50184070-traction - Musculoskeletal Disorders Sprain...

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Unformatted text preview: Musculoskeletal Disorders Sprain complete or incomplete tear in the supporting ligaments surrounding joints. Strain overstretching injury to a muscle or tendon. Sprain commonly result from wrenching or twisting motion Strain typically result from excessively vigorous movement in understretched and overstretched muscles and tendons Sprain Pain and discomfort Edema Decreased joint motion and function Feeling of joint looseness Strain Pain Edema Ecchymoses 1. Administer prescribed medication 2. Provide nursing care for the client who sustain sprain. 3. Provide nursing care for a client who suffer muscle or tendon strain. 4. Provide additional teaching Displacement of a bone from its normal articulation with a joint May be congenital May result from trauma or disease of surrounding joint tissue Pain Visible disruption of joint contour Edema Ecchymoses Impaired joint mobility Change in extremity length and in axis of dislocated bones 1. Administer prescribed medication 2. Prevent from further injury 3. Assist physician in reducing displaced parts as necessary 4. Provide teaching Remember Rest Ice Compress Elevate Disruption in the continuity of bone as a result of trauma or various disease process Highest incidence in males 15-24 years and in elderly persons, women aged 65 years and older Direct blow Crushing force Sudden twisting motion Extreme muscle contraction Fractures Complete fractureinvolves a break across the entire cross section of the bone and is frequently displaced from normal position Incomplete fracture break occurs through the only part of the cross section of the bone. Closed fracture does not produce a break in the skin. Open fracture presence of break in the skin. Greenstick bone bends w/out fracturing across completely, cortex on the covade side remain intact Other fractures Transverse fracture that is straight across the bone, caused by a force applied to the site. Spiral/ oblique fracture twisting around the shaft of the bone, caused by violence forced through the limb. Impacted- fracture where the fragment are driven into one Crush occurs in cancellous bone as result of a compression force. Burst occurs in a short bone resulting from strong direct pressure. Compression fracture which the bone has been compressed Pathologic fracture through an area of diseased bone. Other fractures Avulsion pulling away of a fragmet of bone by a ligament or tendon & its attachment. Epiphyseal fracture through the epiphysis Compound fracture with a surface or open wound. Include more than one break in the bone. Comminuted fracture with more than one fragments Pain Loss of function/sensation Deformity Shortening/lenghtening Crepitus (grating sensation) Swelling Discoloration Excessive motion on site Soft tissue edema Warmth over injured area Paralysis distal to injury resulting from nerve entrapment Signs of shock related to severe tissue injury Fracture care splinting of fracture preservation of body alignment elevation of body part to limit edema application of cold packs observe for changes in color, sensation, or temperature of injured part observe for signs of shock Fat embolism Compartment syndrome Nonunion Arterial damage Infection Hemorrhage/ Shock Fat emboli - serious, potentially life-threatening complication S/Sx: Restlessness mental status changes tachycardia tachypnea hypotension Dyspnea Petechial rash over the upper chest and neck. Compartment syndrome - increased pressure within a limited anatomic space compromising circulation, viability, and function of tissues within that space. S/Sx: increased pain and swelling pain with passive motion inability to move joints loss of sensation pulselessness Infection and osteomyelitis - caused by the interruption of the integrity of the skin; the infection invades bone tissue. S/Sx: fever pain erythema in the affected area tachycardia elevated WBC count Avascular necrosis- interruption in the blood supply to the bony tissue, which results in the death of the bone. S/Sx: pain decreased sensation Pulmonary Emboli- caused by immobility precipitated by a fracture S/Sx: restlessness and apprehension Dyspnea