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Musculoskeletal
Disorders
Prepared by:
Wilfredo A. Dela Cerna, RN
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Rheumatoid Arthritis (RA)
- chronic systemic disease
characterized by inflammatorychanges in the joints and relatedstructures
- common in women than in men- may occur at any age but thepeak is usually between 35-50
years old- IDIOPATHIC cause, said to bean autoimmune problem
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- associated with viral and bacterialinfections, lifestyle and hormonalfactors
Clinical Manifestations
Fatigue
Anorexia
Malaise
Painful joints, warm, swollen, limitedin motion, stiff in morning and period
after inactivity
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Muscle weakness
Diagnostic Tests
Xray
CBC; anemia is common
ESR elevated
Rheumatoid factor (POSITIVE)
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Treatment
Pharmacologic Agents
Salicylates
NSAIDs
Corticosteroids
Methotrexate
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Osteoarthritis
- the most common form of
arthritis- a chronic deterioration and anonsystemic disorder of the joint
cartilage and formation of areactive new bone at the marginsubchondral areas of the joints.
- IDIOPATHIC cause- associated with aging, obesityand trauma
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- common sites are weight-bearing joints and terminal
interphalangeal joints of fingers
Clinical Manifestations
Pain and stiffness of jointsHeberdens nodes
Bouchards nodes
Decreased ROM
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Diagnostic Tests
X-ray
Elevated ESR
Treatment: SAME with RA
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Nursing Interventions
1. Administer analgesics/ anti-
inflammatory2. Provide emotional support
3. Encourage patient to perform as
much self-care as his immobilityand pain allow.
4. Promote rest periods and
comfort
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Gout
- a disorder in the purine
metabolism; causes high levelsof uric acid in the blood and theprecipitation of urate crystals inthe joints and in the kidneys.
- more common in men than inwomen
- familial tendency
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Clinical Manifestations
Joint pain, redness, heat,
swelling; commonly affectedsites are great toe, ankle
Headache
MalaiseAnorexia
Diagnostic Tests
X-Ray
Serum Uric Acid Evaluation
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Management
Drug therapy
ColchicineNSAIDs
Uricosuric Agent
Analgesics
Diet: Low purine
Joint rest and protection
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Nursing Interventions
1. Assess joints for pain, motion,
appearance2. Provide bed rest and joint
immobilization
3. Administer antigoutmedications as ordered.
4. Administer analgesics as
ordered.5. Increase OFI to 2000-3000ml
per day
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Fractures
- a break in the continuity of the
bone usually caused by traumaTypes
1. Open or Compound
2. Closed or Simple3. Transverse
4. Oblique
5. Spiral
6. Greenstick
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Clinical Manifestations
Pain, aggravated by motion
Loss of motionEdema on the site
Hematoma/ discoloration
Assymetry
Diagnostic Tests
X-Ray
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Management
TractionReduction
Application of a Casts
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Nursing Interventions
1. Provide emergency care for
fractures.2. Perform a neurovascular check
on affected extremity
3. Observe for signs andsymptoms of CompartmentSyndrome.
4. Observe for signs andsymptoms of Fat embolism
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5. Encourage diet high in proteinand vitamins to promote healing.
6. Encourage fluid to preventconstipation, renal calculi andUTI.
7. Provide care for client intraction, with a casts or withopen reduction.
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TRACTIONS
- used to treat fractures,dislocations, correct or preventdeformities, improve or correct
contractures or decrease musclespasms by exerting a pullingforce on a part of the body
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Basis for Traction Usage:
1. Patients condition2. Age
3. Weight
4. Skin condition
5. Duration of traction to beapplied
6. Purpose of traction
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Types of Traction
1. Skin Traction
- 5 to 8 lbs (2.5 to 3.5 kg)
2. Skeletal Traction
- 25 to 40 lbs (11.5 to 18 kg)
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SKIN TRACTION
Types:
1. Bucks Traction- exerts straight pull on
affected extremity
- generally used to temporarilyimmobilize the leg in a clientwith a fractured hip
- shock blocks at the foot of
the bed to producecountertraction and prevent theclient from sliding down in bed
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2. Russell Traction
- knee is suspended in a sling
attached to a rope and pulley onthe Balkan Frame
- generally used to stabilize
fractures of the femoral shaftwhile client is awaiting forsurgery.
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3. Cervical Traction
- cervical head halter attached to
weights hang over head of bed- used for soft tissue damage ordegenerative disc disease of
cervical spine and to maintainalignment
- elevate the head of the bed to
produce countertraction
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4. Pelvic Traction
- pelvic girdle with extension
straps attached to ropes andweights
- used for low back pain to
reduce muscle spasms andmaintain alignment
- client in SEMI-FOWLERS with
KNEE BENT
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SKELETAL TRACTION
- traction is applied directly tothe bones using pins, wires, ortongs (Crutchfield Tongs) that
are surgically inserted.- used for fractured femur, tibia,humerus and cervical spine.
