MUSCULO-SKELETAL NURSING

Review of Anatomy and Physiology

• The musculo-skeletal system consists of the

muscles, tendons, bones and cartilage
together with the joints
• The primary function of which is to produce
skeletal movements
 Muscles

Three types of muscles exist in the body

• 1. Skeletal Muscles
– Voluntary and striated
• 2. Cardiac muscles
– Involuntary and striated
• 3. Smooth/Visceral muscles
– Involuntary and NON-striated
 TENDONS

• Bands of fibrous connective tissue that tie

bones to muscles
 LIGAMENTS

• Strong, dense and flexible bands of fibrous

tissue connecting bones to another bone
 BONES
• Variously classified according to shape, location and
size
• Functions
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition
 JOINTS

• The part of the Skeleton where two or more

bones are connected
 CARTILAGES

• A dense connective tissue that consists of

fibers embedded in a strong gel-like substance
 BURSAE

• Sac containing fluid that are located around

the joints to prevent friction
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
• The nurse usually evaluates this small
part of the over-all assessment and
concentrates on the patient’s posture,
body symmetry, gait and muscle and
joint function
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
• 1. HISTORY
• 2. Physical Examination
– Perform a head to toe assessment
– Nurses need to inspect and palpate
– The special procedure is the assessment of joint
and muscle movement
– Usually, a tape measure and a protractor are the
only instruments
 ASSESSMENT OF THE MUSCULO-
SKELETAL SYSTEM
• Gait
• Posture
• Muscular palpation
• Joint palpation
• Range of motion
• Muscle strength
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
• 1. BONE MARROW ASPIRATION
– Usually involves aspiration of the marrow to diagnose
diseases like leukemia, aplastic anemia
– Usual site is the sternum and iliac crest
– Pre-test: Consent
– Intratest: Needle puncture may be painful
– Post-test: maintain pressure dressing and watch out for
bleeding
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
• 2. Arthroscopy
– A direct visualization of the joint cavity
– Pre-test: consent, explanation of procedure,
NPO
– Intra-test: Sedative, Anesthesia, incision will
be made
– Post-test: maintain dressing, ambulation as
soon as awake, mild soreness of joint for 2
days, joint rest for a few days, ice application
to relieve discomfort
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
3. BONE SCAN
• Imaging study with the use of a contrast radioactive material
• Pre-test: Painless procedure, IV radioisotope is used, no
special preparation, pregnancy is contraindicated
• Intra-test: IV injection, Waiting period of 2 hours before X-
ray, Fluids allowed, Supine position for scanning
• Post-test: Increase fluid intake to flush out radioactive
material
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
4. DXA- Dual-energy XRAY absorptiometry
• Assesses bone density to diagnose osteoporosis
• Uses LOW dose radiation to measure bone density
• Painless procedure, non-invasive, no special
preparation
• Advise to remove jewelry
Common musculoskeletal problems

The Nursing Management

Nursing Management of common musculo-skeletal
problems

PAIN
• These can be related to joint inflammation, traction,
surgical intervention
• 1. Assess patient’s perception of pain
• 2. Instruct patient alternative pain management like
meditation, heat and cold application, TENS and
guided imagery
 Nursing Management

PAIN
• 3. Administer analgesics as prescribed
– Usually NSAIDS
– Meperidine can be given for severe pain
• 4. Assess the effectiveness of pain measures
 Nursing Management
IMPAIRED PHYSICAL MOBILITY
• 1. Instruct patient to perform range of motion
exercises, either passive or active
• 2. Provide support in ambulation with assistive
devices
• 3. Turn and change position every 2 hours
• 4. Encourage mobility for a short period and provide
positive reinforcements for small accomplishments
 Nursing Management

SELF-CARE DEFICITS
• 1. Assess functional levels of the patient
• 2. Provide support for feeding problems
– Place patient in Fowler’s position
– Provide assistive device and supervise mealtime
– Offer finger foods that can be handled by patient
– Keep suction equipment ready
 Nursing Management

SELF-CARE DEFICITS
• 3. Assist patient with difficulty bathing and
hygiene
– Assist with bath only when patient has difficulty
– Provide ample time for patient to finish activity
 Musculoskeletal Modalities

