Musculoskeletal Function Presentation

7/29/2019 Musculoskeletal Function Presentation

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1. Herniated intervertebral disk (most commonlyaffecting L4-L5 or L5-S1 interspaces)

2. Fracture of the spine

3. Spine dislocation4. Osteoarthritis5. Scoliosis

6. Tension7. Poor posture and body mechanics8. Lack of muscle tone9. Degenerative disk disease10. Obesit


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1.Myelography

2.MRI, Ct scan3.Electromyogram (EMG)

4.Diskogram


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1. Depressed or absent Achilles

tendon reflex; positive

straight-leg raise test

2. Guarded movement

3. Decreased ROM of spine

4. Diagnostic studies


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1. To relieve pain and muscular spasm

Administer appropriate medications (analgesics,

NSAIDS, muscle relaxants, Flexeril)

Apply moist heat Bedrest; patient in Fowlers position with moderate

hip and knee reflexion

Use firm mattress, bedboard, or floor for back support2. To regain normal electricity of affected muscle

Isometric exercises for abdominal muscles

Daily exercise program


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3. To return joint to normal function Assist with exercises for abdominal

muscles

ROM exercises4. Good body mechanics

Do not lean forward without bendingknees

Exercise under direction of health careprovider

Do not stand in one position for prolongedtime

Sleep in side-lying position with knees and

hips bent


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1. Exercise daily but avoid strenuousexercises

2. Correct posture at all times3. Avoid prolonged sitting, standing,

walking, and driving

4. Rest at intervals5. Use hardboard for bed, or firm mattress6. Avoid prone position

7. Avoid straining or lifting heavy objects


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1. Conservative therapy2. Surgical therapy

a. Percutaneous laser diskectomy; herniated portion of disk islasered

b. Diskectomyc. Laminectomyd. Laminectomy with fusione. Postlaminectomy care

1) Maintain body alignment

2) Leg-roll every 2 h

3) Calf exercises

4) Assess for sensations and circulatory status, especially of lowerextremities

5) Monitor elimination6) Assist with ambulation


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1. Contusions

a. Ecchymosis

b. Hematoma

2. Strains/sprains

a. Pain

b. Swelling

3. Joint dislocation

a. Pain

b. Deformity


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4. Fracturesa. Swelling

b. Pallor, ecchymosis

c. Loss of sensation to body parts

d. Deformity

e. Pain and/or acute tenderness

f. Muscle spasmg. Loss of function

h. Abnormal mobility

i. Crepitus (grating sound on movement of ends of

broken bone)

j. Shortening of affected limb

k. Decreased or absent pulses distal to injury

l. Affected extremity colder than contralateral part


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1. Avulsion

2. Comminuted

3. Greenstick

4. Longitudinal

5. Oblique6. Impacted

7. Interarticular

8. Pathological9. Spiral

10. Stress

11. Displaced


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1. Types

a. Fat emboli

b. Hemorrhage

c. Delayed union/nonunion

d. Sepsis

e. Compartment syndrome

f. Peripheral nerve damage


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1. Contusions

2. Strains/sprains

3. Dislocations

4. Fracturesa. Provide emergency care

1) Immobilization before patient is moved by use of

splints; immobilize joint below and above fracture2) In an open fracture, cover the wound with sterile

dressings or cleanest material available

3) Emergency room


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b. Treatment

1) Splinting/immobilization of the

affected part to prevent soft tissue

from being damaged by bony

fragments2) Internal fixation

3) Open reduction/surgical dissection

and exposure of the fracture forreduction and alignment


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a. Purposes

1) Immobilize fracture

2) Alleviate pain and muscle spasm

3) Prevent or correct deformities

4) Promote healing

b. Types of traction

1) Skin (Bucks extension, Russells, pelvic orcervical traction)

2) Skeletal (halo, Crutchfeild tongs)


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c. Nursing management

1) Maintain straight alignment of ropes and

pulleys2) Assure that the weights hang free

3) Frequently inspect skin for breakdown

4) Maintain position for countertraction5) Encourage movement of unaffected areas

6) Investigate every compliant immediately and

thoroughly7) Maintain continuous pull

8) Clean pints with half-strength peroxide and

sterile swabs 1-2times/d


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a. Immediate care

1) Avoid covering cast until dry (48 h or longer),handle with palms, not fingertips

2) Avoid resting cast on hard surfaces or sharp

edges

3) Keep affected limb elevated above heart on softsurface until dry; no heat lamp

4) Watch for danger signs, e.g., blueness orpaleness, pain, numbness or tingling sensationson affected area; if present, elevate casted area;

if it persists, contact physician


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b. Immediate care

1) When cast is dry, patient should be

mobilized2) Encourage prescribed exercises (Isometrics)

3) Report to physician any break in cast or foul

odor from cast

4) Tell patient not to scratch skin underneathcast; skin may break and infection can set in

