NRSG+102+Mobility+Part+2+Spring+2024 copy.pptx

Mobility Part 2 NRSG 102, Spring 2024 CJ Tillotson, MSN, RN 60% of unintentional injuries are due to musculoskeletal trauma TRAUM A One of the primary causes of disability in the US Sprains and strains being the most prevalent followed by fractures Soft-Tissue Musculoskeletal Injuries Sprain Strain...

Mobility Part 2 NRSG 102, Spring 2024 CJ Tillotson, MSN, RN 60% of unintentional injuries are due to musculoskeletal trauma TRAUM A One of the primary causes of disability in the US Sprains and strains being the most prevalent followed by fractures Soft-Tissue Musculoskeletal Injuries Sprain Strain Ligament tear –anterior cruciate ligament (ACL) Meniscus tear Tendon rupture – Achilles tendon in heel Patellofemoral pain syndrome (PFPS) - runner's knee Joint dislocation Excessive stretching or pulling of muscle or tendon that is weak or unstable Often caused by falls, lifting heavy item, and exercise Strain Classified according to severity 1st, 2nd, 3rd degree Cold and heat, exercise and activity limitations Muscle relaxers, antiinflammatory Excessive stretching of ligament Twisting motions from a fall or sports can be cause Sprain Classified according to severity 2nd degree: immobilization and PWB 3rd degree: immobilization, possible repair Management STRAIN S AND SPRAIN S (cont’d) Diagnosis based on history and physical examination Confirmed by radiography, ultrasound, or MRI Treatment of 1st and 2nd degree strains/sprains RICE 3rd degree strains may require surgical repair of the torn tendon or muscle Immobilization for 4-6 weeks for 3rd degree sprains Joint Dislocation Trauma or illness forces ends of bones from normal position Manifestations: Pain Deformity Limited motion Can occur due to falls, hits, contact sports Joint Dislocati on Can have joint dislocation due to other pathological conditions Subluxation – partial dislocation Medical diagnosis – history of injury and physical assessment X-rays Concern with displaced bone NEUROVASCULAR CHECKS DISTAL TO AFFECTED JOINT!!! Joint Dislocati on Common site is shoulder Dislocations usually treated by closed reduction Meet David https://www.youtube.com/watch?v=HEVjYNA7n Cs May require surgical reduction After reduction, joint rest, NSAIDs, moist heat, PT in some cases Younger adult's d/t fall, heavy lifting, sports Older adult's d/t aging, repetitive motion, falls Rotator Cuff Injury Symptoms: Painful, cannot abduct arm Reduced mobility Confirmed through x-ray, MRI, ultrasound and/or CT Treatment: Conservative: NSAIDs, intermittent steroid injections, PT, activity limitations Surgery may be needed Immobilization after surgery Exercises started postop Neurovascular Assessment Neurovascular assessment is done with ANY type of mobility injury Increased risk of compartment syndrome with injuries Loss of pulses is a late manifestation – report immediately FRACTURES Manifestations Pain Swelling Deformity Ecchymosis Numbness Loss of function Crepitus Muscle spasms Unable to bear wt Types of fractures Closed (simple) fracture does not break through the skin surface Open (compound) fracture disrupts the skin integrity Complete fracture goes through the FRACTURE S entire bone Incomplete fracture goes through part of the bone Displaced fracture has bone fragments that are not in alignment Non-displaced fracture has bone fragments that remain in alignment (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) (Saint Luke's, 2023) Emergen cy Care of the Patient with an Extremit y Fracture Assess ABC Perform quick head to toe assessment Remove clothing, (cut if necessary) to assess affected area Support area above and below injury Apply direct pressure on area if bleeding and pressure over artery nearest the fracture Remove jewelry on affected side in case of swelling Keep patient warm and in supine position Check neurovascular status often (compare sides) Immobilize extremity by splinting above and below fracture Cover any open area with dressing (sterile if possible)  Management FRACTURE S (cont’d) − Confirmation by radiography or CT − Medications − Reduction of fracture − Open reduction − Surgical intervention − Closed reduction − Performed under anesthesia Analgesics Opioids Non-opioids NSAIDs help inflammation but might delay bone healing Medicati ons Muscle relaxers Stool softeners Constipation d/t opioids Constipation d/t decreased mobility Antibiotics Prophylaxis to prevent infection FRACTURES (cont’d) Surgery External fixator Pins or wires inserted through skin and affected bone and then connected to rigid external frame outside the body to stabilize fx during healing Allows early mobilization and ambulation Risk of pin site infection leading to osteomyelitis Risk for noncompliance FRACTURES (cont’d) External fixator Nursing interventions 6 P’s Assess for infection