Diaphoresis ABG changes Treatment Splinting- immobilization of the affected part to prevent soft tissue from being damaged by bony parts Casting- provides rigid immobilization of affected body part for support and stability Treatment Internal fixation- use of metal screws, plates, nails and pins to stabilize reduced fractures Traction Reduction- restoration of the fracture fragments into anatomic alignment and rotation. Nursing care plan/implementation for clients with Fracture Promote healing and prevent complications diet: high protein, iron, vitamins (tissue repair), moderate carbohydrates (prevent weight gain) increase fluid intake Nursing care plan/implementation for clients with Fracture assess for complications of immobility (pneumonia, constipation, decubitus ulcers, osteoporosis) assess casted extremity for presence of foul odor, drainage, paleness or blueness, change in temperature, pulselessness, tingling, numbness Nursing care plan/implementation for clients with Fracture Prevent injury or trauma avoidance of high-risk activities (sky diving, high impact sports, rollerblading) avoidance of safety hazards (throw rugs, untreated vision problems) regular exercise Nursing care plan/implementation for clients with Fracture Provide care related to ambulation with crutches Provide safety measures related to possible complications following fracture Nursing Management Administer prescribed medication Provide care during transfer of the patient - immobilized the fractured extremity - support the affected side. Provide client and family teaching - explain prescribed activity restriction - Teach the proper use of assistive devices. - Provide additional teaching Stages of Bone Healing HEMATOMA AND INFLAMMATION ANGIOGENESIS AND CARTILAGE FORMATION CARTILAGE CALCIFICATION CARTILAGE REMOVAL BONE FORMATION REMODELING Callus formation: 3 to 4 weeks Ossification begins within 2 to 3 week up to 3 to 4 months Progress should be monitored by serial x-rays reveals complete bone union An orthopedic treatment that involves placing tension on a limb, bone or muscle group using variety of weight and pulley systems 1. Decreased muscle spasm 2. Reduce, align, and immobilize fractures 3. Correct or prevent deformity 4. Increase space between joint surfaces. Straight or Running traction involve straight pulling force in one plane. Balanced suspension traction involves exertion of a pull while the limb is supported by hammock or splint Skin traction involves weight applied and held to the skin with a Velcro splint. Skeletal traction involves weight applied and attached to metal/pin inserted into bone Bucks Extension Traction femur & hip fracture Overhead fracture of humerus Head halter cervical spine affection Pelvic girdle lumbosacral affection, herniated nucleus pulposus Dunlops Traction fractured elbow and humerus Halo pelvic scoliosis Halo femoral severe scoliosis Bryants traction femoral fracture, Hip injuries among kids below 3 years old Buttocks are slightly elevated and clear off the bed. Boot leg hip and femoral affection Ninety degrees fracture of the femur Stove- in chest severe chest injury with multiple rib fracture Hammock suspension pelvic affection Skin Traction To control muscle spasm To immobilize an area before surgery Skeletal Traction 1. Uses wires, pins, or tongs placed through the bones 2. MOST frequently used in treating fractures of femur, humerus, tibia & cervical spine. NURSING FOCUS Weights must hang freely. Line of pull is from the first pulley back to the point on the extremity. Tie all knots securely. Skin traction is usually intermittent and skeletal traction is usually continuous.] Never release weights unless ordered 1. Prevent complications of immobility 2. Promote skin integrity 3. Inspect for signs of skin breakdown, irritation or infection 4. Provide client teaching 5. Promote self-care within traction limitation Bucks extension simplest form and provides for straight pull on the affected extremity relieve muscle spasm immobilize a limb temporarily Heel is supported off bed to prevent pressure on heel, weight hangs free of the bed, and foot is well away from footboard of bed, and parallel to the bed. Russel traction - permits the patient to move freely in the bed - permits