Musculoskeletal Flashcards
What is the most common cause of musculoskeletal injury?
traumatic event
What is the teaching related to prevention of musculoskeletal problems in the older adult?
- use ramps in buildings and at street corners.
- eliminate scatter rugs
- treat pain and osteoarthritis
- use a walker or cane to help with walking
- eat the amount and type of food to prevent excess weight which adds stress to joints
- get regular and frequent exercise
- supportive shoes
- gradually initiate activities to promote coordination. Rise slowly.
- avoid walking on uneven surfaces and wet floors.
What are clinical manifestations of a sprain or strain?
pain, edema, decrease function, and contusion
usually self-limiting
**hemarthrosis (bleeding into joint space) can occur
What are acute interventions for sprains and strains?
- stop activity
- apply ice (30 on, 15 off) for vasoconstriction
- compression (30 on, 15 off)
- heat: 24-48 hrs after injury (20-30 on, break)
- rest initially, then use limb!! (protect the joint w/brace, cast, splint
What are the clinical manifestation of a dislocation?
Deformity Hip = shorter and often externally rotated Local pain Tenderness Loss of function Swelling
What are some complications of dislocations? (4)
open joint injuries
intra-articular fracture - break that crosses into the surface of a joint
avascular necrosis - bone cell death from lack of blood supply, common reason for joint replacements in younger people
compartment syndrome
nursing interventions for dislocations are:
Pain relief Support and protect injury Motion restriction after immobilization Rehabilitation program Gentle ROM Exercise program to restore joint to original ROM Gradual return to activities teach: joints can be predisposed to repeated dislocations
What are s/s of carpal tunnel syndrome?
Weakness
Burning pain
Impaired sensation
Clumsiness in fine hand movements
Often seen during pregnancy, premenstrual, menopause – hormones involved
DM and hypothyroidism have higher incidence
What is done to manage carpal tunnel syndrome?
Prevention education
Stop the aggravating movement - Ergonomic changes
Corticosteroid injections (short term relief)
Surgery - Outpatient and endoscopic surgery
*Neurovascular assessment key postoperatively
In fingers distal to surgical site
Rehab takes up to 7 weeks
What are the clinical manifestations of a fracture?
Pain Decreased function Inability to bear weight Guarding (against movement) May or may not have deformity
If suspect fracture: immobilize and ice!!!!
What is done for realignment of a CLOSED reduction fracture?
non-surgical, manual realignment
traction and counetrtraction!!!
local or general anesthesia
immobilization afterwards!!!
What is done for realignment of a OPEN reduction fracture (ORIF)?
Surgery, internal fixation
Risk for infection
Early ROM to prevent adhesions!!
Early ambulation!!
ROM following ORIF (open reduction internal fixation) usually involves Continuous Passive Motion
- Machines that help prevent adhesions
- More rapid healing of the articular cartilage
- Possible decreased incidence of later posttraumatic arthritis
What is the purpose of traction and counetrtraction?
#1 - REDUCE PAIN AND MUSCLE SPASM immobilize joint/bone reduce fracture dislocation treat a pathologic joint condition
What is skin traction and what does the nurse assess for?
Short term (48-72 hrs) Tape, boot, splints applied to skin 5-10 lb weights
Assess for SKIN BREAKDOWN!!
What is skeletal traction and what does the nurse assess for?
Long term pull to maintain alignment
Pin or wire inserted into bone
5-45 lbs
Assess for RISK FOR INFECTION (into bone) and COMPLICATIONS OF IMMOBILITY!!
What are the nursing interventions for traction and countertraction?
Maintain countertraction => elevate end of bed (so pt not pulled to end of bed)
Maintain continuous traction
Keep weights off the floor
Other:
(1) skin care
(2) pin care
(3) prevent infection
(4) positioning
(5) exercise as permitted
(6) psychosocial needs
What can the nurse do if the edges of a cast bother a patient?
petal the edges
What are the DO’s and DON’Ts of cast care?
DO
- Frequent neurovascular assessments
- Apply ice (1st 24 hrs)
- Elevate above heart (1st 48 hours)
- Exercise joints above and below cast
- Use hair dryer on cool setting for itching
- Check with provider before getting wet, and dry thoroughly after getting wet
- Report increasing pain despite elevation, ice, and analgesia => Cast could be too tight – leading to Compartment Syndrome
- Report swelling associated with pain and any discoloration or movement
- Report burning or tingling under cast – Sign of Infection
- Report sores or foul odor under cast – Sign of Infection
- Teach cast removal and alteration is appearance of extremity (esp for kids)
DON’T
- Elevate if compartment syndrome
- Get plaster wet
- Remove padding
- Insert objects inside cast
- Bear weight for 48 hours
- Cover cast with plastic for prolonged period
What is nursing care for a sling?
It supports and elevates arm.
- Contraindicated with proximal humerus fracture
- Ensure axillary is padded and no undue pressure on neck
- Encourage movement of fingers and non-immobilized joints
Superior Mesenteric Artery Syndrome (Cast syndrome)
S/S: distended abdomen, N/V
Assess bowel sounds
Treat with gastric decompression
Don’t confuse with compartment syndrome
6 small meals a day (so stomach not too full)
