Week 2 - Musculoskeletal System PDF

HCAP 1210 Critical Thinking  Who is the PT/OT and what is their responsibility?  Where do you locate your resident's ability to complete in activities of daily living?  Define the terms quadriplegia, hemiplegia, paraplegia Physical Changes Muscles atrophy and...

HCAP 1210 Critical Thinking  Who is the PT/OT and what is their responsibility?  Where do you locate your resident's ability to complete in activities of daily living?  Define the terms quadriplegia, hemiplegia, paraplegia Physical Changes Muscles atrophy and Bones lose strength, Muscle cells Bones lose minerals, decrease in become brittle, and decrease in number. especially calcium. strength. break easily. Activity, exercise, and diet help Joints become stiff Vertebrae shorten. Mobility decreases. prevent bone loss and painful. and loss of muscle strength. Risk of Falls When a client is falling, the support worker’s instinct is to try to prevent Elderly population is at greater risk for the fall. However, trying to prevent a falls. fall could cause greater harm. You could injure yourself and the client as you twist and strain to stop the fall. If a client starts to fall, ease the client See Helping the Falling Client box (p. to the floor; protect the clients head. 548). HCA Responsibility to Reduce Risk of Fall  Bed left at knee height  Bed brakes left on  Call bell always within reach  Lower side rails always left down  Proper positioning and comfort  Assistance to the bathroom  Use of non-slip socks, hip protectors and mats beside the bed at night  Use of chair, bed and door alarms  Continuous assessment and observation by the health care team Critical Thinking!  Why are the elderly population at risk for falls? Name some risk factors associated to falls.  Based on the TEXTBOOK how do you assist someone falling?  Why do we need to protect their head when falling?  What can we do as HCAs to increase their muscle tone, and strength? HINT* ROM What are Musculoskeletal Disorders Affect the ability to move about Affect bones, joints, and muscles A result of injury and aging Can affect people at any age Fractures  A broken bone—tissues around the fracture are usually injured ( muscles, blood vessels, nerves, and tendons)  Types:  Closed—simple fracture  Open—compound fracture  Fractures  Causes:  Falls  Accidents  Cancer  Alcoholism  Osteoporosis  Signs and symptoms  Limb looks bent or out of position  Pain, swelling, limited movement or loss of function  Bruising, colour changes in the skin at the fracture site  Bleeding (internal or external Fracture Healing  Bone ends are brought into normal position (reduction)  Closed reduction  Skin is not opened  Open reduction  Surgery, nails, rods, pins, screws, plates, or wires are used  Cast is applied Critical Thinking!  You are an HCA at your facility. It is the start of your shift and you are walking into the building. You notice immediately a resident wondering by the nursing station and beside them is a wet floor sign but the floor appears dry. As you walk towards the lockers to put your belongings away you hear an incredibly loud noise and screams. You turn and see the resident has had a fall and a piece of bone is sticking out of their right arm.  What hazards were in place (hint there are two)  What type of fracture is this called?  What is your responsibility NOW as an HCA? Cast Care  Made of plaster, fibreglass, or plastic  Plaster dries in 24 to 48 hours  Odourless, white, shiny when dry  As a support worker, you may assist with care of the cast  Box 37-1 (p. 852) Guidelines for Cast Care Critical Thinking Continued!  It has now been one month since the residents fall. They have a cast on their right arm. You resident also has a diagnosis of dementia and becomes quite frustrated by the cast on their arm and tends to waive it around aggressively and bang their arm.  What do signs and symptoms of a fracture look like post healing?  Explain the care provided for a cast?  How will you alleviate their anxiety and frustration knowing they have a diagnosis of dementia?  Hip Fractures  Hip fractures  Fractured hips are common in older adult clients  Older women are at risk  Two signs of a fractured hip are shortening and outward rotation of the leg  Healing is slower in older adults  Postoperative problems present life- threatening risks:  Pneumonia  Urinary tract infections  Thrombi (blood clots) in the leg veins  Pressure ulcers, constipation, and confusion are other risks  Hip Fractures  The fractured hip is fixed in position with a pin, nail, plate, screw, or artificial hip joint  Some hip fractures require partial or total hip replacement  Preoperative and postoperative care  Box 37-2: Caring for Clients With Hip Fractures (p. 853) Critical Thinking!  You are an HCA working at a medical-surgical unit at SMH. You have been assigned to help assist and care for a patient who had a recent hip replacement.  Patient is an 85-year-old women with dementia. She is unable to engage in self care and is acutely confused. She has been voiding herself all morning and is refusing to engage in ROM. She has soiled herself and now requires a bed bath, pericare, and change of clothes.  Explain in detail how you care for a patient with a hip fracture?  What is she at risk for developing post-operation?  Identify other interdisciplinary team members who is involved in her care, and what their role is (hint name 5), what is your role?  