flexion of the knee joint. used in the treatment of intertrochanteric fracture of the femur when surgery is contraindicated Hip is slightly flexed. Pillows may be used under lower leg to provide support and keep the heel free of the bed. Russells Traction Nursing Intervention of Patients with Traction Monitor color, motion, and sensation of the affected extremity Monitor the insertion sites for redness, swelling, or drainage Patient education Maintaining the traction Skin care Assist in toileting A. Open reduction involves reduction and alignment of fractures through surgical opening B. Internal Fixation involves stabilization of reduced fracture with screws, or pins C. Bone graft involves placement of bone tissue for healing, stabilization, or replacement D. Arthroplasty involves joint repair through small arthroscope E. Arthrodesis involves immobilization of joint through fusion. F. Joint replacement involve replacement of joint surface with metal or plastic materials Types of Joint Replacement 1. Total hip replacement involves replacement of the ball and socket of a severely damaged hip joint 2. Total knee replacement involves replacement to tibial, femoral, and patellar joints. G. Tendon transfer involves movement of tendon insertion H. Tenotomy involves cutting tendons I. Fasciotomy involves removal of muscle fascia, relieving constriction J. Osteotomy involves alignment of bone by removal of a wedge Purpose of Orthopedic Surgery: Reconstruct diseased or injured musculoskeletal structure ASSESSMENT 1. Preoperative assessment Elicit the clients medical history Identify current medication and condition Assess nutritional and hydration status Assess skin integrity 2. Postoperative Assessment Assess the cardiovascular ,respiratory , fluid and electrolyte. Nutritional status Assess neurovascular status Assess for joint dislocation Assess for infection Assess for thromboembolism Assess and maintain safety and effectiveness of orthopedic apparatus Total Hip Replacement a plastic surgery that involves removal of the head of the femur followed by placement of a prosthetic implant Signs and symptoms necessitating Surgery Severe chronic pain Loss of joint mobility Excessive joint destruction Infection in the joint Contractures Nursing Management Teach client how to use crutches Teach client mechanics of transferring. Discuss importance of turning and positioning post-op. Place affected leg in an abducted position and straight alignment following surgery Prevent hip flexion of more than 90 degrees. Nursing Management Apply support stockings Advise client to avoid external/internal rotation of affected extremity for 6 months to 1 year after surgery Instruct client to avoid excessive bending, heavy lifting, jogging, jumping Encourage intake of foods rich in Vitamin C, protein, and iron. Administer prescribed medications. Complications Infection Hemorrhage Thrombophlebitis Pulmonary embolism Prosthesis dislocation Prosthesis loosening An implant procedure in which tibial, femoral and patellar joint surfaces are replaced. Assess the neurovascular status of the leg Immobilize knee in extension with a firm compression dressing and an adjustable splint or long leg cast Elevate on pillows Apply ice to control edema and bleeding Encourage active flexion of the foot every hour when patient is awake Drainage: 1st 8 hrs. = 200 ml After 48 hrs = less than 25 ml Types: Below the knee (BKA) Amputation of a Lower Extremity surgical removal of a lower limb or part of the limb. - 10% of patients experience uncomfortable sensations- phantom limb pain. - Phantom limb pain described as a cramp or uncomfortable sensation - disappears with time - the pain is a real sensation and should not be dismissed as illusionary. 1. Monitor for bleeding. 2. Elevate the foot of the bed if hemorrhage is suspected. 3. Apply pressure directly over the area of bleeding. 