• Traction
• Cast
 Nursing Management

Traction
• A method of fracture immobilization by
applying equipments to align bone fragments
• Used for immobilization, bone alignment and
relief of muscle spasm
 Traction

• Skin traction- Buck, Bryant

• Skeletal traction-cervical,tibia, overhead arm

traction
 Traction

• Balanced Suspension traction

• Running/Straight traction
 Traction

• Pulling force exerted on bones to reduce or

immobilize fractures, reduce muscle spasm,
correct or prevent deformities
 Traction

• TO decrease muscle spasms

• TO reduce, align and immobilize fractures
• To correct deformities
 Nursing Management

Traction: General principles

• 1. ALWAYS ensure that the weights hang freely and
do not touch the floor
• 2. NEVER remove the weights
• 3. Maintain proper body alignment
• 4. Ensure that the pulleys and ropes are properly
functioning and fastened by tying square knot
 Nursing Management

Traction: General principles

• 5. Observe and prevent foot drop
– Provide foot plate
• 6. Observe for DVT, skin irritation and
breakdown
• 7. Provide pin care for clients in skeletal
traction- use of hydrogen peroxide
 Nursing Management

Traction: General principles

8. Promote skin integrity
– Use special mattress if possible
– Provide frequent skin care
– Assess pin entrance and cleanse the pin with
hydrogen peroxide solution
– Turn and reposition within the limits of traction
– Use the trapeze
 Nursing Management

CAST
• Immobilizing tool made of plaster of Paris or
fiberglass
• Provides immobilization of the fracture
 Nursing Management

CAST: types
1. Long arm
2. Short arm
3. Short leg
4. Long leg
5. Spica
6. Body cast
 Casting Materials

• Plaster of Paris
– Drying takes 1-3 days
– If dry, it is SHINY, WHITE, hard and resistant
• Fiberglass
– Lightweight and dries in 20-30 minutes
– Water resistant
 Cast application

1. TO immobilize a body part in a specific

position
2. TO exert uniform compression to the
tissue
3. TO provide early mobilization of
UNAFFECTED body part
4. TO correct deformities
5. TO stabilize and support unstable joints
 Nursing Management

CAST: General Nursing Care

• 1. Allow the cast to air dry (usually 24-72
hours)
• 2. Handle a wet cast with the PALMS not
the fingertips
 Nursing Management

CAST: General Nursing Care

• 3. Keep the casted extremity ELEVATED
using a pillow
• 4. Turn the extremity for equal drying. DO
NOT USE DRYER for plaster cast
– Encourage mobility and range of motion
exercises
 Nursing Management

CAST: General Nursing Care

• 5. Petal the edges of the cast to
prevent crumbling of the edges
• 6. Examine the skin for pressure
areas and Regularly check the
pulses and skin
 Nursing Management

CAST: General Nursing Care

• 7. Instruct the patient not to place
sticks or small objects inside the cast
• 8. Monitor for the following: pain,
swelling, discoloration, coolness,
tingling or lack of sensation and
diminished pulses
 Nursing Management

CAST: General Nursing Care

• Hot spots occurring along the cast may
indicate infection under the cast
Common Musculoskeletal
conditions
Nursing management
 METABOLIC BONE DISORDERS

Osteoporosis
• A disease of the bone characterized by a
decrease in the bone mass and density with a
change in bone structure
 METABOLIC BONE DISORDERS

Osteoporosis: Pathophysiology
• Normal homeostatic bone turnover is
altered rate of bone RESORPTION is greater
than bone FORMATION reduction in total
bone mass reduction in bone mineral
density prone to FRACTURE
 METABOLIC BONE DISORDERS

Osteoporosis: TYPES
• 1. Primary Osteoporosis- advanced age,
post-menopausal
• 2. Secondary osteoporosis- Steroid
overuse, Renal failure
 METABOLIC BONE DISORDERS

RISK factors for the development of Osteoporosis

• 1. Sedentary lifestyle
• 2. Age
• 3. Diet- caffeine, alcohol, low Ca and Vit D
• 4. Post-menopausal
• 5. Genetics- caucasian and asian
• 6. Immobility
 METABOLIC DISORDER

ASSESSMENT FINDINGS
• 1. Low stature
• 2. Fracture
– Femur
• 3. Bone pain
 METABOLIC DISORDER

