Management of musculoskeletal problems includes the use of casts, traction, artificial joint replacement and surgery. Health teaching is crucial for better prognosis of the applied care modalities. Nursing care plan is essential to maximize the effectiveness of these treatments modalities and to prevent potential complication associated with each of the interventions. The patient is thought to manage his or her care at home an how to safely resume activities.

If the thumb is included it is known as a thumb spica or gauntlet cast. The foot is flexed at a right angle in a neural position. Long leg cast –extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.  Long arm cast –extends from the upper level of the axillary fold to the proximal palmar crease. secured around the base of the thumb. The elbow usually is immobilized at a right angle.   . Purposes of the cast are: • To immobilize a body part in a specific position • To apply uniform pressure on encased soft tissue • To immobilize a reduced fracture • To correct deformity • To support and stabilize weakened joints ¤ Types of Cast ¤  Short arm cast –extends from below the elbow to the palmar crease. Short leg cast –extends from below the knee to the base of the toes. Managing Care of the Patient with Cast CAST  A rigid external immobilizing device that is molded to the contours of the body.

Body cast –encircles the trunk.  They are used for nondisplaced fractures with minimal swelling and for long – term wear. Hip spica cast –encloses the trunk and a lower extremity. stronger. water resistant. these water-activated polyurethane materials have the versatility of plaster but are lighter in weight.  When wet they are dried with a hair drier on a cool setting to prevent skin breakdown. which allows for hydrotherapy when appropriate. Plaster  Traditional cast  Rolls of plaster bandage are wet in cool water and applied smoothly to the body  Increasing warmth is felt  Plaster casts need to be exposed to allow maximum dissipation of the heat and that most casts cool after about 15 mins. and durable. A double hip spica cast includes both the legs.  Are porous and therefore diminish skin problems. Walking cast –a short or long leg cast reinforced for strength. Shoulder spica cast –a body jacket that encloses the trunk and the shoulder and elbow.    ¤ Casting Materials ¤ Nonplaster  Generally referred to as fiberglass casts. . They do not soften when wet.

control movement and prevent additional injury  are custom fitted to various parts of the body  may be constructed of plastic materials. leather or metal  the orthotist adjust the brace for positioning. canvas. • The nurse provides skin care and makes adjustments for swelling. fit and motion . skin abrasion. and skin breakdown • The splint is over wrapped with an elastic bandage applied in a spiral fashion and with pressure uniformly distributed so that the circulations not restricted. Braces (orthoses)  Provided for long term use  Are used to provide support. Managing the Patient With Splints and Braces  Contoured splints of plaster or pliable thermoplastic  May be used for conditions that do not require rigid immobilization  For those in which welling may be anticipated  For those that require special skin care Nursing considerations: • The splint needs to immobilize and support the body part in a functional position • The splint must be well padded to prevent pressure. • The nurse frequently assesses the neurovascular status and skin integrity of the splinted extremity.

early mobility and active exercise of adjacent uninvolved joints  Complications related to disuse and immobility are minimized . aligned. and immobilized by a series of pins inserted in the bone  Pin position is maintained through attachment to a portable frame  It facilitates patient comfort.Nursing considerations: • helps the patient learn to apply the brace and to protect the skin from irritation and breakdown • assesses neurovascular integrity and comfort when the patient is wearing the brace. encourages the patient to wear the brace as prescribed • reassures the patient that minor adjustments of the brace by the orthotist will increase comfort and minimize problems associated with its longterm use  Managing the Patient With an External Fixator  External Fixators  Are used to manage open fractures with soft tissue damage  Provide stable support for severe comminuted fractures while permitting active treatment of damaged soft tissue  Fractures is reduced.

. • Extremity is elevated at the applied area to reduce swelling • Sharp points on the fixator or pins are covered to prevent device induced injury • Monitor the neurovascular status every 2 to 4 hours and assess each pin for redness. • Be alert for potential problems caused by pressure from the device on the skin. • If the pins or clamps seem loose or sign of infection is noted. pain and loosening of pin. drainage.Nursing considerations: • Prepare the patient psychologically for application of the external fixator. tenderness. nerves or blood vessels and for the development of compartment syndrome • Pin care must be observed which typically includes cleaning each pin site separately three times a day with cotton-tipped applicators soaked in sterile saline solution. notify the physician immediately. • Reassure that the discomfort associated with the device is minimal and that early mobility is anticipated promotes acceptance of the device.

