- Pain or tenderness
-
Musculo-Skeletal System Spasms
- loss of function
SPRAINS AND STRAIN
- mobility
A. Sprain
- crepitus
ETIOLOGY:
- shortening
Wrenching or twisting Types of fracture
Common locations: ankle, knee, A. Complete - entire cross-section of bone.
wrist, thumb, shoulder, neck and lower B. Incomplete - a part of cross-section of bone
MANIFESTATIONS: C. Closed - does not extends through skin.
Pain D. Open - extends through skin.
Discomfort on joint movement E. Communited - broken into pieces.
Swelling F. Depressed - in-driven.
Ecchymoses G. Compression - collapsed
H. Greenstick - splintering on one side.
joint motion and function I. Pathologic - results from a primary disease.
Feeling of joint looseness J. Impacted- bone driven into another bone
NSG CARE: K. Avulsion- pulling of a fragment by ligaments or
Elevate or immobilize tendon
Tape, splint or cast TYPES OF FRACTURES
Assistive device (e.g crutch) SIGNS AND SYMPTOMS:
Surgical repair Pain
Tenderness
Analgesics
or loss of motion
Avoid activities - on affected Shortening
Exercise – on unaffected Crepitus
Ice and warm compress. Edema
B. STRAIN Ecchymosis
ETIOLOGY: Fractures determine through X-ray
Under-stretched or overstretched CAUSES OF PATHOLOGIC FRACTURE
muscles and tendons Osteoporosis
Affected areas: groin, hamstring, Bone Cyst
calf, shoulder, back muscles and the Bone Tumor
Achilles tendon. Paget’s Disease
MANIFESTATIONS: Multiple Myeloma
Pain FIRST AID FOR FRACTURE
I - Immobilize
Soreness
C - Control bleeding
Tenderness E - Elevate
Swelling
Ecchymoses T - Transport
* Radiographs - rule out fracture or E - Emotional support
dislocation A - Assess overall condition
NSG CARE :
• Rest Complication of Fractures
• Avoid activities – unaffected • A. Hemorrhage
• Gradual range of motion • B. Shock
• Stretching exercises after healing • C. Avascular Necrosis
• Surgery • D. Fat emboli (long bones)
MUSCULOSKELETAL INJURIES • E. Osteomyelitis
A. Fracture • F. Gas gangrene
Signs and Symptoms Management of Fracture
- Swelling
- Loss of sensation • A. Close reduction
- Deformity
• B. Open reduction 5. Pelvic traction - for low back pain and to
• C. Internal Fixation - application of maintain alignment.
screws, pins, plates, nails to hold B. Skeletal Traction - traction applied directly to the
fragments,aligned bone.
Can be a Kirschner wire, Steinmann’s pin,
• D. External Fixation - frame with
Crutchfield tongs, Thomas splint
multiple pins through bone Pearson attachment
• E. Casts C. Balanced Suspension traction- produced by a
Common Treatment Procedures counter-force other than the client’s weight
Kinds of Cast: D. Pelvic traction
1. Plaster of Paris - traditional cast BALANCE SUSPENSION TRACTION
longer to dry Purpose of Traction:
- deforms easily A. Align
2. Synthetic Cast - e.g. fiberglass, plastics B. Immobilize
Purpose: C. Alleviate pain and spasm
1. Promote immobility D. Correct deformity
2. Support during healing process. E. Healing
3. Prevent deformity.
4. Hasten early mobilization Nursing Care:
NURSING CARE: Wt. should hang freely
Avoid hair dryer Proper alignment
Palms to support Ropes and pulleys freely movable
Elevate on pillows Coughing and DBE
Expose to air fluid
Tape edges fiber, Ca, CHON diet
Inform the feeling of heat on drying stage Exercise
Relieve itch Assess thrombophlebitis
Tightness Monitor neurovascular
Circulation Prevent infection
Self-care. Emotional support
Ice packs
Client teachings Crutch Walking
Complications of Casting Principles:
A. Compartment Syndrome
B. Infection
Crutch length
Signs and Symptoms - No wt. bearing on axilla
1. Foul-smelling odor - Tripod position
2. temp. - Exercises before beginning
3. “Hot Spot” Gaits
4. Drainage • Four-point gait – wt. allowed on both legs
C. Cast Syndrome • Two-point gait - faster and safer
1. Psychological - similar to claustrophobic
reaction • Three-point gait - faster but requires more
2. Physical - GI motility decreased with strength and balance
decreased mobility • Swing to and swing through gait - more
advanced
TRACTION
- Types of Traction: Up stairs - stronger leg first
A. Skin Traction Down stairs - weaker leg first
1. Buck’s traction - for hip fracture
2. Russell’s traction - for hip and knee Hip Fracture
fracture. Signs and Symptoms:
