Musculoskeletal system Flashcards
Nursing care of a child in a cast
- Expose the plaster cast to air until dry
- When handling wet cast, use palms of hands as fingertips can indent and create pressure areas
- Elevate extremity on a pillow above heart to help reduce swelling and increase venous return
- Assess distal pulses as any deviation from normal may indicate nerve damage of decreased blood supply
*Assess color, warmth, capillary refill, and edema as any deviation from normal may indicate nerve damage
- Assess movement as any deviation from normal may indicate nerve damage
- Ensure small objects are not placed between the cast and extremities as this can cause skin irritation and neurovascular compromise
Purpose of traction
- To realign bone fragments (position distal and proximal bone ends to promote satisfactory bone healing)
- To fatigue involved muscle and reduce muscle spasms so bones can be realigned
- To immobilize the fracture site until realignment has been achieved and sufficient healing has taken place to permit casting or splinting
Types of traction
- Dunlop - used to fracture of humerus
- Bryant - Used for fracture of femur and DDH
- 90-90 traction - used for fracture of femur or tibia
Circulatory impairment
Occurs if the trauma or immobilizing device restricts blood flow in veins or arteries of the affected extremity
Assessment of pulses, capillary refill, skin color and temperature are important.
Nerve compression
Occurs at the time of injury
Develop in the process of realignment or arise as complication of use of an immobilizing apparatus
Compartment syndrome
occurs when pressure within this closed space increases and compromises circulation to the muscles and nerves within the space
Clinical manifestations of compartment syndrome ( 6 p’s)
- Pain - unrelieved by medication and characterized by crying in young children
- Pulselessness - weak or absent pulse (peripheral pulses)
- Pallor - pale, gray or white skin tone (color, capillary refill)
- Paresthesia - tingling, burning (sensation)
- Paralysis - weakness or inability to move extremity (motor ability)
- Pressure (skin is tense and cast appears tight) (edema)
- Poikilothermia - skin temperature assumes that of the environment (temperature)
Treatment of compartment syndrome
remove any mechanically obstructive materials such as tight bandages and extend the joint to free vessels.
Treatment of compartment syndrome
remove any mechanically obstructive materials such as tight bandages and extend the joint to free vessels.
Stages of bone healing
Stage 1: Hematoma formation
Stage 2: Cellular proliferation
Stage 3: Callus formation
Stage 4: Ossification
Stage 5: Consolidation and Remodeling
Emergency treatment of a fracture
- Determine the mechanism of injury.
- Assess the 6 Ps.
- Move the injured part as little as possible.
- Cover open wounds with a sterile or clean dressing.
- Immobilize the limb, including joints above and below the fracture site; do not attempt to reduce the fracture or push protruding bone under the skin.
- Use a soft splint (pillow or folded towel) or rigid splint (rolled newspaper or magazine).
- Uninjured leg can serve as a splint for a leg fracture if no splint is available.
- Reassess neurovascular status.
- Apply traction if circulatory compromise is present.
- Elevate the injured limb if possible.
- Apply cold to the injured area.
- Call emergency medical services or transport to medical facility.
Nursing diagnoses
- Risk for injury
- Acute pain
- Knowledge deficit
- Impaired skin integrity
- Impaired walking
- Impaired physical mobility
*Risk for peripheral neurovascular dysfunction
Stages of bone healing
- Hematoma formation
- Cellular proliferation
- Callus formation
- Ossification
- Consolidation and remodeling
