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  Musculo-Skeletal System SPRAINS AND STRAINA.Sprain   ETIOLOGY:  Wrenching or twisting  Common locations: ankle, knee, wrist, thumb, shoulder, neck and lower MANIFESTATIONS:  Pain  Discomfort on joint movement  Swelling  Ecchymoses     joint motion and function  Feeling of joint loosenessNSG CARE:  Elevate or immobilize  Tape, splint or cast  Assistive device (e.g crutch)  Surgical repair  Analgesics  Avoid activities - on affected  Exercise – on unaffected  Ice and warm compress.B. STRAINETIOLOGY:  Under-stretched or overstretchedmuscles and tendons  Affected areas: groin, hamstring, calf, shoulder, back muscles and the Achilles tendon.MANIFESTATIONS:  Pain  Soreness  Tenderness  Swelling  Ecchymoses * Radiographs - rule out fracture or dislocationNSG CARE : ã Rest ã Avoid activities – unaffected ã Gradual range of motion ã Stretching exercises after healing ã SurgeryMUSCULOSKELETAL INJURIES A. Fracture  Signs and Symptoms - Swelling - Loss of sensation - Deformity - Pain or tenderness - Spasms - loss of function - mobility - crepitus - shorteningTypes of fractureA. Complete - entire cross-section of bone.B. Incomplete - a part of cross-section of boneC. Closed - does not extends through skin.D. Open - extends through skin.E. Communited - broken into pieces.F. Depressed - in-driven.G. Compression - collapsed H. Greenstick - splintering on one side.I. Pathologic - results from a primary disease. J. Impacted- bone driven into another bone K. Avulsion- pulling of a fragment by ligaments or tendon TYPES OF FRACTURESSIGNS AND SYMPTOMS:  Pain  Tenderness    or loss of motion  Shortening  Crepitus  Edema  Ecchymosis  Fractures determine through X-rayCAUSES OF PATHOLOGIC FRACTURE  Osteoporosis  Bone Cyst  Bone Tumor  Paget’s Disease  Multiple MyelomaFIRST AID FOR FRACTURE I- ImmobilizeC- Control bleedingE- ElevateT- TransportE- Emotional supportA- Assess overall conditionComplication of Fractures ã A. Hemorrhage ã B. Shock  ã C. Avascular Necrosis ã D. Fat emboli (long bones) ã E. Osteomyelitis ã F. Gas gangreneManagement of Fracture   ã A. Close reduction  ã B. Open reduction ã C. Internal Fixation - application of screws, pins, plates, nails to hold fragments,aligned ã D. External Fixation - frame with multiple pins through bone ã E. CastsCommon Treatment Procedures Kinds of Cast:1. Plaster of Paris - traditional cast longer to dry - deforms easily2. Synthetic Cast - e.g. fiberglass, plasticsPurpose:1. Promote immobility2. Support during healing process.3. Prevent deformity. 4. Hasten early mobilizationNURSING CARE:  Avoid hair dryer  Palms to support  Elevate on pillows  Expose to air  Tape edges  Inform the feeling of heat on drying stage  Relieve itch  Tightness  Circulation  Self-care.  Ice packs  Client teachingsComplications of CastingA. Compartment Syndrome B. InfectionSigns and Symptoms1. Foul-smelling odor2. temp.3. “Hot Spot”4. Drainage C. Cast Syndrome 1. Psychological - similar to claustrophobic reaction 2. Physical - GI motility decreased with decreased mobilityTRACTION - Types of Traction:A.  Skin Traction  1. Buck’s traction - for hip fracture2. Russell’s traction - for hip and knee fracture.3. Bryant’s traction - for hip fracture in children.4. Cervical traction - for soft tissue damage 5. Pelvic traction - for low back pain and to maintain alignment.B.  Skeletal Traction  - traction applied directly to the bone.Can be a Kirschner wire, Steinmann’s pin, Crutchfield tongs, Thomas splint Pearson attachmentC.  Balanced Suspension traction - produced by a counter-force other than the client’s weight  D. Pelvic traction BALANCE SUSPENSION TRACTIONPurpose of Traction:A. Align B. Immobilize C. Alleviate pain and spasmD. Correct deformityE. HealingNursing Care:  Wt. should hang freely  Proper alignment  Ropes and pulleys freely movable  Coughing and DBE    fluid    fiber, Ca, CHON diet  Exercise  Assess thrombophlebitis  Monitor neurovascular  Prevent infection  Emotional supportCrutch WalkingPrinciples:  Crutch length - No wt. bearing on axilla - Tripod position - Exercises before beginningGaits   ã Four-point gait – wt. allowed on both legs ã Two-point gait - faster and safer ã Three-point gait - faster but requires more strength and balance ã Swing to and swing through gait - more advanced Up stairs - stronger leg first Down stairs - weaker leg firstHip FractureSigns and Symptoms:1. Pain 2. Sensation changes3. Shortening4. External rotation  Hip ReplacementTypes of Hip Fracture: ã Intracapsular - involves the head and neck of the femur ã Extracapsular - affects the trochanteric regionsNURSING CARE FOR TOTAL HIP REPLACEMENTA . Pre-op 1. Temporary skin traction 2. Sandbags or trochanter roll 3. Teach wt. bearing, crutches, isometric exercises, and transfer techniques. 