplasty
• Total hip replacement

23

Hip Fracture Nursing Care

• Hip precautions
• Abductor pillow
• Isometric exercises
• Physical therapy
• Hip chair
• TED stockings and anticoagulants
• Skin integrity

24

Hip Fractures: Nursing Diagnosis

• Pain
• Impaired Physical Mobility
• Impaired Skin Integrity

25

Amputation: Nursing Care; Goals/ Nursing Diagnosis

Goals:
- Physiological healing with no associated complications Pain relief
- Achieve maximal rehabilitation potential
Nursing Diagnosis:
- Pain
- Risk for Infection
- Risk for Dysfunctional Grieving
- Disturbed Body Image
- Impaired Physical Mobility

26

Nursing Care: Amputaiton

• Assess pain
• Strategies for acute and chronic pain
• Drug and non‐drug interventions for pain
• Assistive devices
• Rest periods
• Emotional support

27

Amputation: Phantom Pain

Splint and support
Reposition
Encourage distraction, meditation, deep breathing and relaxation exercises

28

Amputation: Risk for Infection

Protect from contamination
Give antibiotics
Teach stump wrapping
Elevated WBC

29

Collaborative Care: Drug Therapy; Amputation

Muscle relaxant
Tetanus‐diphtheria toxoid or immunoglobulin
Bone‐penetrating antibiotic
- Cephalosporin

30

Amputation: Teaching

- Knowledge to care for needs
- Home management