How would you support the goal of being discharged home as soon as possible?  How do you demonstrate interprofessional communication? Amputation of a Limb  Loss of limb  An amputation is the removal of all or part of an extremity  Traumatic amputation occurs by accident  Surgical amputation is performed when the limb is severely damaged and has to be removed  Most common cause of amputations is diabetes Prostheses  Is an artificial replacement for a missing body part.  Occupational therapists and physiotherapists help the client use the prosthesis  The client may feel that the amputated limb is still there.  The client may complain of pain in the amputated part—this is called phantom limb pain  Phantom Pain  Is pain in a limb that has been amputated  Sometimes hard to control  Can sometimes involve a major psychological adjustment  The dominant theory for the cause of this pain is irritation to the nerve endings in the stump Prostheses Skin Care  Skin care is most important  Often, skin is not exposed to air in prosthesis  May become hot and moist, causing irritation, blisters, and skin infections  Notify your supervisor immediately if client complains of pain at the prosthesis site  Report any redness, swelling, or drainage at the site Critical Thinking!  You are working on the medical-surgical unit at SMH and with your second patient for the day. You patient was admitted because of an episode of diabetic-ketoacidosis and requires monitoring. On rapport it was noted that he has a below the knee left-leg amputation due to poor management of his diabetes and is now fitted with a prothesis. He has a hx of self-care deficit.  Because his diabetes was poorly managed, and hx of poor self-care what do we want to be mindful in assessing immediately as a HCA?  Who do we inform immediately if we notice any concerns with the prothesis site? HINT 3 different team members Osteoporosis  A bone disorder in which the bone becomes porous and brittle, bones break easily—spine, hips, wrists most affected  Common in older adults and in women after menopause  Risk factors:  Lack of estrogen and calcium  Smoking  High alcohol intake  Lack of exercise  Prolonged bed rest and immobility  Arthritis means inflammation of the joint  Swelling, redness, heat, and pain  Occurs with aging, joint injury, and obesity  About 80% of Canadians are affected by age 75 Osteoarthritis  Affects weight-bearing joints such as hips, knees, ankles, and spine (OA)  Cartilage gradually breaks down and wears out  Eventually, bones may rub together  Cartilage does not regrow  Pain:  Pain is often less severe in the morning and worsens Osteoarthritis during the day  Occurs with weight-bearing and joint movement  Severe pain can interfere with rest and sleep (OA)  Cold weather and dampness seem to increase symptoms  Bony growths can thicken and form growths called spurs  Osteoarthritis has no cure  Treatment involves relieving pain and stiffness, good body alignment  Anti-inflammatory, pain medication, often Tylenol   Local heat or cold applications Weight loss for obese persons Osteoarthritis  Cane, walker, range-of-motion (ROM) exercises Treatment  Measures to prevent falls  Assistance with daily activities as needed  Elevated toilet seat helpful for clients with limited ROM in the hips and knees Critical Thinking!  What is the difference between OP and OA? Also mention the risk factor differences.  What joints are commonly affected by OA, and why is this a problem?  You are working a night shift at a residential care facility and caring for a resident who is awake throughout the night and voicing complaints of pain in their hips and spine. The nurse on duty has provided medication for pain relief but the resident is still complaining of pain. What can you do as an HCA to help alleviate pain?  How can we encourage the resident to go back to sleep to promote rest and sleep?  Why is sleep important for the elderly? Gout  Is also called metabolic arthritis  It is caused by an accumulation of uric acid in the cartilage of a joint, especially the tendons  It usually affects the big toe first  Signs include severe and sudden pain, swelling, redness, warmth, stiffness of the joint, low-grade fever  Treat with pain medication, ice packs, and anti-inflammatory drugs Critical Thinking!  You are caring Mrs. Joy who is an 89-year-old female in a home care setting. She is talking about her son has been on multiple hunting trips this past season and has brought her home game meat (ex. Rabbit, pheasant, duck, and even a bison!). She has been enjoying making her meals with all new types of exotic meats. She has voiced to you she would like to go to the supermarket to go pickup some soda as it is on sale at No Frills. As you help her get dressed for the day and help her put on her shoes she shrieks in pain. You immediately ask if she is okay. She reports her right big toe caused her severe pain.  What is your immediate assessment?  What is your immediate action?  What could have caused the Gout?  What patient education will you provide?  How will you help her achieve her goal of going to No Frills?  ---  Aside from Gout, what other foot problems effect the elderly?  Find a statistic pertaining to the percentage of elderly people who are affected by foot problems. Critical Thinking!!!  What is the biggest risk factor because of a lack of mobility in the elderly population, what are other contributors? What complications can arise, what can you do as an HCA?