4. Notify surgeon ASAP. 5. Have clamps available at bedside. Complications of Amputation Infection Wound necrosis Phantom limb pain Contractures Skin breakdown Monitor vital signs q 15 min until stable, then q 2 hours for 1st 24 hours, then q 4 hours. Keep the stump elevated for 1st 24 hours to prevent edema After 48 hours DO NOT elevate with pillows BUT rather elevate the foot of the bed. To prevent contractures: Place patient in a prone position for 15 minutes, four times per day. (especially AKA) after 24-48 hrs to stretch the muscles and prevent flexion contracture of hip Have patient lie in a supine position with the knee in extension (especially BKA). Encourage to do active ROM of extremity to strengthen muscles and inhibit contractures. Maintain on low-Fowlers or flat position after AKA In prone position, place a pillow under the abdomen and stump and keep the legs close together to prevent abduction Support stump with pillow for first 24 hours; place rolled bath blanket along outer aspect to prevent outward rotation. Encourage exercises to prevent thromboembolism Encourage patient to ambulate using correct crutchwalking techniques Crutch Cane Walker Caring for Patient with A disease characterized by exaggerated loss of bone mass and changes in microarchitecture of the bone tissue that compromise bone quality. Bones become fragile and prone to fracture. Characteristics of Osteoporosis Silent": most patients are unaware of osteoporosis until the first bone fracture occurs. It is more common in females than males: in women, hormone secretion drops drastically during menopause and this accelerates bone loss. These factors increase your risk of developing osteoporosis: 1. 2. 3. 4. 5. 6. 7. Heredity factors Early menopause in women Drinking too much coffee and strong tea Cigarette smoking and alcoholism Low calcium intake Lack of exercise Some diseases, such as rheumatoid arthritis, hyperthyroidism or some reproductive disorders. 8. Prolonged use of certain medications, such as steroids and thyroid hormone Aging CALCITONIN ESTROGEN PTH BONE RESORPTION BONE FORMATION Loss of BONE MASS Health history includes questions concerning: Occurrence of osteoporosis Family history Previous Fractures Dietary consumption of calcium Exercise patterns Onset of menopause Use of corticosteroids Alcohol, smoking & caffeine intake BACK PAIN CONSTIPATION SHORTENED STATURE & SPINAL DEFORMITY FRACTURE IMPAIRED MOBILITY BREATHING PROBLEMS 1. Reviewing and evaluating a patient's: physical condition, lifestyle & daily living habits 2. Measuring Bone Density 1. Balance diet rich in CALCIUM & VITAMIN D 2. Regular weight-bearing EXERCISES 3. Hormone replacement therapy (HRT) with ESTROGEN & PROGESTERONE 4. Other medications: Alendronate Calcitonin Prevention of osteoporosis begins from childhood as it is important that you maximize your peak bone mass before the age of 35 years. Sufficient intake of calcium Adequate weight-bearing exercises. Maintain a healthy lifestyle. Home safety to prevent falls and fractures. To maintain bone mass, postmenopausal women may need adequate hormone replacement therapy according to a doctor's advice. ETIOLOGY Result from trauma or secondary infection. Blood-borne (hematogenic) osteomyelitis is common children Chronic illness Long term corticosteroid therapy Clinical Manifestations Localized bone pain Tenderness, heat, and edema Guarding of the affected area Restricted movement Systemic symptom Purulent drainage malaise Lab/ Dx Findings WBC count reveals leukocytosis ESR is elevated Blood cultures identifies the causative agent (Staph. Aureus) Radiograph and bone scan Nursing Management 1. Administer prescribed medication 2. Protect the affected extremity from further injury and pain 3. Promote healing and tissue growth 4. Prepare client for surgical treatment 5. Provide additional teaching 6. May apply warm, wet soaks 20 min several times a day -a slowly progressive, degenerative joint disease characterized by variable changes in weight-bearing joint. -Also known as Degenerative Joint Disease/ Hyperthropic Arthritis Associated with Obesity Aging (>50yr) Trauma Genetic predisposition Congenital abnormalities Pain and muscle spasm, aggravated by use relieved by rest Limited motion Joint grating with movement Flexion contractures Joint tenderness Presence of Heberdens nodes or Bouchards nodes Weight loss Cold intolerance Radiographs may reveal a narrowing of joint space 1. Administer prescribed medication 2. Provide nonpharmacologic comfort measures 3. Position the client to prevent flexion deformity 4.Plan activities that promote optimal function and