Musculoskeletal Care Modalities

Ns. A Fauji, M. Kep., Sp. KMB

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Managing care of the patient in Cast:

A rigid, external immobilizing device

Is used to:
1. Immobilize a reduced Fracture ( allow the
mobilization of the pt)
2. Correct a deformity
3. Apply uniform pressure to underlying soft
tissue
4. Support and stabilize weakened Joint
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Types of Casts:
1.
2.
3.
4.
5.

Short arm cast

2.Long arm cast
Short leg cast
3.Long leg cast
Walking cast ( long or short) reinforced for strength
Body cast: encircle the trunk
Shoulder spica cast: a body jacket that enclosed the trunk
and the shoulder and elbow
6. Hip spica cast: enclose the trunk and lower extremity (
double hip spica cast ( includes both legs

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Casting Materials:

Plaster: Rolls of plaster bandage, need 24 to 72

hrs to dry completely
Nonplaster: Fiberglass cast ( lighter in wt,
stronger, water resistant), has pores so diminish
skin problems

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Long-Arm and Short-Leg Cast and Common

Pressure Areas

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Teaching Needs of the Patient With a Cast

Prior to cast application
Explain condition necessitating the cast
Explain purpose and goals of the cast
Describe expectations during the casting process: eg, the heat
from hardening plaster

Cast care: keep dry; do not cover with plastic

Positioning: elevation of extremity; use of slings
Hygiene
Activity and mobility

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Cont
Explain exercises
Do not scratch or stick anything under the cast
Cushion rough edges
Report the following signs and symptoms: persistent pain or
swelling; changes in sensation, movement, skin color, or
temperature; and signs of infection or pressure areas
Required follow-up care
Cast removal

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Nursing ProcessAssessment of the Patient

With a Cast
Prior to casting
Perform general health assessment
Evaluate emotional status
Determine presenting signs and symptoms and condition
of the area to be casted

Knowledge
Monitor neurovascular status and the potential for
complications

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Nursing ProcessDiagnosis of the

Patient With a Cast
Deficient knowledge
Acute pain
Impaired physical mobility
Self-care deficit
Impaired skin integrity
Risk for peripheral neurovascular dysfunction

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Collaborative Problems/Potential
Complications
Compartment syndrome
Pressure ulcer
Disuse syndrome
Delayed union or nonunion of fracture(s)

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Interventions
Relieve pain
Elevate to reduce edema
Apply ice or cold intermittently
Implement position changes
Administer analgesics
Unrelieved pain may indicate compartment syndrome;
discomfort due to pressure may require change of cast
Muscle setting exercises: see Chart 67-3
Patient teaching: see Chart 67-4

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Interventions (cont.)
Heal skin wounds and maintain skin integrity
Treat wounds to skin before the cast is applied
Observe for signs and symptoms of pressure or infection
Pad cast and cast edges
Patient may require tetanus booster
Maintain adequate neurovascular status
Assess circulation, sensation, and movement
Five Ps
Notify physician at once of signs of compromise
Elevate extremity no higher than the heart
Encourage movement of fingers or toes every hour

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Managing patient with an External fixator:

Are used to manage open fractures with soft tissue damage. They provide
stable support for severe comminuted (crushed or splintered) fractures while
permitting active treatment of damage soft tissue.
Nursing intervention:
Prepare the patient psychologically
Cover sharp points on the fixator or pins to prevent injuries
Elevate the extremity to reduce swelling
Assess neuromuscular status every 2 hrs
Assess pin site for sign of infection and loosening of the pin
Pin care
Encourage isometric and active exercise within the limit of tissue damage.
Later the nurse help the patient to mobilize within the prescribed weight
bearing limit
Teaching patient self care

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External Fixation Devices (cont.)

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Managing the patient in Traction:

Is used as short-term intervention until other

modalities, such as external or internal fixation are
possible.
Traction: is the application of a pulling force to a part of
the body
Is used to minimize muscle spasm, to reduce fractures,
align and immobilize fractures, to reduce deformity.
The effect of traction is evaluated by radioactive
studies.

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Traction (cont.)
All traction needs to be applied in two directions. The lines of pull are
vectors of force. The result of the pulling force is between the two lines
of the vectors of force.

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Managing the patient in Traction (cont):

Principle of effective traction:
1. Countertraction must be maintained for effective traction
2. Must be continuous to be effective
3. Never interrupted
4. Weight are not removed
5. The patient must be in in good body alignment in the
center of the bed
6. Ropes must be unobstructed
7. Weight must hang freely

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Types of tractions:
I.

Skin traction: is used to control muscle spasm and to immobilize an

area before surgery. No more than 2-3.5 kg of traction should be
used, pelvic traction 4.5 to 9 kg depending on the patient weight

Complications:
Skin breakdown, nerve pressure (drop foot), and circulatory
impairment ( DVT)

Nursing interventions:

1.
2.

Ensuring effective traction

Monitor and managing potential complications

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Skin Traction

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Types of tractions (cont):

II. Skeletal traction: applied directly to the bone by using
metal pin or wires. Most frequently used to treat fracture
of long bones and the cervical spine. Is a surgical
procedure. Skeletal traction uses 7-12 kg, as the muscle
relax the traction weight is reduced to prevent fracture
dislocation and to promote healing
After removing the traction cast or splint are then used
to support the healing bone.

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Skeletal Traction

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Nursing Interventions:
1.
2.
3.
4.
5.
6.

Maintaining effective traction: the nurse should not remove wt from

skeletal traction unless life-threatening situation occurs
Maintaining positioning: such as the foot to prevent footdrop (planter
flexion), inward and outward rotation.
Preventing skin breakdown
Monitoring neuromuscular status
Providing pin site care
Promoting exercise
Assess sensation and movement
Assess pulses, color capillary refill, and temperature of fingers or toes
Assess for indicators of DVT
Assess for indicators of infection

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Joint Replacement:

Total Hip Replacement: Is the

replacement of a severely damaged hip
with an artificial joint

Indication: arrithritis, femoral neck fracture,

failure of previous reconstructive surgeries,
and problems resulting from congenital hip
diseases.
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Cont
Nursing interventions:
1.Prevent dislocation:
A. positioning the leg in abduction,
B. dont turn the patient in the affected side,
C. never flex the hip more than 90 degree (
D. dont elevate the head of the bed more than 60 degree
E. protective positioning include maintaining abduction,
avoiding internal and external rotation, hyperextension,
and a cute flexion

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Cont.

2. Monitoring wound drainage

3. Preventing DVT
4. Prevent infection
5. Teach patient self care
6. Continuing care

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Total knee replacement:

Indication: sever pain and functioning disabilities related to joint surfaces
destroyed by arrithritis, bleeding into the joint

Nursing interventions:
1.
2.
3.
4.
5.
6.

Maintain the compressed bandage over the knee

Ice may be applied to decrease the swelling and bleeding
Encourage active flexion of the foot every hour
Prevent complications
Monitor drainage bag
Place the patient leg in continuous Passive motion device ( promote
circulation and movement of the knee joint)
7. Weight bearing limits are prescribed. Patient can get out of the bed the
evening of the surgery or the day after surgery

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CPM Device

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Crutches
If your injury or surgery requires you to get around
without putting any weight on your leg or foot, you
may have to use crutches.
Proper Positioning
When standing up straight, the top of your crutches should
be about 1-2 inches below your armpits.
The handgrips of the crutches should be even with the top
of your hip line.
Your elbows should be slightly bent when you hold the
handgrips.
To avoid damage to the nerves and blood vessels in your
armpit, your weight should rest on your hands, not on the
underarm supports.
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Type

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