4. Familiarize patient with over bed traction trapreze and abduction splintB. Post-op1. Ambulate 2-3 days post-op2. Avoid: - hip flexion - adduction of legs - internal/external rotation of the legs3. Position: Supine4. Report signs of prosthesis dislocation5. ExerciseC.Post-operative discharge teaching1. Maintain abduction2. Avoid stooping3. Don’t lie on operative side 4. Keep operated leg Elevated when seated 5. Never cross legs6. Avoid flexion 7. Avoid over exercise (eg walking) 8. Resume ADL in 3 monthsCOMPLICATIONS OF FRACTUREA. AVASCULAR NECROSIS:SIGNS AND SYMPTOMS:  Asymptomatic on early stages  Pain on weight bearing  Limited movement of joint  X-ray shows structural collapseTREATMENT: SurgeryB. Gas GangreneSIGNS AND SYMPTOMS:  Edema  Profuse drainage & gas bubbles with  fruityodor  Vesicles  Crepitus  Necrotic tissueC. Osteomyelitis:TYPES:  Exogenous  Hematogenous SIGNS AND SYMPTOMS:  Low grade fever  Malaise  Pain  Tenderness  Swelling  Warmth  TREATMENT:  Debridement of open fractures  AntibioticsD. FAT EMBOLISMSIGNS AND SYMPTOMS:  Mentation changes  Respiratory changes  Petechiae on neck, axillae and upper chest ã Hypoxemia ã HypercapneaTREATMENT:  O2 therapy  Mechanical ventilation with PEEP  IV Glucose  Heparin  Steroids  Immobilization  Assist during turning and positioning  ABG analysisAmputation *Indications*a. Traumab. Pheripheral vascular diseasec. Malignant Tumor*Criteria*>degree of vascularity >presence/absence of infection>proximity level of joint   Types of Amputation:A. Disarticulation B. Above-the-knee amputations (AKA ) C. Below-the-knee amputation (BKA ) D. Upper extremity amputation ã Surgical approaches:a. Open or guillotineb. Closed or flapLevels Of AmputationPRE-OP NURSING CARE ã Preparatory exercises ã Teach coughing and DBE  ã Emotional support POST-OP NURSING CARE ã V/S ã Elevate stump over a pillow  Provide stump care:- Elastic bandage- Wash stump daily- Apply pressure- Exercise stump - Prone position 2-3x/day; generally flat position ã Psychologic support ã Teach about Phantom limbScoliosis Signs and Symptoms ã Prominence of one hip ã Deformed rib cage ã Prominence of one scapula ã Difference in shoulder height ã Unequal breast TYPES OF SCOLIOSIS: a. Functional   - flexible deviation that corrects by bending and exercise b. Structural   - permanent, hereditary deviationDIAGNOSTIC TESTS: ã X-ray ã ScoliometryTreatment and ManagementA. NON-SURGICAL1. Bracing a. Milwaukee brace b. Low profile or underarm brace NSG CARE:  Wear braces for 23 hours a day  Pt. should complete the therapy  Cotton undershirts under braces  Loose garments over braces  Activity restrictions  Inform weaning periodTHERAPEUTIC MANAGEMENT2. Exercises - Pelvic Tilt - Abdominal exercises - Swinging - Hanging on a bar3. Electrical Stimulation- used in conjunction withexercise or brace regimen or alone4. Casts - Reiner or Turnbuckle cast5. Traction - Halo traction to immobilize the head and neck 2. SURGICAL MANAGEMENT ã Harrington rods ã Dweyer instrumentation ã Lugue rods   RHEUMATOID ARTHRITIS ã Signs and Symptoms 1. Joint pain and swelling 2. limited movement 3. Muscle aches 4. fatigue 5. anorexia 6. Wt. loss 7. Sjorgen’s syndrome 8. fever and rheumatoid rash (Still’s disease orJRA) 9. Nodules over bony prominences 10. Ulnar drift 11. Deformities: a. Boutonniere b. Swan-neck ETIOLOGY: unknownTHEORIES: ã Autoimmune ã Heredity ã Psychophysiologic factorsPATHOPHYSIOLOGY:a. Synovitisb. Pannus formationc. Fibrous ankylosisd. Bony ankylosisDiagnostic Test: ã Diagnosis based on clinical picture: x-rays, blood studies, and joint fluid aspirate analysisLABORATORY EXAMS: ã C-reactive protein ã Leukocytosis ã Anemia ã Rheumatiod factor ã   ESR ã Antinuclear antibodies present ã Synovial fluid changesTreatment and Management: ã Rest ã Provide warm and cold compresses ã Drugs:a. Aspirinb. NSAID’s : Ibuprofen (Motrin, Advil Indomethacin (Indocin) Sulindac (Clinoril) Phenylbutazone (Butazolidin)Piroxicam (Feldene)Diclofenac (Voltaren)Naproxen (Nasprosyn)c. Corticosteroids
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