1. Muscle/Skeletal Rehabilitation
Lesson #2

2. Objectives Identify the principles of rehabilitation after a fracture
Describe arthroplasty and teaching for the patient in rehabilitation after a joint replacement
Describe the role of the rehab nurse in fracture and arthroplasty rehabilitation
Describe amputation rehabilitation
State the interventions by the rehab nurse that can help the patient with arthritis to improve functional abilities

3. Few Statistics Over 10 million people in USA have osteoporosis
1.5 million fractures are credited to osteoporosis
350, 000 hip fractures included
More than 70% of knee/hip replacements from osteoarthritis

4. Prohibits Surgery Bone infection Severe osteoporosis
Uncontrolled medical problem

5. Desired Post-Fracture Rehab Outcomes
Normal position healing
Full ROM to joints around fracture
Normal strength returns
Prevent complications

6. General Rule
A fracture will require immobilization of the joint both above and below the fracture site during the healing process

7. Types of Fractures
Muscle/Skeletal Rehab Nursing

8. #1 Stable fracture

9. Stable Fractures Require very little treatment
Rehab course begins as soon as initial symptoms of fracture subside.
Perform progressive ROM exercises 3-4 days post fracture
Progressive strengthening of fracture 3rd of 4th week post fracture
Example:
Radial Head Fracture
Non displaced ulna fracture

10. #2 Moderately stable fracture
Requires some form of immobilization yet allows movement of the joints nearest fracture

11. #2 Moderately Stable Fracture

12. #3 Unstable Fracture

13. #4 Grossly Unstable Fracture
Can’t be immobilized
Requires surgical intervention
Requires plaster or fiberglass cast
May require a cast or air brace
Examples:
Hip Fractures
Femur Fractures

14. #4 Grossly Unstable Fracture

15. Unstable Fracture Advantages and Disadvantages
Early mobilization
Early return to general mobility
Sometimes early protected weight bearing
Decreased risk with spinal anesthesia
Newer smaller incisions
Increased risks w/general anesthesia (elderly)
Increased risk of infection
Risk of interference w/the natural physiology of healing process..(screws may loosen, unresolved pain)
Advantages

16. #5 Comminuted Fracture
External Fixator

17. External Fixators
Used for complicated, very commuted and grossly unstable fractures
Usually have a lot of soft tissue damage and edema

18. Basic Principles of Rehab post fracture
#1 All Joints not requiring immobilization should be mobilized
#2 Gait Training/weight bearing as soon as possible
#3 Mobilization of the fracture area as soon as stability has been achieved
#4 Use of Local Help Techniques for pain and muscle spasms
#5 Muscle Strengthening as soon as fracture stabilized
#6 Perform ROM Exercises
#7 Strengthening Exercises

19. Systemic Complications of Fractures
Atelectasis and Pneumonia
Infection
GU stasis
Deep Vein Thrombosis
Fat Emboli
Pulmonary Emboli
Systemic problems of Immobility
ARDS

20. Local Complications of Specific Fractures
Non-Union
Mal-Union
Infection-Osteomyelitis
Stiffness

21. Surgeries Arthroplasty Defined Two Goals Candidates for surgery
Our focus:
Hip
Knee

22. Hip Abductor Wedge

24. Complications of Hip Dislocation
Causes
S&S of dislocation
Five “P’s” neurovascular check
Nursing responsibility
Anterior Posterior

25. Knee Replacement
Purpose
When?
Critical pathway
Other replacements

26. Role of Rehab Nurse in Fractures and Arthroplasty
Routine cast care
Monitor the extremity regularly
Provide/teach skin care/pin site care
Position properly
Supervise and monitor client’s weight bearing
Perform ROM as PT directed
Provide and encourage ADL training
Monitor for systemic and local complications
Monitor and perform pain management

27. Amputations

28. Amputation Rehabilitation
Children do well for injuries requiring rehab
Indications for an amputation is when the limb is no longer of any use
Severe trauma
Thermal injuries
Infections
Tumors
Pain
Severe circulatory problems)
Goal with amputations

29. Level of Amputation Severity of soft tissue damage Assessment
Vascularity of the tissue
Best level of function

30. Types of Amputations

31. Stump Healing Care and inspection S&S of infection W/C support
Expected outcomes

32. Stump Shrinking
Purpose
Dressings

33. Preventing Contractures Principles
#1 Prevent hip flexion and external rotation of stump
#2 Promote prone position
#3 Encourage crutch walking ASAP
#4 Avoid prolong sitting in W/C, bed, chair
#5 Patient performs resistance strengthening exercises on other limb

35. Amputee Mobility Training

36. Problem/Complications of Amputees
Skin problems
Atrophy
Phantom Limb Sensation
Phantom Pain
Interventions
Desensitizing techniques
Alternative methods to help phantom pain
Edema
Bony overgrowths

37. Rehab Nurse Role in Care of Amputation
Appropriate care to enable the patient to wear a prosthetic
Ensure appropriate care of stump healing/shrinking
Prevention of contractures

38. Arthritis
Rheumatoid Arthritis
Osteoarthritis

39. Arthritis Rheumatoid Osteoarthritis Chronic/ ?autoimmune
Systemic and symmetrical
Periods of exacerbation/remission
Onset: insidious
S&S
Treatment:
Drugs, rest, Protect, change environment
Degenerative
Unknown cause
Localized and asymmetrical
Can’t function with ADLs RT pain
S&S
Treatment: Wt loss
Drugs, rest, ROM, heat, Environment changes

40. Arthritis Problems

41. Arthritis Rehabilitation Nurses Role
Minimize morning stiffness
Manage environment
Provide /maintain stress free environment
Encourage/support:
proper positioning
comfort measures

42. Summary So what did I learn? Name one thing
How you will incorporate it into your nursing practice

43. References