Musculoskeletal / Ortho PDF

Musculoskeletal / Ortho Ascending Stairs Cane Step with stronger leg, move the cane to the next step, Walking then move...

Musculoskeletal / Ortho Ascending Stairs Cane Step with stronger leg, move the cane to the next step, Walking then move the weaker leg C Cane Descending Stairs O Opposite Lead with the cane, bring weaker leg down, then step A Affected down with stronger leg L Leg *Remember: Up with the good, down with the bad *Cane always moves before weaker leg* 5 P’s of fractures Pain, pallor, pulselessness, polar (cold), paresthesia Types of Fractures Displaced - bone breaks in pieces and moves out of alignment Non-Displaced - bone breaks and stays in alignment Open - bone breaks through skin Closed - skin is not broken Comminuted - bone breaks into multiple pieces Complete - bone breaks across entire section Incomplete - bone does not break across entire section Oblique - bone broken at angle Compression - bones are crushed Transverse - bone breaks in a straight line Segmental - bone broken in at least 2 places; a segment of bone is separated by breaks Stress - hairline fracture Spiral - fracture spirals around bone; caused by twisting injuries Greenstick fracture - bone breaks on one side and bends on the other; common in peds Buck’s Traction Ensures proper alignment, weights hand freely and do NOT touch the floor Do not remove or lift weights without a doctor’s order Casts NEVER insert anything under cast; allow 24-72 hrs for cast to dry To relieve itch, use cool air from blow dryer Hip Fracture Monitor for s/sx of hemorrhage Thromboembolism is the most common complication; prevention includes passive ROM exercises, elevate foot of bed to 25 degrees, wear elastic stockings NI: avoid internal and external rotation of more than 60 degrees, avoid weight bearing on affected leg, leg position should be ABDUCTION (prevents dislocation), avoid crossing legs, monitor neurovascular status of the injury site (skin color, sensation, cap refill, temp, mobility) Oblique Comminuted Spiral Complete Greenstick Segmental Transverse  Musculoskeletal / Ortho Joint replacement Major complication post op is infection Immobility d/t orthopedic limitations Pt’s are prone to venous thrombosis, skin integrity issues, and buildup of urinary calculi Osteoporosis Bones become weak and brittle; pts are prone to fractures S/sx: hump or kyphosis, back pain, loss of height At risk: postmenopausal, thin, white women NI: encourage a high calcium diet, weight-bearing exercise, supplemental calcium (& Vit D for absorption) Osteomyelitis Infectious bone disease NI: Get blood cultures and antibiotics. If necessary, surgery may be required to drain abscess Gout High uric acid in the body causes buildup of uric acid crystals in the joints Causes severe pain, inflammation, and redness NI: low purine diet (avoid sugar, organ meats, alcohol, yeast), promote high fluid intake, NSAID’s, corticosteroids, rest as needed Rheumatoid Arthritis Autoimmune and inflammatory disease that affects joints Pain relief is high priority During an acute episode, do NOT assess range of motion, as this is painful. Teach patient not to exercise swollen joints S/sx: generalized weakness, fatigue, stiffness, joint deformity NI: Assess the pt using strength testing, palpation, and inspection. avoid weight bearing on inflamed joints, rest, PT & OT Rheumatoid Arthritis Treatment: corticosteroids, immobilization, splinting, immobilization, NSAID’s (pain), rest Diagnostic: Rheumatoid factor blood test Normal Osteoarthritis Rheumatoid arthritis