Musculoskeletal Disorders Part I Osteoporosis Osteomyelitis Osteoarthritis Rheumatoid Arthritis Gout

Musculoskeletal Disorders Part II Fractures Amputations

Manifestations of Fractures Pain Swelling Deformity Numbness Hematoma Formation Muscle spasm

Emergency Care of Fractures Neurovascular Assessment Five Ps − Pain − Pulses − Pallor − Paralysis − Paresthesia Immobilization Alignment Wound Care

Diagnosis of Fracture X-ray Bone Scan Lab Studies CBC Coagulation studies

Promote Factors Which Promote Bone Healing Local Good emergency care and fracture setting Ice Systemic Ca++, Vitamin D, Growth Hormone Adequate Blood Supply Young and Active No Infection

Fracture Treatments Medications Surgery Fixation Devices External Internal Traction Casts

Medications Analgesics Antibiotics Anticoagulants GI Meds Constipation Ulcer prevention

Surgical Treatment External Fixation

Nursing Care for External Fixation Devices Maintain Alignment Frequent Neurovascular and Skin Assessments Infection Prevention Skin care per policy

Surgical Treatment Internal Fixation (ORIF)

Nursing Care for Internal Fixation Devices Neurovasuclar Assessment PAIN Suture Care Hemovac? Hazards of Immobility Lungs, heart, bowels, legs

Traction Manual

Traction Bucks also called Straight Traction

Traction Balanced Suspension

Care of the Client in Traction Maintain alignment Let weight hang free Maintain ropes free Position client Skin Traction NO more then 6 pounds of traction per extremity

Casts Immobilizes Body Part Note Composition Plaster Fiberglass Teaching No objects in cast Keep Dry Assess Neurovascular Position Sling to prevent neck injuries − Even distribution of weight Alignment ID wrinkles in fabric Check skin

Nursing Care of Client with a Cast Neurovascular Checks Assess for Infection Crutch Walking Two Point Gait Four Point Gait Swing to Gait Swing through Gait

Complications Related to Fractures Compartment Syndrome Fat Embolism Syndrome Deep Vein Thrombosis Reflex Sympathetic Dystrophy

Compartment Syndrome (CS) Fascia Lines the Compartment within the limb Increased pressure from hemorrhage or edema Pressure from cast being too tight Results Nerve, vessels, muscles are damaged

COMPARTMENT SYNDROME

Fat Embolism Syndrome Globules of fat, released from fractured bone Fat mixes with platelets Emboli travel to lungs, brain, or other areas. Clotting cascade activated = petechiae

Assessment of Fat Embolism Syndrome Notify MD Immediately Dyspnea Confusion Pulmonary complications − Pulmonary Edema − ARDS Petechiae

Treatment of Fat Embolism Syndrome Maintain Pulmonary Function Intubation Ventilation Fluid Balance Steroid Treatment Stabilize Long Bone Fractures

Deep Vein Thrombosis

Reflex Sympathetic Dystrophy Posttraumatic Condition Persistent Pain Hyperesthesias Swelling Skin color changes Temperature changes Treatment Sympathetic Nervous System Blocking Agent (Alpha or Beta Blocker)

Hip Fracture

Nursing Care of Client with Hip Fracture Neurovascular Assessment Nursing Diagnosis Acute Pain Risk for Infection Impaired Mobility Impaired Sensory Perception

Amputations

Causes PVD Trauma Infections Tumors

Teaching Principals For Clients with an Amputation Wrap Stump Positioning of the Stump Stump Exercises Physical Activities Household modifications Referrals for Social Services

The End