5) If fiberglass cast gets wet, dry with hairdryer on cool setting


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c. After-cast care

1) Wash skin gently

2) Apply baby powder, cornstarch, or baby oil

3) Have patient gradually adjust to

movement without support cast

4) Inform patient that swelling is commonafter cast is removed; elevate limb andapply elastic bandage


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1. Leg shortened, abducted,

externally rotated

2. Pain

3. Hematoma, ecchymosis

4. Confirmed by x-rays


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1. Total hip replacement

2. Abduction of affected extremity3. Turn patient as ordered4. Ice to operative site5. Overbed trapeze to lift self onto fracture bedpan

6. Initial ambulation with walker7. Crutch walking8. Chair with arms, wheelchair, semireclining toilet seat9. Medications

10. Dont sleep on operated side11. Dont flex hip more than 45-60 (dont elevate head

of bed more than 45)12. Continuous passive motion device

C li i


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13. Complicationsa. Dislocation of prosthesis

b. Excessive wound drainage

c. Thrombeombolismd. Infection

14. Postoperative discharge teachinga. Maintain abduction

b. Avoid stoopingc. Do not sleep on the operated side until directed to do so

d. Flex hip only to circle

e. Never cross legs

f. Avoid position of flexion during sexual activity

g. Walking is excellent exercise; avoid overexertion

h. In 3 mo, will be able to resume ADLs, except strenuous

sports


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1. Trauma

2. Peripheral vascular disease

3. Osteogenic sarcoma

B. Types1. Disarticulation

2. Above-the-knee amputation

3. Below-the-knee amputation

4. Guillotine or open surface

5. Closed or flap


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C. Postoperative management

1. Delayed prosthesis fitting

2. Immediate prosthesis fittingD. Nursing management

1. Prevent bleeding

2. Promote circulation

3. Prevent complications of immobility

4. Provide comfort and relieve pain5. Provide psychological and emotional support

6. Patient teaching, regarding stump care


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A. Rheumatoid arthritis (RA)

1. Description

2. Historya. Autoimmunity

b. Environmental factorsc. Viral or streptococcal infection

d. Genetic


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3. Assessmenta. Joint pain and swelling

b. Limited joint movement

c. Contractures; deformities

d. Weakness, fatigue

e. High fever and rheumatoid rash, particularly seen in juvenileRA (Stills disease)

f. Nodules over bony prominences

g. Ulnar drift

4. Diagnostic tests

a. Blood studies1) ASO titer (JRA)

2) Later fixation

3) C-reactive protein

4) Sedimentation rate

b A i i f i l fl id


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b. Aspiration of synovial fluid

c. X-rays

5. Nursing management

a. Relieve pain and discomfort

1) Application of heat; e.g., warm tub baths, warm, moistcompresses, paraffin dips

2) If inflammatory process is acute, application of cold packs orice bag is sometimes effective

3) Support joints with splints; cervical collar in late stages

4) Administer analgesics

b. Promote rest and mobility1) Proper positioning

2) Use firm mattress or bedboard

3) ROM exercises as tolerated

4) Encourage independence and acceptance of limitations

R d i fl ti


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c. Reduce inflammation

d. Provide adequate dietary intake; appropriate diet for obesity

e. Provide operative care for patients undergoing musculoskeletalsurgery, e.g., arthroplasty

f. Preoperative teaching

1) Teach partial weight-bearing use of crutches, isometric

exercises, and transfer techniques

2) Familiarize patient with overbed traction frame, trapeze, and

abduction splint

g. Preoperative teaching

1) Position patient flat in bed with affected extremity in abduction

2) Apply ice to operative area to reduce edema

3) Assess circulation of affected extremity

4) Administer medications to prevent postoperative complications

a) Pulmonary embolism

b) Infection

) E ti f t d kl ti th d f ll i


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5) Encourage active foot and ankle motion the day followingsurgery to prevent circulatory stasis

6) Have patient do active knee and hip flexion with support toprepare for ambulation

7) Help patient ambulate gradually with walker, then crutches,using three-point gait

h. Postoperative discharge teaching

1) Maintain abduction2) Avoid stooping

3) Do not sleep on operated side until directed to do so

4) Flex hip only to circle

5) Never cross legs

6) Avoid position of flexion during sexual activity

7) Walking is excellent exercise; avoid overexertion

8) In 3 mo, will be able to resume ADLs, except strenuouss orts


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1. Pathophysiology2. Characteristic clinical manifestations

a. Intermittent fever and chills

b. Rheumatoid rash (salmon pink, macular rash on chest,tights, and upper arms)

c. Iridocyclitis (inflammation of the iris and ciliary body)

d. Growth retardation3. Diagnosis4. Problems5. Treatment and nursing management


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1. Description2. Pathophysiology3. Clinical manifestations

a. Pain and stiffnessb. Kyphosis

4. Diagnostic tests5. Problems

a. Alteration in comfort (pain)b. Decreased mobility

c. Potential for respiratory difficulty

d. Potential for poor body image and low self-esteem

6 T t t d i t


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6. Treatment and nursing management

a. Analgesics; promote comfort

b. Anti-inflammatory drugs, salicylatesc. Physical therapy, heat application

d. Promote body alignment, especially of the spine

1) Postural exercises2) Splinting, bracing

e. Improve mobility

1) ROM exercises2) Assist with ADLs

f. Prevent respiratory complications


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1. Description2. Pathophysiology3. History

a. Poor posture

b. Traumac. Stress on jointsd. Obesity

4. Assessment

a. Muscular spasm, pain, limitation of motion, stiffness;impaired ADL performanceb. Contractures, deformitiesc. Heberdens nodes on fingersd.

