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MedicalSurgical Nursing: An Integrated Approach, 2E Chapter 24

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Title: MedicalSurgical Nursing: An Integrated Approach, 2E Chapter 24


1
Medical-Surgical Nursing An Integrated
Approach, 2E Chapter 24
  • NURSING CARE OF THE CLIENT MUSCULO-SKELETAL
    SYSTEM

2
Orthopedics
  • The branch of medicine that deals with the
    prevention and correction of the disorders and
    diseases of the musculo-skeletal system.
  • Involves the muscles, skeleton, joints, and
    supporting structures such as ligaments and
    tendons.

3
Orthopedic Nursing
  • The primary goal of the nurse caring for a client
    with locomotor disorders is the prevention of
    contractures (permanent shortening of a muscle)
    or deformities.

4
Skeletal Functions
  • To provide the body with a structural framework.
  • To act as a protective casing for internal organs
    ( the brain, heart, lungs,etc.).
  • To allow movement by muscles attached to the
    skeleton.
  • To store calcium, phosphorus, and magnesium.
  • To manufacture blood cells in the red bone marrow.

5
Types of Bones
  • Two types of bone
  • Cancellous, which resembles a sponge with spaces.
  • Cortical, which is compact bone found in the
    shaft of long bones.

6
Muscle Characteristics
  • Muscles act as motors controlled by nerve fibers
    from the cerebral cortex.
  • Muscles and skeleton work together to permit
    movement.
  • Muscles are attached to bones by tendons.
  • Movement of the muscles may be voluntary or
    involuntary.

7
Joints
  • A joint is a junction of two or more bones.
  • Three types
  • Diarthosis freely movable such as hinge (elbow,
    knee) ball and socket (hip, shoulder), pivot
    (skull, first vertebrae), gliding (wrist) and
    saddle (thumb).
  • Synarthosis joints are immovable.
  • Amphiarthosis slightly movable (vertebrae and
    pelvic bones).

8
Assessment of the Bony Skeleton
  • Notation on any deformities.
  • Body alignment.
  • Abnormal growths due to bone tumors.
  • Shortened extremities.
  • Amputations.
  • Abnormal angulation other than at joints.
  • Crepitus (a grating or crackling sensation or
    sound).

9
Assessment of Spine
Three common spinal curvatures
  • Scoliosis (crooked back lateral curving
    deviation).
  • Kyphosis (hump back increased roundness of the
    thoracic spinal curve).
  • Lordosis (sway back exaggeration of the lumbar
    spine curvature as seen in pregnancy).

10
Musculoskeletal Trauma
  • Strains.
  • Sprains.
  • Dislocations.
  • Fractures.
  • Compartment Syndrome.

11
Strain
  • An injury to a muscle or tendon due to overuse or
    overstretching.
  • May be acute or chronic.

12
Sprain
  • An injury to ligaments surrounding a joint caused
    by a sudden twist, wrench, or fall.
  • Symptoms include pain, edema, loss of motion, and
    ecchymosis.

13
Dislocation
  • What occurs when articular surfaces of a joint
    are no longer in contact. The bones are literally
    out of joint.

14
Fracture
  • A break in the continuity of a bone.
  • More than 90 different classifications. Most
    common are
  • Greenstick, or incomplete.
  • Simple, or closed.
  • Compound, or open.
  • Impacted, or telescoped.
  • Spiral.
  • Comminuted.

15
Compartment Syndrome
  • A form of neurovascular impairment that may lead
    to permanent injury of an affected limb caused by
    the progressive constriction of blood vessels and
    nerves.

16
Casts
  • Since plaster casts dry from the inside out, they
    should not be covered or dried with a hairdryer
    or heat lamp.
  • Moisture and heat from the drying cast should be
    allowed to evaporate naturally.
  • To avoid indentation, a drying cast should be
    placed on pillows and not on a hard surface.
  • When handling the cast, only the palms of the
    hands should be used.
  • Synthetic casts dry in minutes.

