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
what are some complications of skeletal traction
- atelectasis/pneomonia
- constipation
- anorexia
- infection
- VTE
- CAUTI (if unable to use trapeze)
describe skin traction
- used less frquently
- bucks (lower leg) used most frequently
- short term stabolization without pins/wires (used for less complicated fx)
- weights attached by velcro, tape, straps, boots, or cuffs
- be cautious not to exceed tolerance of skin (4.5lb-8lb per extremity)
what are some nursing considerations for skin traction
- inspect area under traction
- assess NV status
- encourage ROM
- same considerations as skeletal
- complications of immobility
compare and contrast skeletal traction and external fixation
skeletal traction:
- short term fx management
- pt immobile - weights placed to pins
- weights cannot be removed
- keeps anatomical alignment until surgery is an option
external fixation:
- short term or longer term fx management
- pt mobile - use of crutches and nonweight bearing on affected extremity
- no weights
- maintains anatomical alignment until surgery is an option
what are some indications for orthopedic surgery
- unstable fx
- deformity
- joint disease (arthoplasty)
- necrotic or infected tissue and tumors
- amputation
what are some goals of orthopedic surgery
- improve function
- restore motion
- relieve pain and disability
- improve quality of life
- safer than most surgeries with rare complications
what are some complications of orthopedic surgery
- blood loss (up to 1500ml anticipated)
- acute post op bleeding common
- post op anemia
- infection
what are some indications of arthoplasty
- hip and knee most common
- OA (bone on bone), RA (synovial fluid probs), trauma, deformity
- avascular necrosis (traumatic injury, steroid usage, alcohol)
whats the mechanism of action of arthoplasty
remove bad and replace with new
what are some complications of arthoplasty
- blood loss
- infection
describe nursing care and educations for arthoplasty
- IV antibiotics 60mins prior to incision
- complications of immobility: VTE prophylaxis, pressure ulcers, pneumonia/atelectasis
- assess NV status
- pain management
- promote ambulation
- home care
hip: abductor pillow <90 degrees
knee: knee immobilizer
