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Flashcards in Musculoskeletal Module Deck (12):
1

Laminectomy 
Nursing Priorities

Pain management (big concern)
Perform neurological and neurovascular assessment are going to be key.
Monitor bowel and bladder function
Assess patient for complaints of severe headache or leakage of CSF, nausea, abdominal discomfort, wound drainage
Use log roll technique so alignment of spine is maintained at all times
Client should “rise as unit” first time getting up.
Numbness and tingling may not be relieved immediately after surgery (warn the patient prior to surgery).

2

Nursing care for hip replacement

Pain management after surgery (PCA, epidural x 2 days post-op)
Teaching about dislocation precautions
Avoid extreme internal rotation, adduction, and 90 degree flexion for at least 4-6 weeks after surgery. (at risk for dislocation)
For 4 weeks
Prevent adduction by using abduction pillow
Avoid crossing legs
Avoid twisting to reach for objects behind
Avoid driving and taking tub baths
Modify equipment to avoid 90 degree hip flexion (raised toilet seat, reachers, long-handled shoe horns, sock pullers)
Teach about signs of infections, DVT (measure calf, monitor for swelling)
Reinforce PT exercises (begin first day post-op) make sure they are doing their exercises correctly).

3

Nursing Care for Osteoporosis

Educate about Calcium intake throughout lifetime is key for their lifestyle
Lifetime Supplementation
1000mg/day premenopausal and postmenopausal women taking ERT
1500 mg/day postmenopausal women without ERT
Educate the patent to eat foods high in Ca (dark green leafy vegetables, sardines)
Educate about weight bearing exercises to force Calcium back into bones
Educate about safe home environment to prevent falls and injuries; keep pathways free, get rid of coffee tables and stuff that could lead to tripping and falling.

4

What is Osteomyelitis?

Acute or chronic infection of the bone
Staphylococcus aureus most common organism
Causes
A. Direct
Fractures, joint replacements, or surgery
B. Indirect
Pathogen travels via bloodstream to affected bone

Long bones common sites for children

Spine, hips, and foot common sites for adults
At risk populations
Children
Elderly (with underlying co-morbidities)
Those with weak immune systems
Need intensive treatment with long term antibiotics

5

Osteomyelitis Nursing Care

Observe for signs of local and systemic infection. (high grade fever, malaise, chills)
Monitor temp at least every 2 hours
Asses and treat pain
Keep patient well hydrated
More caloric intake (well balanced diet)
Prepare for longterm antibiotic use
Educate about ototoxicity and nephrotoxicity. (peaks and troughs with aminoglycosides)
Use of sterile techniques and handwashing (prevention is cheaper than cure)
Immobilize affected extremity
Importance of rest and adequate diet
Send wound cultures

6

Nursing Assessment for Fractures

Deformities (spasms or pulling of muscles that could lead to improper alignment).
Edema and swelling esp with a cast being on too tight.
Monitor for Pain
Crepitus (sickening popping or grating sound) (could mean improper alignment).
Muscle spasms (proper positioning is key)
Bruising
Loss of function

7

Nursing care for Fractures

Nursing Care for fractures
Focus on the 5 P’s (frequent neuro assessment)
Pain
Pallor (inadequate blood supply)
Paresthesias
Pulses
Paralysis
Immobilize joints above and below level of injury (to prevent open fracture)
Cover open wounds with sterile dressing to prevent infection.
Manage pain
Elevate affected extremity IF POSSIBLE, may have a head injury or spine injury.
Apply ice to help deal c inflammation.
Assist in fracture reduction (if asked)
Exercise extremities not affected to prevent muscle atrophy.
Maintain Traction

8

Fracture Complications

Infection
Monitor wound drainage (esp with a compound fracture), fever, pain, and odor
Fat Emobolism
Watch for chest pain, dyspnea, tachycardia, decreased O2 saturation, apprehension, changes in LOC
DVT's are a big worry
Calf pain and tenderness
Compartment syndrome
is an acute medical problem following injury (fracture), surgery or in cases of repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation-watch out for casts and splints) within a confined space (fascial compartment) in the body impairs blood supply.
Without prompt treatment, it may lead to nerve damage and muscle death.
This condition is most commonly seen in the anterior compartment and posterior compartment of the leg.
Symptoms
Unrelieved pain
Diminished or absent pulses distal to the injury
Cyanosis, tingling or lack of sensation, coolness, weakness of extremity

9

Nursing Care for Sprains

Nursing care
Neuro checks with 5P’s
Assess pain and medicate as necessary
Teach RICE
Rest
Ice (15-30 minute at a time for 2-3 days)
Compression
Elevation
PT as ordered by physical therapist

10

Low Back Pain (Basic Patho & Risk Factors)

Pain related to acute or repeated stress on lower back over a period of years
Caused by sprain or strain of ligaments of muscles
Mechanical strain (irritation or injury to disc causing degeneration)
Herniation of the nucleus pulposus (causes pressure on nerve roots)
Risk factors
Degenerative disc disease
Poor muscle tone
Sedentary lifestyle
Obesity
Poor body mechanics
Smoking stress

11

Back Pain Manifestations

Manifestations
Pain at site of injury but may also be referred
Muscle spasms
Straight leg raise test may result in pain that radiates to buttocks and leg along path of sciatic nerve

12

Back Pain Nursing Care

Nursing Care
Goal-improve symptoms and slow progression
Adherence to activity restrictions
Maintain ideal body weight
Following PT exercises
Stretching
Hot/cold therapy
Sleep on firm mattress