 Managing the Patient in Traction  Traction  Is the application of a pulling force to a part of the body. • Traction must be continuous to be effective in reducing and immobilizing fractures. countertraction(a force acting in the opposite direction) must be used to achieved effective traction.  Used primarily as a short – term intervention until other modalities such as external or internal fixation are possible  This reduces the risk of disuse syndrome and minimizes the length of hospitalization Purposes of traction: • to minimize muscle spasms • to reduce. . align and immobilize fractures • to reduce deformity • to increase space between opposing surfaces ☼Principles of Effective Traction ☼ • Whenever traction is applied. • Skeletal traction is never interrupted.

. ¤ Types of Traction ¤  Straight or running traction  Applies the pulling force in a straight line with the body part resting on the bed.  Accomplished by using a weight to pull on traction tape or on a foam boot attached to the skin.  Balanced suspension traction  Supports the affected extremity off the bed and allows for some patient movement without disruption of the line of pull. ♦ Ropes must be unobstructed ♦ Weihts must hang free and not rest on the bed or floor.  Used to control muscle spasms and to immobilize and area before surgery. ♦ Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Buck’s extension traction is an example.• Weights are not removed unless intermittent traction is prescribed. Traction may be applied as: • Skin Traction  Applied to the skin or directly to the bony skeleton. • Any factor that might reduce the effective pull or alter its resultant line of pull must be eliminated: ♦ The patient must be in good body alignment in the center of the bed when traction is applied.

• Assess for sensitivity of skin and fragility especially in adults. • Proper positioning must be maintained to keep the leg in a neutral position. No more than 2 to 3. • Encourages the patient to perform active foot exercises every hour when awake.  Types of skin traction used for adults include:  Buck’s extension (applied to the lower leg)  Cervical head halter (occasionally used to treat neck pain)  Pelvic belt (sometimes used to treat back pain) Nursing interventions: • Avoid wrinkling and slipping of the traction bandage and to maintain countertraction. . • Assess circulatory impairment on the affected area. • Assist the client in shifting position. the tibia and the cervical spine. • Skeletal Traction  Applied directly to the bone  Used occasionally to treat fractures of the femur.5kg of traction can be used on an extremity.

• Provide pin site care. • Prevent skin breakdown.  Frequently uses 7 to 12 kg to achieve the therapeutic effect. the knots in the rope are tied securely. . Nursing Interventions: • Maintain effective traction by checking the apparatus to see that ropes are in the wheel grooves of the pulleys. • Monitor neurovascular status. at the  The surgeon makes a small skin incision and drills the sterile pin or wire through the bone. Local anesthesia is administered insertion site and periosteum.  Thomas splint with a Pearson attachment is frequently used with skeletal traction for fractures of femur. • Maintain positioning by maintaining body alignment in traction as prescribed to promote an effective line of pull.  The patient feels pressure during this process and possibly pain when the periosteum is penetrated.

• Hermiarthroplasty  The replacement of one of the articular surfaces (e. in a hip hermiarthroplasty. nails. Managing the Patient Undergoing Orthopedic Surgery  ¤ Orthopedic Surgery ¤ • Open reduction  The correction and alignment of the fracture after surgical dissection and exposure of the fracture.g. • Joint arthroplasty or replacement  The replacement of joint surfaces with metal or synthetic materials. • Internal fixation  the stabilization of the reduced fracture by the use of metal screws. plates. • Total joint arthroplasty or replacement  the replacement of both articular surfaces within a joint with metal or synthetic materials . and pins • Arthroplasty  The repair of joint problems through the operating arthroscope (an instrument that allows the surgeon to operate within a joint without a large incision) or through open joint surgery. the femoral head and neck are replaced with a femoral prosthesis-the acetabulum is not replaced).

• Tendon transfer  the movement of tendon insertion to improve function. mucous membranes. ♥ Assess the skin. adequate neurovascular function. improved mobility and positive self-esteem Nursing Interventions: ♥ assessment of patient is focused on hydration status. or to reduce fascia contracture.• Meniscectomy  the excision of damaged joint fibrocartilage • Amputation  the removal of a body part • Bone graft  the placement of bone tissue (autologous or homologous grafts) to promote healing. • Fasciotomy  The incision and diversion of the muscle fascia to relieve muscle constriction. or to replace diseased bone. urinary output and laboratory value ♥ relieving pain . vital signs. current medication history. as in compartment syndrome. Nursing Process: Preoperative care of the Patient Undergoing Orthopedic Surgery Goals: ♦ includes relief of pain. to stabilize. health promotion. and possible infection.