Pin care per facility policy Pin Site Nursing Interventions: Pins should not move Monitor neurovascular status and skin integrity Elevate extremity Monitor site for drainage, color, odor Pin Site and redness Expect weeping or drainage of clear fluid for the first 48-72 hours Perform pin care every 8-12 hours as ordered Observe for fat embolism and pulmonary embolism (complications of fracture) Pin Care FRACTURES (cont’d) Surgery Internal fixation Open reduction and internal fixation (ORIF) Nursing interventions Neurovascular checks Pain assessment Maintain position Encourage cough and deep breathing  Traction FRACTUR ES (cont’d) − Exertion of a pulling force applied in 2 directions to reduce and immobilize a fracture − Provides proper bone alignment and reduces muscle spasms − Treats bone deformities − Correct muscle contractures − Two main types − Skeletal traction − Skin traction FRACTURES (cont’d)  Traction − Skeletal traction − Pin, wires, screws or tongs applied directly to bone to help with realignments − Typical weight 15-30 lbs − Monitor for infection − Example: Halo traction − Skin traction − Weight-applied splints, bandages or adhesive tapes to the skin directly below the fracture site − Alleviates muscle spasms and immobilizes lower limb − Typical weight 5-10 lbs − Example: Buck’s traction FRACTURES (cont’d)  Nursing interventions for patients in traction − Ensure weights hang freely − Do not touch floor − Do not remove or lift without order − Ropes/pulleys move freely − Assess for complications of immobility − Skeletal − Never remove weights − Assess pin insertion sights − Provide care − Skin − Assess skin − Protect pressure points with padding Treatment Casting After manual closed reduction Immobilizes Plaster, fiberglass Must dry completely Cast care Nursing interventions Keep elevated Allow 24-72 hours to dry Monitor for circulatory impairment Monitor for infection Patient education No object inside of cast Clean and dry Complicati ons of Fractures Compartment syndrome Fat embolism Deep vein thrombosis Neurovascular compromise Infection Delayed bone healing Avascular necrosis Chronic regional pain syndrome Compartment Syndrome Pressure from edema/hemorrhage https://youtu.be/GUqZpsgoie4 Leads to decreased blood flow, tissue ischemia and neurovascular impairment Can lead to limb loss Assessment Pain Pale, dusky distal tissue Paresthesia Pulselessness (late) Interventions Notify HCP immediately Loosen tight dressing if present Fasciotomy if severe https://www.youtube.com/watch?v=yhIEXC3JrYs&has_verified=1 Fat Embolism Most common after hip fracture Seen most commonly in long bones, usually within 12-48° Fat globules are released from bone marrow Manifestations: Early: dyspnea, increased RR, decreased SpO2, HA, AMS, respiratory distress, tachycardia, confusion, chest pain Late: cutaneous petechiae on neck, chest, upper arms and abdomen Interventions: Bedrest Oxygen Fluid replacement Pain/antianxiety medications Deep Vein Thrombosis Blood clot along lining of a large vein Can lead to pulmonary embolism Manifestations Swelling, pain, tenderness, warmth, or cramping of the affected extremity Treatment Heparin therapy Bed rest with leg elevation Nursing Actions Encourage early ambulation Apply antiembolism stockings, SCD’s Administer anticoagulants as prescribed Specific Fractures - Rib Possible puncture of lungs, heart or arteries Can damage spleen, liver, kidneys Often heal alone without surgical intervention Complications Flail chest https://www.youtube.com/watch?v=-_84U0C yCAk Pneumothorax and/or hemothorax Pneumonia Intra-abdominal bleeding Specific Fractures - Hip Intracapsular – within the joint capsule Extracapsular – outside the joint capsule Most are trochanteric or involve the femoral head Most common cause – falls; most common injury in older adults Osteoporosis is the biggest risk factor Manifestations Specific Fractur es - Hip Pain Inability to walk Shortening of affected leg External rotation of leg Some persons may not exhibit these, especially if there are neurological sensory deficits Diagnosis X-ray MRI Specific Fractures - Hip Treatment Immobilization – traction Surgery Usually within 24 hours of injury Goal of surgery: reduce fracture, decrease pain, prevent complications ORIF – trochanter fx Femoral head prosthesis Replacement of femoral head and acetabulum – Total Hip Replacement (THR) Post-op hip Specific Fractur es - Hip precautions Abduction pillow Do not flex or bend hip more than 90° Avoid low stools, low chairs and low toilets Do not lean forward while sitting Do not rotate hip Use appropriate adaptive equipment to pick things up PT/rehab Decreased muscle strength Nursing care goals Maintain skin integrity Prevent infection Maintain circulation Alleviate pain Increase mobility Encourage quad tightening exercises daily