Obesity/debilitation

Di ti t t


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5. Diagnostic test


a. Reduce pain and discomfort

1) Balance rest with activity

2) Administer analgesics and anti-inflammatory

drugs such as aspirin, Motrin, Clinoril, Indocin

b. Heart application

c. Maintain mobility

1) ROM2) Encourage usual ADLs that involve using all

joints

d. Provide adequate nutrition; obese patients shouldbe ut on a ro riate diet


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1. Description

2. Pathophysiology3. Predisposition

a. Swollen, redden, painful joints

b. Limitation of motion

c. Deformity

4. Diagnostic tests

a. X-rays

b. Blood tests

c. Synovial aspiration

N i


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a. Relieve pain and discomfort

1) Rest affected joint

2)Administer analgesics

b. Reduce urate level in the blood

1) Eliminate purine food from diet, e.g.,

liver, sardines2)Administer medication (aspirin,

Butazolidin, Indocin)


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1. Description2. History

a. Stress on jointsb. Toxins

c. Infections3. Assessment

a. Pain

b. Decreased mobility, especially on abduction4. Interventions

a. Rest

b. Immobilize affected joint by use of pillows, splints, slings

c. Administer pain medication, muscle relaxants (Valium), steroids

d. Apply heat/cold packs to decrease swelling

e. Promote exercise (ROM)

f. Assist in performance of ADLs by modifying activities relative tolimitations

g. Assist with cortisone injection, draining of bursae


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1. Description2. Pathophysiology3. Assessment

a. Pain and tendernessb. Enlarged skullc. Kyphosisd. Bowed legse. Waddling gaitf. Decrease in height

4. Nursing managementa. To relieve pain and discomfortb. Administer analgesicsc. Encourage rest

1) Prevent pathological fractures by using safety precautions

2) Administer specific drugs to prevent bone destruction


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a. Decreased estrogen (menopause)b. Low calcium intakec. Vitamin D deficiencyd. Malabsorptive disease of GI tracte. Immobilityf. Hyperthyroidismg. Hyperparathyroidismh. Prolonged use of steroids

4. Assessmenta. Lower back painb. Kyphosis

c. Decrease in height

5 Diagnostic tests


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5. Diagnostic tests6. Nursing management

a. Provide optimal nutrition diet

b. Assist in restoring hormonal balance, e.g., estrogen forpostmenopausal women (only after evaluation risk factors)

c. Promote mobility and strength

1) Encourage weight-bearing on the long bones

2) ROM exercises

3) Physiotherapy

d. Prevent pathological fractures

e. Promote and relieve pain1) Bedrest

2) Use of back brace or splint for support

3) Use of bedboards or hard mattress

f. Prevent bone resorption


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a. Chronic skin problems, i.e., decubitus ulcers, gangrene

b. Compound fractures4. Assessmenta. Painb. Swelling, redness, warmth on affected area

c. Fever5. Diagnostic testsa. Leukocytosisb. Elevated sedimentation ratec. Culture and sensitivityd. X-ray of affected part

6 Nursing management


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6. Nursing managementa. Promote comfort, relieve pain

1) Bedrest

2) Administer antibiotics3) Support affected extremity with pillows, splints to maintain

proper body alignment

4) Use room deodorant

b. Reduce inflammatory process1) Administer antibiotics

2) Apply heat to affected area

3) Encourage fluid intake

4) Monitor I and Oc. Promote skin integrity

1) Asepsis

2) General skin care

3) Wound care

d P id ti l t


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d. Provide emotional support

1)Allow for expression of fear and

anxiety

2)Provide diversionary activities

e. Improve nutritional status

1)High-protein diet with sufficient

carbohydrates, vitamins, andminerals

2 Small fre uent feedin s


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1. Description

2. Pathophysiology3. Assessment

a. Bone pain and tenderness

b. Muscle weakness

c. Bowed legs

d. Kyphosis

4. Diagnostic tests

5. Nursing interventionsa. Relief of pain

1) Administration of analgesics

2) Bedrest

3) Maintain good body alignment

b P t i li ti


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b. Promote mineralization

of bonec. Promote safety

1)Assist with performance of

ADLs to prevent

pathological fractures

Musculoskeletal Function Presentation

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