3. Bryant’s traction - for hip fracture in 1. Pain
children. 2. Sensation changes
4. Cervical traction - for soft tissue 3. Shortening
damage 4. External rotation
Hip Replacement Exogenous
Types of Hip Fracture: Hematogenous
• Intracapsular - involves the head and SIGNS AND SYMPTOMS:
neck of the femur Low grade fever
• Extracapsular - affects the trochanteric Malaise
regions Pain
Tenderness
NURSING CARE FOR TOTAL HIP Swelling
REPLACEMENT Warmth
A. Pre-op
1. Temporary skin traction TREATMENT:
2. Sandbags or trochanter roll Debridement of open fractures
3. Teach wt. bearing, crutches, isometric Antibiotics
exercises, and transfer techniques. D. FAT EMBOLISM
4. Familiarize patient with over bed
traction trapreze and abduction splint SIGNS AND SYMPTOMS:
B. Post-op Mentation changes
1. Ambulate 2-3 days post-op Respiratory changes
2. Avoid: Petechiae on neck, axillae and upper chest
- hip flexion • Hypoxemia
- adduction of legs • Hypercapnea
- internal/external rotation of the legs TREATMENT:
3. Position: Supine
4. Report signs of prosthesis dislocation O2 therapy
5. Exercise Mechanical ventilation with PEEP
C.Post-operative discharge teaching IV Glucose
1. Maintain abduction Heparin
2. Avoid stooping Steroids
3. Don’t lie on operative side Immobilization
4. Keep operated leg Assist during turning and positioning
Elevated when seated ABG analysis
5. Never cross legs
6. Avoid flexion Amputation
7. Avoid over exercise (eg *Indications*
walking) a. Trauma
8. Resume ADL in 3 months b. Pheripheral vascular disease
COMPLICATIONS OF FRACTURE c. Malignant Tumor
*Criteria*
A. AVASCULAR NECROSIS: >degree of vascularity
>presence/absence of infection
SIGNS AND SYMPTOMS: >proximity level of joint
Asymptomatic on early stages
Pain on weight bearing Types of Amputation:
Limited movement of joint A. Disarticulation
X-ray shows structural collapse B. Above-the-knee amputations (AKA )
TREATMENT: Surgery C. Below-the-knee amputation (BKA )
D. Upper extremity amputation
B. Gas Gangrene
SIGNS AND SYMPTOMS: • Surgical approaches:
Edema a. Open or guillotine
Profuse drainage & gas bubbles b. Closed or flap
with
fruityodor Levels Of Amputation
Vesicles
Crepitus PRE-OP NURSING CARE
Necrotic tissue • Preparatory exercises
C. Osteomyelitis:
TYPES:
• Teach coughing and DBE
• Emotional support • Harrington rods
• Dweyer instrumentation
POST-OP NURSING CARE • Lugue rods
• V/S
• Elevate stump over a pillow
Provide stump care: RHEUMATOID ARTHRITIS
- Elastic bandage • Signs and Symptoms
- Wash stump daily 1. Joint pain and swelling
- Apply pressure 2. limited movement
- Exercise stump 3. Muscle aches
- Prone position 2-3x/day; 4. fatigue
generally flat position 5. anorexia
• Psychologic support 6. Wt. loss
• Teach about Phantom limb 7. Sjorgen’s syndrome
8. fever and rheumatoid rash (Still’s disease orJRA)
Scoliosis 9. Nodules over bony prominences
Signs and Symptoms 10. Ulnar drift
• Prominence of one hip 11. Deformities:
a. Boutonniere
• Deformed rib cage
b. Swan-neck
• Prominence of one scapula ETIOLOGY: unknown
• Difference in shoulder height
• Unequal breast
THEORIES:
TYPES OF SCOLIOSIS: • Autoimmune
a. Functional - flexible deviation that corrects by • Heredity
bending and exercise
• Psychophysiologic factors
b. Structural - permanent, hereditary deviation
PATHOPHYSIOLOGY:
DIAGNOSTIC TESTS:
a. Synovitis
• X-ray b. Pannus formation
• Scoliometry c. Fibrous ankylosis
Treatment and Management d. Bony ankylosis
A. NON-SURGICAL Diagnostic Test:
1. Bracing • Diagnosis based on clinical picture: x-rays,
a. Milwaukee brace blood studies, and joint fluid aspirate analysis
b. Low profile or underarm brace LABORATORY EXAMS:
• C-reactive protein
NSG CARE:
Wear braces for 23 hours a day • Leukocytosis
Pt. should complete the therapy • Anemia
Cotton undershirts under braces • Rheumatiod factor
Loose garments over braces • ESR
Activity restrictions • Antinuclear antibodies present
Inform weaning period
THERAPEUTIC MANAGEMENT • Synovial fluid changes
2. Exercises Treatment and Management:
- Pelvic Tilt • Rest
- Abdominal exercises • Provide warm and cold compresses
- Swinging • Drugs:
- Hanging on a bar a. Aspirin
3. Electrical Stimulation- used in conjunction with b. NSAID’s : Ibuprofen (Motrin, Advil