LABORATORY FINDINGS
• 1. DEXA-scan
– Provides information about bone mineral density
– T-score is at least 2.5 SD below the young adult
mean value
• 2. X-ray studies
 METABOLIC DISORDER

Medical management of Osteoporosis

• 1. Diet therapy with calcium and Vitamin D
• 2. Hormone replacement therapy
• 3. Biphosphonates- Alendronate, risedronate
produce increased bone mass by inhibiting the
OSTEOCLAST
• 4. Moderate weight bearing exercises
• 5. Management of fractures
 METABOLIC DISORDER
Osteoporosis Nursing Interventions
1. Promote understanding of osteoporosis and the
treatment regimen
• Provide adequate dietary supplement of calcium and
vitamin D
• Instruct to employ a regular program of moderate
exercises and physical activity
• Manage the constipating side-effect of calcium
supplements
 METABOLIC DISORDER

Osteoporosis Nursing Interventions

• Take calcium supplements with meals
• Take alendronate with an EMPTY stomach
with water
• Instruct on intake of Hormonal replacement
 METABOLIC DISORDER

Osteoporosis Nursing Interventions

2. Relieve the pain
• Instruct the patient to rest on a firm mattress
• Suggest that knee flex ion will cause relaxation of
back muscles
• Heat application may provide comfort
• Encourage good posture and body mechanics
• Instruct to avoid twisting and heavy lifting
 METABOLIC DISORDER

Osteoporosis Nursing Interventions

• 3. Improve bowel elimination
• Constipation is a problem of calcium
supplements and immobility
• Advise intake of HIGH fiber diet and increased
fluids
 METABOLIC DISORDER

Osteoporosis Nursing Interventions

• 4. Prevent injury
• Instruct to use isometric exercise to
strengthen the trunk muscles
• AVOID sudden jarring, bending and strenuous
lifting
• Provide a safe environment
 Juvenile rheumatoid Arthritis

• Definition:
– AUTO-IMMUNE inflammatory joint disorder of
UNKNOWN cause
– SYSTEMIC chronic disorder of connective tissue

– Diagnosed BEFORE age 16 years old

 Juvenile rheumatoid Arthritis

• PATHOPHYSIOLOGY : unknown

• Affected by stress, climate and genetics

• Common in girls 2-5 and 9-12 y.o.

 Juvenile rheumatoid Arthritis

Systemic JRA Pauci-articular Polyarticular

Morning joint
MILD joint pain
FEVER stiffness and
and swelling
fever
Salmon-pink Weight
IRIDOCYCLITIS
rash Bearing joints
Five or more Less than 4 Five or more
joints joints joints
Anorexia, Very Good
anemia, fatigue prognosis
Poor prognosis
 JRA

• Symptoms may decrease as child enters

adulthood
• With periods of remissions and exacerbations
 JRA

Medical Management
1. ASPIRIN and NSAIDs- mainstay treatment
2. Slow-acting anti-rheumatic drugs
3. Corticosteroids
 JRA

Nursing Management
1. Encourage normal performance of daily
activities
2. Assist child in ROM exercises
3. Administer medications
4. Encourage social and emotional
development
 JRA

Nursing Management
During acute attack:
• SPLINT the joints
• NEUTRAL positioning
• Warm or cold packs
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS
• The most common form of degenerative joint
disorder
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS
• Chronic, NON-systemic disorder of joints
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Pathophysiology
• Injury, genetic, Previous joint damage,
Obesity, Advanced age  Stimulate the
chondrocytes to release chemicals
chemicals will cause cartilage
degeneration, reactive inflammation of
the synovial lining and bone stiffening
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Risk factors

• 1. Increased age
• 2. Obesity
• 3. Repetitive use of joints with previous joint
damage
• 4. Anatomical deformity
• 5. genetic susceptibility
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Assessment findings

• 1. Joint pain
• 2. Joint stiffness
• 3. Functional joint impairment limitation
• The joint involvement is ASYMMETRICAL
• This is not systemic, there is no FEVER, no severe
swelling
• Atrophy of unused muscles
• Usual joint are the WEIGHT bearing joints
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Assessment findings

1. Joint pain
• Caused by
– Inflamed cartilage and synovium
– Stretching of the joint capsule
– Irritation of nerve endings
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Assessment findings

