Chapter27MusculoskeletalCare

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Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 27
Musculoskeletal Care
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Sprain
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Damage to muscles and ligaments
Mild to severe
Ankle most common
Can occur in any joint
Joint must be supported and rested to heal
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Treatment for sprain RICE
 R—rest, do not bear weight
 I—ice, apply ice first 48 hours, ↓ pain and
swelling
 C—compression, apply ace bandage to compress
and prevent further swelling
 E—elevation, keep joint elevated above the heart,
↓pain and swelling
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Fracture
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Break in the bone
Hairline—narrow crack
Comminuted—broken into many small pieces
Promote healing—broken ends must be
supported in close proximity to one another for 4
to 8 weeks or longer
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Fracture
 cast or immobilizer
 May require insertion of pins, wires, or screws
 Open reduction internal fixation
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Joint replacement
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Joint with severe degenerative changes
Usually due to osteoarthritis
Degeneration and inflammation of the joint
Most common—knees and hips
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Musculoskeletal
Conditions
 Amputation
 Limb is surgically removed
 Severely damaged by trauma or lack of blood
supply (gangrene)
 Remaining portion of the limb remaining—stump
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Cast
 Plaster of Paris—takes hours to dry
 Support with pillow to allow air to circulate all
around cast
 Avoid touching with fingertips—leave dents—
cause pressure points on the skin
 If need to touch—use only palms of hands
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Fiberglass
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Lightweight and dry quickly
Educate patient not to scratch inside cast
Cool air from hairdryer
Observe for draining or bad odor
Assess circulation—edema may decrease
circulation and press on nerves
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Neurovascular check
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q2h for the first 24 hrs
Then q4h or facility policy
Sensation, any numbness, tingling, or burning?
Edema?—will impede circulation and press on
nerves
 Temperature, color, and movement
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Capillary refill
 Palpate pulse
 Pain?—pain should gradually decrease in intensity
as healing occurs—a sudden increase in pain could
indicate infection or compression
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Traction
 Skin traction
 Skeletal traction—external fixators
 Risk of bone infection
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Ensure that the weights hang freely—do not
rest on floor
 Ensure that ropes pull in a straight line
without crossing one another
 Assess for skin breakdown beneath external
traction devices
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 When turning a patient in traction—have
another person lift up the weights, causing
slack in ropes while the patient is turned
 After patient is supported and aligned—the
person holding the weights, gently and slowly
releases the weights to hang freely
 Ensure patient’s body is in proper alignment
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Care following joint replacement
 Avoid post-operative dislocation
 Total hip replacement
 Head and neck of femur are removed
 Replaced with titanium implant bonded into the
top of the femur
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
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Muscles not attached immediately
Muscular support for joint is absent
Muscles repair—takes several months
Must avoid adducting the operative leg to the
midpoint of the body or beyond
 Must not flex the hip joint >90°
 Either could cause the new femur head to pop out
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Wedge-shaped abductor pillow
 When turning patient to the unaffected side or
the back—abductor pillow must be kept in place
 Usually you will have orders not to turn the
patient on the operative side during the
immediate post-operative period
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Assisting patient OOB—do not allow patient to
lean forward—would flex hip >90°--causing
possible hip dislocation
 Patient encouraged to use extension gripper to
pick up any dropped items
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Total knee replacement
 Soon after surgery flexion of the new knee joint
begins
 Continuous passive motion (CPM) machine
 Gently flexes the knee according to the number of
degrees of flexion on the setting and then gently
extends the knee
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Effective pain management necessary to tolerate
the passive exercise
 During the first 24° post-operatively—will
experience much discomfort with CPM first begins
flexing the knee
 The more tense the muscles—more pain—teach
relaxation breathing
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nursing Care
 Amputation
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Needs physical, as well as emotional support
Assess for proper healing
Compression sock
Prosthesis
Disturbed body image
Possible life changes
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Assistive Devices
 Crutches
 Canes
 Walkers
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using Crutches
 Three fingerbreadths of space between the
axillary pad and the patient’s axilla
 Prevent compression of nerves—nerve
damage affecting arm and hand
 Stand with crutch tips 4 to 6 inches to the side
of the heel
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using Crutches
 Ensure patient is bearing weight on hands and
wrists, not on the axillae
 Place unaffected leg and crutch on the
upstairs step first and then move unaffected
leg and crutch; reverse process when going
downstairs
 Assist patient to use appropriate gait
 Remind patient to keep affected foot slightly
forward
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using a Cane
 Can bear weight on the affected leg but need
extra support while ambulating
 Single-pronged or multi-pronged canes
 Correct height—top of cane is even with the
patient’s hip joint when the tip is positioned 4
inches away from the side of the foot
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using a Cane
 Ensure patient holds the cane on unaffected
side
 Remind patient to remain erect
 Ensure patient moves unaffected leg and cane
forward together, then moves affected leg
forward
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using a Walker
 Can bear full weight on both legs but need
assistance to maintain balance
 Several styles available
 Metal frame, four legs, moves behind walker and
steps into the frame
 Wheels on front of walker, patient pushes the
walker
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using a Walker
 Correct fit
 Comes up to patient’s hip joint
 When patient grips the handles, elbows should be
bent at a 30° angle
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using a Walker
 Ensure patient stands between back legs of
walker
 Ensure patient sets the walker down and steps
forward into it
 Ensure brakes are set on the rolling style
walker before sitting on the seat
 Instruct patient to move the affected leg
forward with the walker, then move the
unaffected leg forward
Copyright © 2011 F.A. Davis
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