musculoskeletal disorders hltap501a analyse health information
TRANSCRIPT
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Musculoskeletal Disorders
HLTAP501A
Analyse Health Information
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Fractures
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Fractures – Signs & Symptoms
DeformitySwellingBruisingMuscle spasmPain and tenderness
Loss of normal function
Impaired sensation
CrepitusAbnormal mobility
Shock
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Potential blood loss with fractures
Fracture site
Potential blood loss (litres)
Fracture site
Potential blood loss (litres)
Humerus 1.0 - 2.0 Pelvis 1.5 - 4.5
Elbow 0.5 - 1.5 Hip 1.5 - 2.5
Forearm 0.5 – 1.0 Femur 1.0 – 2.0
Spine/ribs 1.0 – 3.0 Knee 1.0 -1.5
Ankle 0.5 – 1.5 Tibia 0.5 – 1.5
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Types of fractures
Simple or closed
Compound or open
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Types of fractures
•Complete•Greenstick•Comminuted•Compression •Impacted•Depressed •Spiral/oblique•Longitudinal/linear•Transverse•Pathological
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Fracture repair
Haematoma formation – stops the bleeding, brings macrophages to the area
Callus formation – the endosteum and periosteum become activated and produce cartilage
Osteoblasts replace the central cartilage with cancellous bone forming a strong bridge through the bone joining the internal and external callus
Osteoclasts and osteoblasts begin to reshape the area. Takes between four months to over one year
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Fracture repair
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Factors that delay healing
InfectionFat embolismTissue fragments between the ends of the bones
Deficient blood supply Continued mobilityOld age
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Treatment
Reduction Closed
GAMPPOP applied
Open ORIF
Immobilisation External fixation
POPSplintsTractionExternal devices –
Ilizarov frame
Internal fixationNails, screws, wires,
rods, plates
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Plaster of Paris (POP) – nursing responsibilities
Frequent neurovascular observationsPOP may take 48 hours to dry – handle gently
Elevate the limb to reduce swellingPalpate the cast for ‘hot spots’ that may indicate the presence of infection
Report any seepage and mark with date and time
Correct use of sling and crutches
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Reasons for tractionTo reduce a fracture and realign bone fragments
To immobilize a fracture and maintain fracture alignment
To reduce, relieve and prevent skeletal muscle spasms
To overcome joint deformity and contractions by stretching the muscles
To rest a diseased joint
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Manual traction
Temporarily immobilises an injured area, through hands pulling on the injured body part e.g. when the doctor
manipulates and pulls the bones for realignment
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Skin traction
Immobilises a body part intermittently over an extended period, through direct application of a pulling force on the patient’s skin (adhesive or non-adhesive traction tape can be used).
Skin traction is usually used when partial immobilization and light traction forces are required
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Skeletal traction Immobilises a body part
for prolonged periods, by attaching weighted equipment directly to the patient’s bones.
Uses Kirschner wires, Steinmann pins, Denham pins, and Zimmer screws.
These are inserted into the bone and is then connected to a device that attaches to the cords used in traction
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Fixed traction
Thomas’ splint does not require gravity to achieve results.
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Balanced tractionUses suspension (which provides greater comfort for the patient but has no influence on the traction forces)
Weights usually water and this
can be reduced or increased as required.
can also be metal discs or sand
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Nursing implications for tractionFor traction to be successful, countertraction is necessary in most instances the countertraction is the patients weight, therefore, do not wedge the patients foot or place it flush with the foot of the bed Maintain the line of pull Centre the patient on the bed Ensure that weights hang freely and do not touch the floor Ropes
Ensure that nothing is lying on or obstructing the ropes, Do not allow the knots at the end of the rope to come into
contact with the pulley. Ensure that the ropes are not frayed and that they are resting
within the groove of the pulleys
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Nursing implications for tractionIn skeletal tractionNever remove the weightsFrequent skin assessment should include pin care per hospital policy
Report signs of infection at the pin sites, such as redness, drainage, and increased tenderness, to the doctor
The patient may require more frequent analgesic administration
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Nursing implications for traction In skin traction assess the skin for redness,
irritation and signs of traction slippingPerform neurovascular assessments frequentlyAssess for common complications of immobility,
including: the formation of pressure ulcers, formation of renal calculi, DVT, pneumonia, paralytic ileus, and loss of appetite
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Neurovascular observations
Circulation – warmth, colour, refill time and oedema
Neurologic status – sensation (checking for numbness, tingling, burning pain)
Movement – check range of movement and strength
Complications will show – pain, pallor, pulse changes, paraesthesia, paralysis
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Compartment syndrome
Early – pain and decreased pulse to distal areas
LaterCyanosisTingling Loss of sensationSevere painEventually renal failure
If untreated amputation
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Compartment syndrome
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Rheumatoid arthritis
Is a chronic, systemic, inflammatory, autoimmune disease
Joints and surrounding muscles, tendons and ligaments
SystemicBlood vesselsSkinHeart
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Rheumatoid arthritis - Systemic effectsSlight feverMalaise – weakness and fatigue by early afternoon
Weight lossNumb, tingling hands and feetEnlarged lymph nodesEnlarged spleenDepressionAnorexia
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Rheumatoid arthritis
Synovitis develops from congestion and oedema of the synovial membrane and joint capsule
Bone atrophy and misalignment cause deformities and restricted movements muscle atrophy, imbalance, partial dislocations
Fibrous tissue calcifies fixation of joint and immobility
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Osteoarthritis Is a chronic, progressive disorder
CausesPrimary
Idiopathic
SecondaryCongenital - CDHTraumaDisease – haemophilia,
acromegaly, gout
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Osteoarthritis – S&S
Joints commonly affected
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Osteoarthritis – S&S
Pain in joint
Crepitus
Joint swelling and warmth
Joint deformity (subluxation)
Loss of ROM
Muscle spasm and contractures
Nodules Herberden’s Bouchard’s Bunion
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Hip replacement
Treatment for fracture or osteoarthritis
Hemiarthroplasty – replacement of either femoral head or acetabulum
Total hip replacement (THR) – both are replaced
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Hip replacement – post op
Routine – observations, pain, wound, drainage, IDC
Specific Maintain abduction Log rollsHip flexion not greater
than 900
Mobilisation – NWB WB
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Hip precautions
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Gout Gout is a condition in which there are deposits of a chemical (sodium urate) in joints, causing arthritis, as well as in soft tissues and the urinary tract.
Urate or uric acid is a chemical formed from the breakdown of purines - DNA building blocks derived from protein.
Hyperuricaemia means that a person has too much uric acid in the blood - which is associated with gout. When uric acid precipitates in a joint (often the big toe) it causes an acute arthritis.
Uric acid can also be deposited in:
soft tissue, causing tophi (white chalky deposits) and tenosynovitis - tendon inflammation.
urinary tract, causing stones and potentially renal failure (since 2/3 of uric acid is excreted by the kidney)
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Osteoporosis