if prescribed relieves swelling and directly reduces discomfort by diminishing nerve impulse • administered analgesic as prescribed to control the acute pain • alternative methods of pain includes:  distraction  focusing  guided imagery  quiet environment  backrubs ♥ maintaining adequate neurovascular function • nurse must frequently assess neurovascular status like color. ♥ promoting health • assess nutritional status and hydration • if patient has diabetes. special fluid and nutritional provisions may be necessary • coughing. • If circulation is compromised:  Notify the physician  Elevate the extremity  Release constricting wraps or casts as prescribed. capilliary refill. is elderly and frail or I the victim of multiple trauma.• immobilize fractured bone to lessen discomfort • elevate edematous extremity to promote venous return • ice. temperature.sensation. edema. pulses. motion of the extremity and document the findings. deep breathing and use of the incentive spirometer are practiced preoperatively for improved respiratory function • smoking should be stopped . pain.

• Encourage movements within limits of therapeutic immobility. ♥ helping the patient maintain self-esteem • promotes trusting relationship for patient to express concerns and anxieties and helps them examine their feelings about changes in self-concept • clarifies any misconceptions • helps them work through modifications needed to adapt to alterations in physical capacity • reestablish positive self-esteem.• cleans the skin with soap and water before surgery ♥ improving mobility • elevate and adequately support edematous extremities with pillows. Expected Outcomes: ♥ reports relief of pain ♥ exhibits adequate neurovascular function ♥ promotes health ♥ maximizes mobility within the therapeutic limits ♥ expresses positive self-esteem .

♥ Monitored closely tissue perfusion because edema and bleeding into the tissue can compromise circulation and result in compartment syndrome. redness and positive Homans’ sign which is an indicative of thromboembolic disease. tenderness. health promotion. ♥ Assess for calf swelling. adequate neurovascular function. respiratory rate or color may indicate pulmonary or cardiovascular complications. understanding of the mobility ♥ Changes in patient’s pulse rate. ♥ Relieving of pain • Patient-controlled analgesia(PCA) and epidural analgesia may be prescribed to control pain. warmth. positive self-esteem and absence of complications. Nursing Interventions: ♥ Reassess the patient’s needs in relation to pain. ♥ Notes the prescribed limits on mobility and assess the patient’s restrictions. health promotion. neurovascular status. . improved mobility. mobility and self-esteem.Nursing Process: Postoperative care of the Patient Undergoing Orthopedic Surgery Goals: ♦ includes relief of pain.

• Physical therapists tailors the exercise program to the individual patient’s need with a goal of . ♥ Improving physical mobility • Metal pins. which increases the risk for urinary calculi. instructs the patient to requests before the pain becomes severe. • Turning. because this adds to the calcium pool in the body and requires that the kidneys excrete more calcium. ankle and calf-pumping exercises hourly while awake to enhance circulation. washing and drying the skin and minimizing pressure over bony prominences re necessary to avoid skin breakdown. • Elevation of the operative extremity and application of cold. if prescribed help to control edema and pain. • Encourage patient to perform muscle-setting. screws. rods.however. and plates used for internal fixations are designed to maintain position of the bone until ossification occurs. ♥ Maintaining health • A well-balanced diet with adequate protein and vitamins is needed for wound healing.• In intramuscular and oral analgesics are prescribe PRN. • Large amount of milk should not be given to orthopedic patient who are on bed rest. • Portable suction of the wound decreases fluid accumulation and hematoma formation. • Monitor for pressure ulcer. ♥ Maintaining adequate neurovascular function • Monitor the neurovascular status of the involved body part and notifies the physician promptly of any indications of diminished tissue perfusion.

thirst. urine output less than 30cc per hour. decreased hemoglobin and hematocrit and notify the physician immediately. ♥ Monitoring and managing potential complications • Nurse monitors the signs and symptoms of hypovolemic shock: increased pulse rate. decrease blood pressure. • Rehabilitation involves progressive increases in the patient’s activities and exercises ♥ Maintaining self-esteem • Nurse continues the plan of preoperative care. and change in mentation.returning of the patient’s highest level of function in the shortest time possible. Evaluation Outcomes: ♥ Reports decreased level of pain ♥ Exhibits adequate neurovascular function ♥ Promotes health ♥ Maximizes mobility within the therapeutic limits ♥ Expresses positive self-esteem ♥ Exhibits absence of complications . restlessness.

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