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Complications of Traction
1. Pressure sores
2. Muscle atrophy3. Weakness
4. Contractures
5. GI disturbances
6. Respiratory problems
7. Circulatory problems
8. Osteomyelitis
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Key Nursing Diagnoses
1. Constipation related to
immobility2. Impaired physical mobility
related to restrictions
associated with traction3. Impaired tissue integrity
related to immobility
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Nursing Intervention
The nurses main responsibility
includes patient teaching,maintaining traction apparatus,assessing for complications andcaring for pins in insertion sites.
Nursing Care:
1. Check traction apparatusfrequently to ensure that:
a. Ropes are aligned and weightsare hanging freely
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b. Bed in proper position
c. Line of traction is within the
long axis of the bone2. Maintain client in proper
alignment
a. Align in center of bedb. DO NOT rest affected limb
against foot of bed
3. Perform neurovascular checksto affected extremity.
4 Ob f d t
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4. Observe for and preventfootdrop
a. Provide footplate
b. Encourage plantarflexion anddorsiflexion
5. Observe for and prevent deep
venous thrombosis6. Observe for and prevent skin
irritation and breakdown
Russell Traction: popliteal areaThomas Splint: popliteal area
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Cervical: pad chin area andprotect ears
7. Provide pin care8. Assist with ADL; provide
overhead trapeze to facilitate
moving, using bedpan9. Prevent complications of
immobility
10. Encourage active ROMexercises to unaffected extremity
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11. Check carefully for ordersabout turning
Bucks Traction: client may turn tounaffected side (place pillowsbetween legs before turning)
Russell Traction: client may turnslightly from side to side withoutturning body below the waist
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CASTS
- used to immobilize a body part
Casting Materials:1. Plaster of Paris
- takes 24 72 hours to dry
- precautions must be takenuntil cast is dry to preventdents
- signs of a dry casts: SHINYWHITE, HARD, RESISTANT
t b k t d i t
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- must be kept dry since watercan ruin a plaster cast
2. Synthetic Casts (Fiberglass)- strong, lightweight; sets inabout 20 minutes
- can be dried using cast dryer orhair blowdryer on cool setting
- water-resistant; however it
must be dried thoroughly toprevent skin problem under thecast
C t D i ( Pl t C t)
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Cast Drying ( Plaster Cast)
1. Use palms of hands, NOT
FINGERTIP, to support castwhen moving or lifting client
2. Support cast on rubber or
plastic protected pillows withcloth pillowcase along length ofcast until dry
3. Turn client every 2 hours toreduce pressure and promotedrying
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4. DO NOT cover the cast until it isdry (may use fan to facilitate
drying)5. DO NOT use heat lamp or hair
dryer on plaster cast
Nursing Care for Clients with Cast:
1. Perform neurovascular checks
to area distal to cast:
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a. Report absent or diminishedpulse, cyanosis or blanching,
coldness, lack of sensation orinability to move fingers ortoes, and excessive swelling
b. Report complaints of burning,tingling or numbness
2. Note any odor from the castthat may indicate infection
3. Note any bleeding on cast in asurgical patient
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4. Check for hot spots that mayindicate inflammation under cast.
5. Instruct the patient to wiggletoes or fingers
6. Elevate the affected extremity
above the heart7. DO NOT scratch or insert foreign
objects under cast
8. Avoid eating crackers while oncasts
ASSISTIVE DEVICES fo WALKING
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ASSISTIVE DEVICES for WALKING:
1. Cane
Nursing Care: Teach client tohold cane in hand oppositeaffected extremity and to
advance cane at the same timethe affected leg is movedforward
2 Walker
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2. Walker
Nursing Care: Teach client tohold upper bars of walker at eachside, then to move the walkerforward and step into it.
3. Crutches
- when the client assumes erectposition the top of crutch mustbe 2 INCHES below the axilla,and the tip of each crutch is 6INCHES in front and sides of thefeet
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clients elbow should be
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- clients elbow should beslightly flexed when head is onhand grip
- weight should NOT be borneby the axilla.
CRUTCH GAITS:a. FOUR-POINT GAIT
- used when weight bearing is
allowed on both extremities
Ad th i ht t h
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a. Advance the right crutch
b. Step forward with left foot
c. Advance left crutchd. Step forward with right foot
b. TWO-POINT GAIT
- typical walking pattern
- an acceleration of Four-pointgait
a Step forward moving both right
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a. Step forward moving both rightcrutch and left leg simultaneously
b. Step forward moving both leftcrutch and right legsimultaneously.
c. THREE-POINT GAIT
- used when weight bearing is
permitted on one extremity only
a Advance both crutches and
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a. Advance both crutches andaffected extremity severalinches, maintaining goodbalance
b. Advance the unaffected leg tothe crutches, supporting theweight of the body on thehands.
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