Showing posts with label musculoskeletal disorder. Show all posts
Showing posts with label musculoskeletal disorder. Show all posts

DISORDERS OF THE MUSCULOSKELETAL SYSTEM

Thursday, May 22, 2008 | Labels: | 0 Comments  

Spinal Fusion

  1. General information
    1. Fusion of spinous processes with bone graft from iliac crest to provide stabilization of spine
    2. Performed in conjunction with laminectomy
  2. Nursing interventions
    1. Provide pre-op care as for laminectomy.
    2. In addition to post-op care for laminectomy
      1. Position client correctly.
        1. lumbar spinal fusion: keep bed flat for first 12 hours, then may elevate head of bed 20°-30°, keep off back for first 48 hours.
        2. cervical spinal fusion: elevate head of bed slightly.
      2. Assist with ambulation.
        1. time varies with surgeon and extent of fusion.
        2. usually out of bed 3-4 days post-op.
        3. apply brace before getting client out of bed.
        4. apply special cervical collar for cervical spinal fusion.
      3. Promote comfort: client may experience considerable pain from graft site.
    3. In addition to client teaching and discharge planning for laminectomy, advise client that
      1. Brace will be needed for 4 months and lighter corset for 1 year after surgery.
      2. It takes 1 year until graft becomes stable.
      3. No bending, lifting, stooping, or sitting for prolonged periods for 4 months.
      4. Walking without excessive tiring is healthful exercise.
      5. Diet modification will help prevent weight gain resulting from decreased activity.

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Discectomy

  1. General information
    1. Excision of inter-vertebral disc.
    2. Indications
      1. Most commonly used for herniated nucleus pulposus not responsive to conservative therapy or with evidence of decreasing sensory or motor status
      2. Also indicated for spinal decompression as with spinal cord injury, to remove fragments of broken bone, or to remove spinal neoplasm or abscess
    3. Spinal fusion may be done at the same time if spine is unstable
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Teach client log rolling (turning body as a unit while maintaining alignment of spinal column) and use of bedpan.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Position client as ordered.
      1. Lower spinal surgery: generally flat
      2. Cervical spinal surgery: slight elevation of head of bed
    3. Maintain proper body alignment; with cervical spinal surgery avoid neck flexion and apply cervical collar as ordered.
    4. Turn client every 2 hours.
      1. Use log-rolling technique and turning sheet.
      2. Place pillows between legs while on side.
    5. Assess for complications.
      1. Monitor sensory and motor status every 2-4 hours.
      2. With cervical spinal surgery client may have difficulty swallowing and coughing.
        1. monitor for respiratory distress.
        2. keep suction and tracheostomy set available.
    6. Check dressings for hemorrhage, CSF leakage, infection.
    7. Promote comfort.
      1. Administer analgesics as ordered.
      2. Provide additional comfort measures and positioning.
    8. Assess for adequate bladder and bowel function.
      1. Monitor every 2-4 hours for bladder distension.
      2. Assess bowel sounds.
      3. Prevent constipation.
    9. Prevent complications of immobility.
    10. Assist with ambulation.
      1. Usually out of bed day after surgery.
      2. Apply brace or corset if ordered.
      3. If client allowed to sit, use straight-back chair and keep feet flat on floor.
  4. Provide client teaching and discharge planning concerning
    1. Wound care
    2. Maintenance of good posture and proper body mechanics
    3. Activity level as ordered
    4. Recognition and reporting of signs of complications such as wound infection, sensory or motor deficits

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Herniated Nucleus Pulposus (HNP)

