musculoskeletal modalities Flashcards
what are some indications for casting
- immobilize fracture
- correct prevent deformity
- support weakened joints
describe application of casting
fliberglass or plaster of paris
joints proximal and distal
what are some complications of casting
- pressure ulcers (need uniformity of cast)
- compartment syndrome
describe nursing focus and education for casts
- neurovascular checks (6Ps)
- cold therapy (reduce inflammation)
- keep clean, dry and elevate
- do not scratch -> infection
- discuss potential complications
- casting options
what are your expctations of vital signs when experiencing pain?
increased BP, HR, and respirations
so dont focus too much on it if someones chillin with a broken bone
what are the 6 Ps of neurovascular assessment
- pain
- pallor
- paralysis
- pulselessness
- parasthesias
- poikilothermia
what are some causes of compartment syndrome
- trauma
- fracture
- severely bruised muscle
- severe sprain
- cast/bandage (when theyre put on too soon)
what is happening with compartment syndrome
- fascia covers muscle -> this shit DOES NOT expand
- muscles, nerves, blood supply, and fascia in compartments
- swelling occurs = nowhere to go
- increased pressure in compartment
- blood flow is compromised
- worst case = ischemia and limb death
how will a client with compartment syndrome present
- pain disproportionate to injury
- numbness and tingling to extremity; paleness
- NO pain relief despite analgesics
whats a diagnostic test for compartment syndrome
stryker
this thing gets stuck in the swelling part and tests pressure inside
what are some acute interventions for compartment syndrome
- remove cast
- fasciotomy
how can nurses hep with compartment syndrome
education
- immobilized fx should not hurt
- numbness and tingling to extremity/warmth and pain out of proportion is bad
- keep clean and dry
- report fever or S&S of infection
describe fasciotomy care
- negative pressure wound therapy with instillation has been used effectively to assist in granulation in acute, subacute, and chronic wounds
- leaves a giant ass scar
what are some indications for external fixation
- fx with soft tissue damage or wounds
- complicated fracture
its a little bridge until you can fix it w surgery
whats happening with external fixation
- surgical pins inserted through skin to bone
- metal external frame attached to pins
- holds proper alignment (until healed or surgery)
what are some benefits of external fixation
- immediate fx stabilization
- minimize blood loss (ORIF)
- increased comfort
- improved wound care
- early mobilization
what are some complications of external fixation
- pin loosening
- infection/osteomyelitis
- compartment syndrome (can bleed into muscle)
how can nurses help with external fixation
education
- pin cleaning
- altered body image
- discuss complications (what to looks for)
- monitor neruvascular status (24hrs)
- may need casting/splint after removal
describe pin cleaning
- use sterile water, gauze, and cotton swab
- use a new swab for each pin
- massage skin around pin
- circle pin with sterile swab
- dont double dip
- clean length of each pin
when can a person shower after getting external fixation
10 days post op
what are some indications of skeletal traction
- short term fx management
- decrease msucle spams/pain
- fx with soft tissue damage/wounds
- maintain alignment while waiting for surgery
- correct/prevent deformities
describe the mechanism of action of skeletal traction
- local anesthesia used
- traction and countertraction (pt is countertraction)
- patients body weight and weight on pullies
- weights on pullies should be chillin
- pulling reduces painful muscle spasms
what can a client expect with skeletal traction
- pressure/pain during exertion
- weights attached to pins/wires
- complete bed rest during therapy, trapeze provided
- adjustment of weights as muscles relax
what are some nursing considerations for skeletal traction
- check throughout shift and Q8 (NV status and VTE)
- pain control
- prevent skin breakdown
- prevent shearing injuries
- PT consult for AROM and PROM
- pin care
- anxiety reduction