17
Traction
  • The principle of traction is to have two forces
    pulling in opposite directions. Traction consists
    of weights and counterweights.
  • Traction may be used to reduce a fracture,
    immobilize an extremity, lessen muscle spasms, or
    correct or prevent a deformity.

18
Rehabilitation
  • Physical Therapy.
  • Learning the proper use of equipment such as
    crutches, canes, or walkers.

19
Surgical Methods Open Reduction
  • A surgical procedure that enables the surgeon to
    reduce (repair) the fracture under direct
    visualization.
  • Major disadvantage is chance of infection.

20
Circulation, Movement, and Sensation Assessments
The Five Ps
  • Pain.
  • Pallor (slow capillary return).
  • Paresthesia (unrelieved tingling or numbness).
  • Puffiness (edema).
  • Pulselessness.

21
Inflammatory Diseases
  • Rheumatoid Arthritis.
  • Bursitis (an inflammation of the bursa, a sac
    filled with synovial fluid that facilitates joint
    movement. Major bursae are found in the shoulder,
    knee, hip, and elbow).
  • Polymyositis (involves striated muscle).
  • Osteomyelitis (inflammation of the bone and bone
    marrow).

22
Degenerative Disorders
  • Osteoporosis.
  • Degenerative joint disease.
  • Total joint arthoplasty.

23
Osteoporosis
  • An increase in the porosity of bones causing an
    increased susceptibility to fractures of the hip,
    spine, and wrist.
  • Of those affected, 80 are women.

24
Degenerative Joint Disease
  • Also called osteoarthritis.
  • Considered a wear and tear disease,
    characterized by slow and steady progressive
    destructive changes of the joint.
  • The most common type of arthritis.

25
Total Joint Arthroplasty
  • Joint replacement or arthroplasty is the
    replacement of both articular surfaces within a
    joint capsule.
  • The hip, knee, shoulder, and fingers are the
    joints most frequently replaced.
  • Joint replacement is usually an elective
    procedure and clients may wish to have autologous
    blood transfusions.

26
Musculoskeletal Disorders
  • Amputations.
  • Temporomandibular joint disease/disorder.
  • Carpal Tunnel syndrome.

27
Amputations
  • Removal of all or part of an extremity.
  • Done in response to injuries resulting in
    extensive laceration of arteries or nerves, or
    diseases such as malignant tumors, infections,
    and peripheral vascular disorders.

28
Temperomandibular Joint Disease/Disorder (TMD)
  • Commonly referred to as TMJ by general
    population, this is a collection of conditions
    affecting the temperomandibular joint and/or the
    muscles of mastication.
  • Causes include trauma, stress, teeth clenching or
    grinding (bruxism), and joint diseases such as
    arthritis.
  • Common symptoms include limited jaw movement,
    clicking or crepitus when jaw moves, popping when
    chewing or talking, and radiating pain in the
    face, neck, or shoulders.

29
Carpal Tunnel Syndrome
  • Occurs when the median nerve in the wrist is
    compressed by inflamed, edemetous flexor tendons.
  • Symptoms include pain, paresthesia, and weakness
    of the thumb, index finger, middle and part of
    the ring finger but never the pinky.
  • Caused by repetitive motion.

30
Systemic Disorders with Musculoskeletal
Manifestations
  • Gout.
  • Lyme Disease.

31
Gout
  • A metabolic disease of ineffective purine
    metabolism resulting from deposits of needlelike
    crystals of uric acid in connective tissue, join
    spaces, or both.
  • Attack generally begins with severe constant
    pain.
  • Clients should avoid foods high in purine (e.g.
    liver, sardines, sweetbreads, anchovies, gravies,
    and asparagus).

32
Lyme Disease
  • Caused by a spirochete Borrelia burgdorferi
    carried by deer ticks.
  • First symptom in most cases is a red rash. Other
    symptoms include headache, neck stiffness, fever,
    and pain.
  • Untreated Lyme Disease can result in arthritis,
    fatigue, facial palsy, meningitis, and
    encephalitis.
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