RESPONSES TO ALTERED
COORDINATION
• Three types of muscles: skeletal, smooth,
and cardiac
• Skeletal muscle attaches to the bones and
usually crosses at least one joint.
• Forms the major muscle mass of the
body
• Called voluntary muscle because it is
under direct voluntary control of the
brain
Cardiac muscle is a specially adapted
involuntary muscle with its own
regulatory system.
THE SKELETON
• Gives us our recognizable human form
• Protects our vital organs
• Allows us to move
• Produces blood cells
• Made up of approximately 206 bones
• The skull protects the brain.
• The thoracic cage protects the heart, lungs, and
great vessels.
• The pectoral girdle consists of two scapulae and two
clavicles.
• The pelvis supports the body
weight and protects the
structures within the pelvis: the
bladder, rectum, and female
reproductive organs.
• The lower extremity consists of
the bones of the thigh, leg, and
foot.
• The foot consists of
three classes of bones:
• Ankle bones (tarsals)
• Foot bones
(metatarsals)
• Toe bones
(phalanges)
DIAGNOSTIC PROCEDURE
Indications for EMG
EMG is used to diagnose conditions affecting:
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[Link] dystrophy.
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[Link] Junction:
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[Link] Neurons:
[Link] lateral sclerosis (ALS).
[Link] muscular atrophy.
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/infection
NURSING INTERVENTIONS
ARTHROSCOPY
• Endoscopic procedure that allows
direct visualization of joint structure
through a large bore needle.
• May be combined with arthrography
and biopsy
PRETEST
CONSENT
NPO 8-12 HOURS
POST TEST
• PAIN MEDs
• ELASTIC WRAPS – 2-4 days
• Walk after sensation returns (Crutches)
• Limit activity (Affected Leg) for 1-4 days
• R –I –C –E (up to 2 days)
ARTHROGRAM
An x-ray of the joint wherein a contrast media is used to visualize
the joint more clearly
PRETEST
Local Anesthesia used
NPO 8 hrs
Assess for ALLERGIES (IODINE)
Obtain CONSENT
INTRATEST: Remain Still !!
ARTHROGRAM
POST TEST
- Minimize use of Joint
- Joint edematous & tender – 2 days
- ICE PACKS & ANALGESICS
- ACE WRAP (knee)
- REPORT : EDEMA & tenderness > 2 days
GENERAL COMPLICATION OF IMMOBILITY
ASSISTIVE DEVICE FOR WALKING
Crutch Walking
Crutches are artificial supports that assist patients who need
aid in walking because of disease, injury, or a birth defect.
MEASURING FOR CRUTCHES
• When the patient is lying down (an approximate
measurement):
• wear shoes
• Measure from the anterior fold of the axilla to the sole. Then
add 2 inches (5 cm).
• Alternatively, subtract 16 inches (40 cm) from the patient's
height.
MEASURING FOR CRUTCHES
When the patient is standing erect:
fitted with large rubber suction tips.
Elbow is flexed 30 degrees with the hand resting on the grip.
A two-finger-width insertion between the axillary fold and
the underarm piece grip.
The tip of the crutch is placed 6 to 8 inches (15 to 20 cm)
lateral to the forefoot.
MUSCULOSKELETAL INJURIES
CONTUSIONS, STRAINS, AND SPRAINS
CONTUSIONS, STRAINS, AND SPRAINS
• Contusion is a soft tissue injury
• Strain is a pulled muscle from overuse,
overstretching, or excessive stress
• Sprain is an injury to ligaments surrounding a
joint ; twisting motion
WHAT CAUSES SPRAIN
SIGN AND SYMPTOMS OF SPRAIN
WHERE DO SPRAIN OCCUR
WHAT CAUSES STRAIN
WHERE DO STRAIN OCCURS
BONE AND JOINT INJURIES DISLOCATION
DISLOCATIONS
• Sometimes a dislocated joint will spontaneously reduce before your
assessment.
• Confirm the dislocation by taking a patient history.
• A dislocation that does not reduce is a serious problem.
DISLOCATIONS
TYPES OF DISLOCATIONS
Complete dislocations (luxation): A complete
dislocation happens when the bones in your joint are
totally separated and pushed out of place.
