MUSCULOSKELETAL

PROBLEMS
 Outline
Biology of bones
Fracture
Spinal injury & nursing care
Joints
Biology of bones
 Fracture
Break of the bone
Types:
Closed (simple):
bone does not
penetrate the skin
Open
(Compound): bone
penetrate the skin
May be
complicated with
soft tissue injuries
Fracture healing
Management of fractures
CONSERVATIVE SURGICAL FIXATION

Internal / External
Casts fixation
 Care of fractures
Traction, reduction
Immobilization
At least 6 to 8 weeks
Wound care
Physiotherapy
Partial weight bearing
gradually to full weight
bearing
Regaining range of motion
Muscle strengthening
SPINAL INJURY
&
NURSING CARE
 Anatomy
5 sections
Cervical (7)
Thoracic (12)
Lumbar (5)
Sacral (5)
Coccyx (1)
Anatomy of the Spine
 Functions
Spine
Protection
Motion
Function of spinal
cord: part of
central nervous
system
Motor
Sensory
Autonomic
 Spine Injury
Bone : fracture,
spondylolisthesis (slipped)
Soft tissue : ligament
sprain, muscle strain,
disc problems
 Spine injury
Spinal cord: complete/ incomplete
contusion/ compression/ severed
Infections / tumour/ neuron disease/
cord syndromes etc
 Complications
Late
Autonomic dysreflexia ( T6 lesions)
Infection : skin, bladder, lungs
Decubitus ulcer
Malnutrition & dehydration
Deep vein thrombosis
GI : constipation, cholecystitis,
cholelisthiasis
Contractures, spasticity
 Nursing Care
Major objectives
Prevent secondary complications
Facilitate maximal functional recovery
Support for patient & family
Educate patient & family in all aspects
of the care needed to maintain his/her
wellbeing
 Nursing care in convalescence
home
Posturing
Support injured spine
Maintain limbs & joints in functional
position
Avoid deformity & contractures
Reducing incidence of spasticity
Relieve pressure
 Posturing
How ?
Many ways need
to suit patient &
availability and skill
of nursing staf
Bed
Pillows
Balloons / gloves
filled with water
 Lifts and Turns
Straight lifting
For transferring & lifting patient to the
side of the bed for nursing care
Lifts and Turns
 Log roll
For carrying out nursing care
For lateral positioning
 Pelvic twist
Suitable for
tetraplegic
Must NOT be
used in
thoracolumbar
lesions
 Posturing
Important note!
In all lifts and turns, the person holding
the head is in charge of the timing and
coordination
Frequency of turns determined by
patients tolerance
Initially 2 to 3 hourly
With increasing intervals as long as no
markings
 Care of the limbs
Legs
i. supine
Avoid hyperextension of the knees
Keep feet in line with the hips
Hold foot at 90o using foot boards/ pillows
Avoid pressure on the heels
ii. Side
- Lower leg should be extended
- Upper leg slightly flexed
- Lying on pillow & not over the lower leg
 Care of the limbs
Arms
Supine
joints need to be placed in full range of
positions
Hands & arms must always be supported
Side
Both arms positioned forward, supported on
pillows
Underlying shoulder protected from pressure
by gently pulled forward/ axillary pillow
 Skin and Pressure
Examine & relieve pressure regularly
Skin inspection daily
Aware of hazards of sensory loss
Keep clean bath, fingernails, toe
nails, hair
Avoid damage
Conscious of pressure
Risk higher in times of physical/ emotional
stress, depression, tiredness & intercurrentr
illnesses
Treat minor abrasions/ injuries
 Skin and Pressure
Braden scale : predicting pressure
sore risk
Sensory perception
Moisture
Activity
Mobility
Nutrition
Friction & shear
 Bladder management
Prevent urinary tract infection
Managing fluid balance
Patient education how to care for
bladder
 Bladder management fluid
management
Intermittent
catheterization
(CIC)
Aim: output <
500 mls/6
hours
If volume >
600 mls/6
hours reduce
intake or
perform more
frequent
catheterization
 Bladder management fluid
management
Suprapubic
catheterization (SPC)
Aim: output of 3 L/day
To maintain capacity, clamp
catheter daily to achieve a
volume of 300 mls
Indwelling catheter (CBD)
Aim: output of 3 L/day
To maintain capacity, clamp
catheter daily to achieve a
volume of 300 mls
 Bowel care
Upper motor neuron lesion
Reflex emptying after suppositories or
digital stimulation
May not need laxatives if diet appropriate
Lower motor neuron lesion
Flaccid
Manual evacuation & laxatives usually
required but may be able to empty using
abdominal muscles
Suppositories inefective
 JOINTS
Formed when
two ends of a
bone come
together
Holds the bones
together and
allow movement
Types of joint
 Arthritis
Means joint inflammation
Refers to more than 100 rheumatic
diseases and other conditions that
can cause pain, stiffness and
swelling in the joints
Can afect any type of joints, but
most commonly afect synovial joints