Musculoskeletal Care
Musculoskeletal Care Overview
Terminology and Definitions
Amputate (AMP-yoo-tayt): To surgically remove a limb or part of a limb.
Continuous Passive Motion Machine (PASS-iv MOH-shun muh-SHEEN): A device that passively moves a joint through a controlled range of motion to promote healing after surgery.
External Fixator (eks-TER-nuhl fix-AY-ter): A device used to stabilize bone and soft tissues at a distance from the operative or injury focus.
Arthroplasty (AR-throh-PLAS-tee): Surgical reconstruction or replacement of a joint.
Osteoarthritis (OSS-tee-oh-arth-RYE-tiss): A degenerative joint disease characterized by the breakdown of cartilage.
Physical Therapist (FIZ-1~-kuhl THER-ah-p1st): A healthcare professional who helps patients improve their mobility and manage pain through physical rehabilitation.
Prosthesis (pross-THEE-s1ss): An artificial device that replaces a missing body part, such as a limb.
Residual Limb (ri-ZIJ-oo-uhl LIM): The remaining part of a limb after an amputation.
Skeletal Traction (SKEL-uh-tuhl TRAK-shun): A type of traction that involves the use of pins or wires inserted into the bone to keep broken bones in alignment.
Skin Traction (SKIN TRAK-shun): A method of using weights and pulleys to apply force to the skin to stabilize fractures.
Spica Cast (SPYE-kah): A type of cast that immobilizes the hips and/or legs, often used to treat hip dysplasia in children.
Sprain (SPRAYN): An injury that occurs when ligaments are stretched or torn.
Chapter Concepts
Caring
Comfort
Mobility
Safety
Self-care
Learning Outcomes
Define various terms related to musculoskeletal care.
Answer: Key terms related to musculoskeletal care, such as "Amputate," "Arthroplasty," "Osteoarthritis," "Prosthesis," and various immobilization devices, are defined in the "Terminology and Definitions" section above.
Describe common musculoskeletal conditions that result in limited mobility.
Answer: Common conditions include Fractures (breaks in the bone), Joint Replacements (surgical replacement of damaged joints), Amputations (removal of a limb), and Sprains (damage to ligaments).
Discuss the role of a physical therapy team in healthcare.
Answer: Physical therapists assess musculoskeletal deficiencies, develop plans to restore mobility and strength, and collaborate with nursing staff for effective patient management and rehabilitation.
Differentiate the uses of x-rays, CT scans, and MRIs for diagnosing musculoskeletal conditions.
Answer:
X-rays: Primarily for detecting fractures and bone breaks.
Computed Tomography (CT Scans): Useful for complex fractures and assessing internal injuries.
Magnetic Resonance Imaging (MRI): Best for soft tissue imaging, identifying ligament tears, and certain bone tumors.
Describe six types of immobilizing devices for musculoskeletal disorders.
Answer:
Casts: Made from plaster or fiberglass to immobilize fractured bones.
Traction Devices: Utilize weights to realign broken bones, including Skin Traction (force applied to skin) and Skeletal Traction (pins/wires inserted into bone).
Splints: Temporary devices providing immobilization to an injured area.
External Fixators: Devices stabilizing bone and soft tissues from a distance.
Spica Casts: Immobilize hips and/or legs, often used for hip dysplasia.
Outline nursing care for patients with conditions such as casts, traction, amputation, and joint replacement.
Answer:
Cast Care: Monitor for drying, potential pressure sores; advise against touching wet cast; support with pillows.
Traction Care: Maintain alignment; assess skin for breakdown; conscientiously monitor pin sites to prevent infection.
Post-operative Care (Joint Replacement):
Hip Arthroplasty: Prevent dislocation (use abductor pillows); monitor for complications.
Knee Arthroplasty: Use CPM machines for gentle flexion; manage weight-bearing carefully; implement pain management strategies.
Amputation Care: Address physical and emotional needs; ensure proper shaping of the residual limb for prosthetics.
Discuss guidelines for assisting patients with ambulation using assistive devices.
Answer:
Crutches: Ensure proper fit and technique for stairs, used when unable to bear full weight.
Canes: Offer unilateral support; provide stability.
Walkers: Provide enhanced stability for balancing; ensure proper fitting to hip height.
Knee Walkers: Ideal for lower limb injuries, allowing wheeled mobility without weight-bearing on the injured leg.
Develop a care plan for patients with impaired mobility due to musculoskeletal conditions.
Answer: A care plan involves continuous assessment of patient status (pain levels, mobility), coordinating care with nursing and physical therapy teams, implementing specific nursing interventions (e.g., cast care, traction care, post-op care), ensuring patient safety, and detailed, timely documentation of progress and interventions.
Discuss content related to connections between nursing care and patient features.
Answer: Nursing care is highly individualized based on patient-specific features, such as their diagnosis (e.g., osteoarthritis requiring knee replacement), pre-existing conditions, age, emotional state, and ability to self-care. The clinical assignment example highlights how pre- and post-operative care must be tailored to the patient's specific procedure and recovery needs.
Identify safety issues in musculoskeletal care.
Answer: Safety issues include preventing pressure sores from casts/immobilization, preventing infection at pin sites for traction, avoiding dislocation after joint replacement (especially hip), ensuring correct use and fitting of assistive ambulation devices to prevent falls, proper monitoring of neurovascular status, and managing pain to prevent further injury or non-compliance.
Answer questions pertaining to skills detailed in the chapter.
Answer: Specific questions are not provided, but the skills outlined are:
27.1 Performing Neurovascular Checks: Involves assessing circulation, sensation, and movement in the affected limb to detect complications.
