Musculoskeletal System National University: College of Nursing
Musculoskeletal System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide
Transcript
Slide 1: MUSCULO-SKELETAL SYSTEM Nurse Licensure Examination Review
Slide 2: Review of Anatomy and Physiology The musculo-skeletal system consists of the muscles,
tendons, bones and cartilage together with the joints The primary function of which is to produce
skeletal movements
Slide 3: Muscles Three types of muscles exist in the body 1. Skeletal Muscles Voluntary and
striated 2. Cardiac muscles Involuntary and striated 3. Smooth/Visceral muscles Involuntary
and NON-striated
Slide 4: TENDONS Bands of fibrous connective tissue that tie bones to muscles
Slide 5: LIGAMENTS Strong, dense and flexible bands of fibrous tissue connecting bones to another
bone
Slide 6: BONES Variously classified according to shape, location and size Functions 1. Locomotion
2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition
Slide 7: JOINTS Thepart of the Skeleton where two or more bones are connected
Slide 8: CARTILAGES A dense connective tissue that consists of fibers embedded in a strong gel-like
substance
Slide 9: BURSAE Saccontaining fluid that are located around the joints to prevent friction
Slide 10: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM The nurse usually evaluates this small part
of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle
and joint function
Slide 11: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM 1. HISTORY 2. Physical Examination
Perform a head to toe assessment Nurses need to inspect and palpate The special procedure is the
assessment of joint and muscle movement Usually, a tape measure and a protractor are the only
instruments
Slide 12: ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM Gait Posture Muscular palpation
Joint palpation Range of motion Muscle strength
Slide 13: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 1. BONE
MARROW ASPIRATION Usually involves aspiration of the marrow to diagnose diseases like leukemia,
aplastic anemia Usual site is the sternum and iliac crest Pre-test: Consent Intratest: Needle
puncture may be painful Post-test: maintain pressure dressing and watch out for bleeding
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 14: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 2.
Arthroscopy A direct visualization of the joint cavity Pre-test: consent, explanation of procedure,
NPO Intra-test: Sedative, Anesthesia, incision will be made Post-test: maintain dressing,
ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application
to relieve discomfort
Slide 15: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 3. BONE SCAN
Imaging study with the use of a contrast radioactive material Pre-test: Painless procedure, IV
radioisotope is used, no special preparation, pregnancy is contraindicated Intra-test: IV injection,
Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning Post-test:
Increase fluid intake to flush out radioactive material
Slide 16: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 4. DXA- Dual-
energy XRAY absorptiometry Assesses bone density to diagnose osteoporosis Uses LOW dose
radiation to measure bone density Painless procedure, non-invasive, no special preparation Advise
to remove jewelry
Slide 18: Common musculoskeletal problems The Nursing Management
Slide 19: Nursing Management of common musculo- skeletal problems PAIN These can be related to
joint inflammation, traction, surgical intervention 1. Assess patient’s perception of pain 2. Instruct
patient alternative pain management like meditation, heat and cold application, TENS and guided
imagery
Slide 20: Nursing Management PAIN 3. Administer analgesics as prescribed UsuallyNSAIDS
Meperidine can be given for severe pain 4.Assess the effectiveness of pain measures
Slide 21: Nursing Management IMPAIRED PHYSICAL MOBILITY 1. Instruct patient to perform range of
motion exercises, either passive or active 2. Provide support in ambulation with assistive devices
3. Turn and change position every 2 hours 4. Encourage mobility for a short period and provide
positive reinforcements for small accomplishments
Slide 22: Nursing Management SELF-CARE DEFICITS 1. Assess functional levels of the patient 2.