2. Stiffness
 commonly occurs in the morning after
awakening
 Lasts only for less than 30 minutes
 DECREASES with movement, but worsens
after increased weight bearing activitry
Crepitation may be elicited
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Diagnostic findings

1. X-ray
• Narrowing of joint space
• Loss of cartilage
• Osteophytes
2. Blood tests will show no evidence of systemic
inflammation and are not useful
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Medical management

• 1. Weight reduction
• 2. Use of splinting devices to support joints
• 3. Occupational and physical therapy
• 4. Pharmacologic management
– Use of PARACETAMOL, NSAIDS
– Use of Glucosamine and chondroitin
– Topical analgesics
– Intra-articular steroids to decrease inflam
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Nursing Interventions

1. Provide relief of PAIN
– Administer prescribed analgesics
– Application of heat modalities. ICE PACKS may
be used in the early acute stage!!!
– Plan daily activities when pain is less severe
– Pain meds before exercising
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Nursing Interventions

2. Advise patient to reduce weight
– Aerobic exercise
– Walking
3. Administer prescribed medications
– NSAIDS
 DEGENERATIVE JOINT DISEASE

OSTEOARTHRITIS: Nursing Interventions

4. Position the client to prevent flexion
deformity
– Use of foot board, splints, wedges and pillows
 Rheumatoid arthritis

• A type of chronic systemic inflammatory

arthritis and connective tissue disorder
affecting more women (ages 35-45) than
men
 Rheumatoid arthritis

FACTORS:
Genetic
Auto-immune connective tissue disorders
Fatigue, emotional stress, cold, infection
 Rheumatoid arthritis

Pathophysiology
• Immune reaction in the synovium 
attracts neutrophils  releases enzymes 
breakdown of collagen  irritates the
synovial liningcausing synovial
inflammation edema and pannus
formation and joint erosions and swelling
 Rheumatoid arthritis

ASSESSMENT FINDINGS
• 1. PAIN
• 2. Joint swelling and stiffness-SYMMETRICAL,
Bilateral
• 3. Warmth, erythema and lack of function
• 4. Fever, weight loss, anemia, fatigue
• 5. Palpation of join reveals spongy tissue
• 6. Hesitancy in joint movement
 Rheumatoid arthritis

ASSESSMENT FINDINGS
• Joint involvement is SYMMETRICAL and
BILATERAL
• Characteristically beginning in the hands,
wrist and feet
• Joint STIFFNESS occurs early morning, lasts
MORE than 30 minutes, not relieved by
movement, diminishes as the day
progresses
 Rheumatoid arthritis

ASSESSMENT FINDINGS
• Joints are swollen and warm
• Painful when moved
• Deformities are common in the hands and
feet causing misalignment
• Rheumatoid nodules may be found in the
subcutaneous tissues
 Rheumatoid arthritis

Diagnostic test
• 1. X-ray
– Shows bony erosion
• 2. Blood studies reveal (+) rheumatoid
factor, elevated ESR and CRP and ANTI-
nuclear antibody
• 3. Arthrocentesis shows synovial fluid that
is cloudy, milky or dark yellow containing
numerous WBC and inflammatory proteins
 Rheumatoid arthritis

MEDICAL MANAGEMENT
• 1. Therapeutic dose of NSAIDS and Aspirin
to reduce inflammation
• 2. Chemotherapy with methotrexate,
antimalarials, gold therapy and steroid
• 3. For advanced cases- arthroplasty,
synovectomy
• 4. Nutritional therapy
 Rheumatoid arthritis

MEDICAL MANAGEMENT
GOLD THERAPY:
• IM or Oral preparation
• Takes several months (3-6) before effects
can be seen
• Can damage the kidney and causes bone
marrow depression
• May NOT work for all individuals
 Rheumatoid arthritis

Nursing MANAGEMENT
1. Relieve pain and discomfort
• USE splints to immobilize the affected extremity
during acute stage of the disease and
inflammation to REDUCE DEFORMITY
• Administer prescribed medications
• Suggest application of COLD packs during the
acute phase of pain, then HEAT application as
the inflammation subsides
 Rheumatoid arthritis

