Week 11 - care of pt. w/ MSK issues

contusion

A soft tissue injury caused by blunt force

Strain

an injury to the musculotendinous due to overuse, overstretching, and excessive stress

sprain

injury to the ligaments and supporting muscle fibers that surround a joint

fracture

disruption/break in the structure of the bone

MSK injury - Subjective assessment: what would you ask

Ask for: past health history, medications, past surgeries/treatments, health perception/management, , nutrition, activity, coping

MSK injury - Objective assessment

physical examination, general overview, size, shape and symmetry, plaption, moition, posture and gait

MSK injury cues

• edema and swelling

• pain/tenderness

• muscle spasms

• deformity

• contusion

• loss of fxn

• crepitation

• gaurding

MSK imaging - X-ray

• most common

• checks the structural and functional changes of bones and joints

Nursing responsibility

• remove any objects that can disrupt results

MSK imaging - DEXA scan

• low doxe x-ray that checks calcium and other minerals in bones

• checks strength and thickness

Nursing responsibility

• during - avoid excessive exposure to pt. or self

Circulation, Motion and Sensation

Circulation - color, cap refill, pulse of affected extremity, skin temp

Motion - ability to move extremities and digits

Senation - can they feel, avoid use of shapr objects for this

lower extremities - long leg cast

used for: unstable ankle fracture, soft tissue injury, knee injury, tibia fracture

lower extremities - short leg cast

used for: stable ankle and foot

lower extremities - cylinder cast

knee injuries or fractures

lower extremities - robert jones dressing

used to - temporarily limit mobility

imaging cont. - CT scan

3D pic to identify soft tissue or bony abnormalities and other MSK trauma

nursing responsibility

before - evaluate renal fxn before contrast, and allergies to shellfish

during - warn that contrast cause feelings of warm and flushed, pt must lie completely still

after - encourage fluid intake to avoid renal complications w/ contrast

imaging cont - MRI

radiowave and magnetic field used to look at soft tissue, pt. inside scanning chamber

nursing respnsibility

before - oral/IV contrast, check pregnant, allergies, remove all metal, surgical history of staples, plates, dental bridges, other metal appliances, remove metal foil patches, assess claustriphobia

During - pt must lie completely still

Imaging cont. - EMG

evaluates electrical potential of skeletal muscle contraction, lower motor neuron dysfnx, primary muscle dz

nursing responsibility

before - explain procedure, that pain and discomfort from needle insertion, possible stimulant restriction 2-3 hrs prior

After - assess needles for hematoma, inflammation, analgesic use as needed

General MSK injury treatment - RICE

Rest

Ice

Compression

Elevation

general MSK injury treatment

monitor neurovascular status of affected extremity

• check circulation, movement, sensation

specifically Fracture treatment - goals of this treatment

anatomic realignment (reduction)

immobility

restoration of normal to near normal function

levels of weight bearing - non-weight bearing

no weight is placed on injured limb

levels of weight bearing - touch down weight bearing

the injured limb is used only for balance le

levels of weight bearing - Partial weight bearing

only a percentage of body weight is placed on limb

levels of weight bearing - weight bearing as tolerated

a comfortable amount of weight is placed on injured limb - comfort decided by pt.

levels of weight bearing - full weight bearing

full body weight is placed on the injured limb

fracture treatments - closed reduction

non surgical - manual realignment of the bones

traction is applied

pt under general or local anesthesia

immmbilization after - traction, cast, splint or brace

fracture treatment - open reduction and internal fixation (ORIF)

surgical fixation

internal fixation

wires, screws, pins, plates, rods, nails

Casts

temporary immobilization after closed reduction

allows pt to perform many ADLs

two most common material - plaster of paris, fiberglass

doesnt accomodate for swelling

musring care of cliet with cast

• apply ice every 24 hrs

• elevate cast above heart during first 48hrs to avoid swelling

• outline, date, time and any drainage leak

• DO NOT - get wet, remove pads, insert objects or bear weight on cast in first 48hrs, place in dependent position.