Provide support for feeding problems Place patient in Fowler’s position Provide assistive device
and supervise mealtime Offer finger foods that can be handled by patient Keep suction equipment
ready
Slide 23: Nursing Management SELF-CARE DEFICITS 3. Assist patient with difficulty bathing and
hygiene Assist with bath only when patient has difficulty Provide ample time for patient to finish
activity
Slide 24: Musculoskeletal Modalities Traction Cast
Slide 25: Nursing Management Traction A method of fracture immobilization by applying equipments
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
to align bone fragments Used for immobilization, bone alignment and relief of muscle spasm
Slide 26: Traction Skin traction Skeletal traction
Slide 27: Traction Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle
spasm, correct or prevent deformities
Slide 30: Nursing Management Traction: General principles 1. ALWAYS ensure that the weights hang
freely and do not touch the floor 2. NEVER remove the weights 3. Maintain proper body alignment
4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot
Slide 31: Nursing Management Traction: General principles 5. Observe and prevent foot drop
Provide foot plate 6. Observe for DVT, skin irritation and breakdown 7. Provide pin care for clients
in skeletal traction- use of hydrogen peroxide
Slide 32: Nursing Management CAST Immobilizing tool made of plaster of Paris or fiberglass
Provides immobilization of the fracture
Slide 33: Nursing Management CAST: types 2. Long arm 3. Short arm 4. Spica
Slide 34: Casting Materials Plaster of Paris Drying takes 1-3 days If dry, it is SHINY, WHITE, hard
and resistant Fiberglass Lightweight and dries in 20-30 minutes Water resistant
Slide 35: Nursing Management CAST: General Nursing Care 1. Allow the cast to dry (usually 24-72
hours) 2. Handle a wet cast with the PALMS not the fingertips 3. Keep the casted extremity
ELEVATED using a pillow 4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast
Slide 36: Nursing Management CAST: General Nursing Care 5. Petal the edges of the cast to prevent
crumbling of the edges 6. Examine the skin for pressure areas and Regularly check the pulses and skin
Slide 37: Nursing Management CAST: General Nursing Care 7. Instruct the patient not to place sticks
or small objects inside the cast 8. Monitor for the following: pain, swelling, discoloration, coolness,
tingling or lack of sensation and diminished pulses
Slide 38: Common Musculoskeletal conditions Nursing management
Slide 39: METABOLIC BONE DISORDERS Osteoporosis A disease of the bone characterized by a
decrease in the bone mass and density with a change in bone structure
Slide 40: METABOLIC BONE DISORDERS Osteoporosis: Pathophysiology Normal homeostatic bone
turnover is altered rate of bone RESORPTION is greater than bone FORMATION reduction in total
bone mass reduction in bone mineral density prone to FRACTURE
Slide 41: METABOLIC BONE DISORDERS Osteoporosis: TYPES 1. Primary Osteoporosis- advanced age,
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
post-menopausal 2. Secondary osteoporosis- Steroid overuse, Renal failure
Slide 42: METABOLIC BONE DISORDERS RISK factors for the development of Osteoporosis 1.
Sedentary lifestyle 2. Age 3. Diet- caffeine, alcohol, low Ca and Vit D 4. Post-menopausal 5.
Genetics- caucasian and asian 6. Immobility
Slide 43: METABOLIC DISORDER ASSESSMENT FINDINGS 1. Low stature 2. Fracture Femur 3.
