Management of Musckuloskeletal System

3. RISK FOR INFECTION r/t altered skin integrity, inadequate nutrition and fluid intake, presence of environmental pathogens, invasive instrumentation, and immobility

4. RISK FOR INJURY r/t acute confusion evidence by trying to get out of bed.

Prevention of future falls

Home care

• Take pain medication exactly as directed.

• Don’t drive until your doctor says it’s okay. And never drive if you are taking opioid pain medication.

• Wear the support stockings you were given in the hospital. Wear them 24 hours a day for 3 week(s).

• Get up and carefully move around at night to relieve pain.

• If you received an artificial hip joint, tell all your health care providers (including your dentist) about the joint before any procedure. You will likely need to take antibiotics before dental work and other medical procedures to reduce the risk of infection.

Incision care

• Avoid infection by washing your hands often. If an infection occurs, it will need to be treated with antibiotics immediately. So call your doctor right away if you think you may have an infection. Symptoms of infection include a fever or leakage of white, greenish, or yellowish-colored fluid from the incision.

• Check your incision daily for redness, tenderness, or drainage.

• Avoid soaking your wound in water (no hot tubs, bathtubs, swimming pools) until your doctor says it’s OK.

• Wait 7 day(s) after your surgery to begin showering. Then shower as needed. Carefully wash your incision with soap and water. Gently pat it dry. Don’t rub the incision, or apply creams or lotions. And sit on a shower stool when you shower to keep from falling.

Sitting and sleeping

Moving safely

Common Side Effects:

Nursing Interventions:

Health teaching:

Dosage:

Common Side Effects:

Nursing Interventions:

Health teaching:

FONTS

Management of Musckuloskeletal System Disorders

Patient's history

XRAY OF RIGHT HIP

SUBJECTIVE:

• Fell at home when she tried to get up to go to the bathroom
• Her husband took her to the hospital
• Past Medical Hx: Hypertension - well controlled by Enalapril (Vasotec) for the past 6 years.
• She had flu a week ago
• Complains of pain in right hip

Today's Patient: Mrs. Z

• 72 y/o Female
• Fell at home
• Admitting Diagnosis: Fractured Right Hip
• Alert and oriented upon admission
• 1 day Post ORIF (Open Reduction with

Internal Fixation)

• Dressing: Small amount of dried dark red

drainage

Nursing Care Kardex

Patient's History

OBJECTIVE:

BP: 110/84

Diaphoretic and pale skin

Pedal pulses present

Capillary Refill: 2 seconds

Restless

Oriented x2

Name: Mrs. Z Age: 72 y/o

Diagnosis: Fracture of Right Hip

• VS q4h
• Ambulate with assistance PRN
• O2 @ 2L/min/NP
• Neurovascular checks q4h for the first 24 hours
• I & O
• IV of D5/0.45% NS at 75ml/hr
• IV PCA with Morphine Sulfate 1mg/hr continuous infusion
• Catheter care: BID
• Diet: Clear Fluid
• Routine Meds: FeSO4 325 mg PO TID with meals (start when on regular diet)

Docusate Sodium 100mg PO daily

Five Nursing Priorities

1. IMPAIRED PHYSICAL MOBILITY r/t pain, stiffness, and physical deconditioning as evidenced by limited joint movement, difficulty ambulating, inability to participate in physical rehabilitation, and guarded movement

(Injections) Roxanol, Astramorph PF, Duramorph, Infumorph, Morphine HP

• Cramps
• difficulty having a bowel movement (stool)
• drowsiness
• false or unusual sense of well-being
• relaxed and calm feeling
• sleepiness or unusual drowsiness
• weight loss

Adverse Reactions:

• No alcohol or CNS depressants
• Recommend non-pharmacological interventions for pain
• No ambulating without assistance
• No driving
• Take before pain is severe
• Do not abruptly withdraw medication
• Teach client with PCA pump how to safely administer the medicine
• Encourage deep breathing and coughing exercises

Morphine Sulfate 1mg/ml

Narcotic Analgesic, dyspnea associated with acute left ventricular failure and pulmonary edema; preoperative sedation

(Tablets) MS Contin

Relieves pain by stimulating opiate receptors in CNS.

Reduces stimuli from sensory nerve endings; pain threshold is increased

Exercise therapy: Joint Mobility

- Pain Control Measures

- Optimal body position for passive or active joint movement

- ROM exercises

- Collaborate with Physiotherapist

• Nausea
• Anorexia
• Cramping
• Diarrhea

• May take up to 3 days to soften stools.
• Do not crush/chew tablets/caps
• Do not take for long term therapy
• Report cramping, weakness, dizziness, and an increase in being thirsty.
• Inform provider if constipation is unrelieved or symptoms of electrolyte imbalance occur
• Teach family and client that normal bowel movements do not occur daily.

