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Week 15 Musculoskeletal Nursing
Week 15 Musculoskeletal Nursing
SPRAINS
→ Injury to the LIGAMENT and TENDON
surrounding joint.
→ Caused by TWISTING motion or
HYPEREXTENSION of a joint
→ Common site of sprain: knee joint affecting the
anterior cruciate ligament.
Degrees:
1st degree
o Stretching of ligamentous fibers
2nd degree: Types:
o Partial tearing of ligament 1. COMPLETE: break across the entire cross-section
of the bone
3 degree:
rd
2. INCOMPLETE: breakthrough only a part of the
o Complete tearing or rupture of ligament
cross-section of the bone
3. COMMINUTED: produces several bone fragments
4. CLOSED: does not cause a break in the skin
5. OPEN: skin or mucous membrane wound extends to
the fractured bones
a. Grade I: clean wound less than 1cm
b. Grade II: larger wound without extensive
soft tissue damage
c. Grade III: highly contaminated, extensive
soft tissue damage
6. AVULSION: fragment of bone pulled away by
tendon and its attachment
7. COMPRESSION: bone compressed (seen in 6 P’S OF NEUROVASCULAR ASSESSMENT
vertebral fracture)
8. DEPRESSED: fragments are driven inward (skull
and facial bones)
9. EPIPHYSEAL: fracture through the epiphysis
(fracture in the head of the femur)
10. GREENSTICK: one side of the bone is broken and
the other side is bent (this is the most common
fracture in school-age)
11. IMPACTED: bone fragment driven into another
bone fragment
12. OBLIQUE: occurs at an angle across the bone
13. PATHOLOGIC: occurs through an area of diseased
bone
14. SPIRAL: a fracture that twists around the shaft of
the bone 1. Pain:
15. STRESS: results from repeated loading of bone and 2. Paralysis: mobilized – stretching.
muscle 3. Pulse: check for distal
16. TRANSVERSE: straight across the bone
4. Pallor: capillary refill.
5. Paresthesia- tingling sensation
6. Poikilothermia – temperature
OPEN fracture:
o Cover wound with a sterile dressing.
o Never attempt to reduce the fracture.
CAST
→ Rigid external immobilizing device molded to the
contours of the body
→ Immobilizes and reduces fracture
→ Corrects a deformity
→ Support and stabilize weakened joint
Plaster of Paris
→ Advantages:
o Cheaper in price
o Achieves better mold
→ Disadvantages:
o Not durable
Clinical Manifestations: o Longer to dry (24-72 hrs to dry)
Pain o Cannot be wet
Loss of function Fiberglass
Deformity → Advantages:
Shortening o Lighter, durable, stronger
Crepitus (crumbling sensation upon palpation) o Water-resistant
Localized edema and ecchymosis o Faster to dry (minutes)
Emergency Management: → Disadvantage:
Immobilization thru adequate splinting o More pricey
o Neurovascular status is checked before and after Plaster of Paris Fiberglass
o Do not flex!
o Isotonic contraction – shorten muscles
that causes movement of the extremity
o Performed hourly while awake
EXTERNAL FIXATOR
Nursing Management:
General Nursing Management: Cast, Splint, Brace Post-application:
Assess neurovascular status (6Ps) → Elevation
Unrelieved pain: Notify the physician → Cover sharp points
o Fracture: immobilize → Assess neurovascular status every 2-4 hrs
o Edema: elevation and cold compress → Clean pin site
Monitor for infection → Check for signs of infection
o Hot spot – hot parts inside the cast. → Isometric and active exercises
o Management: using a straw, blow inside the → Never adjust the clamps!
cast to relieve itchiness.
o Windowing - cutting portion of a cast to Roger Anderson External Fixator (RAEF)
relieve pressure.
Assess for complications:
o Compartment Syndrome – the pressure of
muscles that decreases blood flow (painful)
o Pressure Ulcers – due to prolonged period
of casting.
o Disuse Syndrome – deterioration of
muscles due to immobilization.
Compartment Syndrome
→ Vascular insufficiency and nerve compression due to
unrelieved swelling in a limited space
TRACTION
Management:
BIVALVING (cast cut in half longitudinally) → Application of a pulling force to a part of the body.
Elevation above heart level Purposes:
Pressure not relieved: FASCIOTOMY Minimize spasms
- Hihiwaan ka sa skin to allow expansion.(painful) Reduce, align, and immobilize fractures
- If the pressure was not relived, distal extremities Reduce deformity
will die because of lack of blood supply. Increase space between opposing surfaces
Monitor neurovascular status
Pressure Ulcers
→ Tissue anoxia and ulcer due to pressure from cast or
inappropriately applied brace
→ Bony prominences: most susceptible parts
→ Pain and tightness
→ Warm area on cast or brace (erythema)
→ Skin breakdown
Management:
BIVALVING
WINDOWING (cutting portion of a cast)
Disuse Syndrome
→ Muscular atrophy and loss of strength due to Types:
immobilization from cast, splint, or braces → SKIN TRACTION – Tape only!
Management: → SKELETAL TRACTION*
Prevention: o Ensure effective traction
o Tense/contract muscle (isometric o Prevent skin breakdown
contraction) o Assess nerve damage and circulatory
o Isometric contraction –only tone impairment
increases. o *Pin site care
o Promote exercise
o Assess potential complications:
Atelectasis and pneumonia
DBCT
Deep Breathing, Coughing and
Turning
Constipation and anorexia
Urinary stasis and infection
Venous thromboembolism (anti embolic
Diagnostic Evaluation:
Barlow test
- gently adducting the hip while palpating for the
head falling out the back of the acetabulum and
that no posterior-directed force be applied.
Ortolani test
o Most reliable from birth to 4 weeks of age
o At 6-10 weeks, adduction contracture
develops and Ortolani Sign disappears SCOLIOSIS
o Beyond 4 weeks – limited hip abduction Complex spinal deformity in three planes usually
(sensitive test) involving LATERAL curvature, spinal rotation,
o Older infant/children – one leg appears causing rib asymmetry.
SHORTER Scoliosis – lateral curvature
Barlow – adduction - refers to moving your limbs closer to the Kyphosis – anterior curvature (kuba)
midline. Lordosis – L shape lumbar
Ortolani – abduction- moved away from your body's midline
Short Adducted Externally Rotated
Cause:
Unknown
Therapeutic Management:
Correction of the deformity
Maintenance of the correction until normal muscle
balance is regained
Follow up observation to avert possible recurrence
Cause: PONSETI METHOD
Unknown (Idiopathic Scoliosis) Percutaneous Heelcord Tenotomy
Dennis Browne bar
Correction of deformity:
Therapeutic Management:
Observation and regular clinical and radiographic
observation (mild curvature)
Orthotic intervention (bracing)
Surgical spinal fusion
Milwaukee Brace
Dennis Browne bar
CONGENITAL CLUBFOOT
→ A.K.A Congenital Talipes Equinovarus
→ Complex deformity of the ankle and foot that
includes forefoot adduction, cavus, hindfoot varus,
and ankle equinus