Bone pain
Slide 44: METABOLIC DISORDER LABORATORY FINDINGS 1. DEXA-scan Provides information about
bone mineral density T-score is at least 2.5 SD below the young adult mean value 2. X-ray studies
Slide 45: METABOLIC DISORDER Medical management of Osteoporosis 1. Diet therapy with calcium
and Vitamin D 2. Hormone replacement therapy 3. Biphosphonates- Alendronate, risedronate
produce increased bone mass by inhibiting the OSTEOCLAST 4. Moderate weight bearing exercises
5. Management of fractures
Slide 46: METABOLIC DISORDER Osteoporosis Nursing Interventions 1. Promote understanding of
osteoporosis and the treatment regimen Provide adequate dietary supplement of calcium and
vitamin D Instruct to employ a regular program of moderate exercises and physical activity
Manage the constipating side-effect of calcium supplements
Slide 47: METABOLIC DISORDER Osteoporosis Nursing Interventions Take calcium supplements with
meals Take alendronate with an EMPTY stomach with water Instruct on intake of Hormonal
replacement
Slide 48: METABOLIC DISORDER Osteoporosis Nursing Interventions 2. Relieve the pain Instruct the
patient to rest on a firm mattress Suggest that knee flexion will cause relaxation of back muscles
Heat application may provide comfort Encourage good posture and body mechanics Instruct to
avoid twisting and heavy lifting
Slide 49: METABOLIC DISORDER Osteoporosis Nursing Interventions 3. Improve bowel elimination
Constipation is a problem of calcium supplements and immobility Advise intake of HIGH fiber diet
and increased fluids
Slide 50: METABOLIC DISORDER Osteoporosis Nursing Interventions 4. Prevent injury Instruct to
use isometric exercise to strengthen the trunk muscles AVOID sudden jarring, bending and strenuous
lifting Provide a safe environment
Slide 51: Juvenile rheumatoid Arthritis Definition: AUTO-IMMUNE inflammatory joint disorder of
UNKNOWN cause SYSTEMIC chronic disorder of connective tissue Diagnosed BEFORE age 16 years
old
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 52: Juvenile rheumatoid Arthritis PATHOPHYSIOLOGY : unknown Affected by stress, climate
and genetics Common in girls 2-5 and 9-12 y.o.
Slide 53: Juvenile rheumatoid Arthritis Systemic JRA Pauci-articular Polyarticular FEVER MILD joint pain
Morning joint and swelling stiffness and fever IRIDOCYCLITIS Salmon-pink Weight rash Bearing joints
Five or more Less than 4 Five or more joints joints joints Anorexia, Very Good Poor prognosis anemia,
fatigue prognosis
Slide 54: JRA Symptoms may decrease as child enters adulthood With periods of remissions and
exacerbations
Slide 55: JRA Medical Management 2. ASPIRIN and NSAIDs- mainstay treatment 3. Slow-acting anti-
rheumatic drugs 4. Corticosteroids
Slide 56: JRA Nursing Management 2. Encourage normal performance of daily activities 3. Assist child in
ROM exercises 4. Administer medications 5. Encourage social and emotional development
Slide 57: JRA Nursing Management During acute attack: SPLINT the joints NEUTRAL positioning
Warm or cold packs
Slide 58: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS The most common form of degenerative
joint disorder
Slide 59: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS Chronic, NON-systemic disorder of joints
Slide 60: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Pathophysiology Injury, genetic, Previous
joint damage, Obesity, Advanced age Stimulate the chondrocytes to release chemicals chemicals will
cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening
Slide 61: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Risk factors 1. Increased age 2. Obesity
3. Repetitive use of joints with previous joint damage 4. Anatomical deformity 5. genetic
susceptibility
Slide 62: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 1. Joint pain 2.
Joint stiffness 3. Functional joint impairment limitation The joint involvement is ASYMMETRICAL
This is not systemic, there is no FEVER, no severe swelling Atrophy of unused muscles Usual
joint are the WEIGHT bearing joints
Slide 63: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 1. Joint pain Caused
by Inflamed synovium Stretching of the joint capsule Irritation of nerve endings
Slide 64: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 2. Stiffness commonly
occurs in the morning after awakening Lasts only for less than 30 minutes DECREASES with
movement Crepitation may be elicited
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 65: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Diagnostic findings 1. X-ray Narrowing of
joint space Loss of cartilage Osteophytes 2. Blood tests will show no evidence of systemic
inflammation and are not useful
Slide 66: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Medical management 1. Weight reduction