- Apply or provide assistive device for ambulation

- Assist for initial ambulation

Softens stools by increasing the water and fat penetration in the intestines

Laxative, for constipation, prophylaxis for patients who should not strain during defecation

Generic name:

Brand name:

Docusate Sodium 100mg

Soflax, Colace, Kaopectate

Roxanol

- Solution 20 mg/mL

Roxanol Rescudose

- Solution 10 mg per 2.5 mL

Roxanol 100

- Solution 100 mg per 5 mL

Roxanol T

- Solution 20 mg/mL

Roxanol UD

- Solution 10 mg per 2.5 mL

- Solution 20 mg per 5 mL

- Solution 30 mg per 1.5 mL

Route of administration: IM, IV, Oral, Suppository

• Maintain records
• Monitor urine output, bowel sounds, VS, and pain for type of location, intensity and duration
• Do not mix with barbiturates
• Hold medication if respirations <12/min (Adult) <20/min (Children)
• Have Narcan available at bed side

2. ACUTE PAIN r/t tissue trauma, disruption of skin integrity, and edema as evidenced by a reluctance to move, guarding of the affected area, a persistent score of greater than 8 on a 10-point pain scale, and facial grimacing

Astramorph PF

- Injection 0.5 mg/mL

- Injection 1 mg/mL

Duramorph

- Injection 0.5 mg/mL

- Injection 1 mg/mL

Infumorph

- Injection 10 mg/mL

- Injection 25 mg/mL

MS Contin

- Tablets, controlled-release 15 mg

- Tablets, controlled-release 30 mg

- Tablets, controlled-release 60 mg

- Tablets, controlled-release 100 mg

- Tablets, controlled-release 200 mg

Drug Classification/Uses:

Mechanism of action:

Dosage:

Route of administration: Oral, Rectal

Monitor I & O, bowel sounds, and serum electrolytes, and/or abdominal pain and cramping.

Soft-Lax

- Capsules 100 mg

- Monitor pain

- Implement use of PCA

- Medicate before an activity

Generic name:

Drug Classification/Uses:

Colace

- Capsules 50 mg

- Capsules 100 mg

- Syrup 60 mg/15 mL

Brand name:

Docusate Sodium

Adults and Children older than 12 y/o

PO 50 to 500 mg daily.

Kaopectate Stool Softener

- Capsules 240 mg

Mechanism of action:

- Evaluate effectiveness of pain-control measures

- Position the pt in proper body alignment

Incision site care

- Inspect for signs of infection

(Note characteristics of drainage)

- Clean the incision and around the drain site/tube

- Change dressing

Nutrition Mgt.

-Collaborate with dietician

-Encourage calorie intake

- Lift not drag!

- Assess for decreased or absent vision and impaired temperature and pain sensation

- • Assess client’s behaviour and cognition systematically and continually throughout the day and night as appropriate.

• -Communicate client status, cognition and behavioural manifestations to all necessary providers.

• -Establish and maintain

elimination patterns

- Plan care that allows for appropriate sleep- wake cycle disruption

5. IMPAIRED GAS EXCHANGE r/t prolonged anesthesia

•- Monitor respiratory rate and effort

- Auscultate breath sounds

- Handle injured tissues/bones gently

- Encourage deep breathing and coughing exercises

- Reposition frequently

-Observe sputum

for signs of blood

Which of the following indicates a neurovascular problem during the nurse's assessment of a patient with a fracture?

a. Exaggeration of extremity movement

b. Increased redness and heat below the injury

c. Decreased sensation distal to the fracture site

d. Purulent drainage at the site of an open fracture

Which of the following symptoms should the nurse be monitoring for a patient with pelvic fracture?

a. Changes in urinary output

b. Petechiae in abdomen

c. palpable lump in the buttock

d. sudden decrease in blood pressure

3. Lifestyle

-Avoid smoking and alcohol.

4. Medical option

-BMD testing

Weight-bearing exercise activities, exercise that focuses on posture and balance, and exposure to sunlight.

HEALTH PROMOTION STRATEGIES

2. Exercise

• Do all exercises as per instruction.

• Arrange your household to keep

the items you need within reach.

• Remove electrical cords, throw rugs,

and anything else that may cause you to fall.

• Use nonslip bath mats, grab bars, an elevated

toilet seat, and a shower chair in your bathroom.

• Don’t bend at the hip when you bend over. Don’t bend at the waist to put on socks and shoes. And avoid picking up items from the floor.

• Use a cane, crutches, a walker, or handrails until your balance, flexibility, and strength improve. And remember to ask for help from others when you need it.

• Free up your hands so that you can use them to keep balance. Use a fanny pack, apron, or pockets to carry things.

• Follow your doctor’s orders regarding how much weight to place on the affected leg.

• Use an elevated toilet seat for 6 week(s) after surgery.

• Use pillows between your legs when sleeping

on your back or on your healthy side.

• Sit on a firm cushion when you ride in a car and avoid sitting too low. Try not to bend your hip too much when getting in and out of the car.

• Don’t sit for more than 30 to 45 minutes at a time.

• Use chairs with arms, and sit with your knees slightly lower than your hips. Don’t sit on low or sagging chairs or couches.

• Don’t lean forward while sitting.

• Don’t cross your legs.

• Keep your feet flat on the floor. Don’t turn your foot or leg inward. This stresses your hip joint.

Calcium and Vit D

Estrogen Replacement

Decrease fall-risk Environment

5. Supplements:

- supplemental calcium that contains vitamin D.

- recommended vitamin D is

400-1000 IU for younger adults and

800-2000 IU for older adults and for people with high risk for osteoporosis.

Health Teaching Plan

Limit Caffeine

(e.g. low-fat and skim milk, non fat yogurt, and reduced fat cheese, salmon and sardines, leafy green vegetables.)

Adequate intake of Calcium and vitamin D.

HEALTH PROMOTION STRATEGIES