Individuals Experiencing
Musculoskeletal Disorders
NURS 2016
 Musculoskeletal Includes:
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Bones
Joints
Muscles
Tendons
Ligaments
Bursae
 Complications include:
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Trauma
Contusion
Strain
Sprain
Joint dislocation: subluxation &
avascular necrosis
Musculoskeletal Disorders
 Low Back Pain
 Most is self-limiting and will improve on its own with
time
 Sciatica
 Osteoporosis
 Bone density loss
 Small frame, non obese women
 Osteomyelitis
 Bone infection
 Septic Arthritis
 Joint infection
Musculoskeletal Trauma
Initial Assessment
Circulation
Movement
Sensation
Contusions, Strains, and
Sprains
 Contusion is a soft tissue injury
 Strain is a pulled muscle from
overuse, overstretching, or
excessive stress
 Sprain is an injury to ligaments
surrounding a joint
Treatment: strains, sprains,
contusions
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Rest
Ice
Compression
Elevate
Joint Dislocations
 Subluxation is a partial dislocation of
the articulating surfaces
 Medical Management is
immobilization
 Nursing Management
 provide comfort
 neurovascular status
 protect joint
Fractures
 Break in the continuity of the bone
Fractures: Break in the continuity of the
bone
Clinical Manifestations
 Clinical manifestations
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Pain
Loss of function
Deformity
False motion
Shortening
Crepitus
Swelling & discoloration
Management
 Emergency Management: stabilize
limb
(affected area)
 Reduction
 Closed
 Open
 Traction
Complications
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Shock
Fat Embolism Syndrome
Compartment Syndrome
Delayed Union/Nonunion
Avascular Necrosis
Infection
Nursing Process: Fracture
Assessment
 Objective Data: assess clinical
manifestations for fx.
 Subjective Data
 Health Info: past hx, meds, surgery
 Functional: motion, weakness, spasm,
pain, tingling
Nursing Process: Planning
Nursing Diagnosis
 Risk for peripheral neurovascular
dysfunction related to nerve compression
 Acute pain, evidenced by pain descriptors,
guarding, crying, related to edema,
movement of bone fragments, and muscle
spasms.
 Risk for infection related to disruption of
skin integrity and presence of
environmental pathogens secondary to
open fracture.
Nursing Process: Interventions
Expected Outcome: normal neurovascular
examination
Nursing Strategies
 Assess for S&S peripheral neurovascular
dysfunction
 Unrelieved pain or pain on passive
movement
 Paresthesias, cool, pallor, diminished pulses
 Elevate extremity above level of heart to
reduce edema by promoting venous return
The Patient with a Hip Fracture
 Surgical repair is preferred method of
treatment.
 Intra capsular Fx (head and neck of femur):
endoprothesis
 Extracapsulr Fx (trochanteric): nails, plates,
intramedullary devices.
Nursing Management for both is the same.
Nursing Interventions
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Relieving Pain
Promoting Hip Function & Stability
Promoting Wound Healing
Promoting Normal Urinary Elimination
Patterns
Promoting Skin Integrity
Promoting Effective Coping Mechanisms
Promoting Patient Orientation &
Participation in Decision Making
Monitoring & Preventing Potential
Complications
Joint Replacement
 Arthroplasty: replacement of all parts
of the joint
 Contributing factors to joint
replacement:
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Pain
Osteoarthritis
Rheumatoid arthritis
Trauma
Congenital deformity
Joint Replacement Cont’
 Joints frequently replaced:
 Hip
 Knee
 Finger
 Joints sometimes replaced:
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Shoulder
Elbow
Wrist
Ankle
Special considerations with Hip
Fractures/Repair/Replacement
Do
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NOT
Force flexion >90
Force adduction
Force internal rotation
Cross legs
Put footwear on
without assistive
device before 8 weeks
 Sit on chair without
arms to aid in raising
to stand
DO
 Use elevated toilet
seat
 Place chair inside
shower or tub
 Use pillow between
legs when on side
 Keep hip in neutral
position
 Notify surgeon if
severe pain, deformity
or loss of function
Continued Strategies for Hip
Repair/Replacements
 Provide abduction pillow to prevent adduction
 Monitor and manage complications
 Neurovascular
 DVT
 Pulmonary
 Skin
 Bladder control
 Delayed complications: infection, nonunion,
avascular necrosis, fixation device problems.
 Monitor drainage from site (hemovacs)
 200 -400ml of drainage is common in first day
Cast Application
Analgesic: admin ordered analgesic
Skin preparation: clean, dry
Support body part during application
Monitor smoothness of cast material
Position limp on pillow to dry,
elevated above heart.
 Position client comfortably - q2hr
 Prepare for discharge
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5 P Assessment
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Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Unexpected Outcomes of
Casting
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Malunion
Osteomyelitis
Pressure ulcer
Muscle weakness
Cold extremity
Skin irritation
Unable to perform cast care
Post Removal
 Observe underlying skin: colour,
temp, integrity
 Assess client’s verbal and nonverbal
responses
 Explain exercise plan and
demonstrate exercises
 Skin care
Traction
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Maintain established line of pull
Prevent friction of skin
Maintain counteraction
Continuous (usually)
Maintain correct body alignment
Skin Traction
Non-invasive
 Assess traction setup
 Assess mobility
restrictions
 Assess Pain
 Assess NV status
 Understanding
Intermittent
release
Skeletal Traction
 Traction is external and internal (via
pins, wires, nails)
 Similar care principles as skin
traction.
 Continuous
 Pin Care
 Inspect pins every 8 hours at minimum
Principles of Traction
 Weights or traction never removed
unless ordered
 Patient must be in proper alignment
 Ropes unobstructed
 Weights hang free
 Knots or other devices not hung-up
on pulleys or bedframe
Amputation
 Levels: determined by
 Circulation and function at most distal end that will
heal
 Complications: hemorrhage, infection, skin
breakdown, joint contracture and phantom pain
 Rehabilitation: multidisciplinary
 Nursing Management
 relieving pain
 minimizing altered sensory perception
 promoting wound healing
 enhancing body image
 self-care
Amputation
Stump Dressing
 Promote healing
 Residual limb shaping for prosthesis
fitting
 Control edema
 Gentle handling
 Aseptic technique
 Closed rigid or soft dressing