2. Use of splinting devices to support joints 3. Occupational and physical therapy 4.
Pharmacologic management Use of PARACETAMOL, NSAIDS Use of Glucosamine and chondroitin
Topical analgesics Intra-articular steroids to decrease inflam
Slide 67: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions 1. Provide relief of
PAIN Administer prescribed analgesics Application of heat modalities. ICE PACKS may be used in
the early acute stage!!! Plan daily activities when pain is less severe Pain meds before exercising
Slide 68: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions 2. Advise patient to
reduce weight Aerobic exercise Walking 3. Administer prescribed medications NSAIDS
Slide 69: Rheumatoid arthritis A type of chronic systemic inflammatory arthritis and connective tissue
disorder affecting more women (ages 35-45) than men
Slide 70: Rheumatoid arthritis FACTORS: Genetic Auto-immune connective tissue disorders Fatigue,
emotional stress, cold, infection
Slide 71: Rheumatoid arthritis Pathophysiology Immune reaction in the synovium attracts
neutrophils releases enzymes breakdown of collagen irritates the synovial liningcausing synovial
inflammation edema and pannus formation and joint erosions and swelling
Slide 72: Rheumatoid arthritis ASSESSMENT FINDINGS 1. PAIN 2. Joint swelling and stiffness-
SYMMETRICAL, Bilateral 3. Warmth, erythema and lack of function 4. Fever, weight loss, anemia,
fatigue 5. Palpation of join reveals spongy tissue 6. Hesitancy in joint movement
Slide 73: Rheumatoid arthritis ASSESSMENT FINDINGS Joint involvement is SYMMETRICAL and
BILATERAL Characteristically beginning in the hands, wrist and feet Joint STIFFNESS occurs early
morning, lasts MORE than 30 minutes, not relieved by movement, diminishes as the day progresses
Slide 74: Rheumatoid arthritis ASSESSMENT FINDINGS Joints are swollen and warm Painful when
moved Deformities are common in the hands and feet causing misalignment Rheumatoid nodules
may be found in the subcutaneous tissues
Slide 75: Rheumatoid arthritis Diagnostic test 1. X-ray Shows bony erosion 2. Blood studies
reveal (+) rheumatoid factor, elevated ESR and CRP and ANTI-nuclear antibody 3. Arthrocentesis
shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory
proteins
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 76: Rheumatoid arthritis MEDICAL MANAGEMENT 1. Therapeutic dose of NSAIDS and Aspirin to
reduce inflammation 2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid
3. For advanced cases- arthroplasty, synovectomy 4. Nutritional therapy
Slide 77: Rheumatoid arthritis MEDICAL MANAGEMENT GOLD THERAPY: IM or Oral preparation
Takes several months (3-6) before effects can be seen Can damage the kidney and causes bone
marrow depression
Slide 78: Rheumatoid arthritis Nursing MANAGEMENT 1. Relieve pain and discomfort USE splints to
immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE
DEFORMITY Administer prescribed medications Suggest application of COLD packs during the
acute phase of pain, then HEAT application as the inflammation subsides
Slide 79: Rheumatoid arthritis Nursing MANAGEMENT 2. Decrease patient fatigue Schedule activity
when pain is less severe Provide adequate periods of rests 3. Promote restorative sleep
Slide 80: Rheumatoid arthritis Nursing Management 4. Increase patient mobility Advise proper
posture and body mechanics Support joint in functional position Advise ACTIVE ROME
Slide 81: Rheumatoid arthritis Nursing Management 5. Provide Diet therapy Patients experience
anorexia, nausea and weight loss Regular diet with caloric restrictions because steroids may increase