independence 5. Refer to physical and occupational therapy 6. Prepare the client fro surgical treatment as indicated 7. Provide referrals Medication Aspirin inhibits cyclooxygenase enzyme, it diminishes the formation of prostaglandins anti-inflammatory, analgesic, antipyretic action inhibit platelet aggregation in cardiac disorders Adverse effects: GI: Epigastric distress, nausea, and vomiting Blood: inhibition of platelet aggregation and a prolonged bleeding time Respiratory: In toxic doses, can cause respiratory depression Hypersensitivity Reyes syndrome: Acute encephalopathy following a viral illness and is characterized pathologically by cerebral edema and fatty changes in the liver Toxicity: (mild or severe) Mild salicylism: nausea, vomiting, marked hyperventilation, headache, mental confusion, dizziness, and tinnitus Severe salicylism: restlessness, delirium, hallucinations, convulsions, coma, respiratory and metabolic acidosis and death from respiratory failure. Ibuprofen anti-inflammatory, analgesic,and antipyretic acitivity use for chronic treatment of rheumatoid and osteoarthritis less GI effects than aspirin reversible inhibitors of the cyclooxygenases and inhibit the synthesis of prostaglandins Adverse effects: GI: dyspepsia to bleeding CNS: headache, tinnitus and dizziness Indomethacin anti-inflammatory, analgesic and antipyretic acitivity inhibits cyclooxygenase enzyme more potent than aspirin as an antiinflammatory agent Adverse effects: *dose-related GI: nausea, vomiting, anorexia, diarrhea and abdominal pain CNS: frontal headache, dizziness, vertigo, light-headedness, and mental confusion Hypersensitivity reaction Nursing Management Promote comfort: reduce pain, spasms, inflammation, swelling medications as prescribed. Heat to reduce muscle spasm Cold to reduce swelling and pain Prevent contractures: exercise, bed rest on firm mattress, splints to maintain proper alignment Position: elevate extremity to reduce swelling Promote independence Rheumatoid Pain Early morning stiffness which gets better as the day progresses. May be exacerbated by exercise. Joints Typical deformity is symmetrical (bilateral) with swelling. Ulnar deviation General Weight loss, fatigue, and fever. Osteoarthritis Stiffness worsens during the day. Feels better after exercise. May be localized to a single joint or more, may not be swollen, but may be painful. Finger joints may become affected. Rheumatoid arthritis chronic systemic inflammatory disease destruction of connective tissue and synovial membrane within the joints weakens and leads to dislocation of the joint and permanent deformity Risk Factors: exposure to infectious agents fatigue stress Diagnostic tests Elevated ESR Mild leukocytosis Anemia Positive RF Signs and Symptoms inflammation, tenderness, and stiffness of the joints moderate to severe pain and morning stiffness lasting longer than 30 minutes joint deformities, muscle atrophy, and decreased range of motion spongy, soft feeling in the joints low grade fever, fatigue and weakness Signs and Symptoms anorexia, weight loss, and anemia elevated ESR, and positive RF Nonreactive: 0-39 IU/ml (CRP) Weakly reactive: 40-79 IU/ml (CRP) Reactive: greater than 80 IU/ml (CRP) X-ray showing joint deterioration Rheumatoid Arthritis Rheumatoid Arthritis Medication Salicylates (acetylsalicylic acid ) NSAIDs Corticosteroids- anti-inflammatory Gold salts Gold salts slow-acting, anti-inflammatory agents Gold sodium thiomalate, Aurothioglucose, Auranofin - these drugs cannot repair existing damage, rather they can only prevent further injury - use in the treatment of RA that does not respond to salicylates or other NSAID therapy Adverse effects: dermatitis of the skin or of the mucous membranes proteinuria and nephrosis Gold salts should be avoided in patients suffering from hepatic or renal disease, pregnancy. Serious Toxicity: Dimercaprol Treatment Hot and Cold packs to affected joints Surgical Procedures: synovectomy, arthrotomy, arthrodesis, arthroplasty Nursing Management Prevent or correct deformities bed rest daily ROM exercises heat and/or pain medication increase oral fluid intake at least 1500 mL to prevent renal calculi A metabolic disease marked by urate crystal deposits in joints throughout the