Fundamentals of Nursing - Promoting Musculoskeletal Function

Promoting Musculoskeletal Function

Immobilization

  • Immobilization or bed rest may be required for recovery in conditions such as:
    • Stroke
    • Post-operative recovery
    • Trauma

Systemic Complications of Immobility

  • Immobilization affects all body systems.
Musculoskeletal System
  • Decreased strength
  • Weakness
  • Muscle atrophy
  • Loss of muscle strength by 3-5%.
  • Calcium loss from bones.
  • Increased risk of falls due to weakness
  • Contractures.
Respiratory System
  • Decreased lung volume
  • Pooling of mucous
  • Cilia less effective
  • Decreased oxygen saturation
  • Aspiration
  • Atelectasis
Circulatory System
  • Loss of plasma volume
  • Loss of orthostatic compensation
  • Increased heart rate
  • Development of DVT (Deep Vein Thrombosis)
Gastrointestinal System
  • Reflux
  • Loss of appetite
  • Decreased peristalsis
  • Constipation
Genitourinary System
  • Incomplete bladder emptying
  • Formation of calculi in kidneys and infection.
Psychological
  • Anxiety
  • Depression
  • Sensory deprivation
  • Learned helplessness
  • Delirium

Types of Immobilization

  • Splints
    • Indications:
      • Immobilize injured part
      • First aid
    • Care:
      • NV (Neurovascular) checks
  • Casts
    • Indications:
      • Prolonged immobilization
    • Care:
      • NV checks
      • Skin assessment
      • Education
  • Traction
    • Skin Traction:
      • Uses Velcro boots, belts, halters, and slings.
      • Applied snugly to the skin.
    • Skeletal Traction:
      • Requires surgical placement of pins, tongs, screws, or wires anchored to the bone.
      • Can support more weight than skin traction.
    • Indication
      • Broken extremity
      • Realign body, control pain, prevent spasms
    • Care:
      • Ensure proper alignment
      • Weights dangling freely
  • External Fixators
    • Metal inserts are attached to an external frame.
    • Fixators allow patient to be more active.
    • Device needs to be checked for stability every 4 hours.
    • Pin care is required to prevent infection.
    • Pins, screws, or tongs inserted through one or more bones to stabilize fragments during healing.

Assessment

  • Respiratory
  • Neurovascular
  • Pain
  • ADLs (Activities of Daily Living)

Continuous Passive Motion (CPM) Machine

  • Continuous passive motion machine exercise the extremity and joint
  • Physician order required

Support Devices

  • Foam and gel pads
  • Sheepskin pads
  • Heel and elbow protectors
  • Pulsating air pads
  • Pressure Relief devices
  • Alternating air mattress pad
  • Heel protector

Bandages

  • Indications:
    • Immobilization
    • Reduce swelling
  • Care:
    • Distal to proximal application
    • NV checks
  • Applying an elastic bandage-spiral turns

Mechanical Lifts

  • Indications:
    • Immobile patient
  • Care:
    • Facility policy
    • DO NOT leave patient unattended
  • Sit-to-stand power lift

Types of Exercise

  • AROM (Active Range of Motion):
    • Patient is active
  • PROM (Passive Range of Motion):
    • Patient is passive
  • Isometric:
    • Muscle contraction

Aids to Mobilization

  • Walkers
    • Elbows bent 15−3015-30 degrees
    • Use of bilateral hands/arms, one leg.
  • Canes
    • Elbows bent 15−3015-30 degrees
    • Used on strong side
  • Crutches
    • Adjusted for patient height
    • NO WEIGHT BEARING ON AXILLA
  • Wheelchairs
  • Prostheses are used to replace missing body parts
    • Prostheses for stabilization

Nursing Considerations

  • SAFETY
  • Proper fit
  • Proper use
  • Client teaching

Ambulating with Assistive Device

  • Walker
  • Canes and Walkers
    • Cane opposite affected leg