musculoskeletal nursing Flashcards
cast
support/stabilize weakened joints.
- proximal/distal joints are included
- mainstay tx for fracture
- circumferential immobilization
- should be put on once the inflammation does down
splint
- the acute care setting and for initial treatment of fracture prior to casting.
- Splints are non-circumferential- > allows natural swelling during the inflammatory phase of the injury (Cast is circumferential immobilizer!)
braces (orthoses)
- Used to provide support, control movement, and prevent additional injury.
- They are customized to various parts of the body- > tend to indicate for longer term use than splints.
ex: TLSO
assessing and preventing neurovascular compromise
- Peripheral circulation; motion; sensation (and COMPARE these to the opposite extremity and the baseline)
- Peripheral circulation: peripheral pulses; capillary refill; edema; temperature of the skin
- Sensation: assess for paresthesia; or absence of feeling of the affected extremity
- Remember the 6 P’s! (paresthesia, pain, pallor, pulselessness, paralysis, poikilothermia- takes temp of room)
nursing care responsibilities
physical assessment, skin assessment/neurovascular status, explain what to expect, elevate affected extremity, assess for pain, infection, unaffected joints MUST be exercised and moved ROM (dorsiflexion- toes up vs. plantar flexion- foot points down)
practical application: cast
Handle the wet cast with the palm of your hands, not your fingertips
- Drainage stain on the cast: assess! –> Outline, date and time
- do not put anything inside the cast
if cast is itching
blow hair dryer cool air
compartment syndrome
most serious complication
-tight and rigid cast/splint can constrict blood flow to limb which compromises tissue perfusion
sign - way more than expected pain
tx of compartment syndrome
loosen or remove the cast or splint to release the constriction.
-Extremity must be elevated NO HIGHER than the heart level to maintain arterial perfusion.
pressure ulcer
- cast/splint puts pressure on soft tissue that causes tissue anoxia
S/S: patient may complain painful “hot spot” and tightness under the cast; cast may feel warmer in the affected area; drainage may stain the cast
disuse syndrome
Immobilization can cause muscle atrophy, loss of strength - > disuse syndrome (deterioration of body system as a result of prescribed musculoskeletal inactivity).
prevent disuse syndrome
Prevention: teach patient to tense or contract the muscle without moving the underlying bone (isometric muscle contraction)- must be done hourly while awake.
-Ex: Arm cast- > instruct patient to make a fist; Leg cast: push down the knee (straighten it)
external fixators used for
- Used to manage fractures with soft tissue damage.
- Commonly used in fractures of the humerus, forearm, femur, tibia, pelvis; the fixators provide skeletal stability for severe comminuted fracture. (crush or splintered fracture)
external fixators
This involves surgical insertion of pins through the skin and soft tissue and through the bone.
- And metal external frame is attached to these pins to hold the fracture in proper alignment.
nursing responsibilities of external fixators
- prepare psychologically
- extremity elevated to level of heart
- monitor neurovascular status Q 2-4 hrs
- Monitor pin site insertion for s/s of infection (end goal: prevent osteomyelitis- bone infection)
- Clean the pin site separately to prevent cross-contamination with chlorhexidine
- Call prescriber if RN notices s/s of infection or the clamps seem loose. (NEVER ADJUST THE CLAMPS)
- Isometric exercises as tolerated
- Assist patient become mobile – check prescribed weight-bearing limits!