Subluxation: Subluxation is the medical term for a
partial dislocation. You have a subluxation if
something pulls your joint apart and the bones still
touch, just not as completely as usual.
CLOSED FRACTURE
a break in the continuity of the bone
which does not communicate with
the outside of the body.
.
OPEN FRACTURE
Open fracture (also called
compound fracture): The bone
pokes through the skin and can
be seen, or a deep wound
exposes the bone through the
skin
COMPLETE FRACTURE
Complete fractures are fractures where the parts of
the bone that have been fractured are completely
separated from each other. There is complete
separation of the cortex circumferentially.
Complete fractures can be classified as:
transverse: straight across the bone
oblique: oblique line across the bone
spiral: looks like a cork-screws
longitudinal: along the long-axis of the bone
INCOMPLETE FRACTURE
An incomplete, or greenstick, fracture occurs when
the bone cracks and bends but does not
completely break; when the bone does break into
separate pieces, the condition is called a complete
fracture. An impacted fracture occurs when the
broken ends of the bone are jammed together
Usually seen in young children, more
commonly less than 10 years of age. They
are commonly mid-diaphyseal, affecting
the forearm and lower leg. They are
distinct from torus fractures.
SPIRAL FRACTURE
Spiral fractures are complete fractures of
long bones that result from a rotational
force applied to the bone. Spiral fractures
are usually the result of high energy
trauma and are likely to be associated
with displacement.
OBLIQUE FRACTURE
Oblique fractures occur when your
bone is broken at an angle. The
fracture is a straight line that's angled
across the width of your bone.
COMPRESSION FRACTURE “ IMPACT”
A compression fracture is a type of
broken bone that can cause your
vertebrae to collapse, making
them shorter. This often happens
to the front of the vertebrae but
not the back, causing you to stoop
forward over time.
CRUSH COMPRESSION FRACTURE
• small breaks or cracks in the
vertebrae (the bones that make
up your spinal column). The
breaks happen in the vertebral
body, which is the thick, rounded
part on the front of each vertebra.
Fractures in the bone cause the
spine to weaken and collapse.
Over time, these fractures affect
posture
EMERGENCY MANAGEMENT
SAFETY FIRST!!
ABCD (PRIORITY)
ABCDs
Life threats managed first
Don’t overlook life/limb threatening musculoskeletal trauma
Don’t be distracted by “gross” but non-life/limb threatening
musculoskeletal injury
COMPLICATION OF FRACTURE
SHOCK
FAT EMBOLISM
COMPARTMENT SYNDROME
AVASCULAR NECROSIS
PULMONARY EMBOLISM
INFECTION/OSTEOMYELITIS
NURSING INTERVENTIONS
The nurse should instruct the patient regarding proper
methods to control edema and pain.
It is important to teach exercises to maintain the health of the
unaffected muscles and to increase the strength of muscles
needed for transferring and for using assistive devices.
Plans are made to help the patients modify the home
environment to promote safety such as removing any
obstruction in the walking paths around the house.
NURSING INTERVENTIONS
Wound management. Wound irrigation and
debridement are initiated as soon as possible.
Elevate extremity. The affected extremity is elevated
to minimize edema.
Signs of infection. The patient must be assessed for
presence of signs and symptoms of infection.
DISCHARGE AND HOME CARE GUIDELINES
Control swelling and pain.
Describe approaches to reduce swelling and pain such as elevating the
extremity and taking analgesics as prescribed.
Care of the affected area.
Describe management of immobilization devices or care of the incision.
Consume diet to promote bone healing.
Mobility aids. Demonstrate use of mobility aids and assistive devices
safely.
Avoid excessive use of injured extremity and observe weight-bearing
limits.
SPRAIN
A sprain occurs when a joint is twisted or stretched
beyond its normal range of motion.
SPRAIN
Signs and symptoms
Point tenderness
Swelling and ecchymosis
Pain
Instability of the joint
SPRAIN
GRAIN OF SPRAIN AND STRAIN
CAUSE OF INJURY
CAUSE OF INJURY
TREATMENT
THANK YOU