exercise or brace regimen or alone Indomethacin (Indocin) Sulindac (Clinoril)
4. Casts - Reiner or Turnbuckle cast Phenylbutazone (Butazolidin)Piroxicam (Feldene)
5. Traction - Halo traction to immobilize the head Diclofenac (Voltaren)Naproxen (Nasprosyn)
and neck c. Corticosteroids
2. SURGICAL MANAGEMENT
d. Gold 2. Drugs: Colchicine, Allopurinol (Zyloprim),
e. D-Penicillamine Probenecid (Benemid), NSAIDs
f. Antimalarials: 3. Avoid purine-rich foods
Plaquenil (Hydroxychloroquine), 4. fluid intake
Aralen (Chloroquine) 5. Avoid:
THERAPEUTIC MANAGEMENT a. Alcohol
• Exercises b. Diuretics
• Promote activity during remissions c. Trauma
d. Stress
• Surgery
e. Fasting
a. Synovectomy - removal of inflamed synovial
f. Xanthine - containing food
lining relieves pain and increases joint stability
6. Maintain alkaline urine
and mobility
b. Arthrodesis - fusion of joints decrease joint
Paget’s Disease
instability and joint pain
c. Osteotomy - removal of bone thus changing
Bones commonly affected:
the weight-bearing surfaces relieves pain and
- pelvic, long, spinal and cranial bones
increases joint stability
d. Implant Athroplasty increases joint mobility
Signs And Symptoms:
and stability and decreases pain
1. Pain and tenderness
2. Enlarged skull
OSTEOARTHRITIS
3. Kyphosis
Signs and Symptoms
4. Bowed legs
a. Mascular spasm
5. Waddling gait
b. Pain
6. in height
c. Limited motion
7. Barrel shaped chest
d. Stiffness
e. Crepitus
Diagnostic Procedures:
f. Heberden’s nodes
g. Bouchard’s nodes • Bone Scan
h. Narrowing joint spaces with X-ray • Laboratory: anemia, serum alkaline PO4
Precipitating factors: Treatment and Implementation
a. Poor posture a. Symptomatic - can be treated by surgery and braces
b. Trauma b. Administration of specific drugs
c. Stress on joints
d. Obesity OSTEOPPHOROIS
THERAPEUTIC MANAGEMENT: Signs and Symptoms:
1. Balance rest and activity 1. Lower back pain
2. Ideal body wt. 2. Kyphosis
3. Pain reliever 3. in height
4. Hot & cold packs Predisposing factors:
5. Exercises a. Menopause
6. Emotional support b. Ca
7. Inform about possible surgery c. Vitamin D deficiency
d. GI disease
GOUT e. Immobility
Signs and Symptoms f. Hyperthyroidism
1. Hyperuricemia g. Hypoparathyroidism
2. Joint pain h. Prolonged use of steroids
3. Tophi i. Cushing’s disease
4. ESR
5. WBC Diagnostic tests : x-rays
Predisposing factor: Treatment and Management:
- genetic defect of purine metabolism Diet
- Men 20-60 years old (20:1) Medication
Nursing Care Physiotherapy
1. Joint rest Nursing Care:
• Ca, CHON and vitamin D • Steroids e.g Dexamethasone (Decadron)
• Hormonal replacement • Exercises
• Promote mobility and strength • Chemonucleolysis
a. Wt bearing B. Surgical:
b. ROM exercise • Diskectomy
c. Back brace or splint for support • Laminectomy
d. Use of bedboards or hard mattress
• Spinal Fusion- if three or more discs are
• Prevent pathological fractures involved
HERNIATED NUCLEUS PULPOSUS
Common site:
Lumbosacral area between L4 and L5 but
herniation can also occur in the cervical region SNURSING CARE TO PATIENT WITH
between C5 & C6 or C6 & C7 LAMINECTOMY
ETIOLOGY:
• Flat bed rest
• Trauma
• Support pillows
• Aging
SIGNS AND SYMPTOMS:
• Place phone and call bell within
patient’s reach
• LUMBAR • Assist the patient with turns
1. Low back pain • Observe dressing
2. Sciatica • Avoid sitting
3. Positive Lasegue’s sign • Elastic hose
4. Weakness of the foot • ROM
5. Sensory Alterations
• DBE and coughing exercise
SIGNS AND SYMPTOMS: • Monitor B&B function
B. CERVICAL • Ambulate patient as soon as effects of
1 Neck Pain that may radiate down arm anesthesia dissipates
to the hand • Teach about proper body mechanics.
2. Weakness of the affected upper
extremity
DIAGNOSTIC TESTS:
1.Magnetic Resonance Imaging- most
useful non-invasive diagnostic tool.
2. Myelogram- if MRI is not available;
shows both lateral and central herniation
with compression.
3. Electromyography(EMG)- assess
function of certain weak muscles.
4. CT Scan- usually done in conjunction
with myelogram
THERAPEUTIC MANAGEMENT:
A. NON SURGICAL MANAGEMENT
• Bed rest
• Support devices such as corset,
brace or cervical collar; firm mattress;
skin traction
• Heat compress
• Drugs:
• Analgesics
• Muscle Relaxants
• NSAIDs e.g Phenylbutazone
(Butazolidin); Ibuprofen