body. - Linked to a genetic deficit in purine metabolism - Age (>50yr) - Higher incidence in men Signs and Symptoms extreme pain swelling erythema of the involved joints fever tophi sudden attacks, usually at night Pain, joint swelling and inflammation Intolerance to the weight of bed linen over the affected joint Pruritus or skin ulceration Signs of renal involvement 1. Arthrocentesis reveals urate crystal in synovial fluid 2. Serum uric acid level is increased 3. Radiographs may show joint damage in advanced disease. Treatment Allopurinol - a purine analog - reduces the production of uric acid by competitively inhibiting uric acid biosynthesis which are catalyzed by xanthine oxidase. Allopurinol - Effective in the treatment of primary hyperuricemia of gout and hyperuricemia secondary to other conditions (malignancies). Adverse effects: hypersensitivity reactions, nausea and diarrhea Colchicine Effective for acute attacks of gouty arthritis pain Reduces inflammation in the joint. Does not prevent the progression of gout but have a suppressive, prophylactic effect reducing the frequency of acute attacks and relieves pain. Anti-inflammatory activity alleviating pain within 12 hours Colchicine Adverse effects: nausea, vomiting, abdominal pain, diarrhea, agranulocytosis, aplastic anemia, alopecia 1. Administer prescribed medication 2. Promote measures to prevent exacerbations. 3. Provide measures to promote comfort and reduce pain 4. Provide client teaching Caring for Patient with What is Osteomalacia involves softening of the bones caused by a deficiency of vitamin D or problems with the metabolism of this vitamin. ? In children, the condition is called rickets and is usually caused by a deficiency of vitamin D . In adult, the condition is usually caused by: 1. Inadequate dietary intake of vitamin D 2. Inadequate exposure to sunlight (ultraviolet radiation) 3. Malabsorption of vitamin D Other conditions: 1. Hereditary or acquired disorders of vitamin D metabolism 2. Kidney failure and acidosis , 3. PO4 depletion associated with low dietary intake or kidney disease 4. Side effects of medications used to treat seizures . Risk factors are related to the causes. In the elderly, there is an increased risk for those who tend to remain indoors and who avoid milk because of lactose intolerance The incidence is 1 in 1000 people. diffuse bone pain , especially in the hips muscle weakness symptoms associated with low calcium 1. numbness around the mouth & of extremities 2. Carpopedal spasms 3. Bowing of legs 4. Waddling or limping GAIT 5. Decrease in height/ Spinal Deformities (i.e. KYPHOSIS) In children, symptoms of rickets include: delayed sitting, crawling, and walking; pain when walking; and the development of bowlegs or knock-knees. 1. Bone biopsy: (+) increase in osteoid 2. Bone X-ray or CT scan of lumbosacral spine shows demineralization. 3. Studies of the vertebrae: (+) compression fx 4. Low serum vitamin D level 5. Low serum calcium & phosphate levels 6. Elevated ALP (Alkaline Phosphatase) 1. Adequate dietary intake of dairy products that are fortified with vitamin D 2. Adequate exposure of the body to sunlight Oral supplements of vitamin D , calcium, and phosphorus Large doses of Vitamin D with exposure to sunlight may be indicated in people with intestinal malabsorption . Monitoring of blood levels of phosphorus and calcium may be indicated with some underlying conditions. Braces or surgery to correct deformities Protrusion of the nucleus of the disk into the fibrous ring of the disk with subsequent nerve compression May occur in any portion of the vertebral column Signs & Symptoms 1. 2. 3. 4. Pain Sensory changes Loss of reflex Muscle weakness 1. Cervical Pain/ Stiffness head, neck & upper extremities Paresthesia, numbness Weakness Low back pain radiating to the buttocks and leg Postural deformity of the spine (+) Straight-Leg Raise test Weakness & Asymmetric reflexes Sensory loss 2. Lumbar Nursing Alert: Perform repeated assessments of sensorimotor functions/ reflexes to determine progression of condition Alleviating pain 1. Anti-inflammatory drugs, muscle relaxants, and narcotic analgesics 2. Use of bed boards under the mattress 3. Bed rest supine or low fowlers or side lying position with slight knee flexion and pillows between knees. 