Nursing MANAGEMENT
2. Decrease patient fatigue
• Schedule activity when pain is less
severe
• Provide adequate periods of rests
3. Promote restorative sleep
 Rheumatoid arthritis

Nursing Management
4. Increase patient mobility
• Advise proper posture and body
mechanics
• Support joint in functional position
• Advise ACTIVE ROME
• Avoid direct pressure over the joint
 Rheumatoid arthritis

Nursing Management
5. Provide Diet therapy
• Patients experience anorexia, nausea
and weight loss
• Regular diet with caloric restrictions
because steroids may increase appetite
• Supplements of vitamins, iron and
PROTEIN
 Rheumatoid arthritis

6. Increase Mobility and prevent deformity:

• Lie FLAT on a firm mattress
• Lie PRONE several times to prevent HIP
FLEXION contracture
• Use one pillow under the head because of
risk of dorsal kyphosis
• NO Pillow under the joints because this
promotes flexion contractures
 Rheumatoid arthritis

• Capsaicin
– Unknown mechanism
– Reduces pain
– Applied over the affected area
– Do NOT bandage the area
– Side effect: burning sensation
– Wash hands after application
 Hot versus Cold

HOT Cold

Use to RELIEVE joint

Use to control
stiffness, pain and
inflammation and pain
muscle spasm

After acute attack ACUTE ATTACK

 OA versus RA
RA OA
Onset is early Onset is late
Chronic systemic
Degenerative disease
disease
Involves the synovium Involves the cartilages
Involved joints are
Involved joints are
unilateral- weight
symmetrical- fingers,
bearing knee, hips
cervical spine
spine
No other S/SX
Malaise, fever, anemia
systemic
 OA versus RA
RA OA
Joint tenderness,
swelling, warmth and Crepitus, stiffness in
redness the morning decreases
Subcutaneous nodules after activity
Stiffness that dimishes
Rest the joints, Avoid
Rest the joint, cold and
overactivity, Weight
heat modalities, ASA,
reduction, cold and
NSAIDS, DMARDS
warm modalities, ASA
 Gouty arthritis

• A systemic disease caused by deposition of

uric acid crystals in the joint and body
tissues
• CAUSES:
• 1. Primary gout- disorder of Purine
metabolism
• 2. Secondary gout- excessive uric acid in
the blood like leukemia
 Gouty arthritis

• ASSESSMENT FINDINGS
• 1. Severe pain in the involved joints,
initially the big toe
• 2. Swelling and inflammation of the joint
• 3. TOPHI- yellowish-whitish, irregular
deposits in the skin that break open and
reveal a gritty appearance
• 4. PODAGRA-big toe
 Gouty arthritis

ASSESSMENT FINDINGS
• 5. Fever, malaise
• 6. Body weakness and headache
• 7. Renal stones
 Gouty arthritis

DIAGNOSTIC TEST
• Elevated levels of uric acid in the blood
• Uric acid stones in the kidney
• (+) urate crystals in the synovial fluid
 Gouty arthritis

• Medical management
• 1. Allopurinol- take it WITH FOOD
» Rash signifies allergic reaction

• 2. Colchicine
• For acute attack
• 3. Probenecid
• For uric acid excretion
in the kidney
 Gouty arthritis
Nursing Intervention
1. Provide a diet with LOW purine
• Avoid Organ meats, aged and processed foods
• STRICT dietary restriction is NOT necessary
2. Encourage an increased fluid intake (2-3L/day) to
prevent stone formation
3. Instruct the patient to avoid alcohol
4. Provide alkaline ash diet to increase urinary pH
5. Provide bed rest during early attack of gout
 Gouty arthritis

Nursing Intervention
6. Position the affected extremity in mild flexion
7. Administer anti-gout medication and
analgesics
 Fracture

• A break in the continuity of the bone and is

defined according to its type and extent
 Fracture

• Severe mechanical Stress to bone  bone

fracture
• Direct Blows
• Crushing forces
• Sudden twisting motion
• Extreme muscle contraction
 Fracture

TYPES OF FRACTURE
• 1. Complete fracture
– Involves a break across the entire cross-section
• 2. Incomplete fracture
– The break occurs through only a part of the cross-
section
 Fracture

TYPES OF FRACTURE
• 1. Closed fracture
– The fracture that does not cause a break in the
skin
• 2. Open fracture
– The fracture that involves a break in the skin
 Fracture