27.2 Setting Up a Continuous Passive Motion Machine: Involves properly adjusting the device to a controlled range of motion as prescribed for post-operative joint healing.
27.3 Applying Elastic Bandages: Involves wrapping a limb with appropriate tension to provide compression, reduce swelling, or support.
Critical Thinking Connections
Clinical Assignment Example
Scenario: A patient scheduled for a total knee replacement at 7:30 a.m. due to osteoarthritis requires pre-operative and post-operative care. Key questions may pertain to the procedure and post-operative care.
Answers to scenario questions:
Total knee replacement procedure: This is an arthroplasty involving surgical removal and replacement of the damaged knee joint, typically due to osteoarthritis. The goal is to restore mobility and reduce pain.
Pre-operative care: Includes preparing the patient for surgery, ensuring understanding of the procedure, addressing concerns, and completing necessary assessments (e.g., neurovascular checks) to establish a baseline.
Post-operative recovery: Focuses on pain management, preventing complications (e.g., infection, DVT), monitoring the surgical site, facilitating early mobilization with devices like a CPM machine, and initiating physical therapy.
A CPM machine and its usage: A Continuous Passive Motion machine gently moves the joint through a controlled range of motion post-surgery (e.g., knee arthroplasty) to promote healing, reduce stiffness, and prevent adhesions.
Timeline for patient ambulation post-surgery and required joint care: Ambulation timelines vary by patient and surgical protocol but generally begin early with assistance from assistive devices and physical therapy. Required joint care includes consistent exercises, protection from excessive stress, adherence to weight-bearing restrictions, and ongoing monitoring for pain or complications.
Critical Thinking Questions
Understanding the total knee replacement procedure.
Answer: A total knee replacement (arthroplasty) is a surgical procedure to replace a damaged knee joint, often due to osteoarthritis, with artificial components. It aims to alleviate pain and restore joint function.
Concerns during pre-operative care and post-operative recovery.
Answer:
Pre-operative concerns: Patient education, informed consent, baseline assessments (e.g., neurovascular status), and ensuring the patient is physically and psychologically prepared for surgery.
Post-operative concerns: Pain management, preventing infection, deep vein thrombosis (DVT) prophylaxis, early mobilization challenges, potential for joint dislocation (especially hip), and managing psychological adjustment.
What a CPM machine is and its usage.
Answer: A Continuous Passive Motion (CPM) machine is a device that supports a limb (e.g., knee) and gently moves it through a prescribed range of motion without active muscle involvement from the patient. Its usage is primarily post-knee arthroplasty to promote joint mobility, reduce swelling, and aid in healing.
Timeline for patient ambulation post-surgery and required joint care.
Answer: The timeline for ambulation post-surgery is individualized and determined by the surgical team and physical therapy plan, but often begins within 24-48 hours with maximal assistance. Required joint care includes adherence to mobility restrictions, using assistive devices, performing prescribed exercises, managing pain, and monitoring for signs of complications or infection.
Common Musculoskeletal Conditions Resulting in Limited Mobility
Definition of Specific Conditions
Fractures: Breaks in the bone can be complete or incomplete, with hairline fractures being the narrow cracks.
Joint Replacements: Involves the surgical removal and replacement of damaged joints, commonly due to arthritis.
Amputations: Removal of a limb due to injury, infection, or other health conditions, with care necessary for the residual limb.
Sprains: Damage to ligaments, showing ranges from mild (tenderness and swelling) to severe (complete tears).
Treatment Acronym for Sprains
RICE: Rest, Ice, Compression, Elevation.
Role of Physical Therapists
Physical therapists assess musculoskeletal deficiencies and create plans to restore mobility and strength.
Collaboration with nursing staff is critical for effective patient management.
Imaging Techniques
X-rays: Primarily used for detecting fractures and breakages.
Computed Tomography (CT Scans): Helpful for complex fractures and internal injuries.
Magnetic Resonance Imaging (MRI): Used for soft tissue imaging, ligament tears, and certain bone tumors.
Types of Immobilization Devices Used in Musculoskeletal Disorders
Casts: Made from plaster or fiberglass to immobilize fractured bones.
Traction Devices: Utilize weights to realign broken bones; includes skin and skeletal traction types.
Splints: Temporary devices to immobilize an injured area.
External Fixators: Devices used to stabilize bone and soft tissues at a distance from the operative or injury focus.
Spica Casts: Used to immobilize the hips and/or legs, particularly for hip dysplasia.
Nursing Care for Patients with Musculoskeletal Conditions
Cast Care
Monitor for drying and potential pressure sores;
Advise against touching the wet cast; support with pillows for even drying.
Traction Care
Maintain appropriate alignment; assess skin for breakdown.
Conscientiously monitor pin sites to prevent infection.
Post-operative Care Guidelines
Hip Arthroplasty: Focus care to prevent dislocation; use abductor pillows; monitor for symptoms indicating complications.
Knee Arthroplasty: Include use of CPM machines for gentle flexion; careful weight management; pain management strategies.
Amputation Care: Address both physical and emotional needs; ensure proper shaping of the residual limb for prosthetics.
Assistive Devices for Ambulation
Types and Guidelines for Use
Crutches: Used for patients unable to bear full weight; ensure proper fit and use techniques for stairs.
Canes: Offer support for patients requiring unilateral assistance.
Walkers: Provide stability for those needing help balancing; ensure proper fitting to the hip height.
Knee Walkers: Ideal for patients with lower limb injuries, allowing for wheeled mobility without weight-bearing on the injured leg.
Documentation and Evaluation Guidelines
Continuous assessment of patient status, pain levels, and rehabilitation progress is crucial.
Use clear and timely documentation