4. Moist heat application 5. Relaxation techniques Signs & Symptoms: Abnormal lateral deviation of spine Unleveled shoulder Asymmetric waistline Prominent scapula Complications: Related to respiratory problems due to decreased lung expansion as a result of severe curvature of the spine Nursing Implementation 1. Monitor progression of the curvature 2. Prepare the child and parents for the use of a brace if prescribed usually worn from 16 to 23 hours a day inspect the skin for signs of redness or breakdown keep the skin clean and dry, avoiding lotions and powders advise the child to wear soft nonirritating clothing under the brace Nursing Implementation Prepare the child and parents for surgery if prescribed. Postoperative: maintain proper alignment; avoid twisting movements logroll the child when turning, to maintain alignment instruct in activity restrictions instruct the child to roll from a side-lying position to a sitting position, and assist with ambulation Paget's Disease of Bone Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones and vertebrae Primary bone resorption followed by bone formation Diseased bone is highly vascularized but structurally weak More common in the adult (>50 y/o) Male > female Clinical Manifestations bowing of femur and tibia enlargement of the skull cranial nerve compression respiration distress pain high cardiac output failure Diagnostics X-rays Serum alkaline phosphatase- elevated Serum calcium- elevated Bone scan Nursing Management Prevent pathological fractures Control pain Administer drugs as prescribed Bone Tumors Osteosarcoma Most common primary bone tumor Occurs between 10-25 years of age, with Paget's disease and exposure to radiation Exhibits a moth-eaten pattern of bone destruction. Most common sites: metaphysis of long bones especially the distal femur, proximal tibia and proximal humerus Osteosarcoma Clinical Manifestations local signs pain ( dull, aching and intermittent in nature), swelling, limitation of motion systemic symptoms: malaise, anorexia, and weight loss Diagnostics Biopsy- confirms the diagnosis X-ray MRI Bone Scan Medical Management Radiation Chemotherapy Surgical management amputation limb salvage procedures Nursing Management Promote understanding of the disease process and treatment regimen Promote pain relief Prevent pathologic fracture. Promote coping skills and self esteem Assess for potential complications (infection, complications of immobility). Nursing Management Provide care for client with amputation Observe for signs of bleeding Elevate stump on pillow for 24-40 hrs Turn patient to prone position for short time first post-op day then 2-3x daily Nursing Management Encourage exercise as soon as possible (1st or 2nd post-op day) Dangle and transfer patient to wheelchair and back within 1st or 2nd day post-op; crutch walking started as soon as patient feels sufficiently strong Apply lanolin to dry skin Other Musculoskeletal Disorders Dysplasia of the Hip condition in which the head of the femur is improperly seated in the acetabulum, or hip socket, of the pelvis. Congenital or develop after birth Assessment Neonates: laxity of the ligaments around the hip, which allows the femoral head to be displaced from the acetabulum upon manipulation. Implementation: Splinting of the hips with Pavlik harness to maintain flexion and abduction and external rotation (neonatal period) Assessment Infants beyond the newborn period: a. Asymmetry of the gluteal and thigh skinfolds when the child is placed prone and the legs are extended against the examining table. b. Limited range of motion in the affected hip. c. Asymmetric abduction of the affected hip when the child is placed supine with the knees and hips flexed. d. apparent short femur on the affected side (Galleazzi sign, Allis sign) Spica Cast CARPAL TUNNEL SYNDROME: It occurs when the median nerve at the wrist is compressed ASSESSMENT: Pain Numbness Paresthesia Thumb, 1st & 2nd fingers affected=Tinel Sign( tingling sensation when inner wrist is percussed) Management: Wrist splinting Avoid repetitive wrist movement Carpal canal cortisone injection Surgical release of tendon sheat ...
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