TYPES OF FRACTURE
• 1. Comminuted fracture
– A fracture that involves production of several
bone fragments
• 2. Simple fracture
– A fracture that involves break of bone into two
parts or one
 Fracture

ASSESSMENT FINDINGS
• 1. Pain or tenderness over the involved area
• 2. Loss of function
• 3. Deformity
• 4. Shortening
• 5. Crepitus
• 6. Swelling and discoloration
 Fracture

ASSESSMENT FINDINGS
1. Pain
• Continuous and increases in severity
• Muscles spasm accompanies the fracture is a
reaction of the body to immobilize the
fractured bone
 Fracture

ASSESSMENT FINDINGS
2. Loss of function
• Abnormal movement and pain can result to
this manifestation
 Fracture

ASSESSMENT FINDINGS
3. Deformity
• Displacement, angulations or rotation of the
fragments Causes deformity
 Fracture

ASSESSMENT FINDINGS
4. Crepitus
• A grating sensation produced when the bone
fragments rub each other
 Fracture

• DIAGNOSTIC TEST
• X-ray
 Fracture

EMERGENCY MANAGEMENT OF FRACTURE

• 1. Immobilize any suspected fracture
• 2. Support the extremity above and below when
moving the affected part from a vehicle
• 3. Suggested temporary splints- hard board, stick,
rolled sheets
• 4. Apply sling if forearm fracture is suspected or
the suspected fractured arm maybe bandaged to
the chest
 Fracture

EMERGENCY MANAGEMENT OF FRACTURE

• 5. Open fracture is managed by covering a
clean/sterile gauze to prevent contamination
• 6. DO NOT attempt to reduce the facture
 Fracture

MEDICAL MANAGEMENT
• 1. Reduction of fracture either open or closed,
Immobilization and Restoration of function
• 2. Antibiotics, Muscle relaxants such as
METHOCARBAMOL and Pain medications
 Fracture

General Nursing MANAGEMENT

For CLOSED FRACTURE
• 1. Assist in reduction and immobilization
• 2. Administer pain medication and muscle
relaxants
• 3. teach patient to care for the cast
• 4. Teach patient about potential complication of
fracture and to report infection, poor alignment
and continuous pain
 Fracture
General Nursing MANAGEMENT
For OPEN FRACTURE
• 1. Prevent wound and bone infection
• Administer prescribed antibiotics
• Administer tetanus prophylaxis
• Assist in serial wound debridement
• 2. Elevate the extremity to prevent edema
formation
• 3. Administer care of traction and cast
 Fracture
• FRACTURE COMPLICATIONS
• Early
• 1. Shock
• 2. Fat embolism
• 3. Compartment syndrome
• 4. Infection
• 5. DVT
 Fracture
• FRACTURE COMPLICATIONS
• Late
• 1. Delayed union
• 2. Avascular necrosis
• 3. Delayed reaction to fixation devices
• 4. Complex regional syndrome
 Fracture
• FRACTURE COMPLICATIONS: Fat Embolism
• Occurs usually in fractures of the long bones
• Fat globules may move into the blood stream
because the marrow pressure is greater than
capillary pressure
• Fat globules occlude the small blood vessels of
the lungs, brain kidneys and other organs
 Fracture
• FRACTURE COMPLICATIONS: Fat Embolism
• Onset is rapid, within 24-72 hours
• ASSESSMENT FINDINGS
• 1. Sudden dyspnea and respiratory distress
• 2. tachycardia
• 3. Chest pain
• 4. Crackles, wheezes and cough
• 5. Petechial rashes over the chest, axilla and
hard palate
 Fracture
• FRACTURE COMPLICATIONS: Fat Embolism
• Nursing Management
• 1. Support the respiratory function
• Respiratory failure is the most common cause
of death
• Administer O2 in high concentration
• Prepare for possible intubation and ventilator
support
 Fracture
• FRACTURE COMPLICATIONS: Fat Embolism
• Nursing Management
• 2. Administer drugs
• Corticosteroids
• Dopamine
• Morphine
 Fracture
• FRACTURE COMPLICATIONS: Fat Embolism
• Nursing Management
• 3. Institute preventive measures
• Immediate immobilization of fracture
• Minimal fracture manipulation
• Adequate support for fractured bone during turning
and positioning
• Maintain adequate hydration and electrolyte
balance
 Fracture
• Early complication: Compartment
syndrome
• A complication that develops when tissue
perfusion in the muscles is less than
required for tissue viability
 Fracture
• Early complication: Compartment syndrome
• ASSESSMENT FINDINGS
1. Pain- Deep, throbbing and UNRELIEVED pain by
opiods
• Pain is due to reduction in the size of the muscle
compartment by tight cast
• Pain is due to increased mass in the compartment
by edema, swelling or hemorrhage
 Fracture