appetite Supplements of vitamins, iron and PROTEIN
Slide 82: Rheumatoid arthritis 6. Increase Mobility and prevent deformity: Lie FLAT on a firm mattress
Lie PRONE several times to prevent HIP FLEXION contracture Use one pillow under the head
because of risk of dorsal kyphosis NO Pillow under the joints because this promotes flexion
contractures
Slide 83: Hot versus Cold HOT Cold Use to RELIEVE joint Use to control stiffness, pain and inflammation
and pain muscle spasm After acute attack ACUTE ATTACK
Slide 84: Gouty arthritis A systemic disease caused by deposition of uric acid crystals in the joint and
body tissues CAUSES: 1. Primary gout- disorder of Purine metabolism 2. Secondary gout-
excessive uric acid in the blood like leukemia
Slide 87: Gouty arthritis ASSESSMENT FINDINGS 1. Severe pain in the involved joints, initially the
big toe 2. Swelling and inflammation of the joint 3. TOPHI- yellowish-whitish, irregular deposits in
the skin that break open and reveal a gritty appearance 4. PODAGRA
Slide 88: Gouty arthritis ASSESSMENT FINDINGS 5. Fever, malaise 6. Body weakness and headache
7. Renal stones
Slide 89: Gouty arthritis DIAGNOSTIC TEST Elevated levels of uric acid in the blood Uric acid stones
in the kidney
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 90: Gouty arthritis Medical management 1. Allupurinol- take it WITH FOOD Rash signifies
allergic reaction 2. Colchicine For acute attack
Slide 91: Gouty arthritis Nursing Intervention 1. Provide a diet with LOW purine Avoid Organ meats,
aged and processed foods STRICT dietary restriction is NOT necessary 2. Encourage an increased fluid
intake (2- 3L/day) to prevent stone formation 3. Instruct the patient to avoid alcohol 4. Provide alkaline
ash diet to increase urinary pH 5. Provide bed rest during early attack of gout
Slide 92: Gouty arthritis Nursing Intervention 6. Position the affected extremity in mild flexion 7.
Administer anti-gout medication and analgesics
Slide 93: Fracture A break in the continuity of the bone and is defined according to its type and extent
Slide 94: Fracture mechanical Stress to bone Severe bone fracture Direct Blows Crushing
forces Sudden twisting motion Extreme muscle contraction
Slide 95: Fracture TYPES OF FRACTURE 1. Complete fracture Involves a break across the entire
cross- section 2. Incomplete fracture The break occurs through only a part of the cross-section
Slide 97: Fracture TYPES OF FRACTURE 1. Closed fracture The fracture that does not cause a break
in the skin 2. Open fracture The fracture that involves a break in the skin
Slide 99: Fracture TYPES OF FRACTURE 1. Comminuted fracture A fracture that involves production
of several bone fragments 2. Simple fracture A fracture that involves break of bone into two parts
or one
Slide 100: Fracture ASSESSMENT FINDINGS 1. Pain or tenderness over the involved area 2. Loss of
function 3. Deformity 4. Shortening 5. Crepitus 6. Swelling and discoloration
Slide 101: Fracture ASSESSMENT FINDINGS 1. Pain Continuous and increases in severity Muscles
spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone
Slide 102: Fracture ASSESSMENT FINDINGS 2. Loss of function Abnormal movement and pain can
result to this manifestation
Slide 103: Fracture ASSESSMENT FINDINGS 3. Deformity Displacement, angulations or rotation of the
fragments Causes deformity
Slide 104: Fracture ASSESSMENT FINDINGS 4. Crepitus A grating sensation produced when the bone
fragments rub each other
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 105: Fracture DIAGNOSTIC TEST X-ray
Slide 106: Fracture EMERGENCY MANAGEMENT OF FRACTURE 1. Immobilize any suspected fracture