  1. General information
    1. Protrusion of nucleus pulposus (central part of intervertebral disc) into spinal canal causing compression of spinal nerve roots
    2. Occurs more often in men
    3. Herniation most commonly occurs at the fourth and fifth intervertebral spaces in the lumbar region
    4. Predisposing factors include heavy lifting or pulling and trauma
  2. Medical management
    1. Conservative treatment
      1. Bed rest
      2. Traction
        1. lumbosacral disc: pelvic traction
        2. cervical disc: cervical traction
      3. Drug therapy
        1. anti-inflammatory agents
        2. muscle relaxants
        3. analgesics
      4. Local application of heat and diathermy
      5. Corset for lumbosacral disc
      6. Cervical collar for cervical disc
      7. Epidural injections of corticosteroids
    2. Surgery
      1. Discectomy with or without spinal fusion
      2. Chemonucleolysis
        1. injection of chymopapain (derivative of papaya plant) into disc to reduce size and pressure on affected nerve root
        2. used as alternative to laminectomy in selected cases
  3. Assessment findings
    1. Lumbosacral disc
      1. Back pain radiating across buttock and down leg (along sciatic nerve)
      2. Weakness of leg and foot on affected side
      3. Numbness and tingling in toes and foot
      4. Positive straight-leg raise test: pain on raising leg
      5. Depressed or absent Achilles reflex
      6. Muscle spasm in lumbar region
    2. Cervical disc
      1. Shoulder pain radiating down arm to hand
      2. Weakness of affected upper extremity
      3. Paresthesias and sensory disturbances
    3. Diagnostic tests: myelogram localizes site of herniation
  4. Nursing interventions
    1. Ensure bed rest on a firm mattress with bed board.
    2. Assist client in applying pelvic or cervical traction as ordered.
    3. Maintain proper body alignment.
    4. Administer medications as ordered.
    5. Prevent complications of immobility.
    6. Provide additional comfort measures to relieve pain.
    7. Provide pre-op care for client receiving chemonucleolysis.
      1. Administer cimetidine (Tagamet) and diphenhydramine HCl (Benadryl) every 6 hours as ordered to reduce possibility of allergic reaction.
      2. Possibly administer corticosteroids before procedure.
    8. Provide post-op care for client receiving chemonucleolysis.
      1. Observe for anaphylaxis.
      2. Observe for less serious allergic reaction (e.g., rash, itching, rhinitis, difficulty in breathing).
      3. Monitor for neurologic deficits (numbness or tingling in extremities or inability to void).
    9. Provide client teaching and discharge planning concerning
      1. Back-strengthening exercises as prescribed
      2. Maintenance of good posture
      3. Use of proper body mechanics, how to lift heavy objects correctly
        1. maintain straight spine.
        2. flex knees and hips while stooping.
        3. keep load close to body.
      4. Prescribed medications and side effects
      5. Proper application of corset or cervical collar
      6. Weight reduction if needed

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Total Hip Replacement

  1. General information
    1. Replacement of both acetabulum and head of femur with prostheses
    2. Indications
      1. Rheumatoid arthritis or osteoarthritis causing severe disability and intolerable pain
      2. Fractured hip with nonunion
  2. Nursing interventions
    1. Provide routine pre-op care.
    2. In addition to routine post-op care for the client with hip surgery
      1. Maintain abduction of affected limb at all times with abductor splint or 2 pillows between legs
      2. Prevent external rotation (may vary depending on type of prosthesis and method of insertion) by placing trochanter rolls along leg.
      3. Prevent hip flexion.
        1. keep head of bed flat if ordered.
        2. may raise bed to 45° for meals if allowed.
      4. Turn only to unoperative side if ordered; use abductor splint or 2 pillows between knees while turning and when lying on side.
      5. Assist client in getting out of bed when ordered.
        1. usually on second post-op day.
        2. avoid weight bearing until allowed.
        3. avoid adduction and hip flexion; do not use low chair.
    3. Provide client teaching and discharge planning concerning
      1. Prevention of adduction of affected limb and hip flexion
        1. do not cross legs.
        2. use raised toilet set.
        3. do not bend down to put on shoes or socks.
        4. do not sit in low chairs.
      2. Signs of wound infection
      3. Exercise program as ordered
      4. Partial weight bearing only until full weight bearing allowed

Tuesday, May 20, 2008 | Labels: | 0 Comments  

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