• Early complication: Compartment syndrome

• ASSESSMENT FINDINGS
• 2. Paresthesia- burning or tingling sensation
• 3. Numbness
• 4. Motor weakness
• 5. Pulselessness, impaired capillary refill time
and cyanotic skin
 Fracture

• Early complication: Compartment

syndrome
• Medical and Nursing management
• 1. Assess frequently the neurovascular
status of the casted extremity
• 2. Elevate the extremity above the level
of the heart
• 3. Assist in cast removal and FASCIOTOMY
 Strains

• Excessive stretching of a muscle or tendon

• Nursing management
• 1. Immobilize affected part
• 2. Apply cold packs initially, then heat packs
• 3. Limit joint activity
• 4. Administer NSAIDs and muscle relaxants
 Sprains

• Excessive stretching of the LIGAMENTS

• Nursing management
• 1. Immobilize extremity and advise rest
• 2. Apply cold packs initially then heat packs
• 3. Compression bandage may be applied to
relieve edema
• 4. Assist in cast application
• 5. Administer NSAIDS
 Herniated disk

• Occurs when all or part of the nucleus

pulposus forces through the weakened or
torn outer ring (annulus pulposus
 Herniated disk

• Impingement on the spinal nerves will result

to BACK PAIN
 Herniated disk

• Causes
1. Trauma
2. Strain
3. Joint degeneration
 Herniated disk

ASSESSMENT findings
1. Severe lower BACK PAIN that may radiate
to the buttocks or legs and feet
2. Motor and sensory loss in the area supplied
by the compressed nerves
 Herniated disk

DIAGNOSIS of Herniated disk

1. Straight leg raising test
– (+) leg pain
2. LeSegue’s test
– 90 degrees knee and thigh  (-) DTR
3. XR
4. CT
5. MRI
 Herniated disk

Nursing Implementation
1. Provide complete BED rest for several
days
2. Advise heat application over the area to
lessen pain and muscle spasm
 Herniated disk

Nursing Implementation
3. Provide exercise on bed
4. Assist in pelvic traction application
5. Provide the drugs as ordered
Aspirin
Diazepam
Muscle relaxant
 Herniated disk

Nursing Implementation
6. Provide care for laminectomy
 Laminectomy

• Removal of the spinal lamina to stabilize the

vertebral joint and
Removal of the protruding disk

• Usually accompanied by insertion of metal

plates
 Laminectomy

• Pre-operatively
– Routine pre-operative care
– Remind the patient that he should lie non his
BACK after the operation
– Monitor for worsening of symptoms
– Use anti-embolic stocking
– Encourage ROME
– Coordinate with the PT
 Laminectomy

• Pre-operatively
– Fluids to prevent renal stones
– Incentive spirometry
– Maintain on BED rest
 Laminectomy

• POST-operatively
– Maintain BED rest
– VERY IMPORTANT : LOG ROLLING TECHNIQUE to
turn
– Never lie on PRONE
– HEMOVAC drainage system= check tubing for
kinks, record amount, report colorless moisture
in dressing
– Provide straight BACKED chair for LIMITED sitting
ONLY
 Laminectomy

• HOME CARE
– AVOID sitting for a prolonged period of time
– AVOID twisting, bending at the waist
– Sleep on BACK
– Proper weight to PREVENT lordosis
 Amputation

Nursing Interventions
Post-operative care: after amputation
• Elevate stump for the FIRST 24 HOURS to
minimize edema and promote venous
return
• Place patient on PRONE position after 24
hours
 Amputation

Nursing Interventions
Post-operative care: after amputation
• Assess skin for bleeding and hematoma
• Wrap the extremity with elastic bandage