2. Support the extremity above and below when moving the affected part from a vehicle 3.
Suggested temporary splints- hard board, stick, rolled sheets 4. Apply sling if forearm fracture is
suspected or the suspected fractured arm maybe bandaged to the chest
Slide 107: Fracture EMERGENCY MANAGEMENT OF FRACTURE 5. Open fracture is managed by
covering a clean/sterile gauze to prevent contamination 6. DO NOT attempt to reduce the facture
Slide 108: Fracture MEDICAL MANAGEMENT 1. Reduction of fracture either open or closed,
Immobilization and Restoration of function 2. Antibiotics, Muscle relaxants and Pain medications
Slide 109: Fracture General Nursing MANAGEMENT For CLOSED FRACTURE 1. Assist in reduction
and immobilization 2. Administer pain medication and muscle relaxants 3. teach patient to care
for the cast 4. Teach patient about potential complication of fracture and to report infection, poor
alignment and continuous pain
Slide 110: Fracture General Nursing MANAGEMENT For OPEN FRACTURE 1. Prevent wound and
bone infection Administer prescribed antibiotics Administer tetanus prophylaxis Assist in serial
wound debridement 2. Elevate the extremity to prevent edema formation 3. Administer care of
traction and cast
Slide 111: Fracture FRACTURE COMPLICATIONS Early 1. Shock 2. Fat embolism 3.
Compartment syndrome 4. Infection 5. DVT
Slide 112: Fracture FRACTURE COMPLICATIONS Late 1. Delayed union 2. Avascular necrosis
3. Delayed reaction to fixation devices 4. Complex regional syndrome
Slide 113: Fracture FRACTURE COMPLICATIONS: Fat Embolism Occurs usually in fractures of the
long bones Fat globules may move into the blood stream because the marrow pressure is greater
than capillary pressure Fat globules occlude the small blood vessels of the lungs, brain kidneys and
other organs
Slide 114: Fracture FRACTURE COMPLICATIONS: Fat Embolism Onset is rapid, within 24-72 hours
ASSESSMENT FINDINGS 1. Sudden dyspnea and respiratory distress 2. tachycardia 3. Chest
pain 4. Crackles, wheezes and cough 5. Petechial rashes over the chest, axilla and hard palate
Slide 115: Fracture FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 1. Support
the respiratory function Respiratory failure is the most common cause of death Administer O2 in
high concentration Prepare for possible intubation and ventilator support
Slide 116: Fracture FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 2.
Administer drugs Corticosteroids Dopamine Morphine
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
Musculoskeletal System National University: College of Nursing
Slide 117: Fracture FRACTURE COMPLICATIONS: Fat Embolism Nursing Management 3. Institute
preventive measures Immediate immobilization of fracture Minimal fracture manipulation
Adequate support for fractured bone during turning and positioning Maintain adequate hydration
and electrolyte balance
Slide 118: Fracture Early complication: Compartment syndrome A complication that develops
when tissue perfusion in the muscles is less than required for tissue viability
Slide 119: Fracture Early complication: Compartment syndrome ASSESSMENT FINDINGS 1. Pain-
Deep, throbbing and UNRELIEVED pain by opiods Pain is due to reduction in the size of the muscle
compartment by tight cast Pain is due to increased mass in the compartment by edema, swelling or
hemorrhage
Slide 120: Fracture Early complication: Compartment syndrome ASSESSMENT FINDINGS 2.
Paresthesia- burning or tingling sensation 3. Numbness 4. Motor weakness 5. Pulselessness,
impaired capillary refill time and cyanotic skin
Slide 121: Fracture Early complication: Compartment syndrome Medical and Nursing management
1. Assess frequently the neurovascular status of the casted extremity 2. Elevate the extremity
above the level of the heart 3. Assist in cast removal and FASCIOTOMY
Slide 122: Strains Excessive stretching of a muscle or tendon Nursing management 1.
Immobilize affected part 2. Apply cold packs initially, then heat packs 3. Limit joint activity 4.
Administer NSAIDs and muscle relaxants
Slide 123: Sprains Excessive stretching of the LIGAMENTS Nursing management 1. Immobilize
extremity and advise rest 2. Apply cold packs initially then heat packs 3. Compression bandage
may be applied to relieve edema 4. Assist in cast application 5. Administer NSAIDS
Nurse Licensure Examination Reviewer Dennis B. Brosola, RN, MSN
