Review of Anatomy and

Physiology
“ The musculo-skeletal system consists
MUSCULO-SKELETAL of the muscles, tendons, bones and
cartilage together with the joints
NURSING “ The primary function of which is to
produce skeletal movements
Board review

Muscles TENDONS
Three types of muscles exist in the body “ Bands of fibrous connective tissue that
“ 1. Skeletal Muscles tie bones to muscles
“ Voluntary and striated
“ 2. Cardiac muscles
“ Involuntary and striated
“ 3. Smooth/Visceral muscles
“ Involuntary and NON-striated

LIGAMENTS BONES
“ Strong, dense and flexible bands of “ Variously classified according to shape,
fibrous tissue connecting bones to location and size
another bone “ Functions
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition

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JOINTS CARTILAGES
“ Thepart of the Skeleton where two or “A dense connective tissue that consists
more bones are connected of fibers embedded in a strong gel-like
substance

ASSESMENT OF THE
BURSAE MUSCULO-SKELETAL SYSTEM
“ Sac containing fluid that are located “The nurse usually evaluates
around the joints to prevent friction this small part of the over-all
assessment and concentrates
on the patient’s posture, body
symmetry, gait and muscle and
joint function

ASSESMENT OF THE ASSESSMENT OF THE

MUSCULO-SKELETAL SYSTEM MUSCULO-SKELETAL SYSTEM
“ 1. HISTORY “ Gait
“ 2. Physical Examination “ Posture
“ Perform a head to toe assessment
“ Muscular palpation
“ Nurses need to inspect and palpate
“ The special procedure is the
“ Joint
palpation
assessment of joint and muscle “ Range of motion
movement
“ Muscle strength
“ Usually, a tape measure and a
protractor are the only instruments

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ASSESMENT OF THE ASSESMENT OF THE
MUSCULO-SKELETAL SYSTEM MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES LABORATORY PROCEDURES
“ 1. BONE MARROW ASPIRATION “ 2. Arthroscopy
“ Usually involves aspiration of the marrow to “ A direct visualization of the joint cavity
diagnose diseases like leukemia, aplastic “ Pre-test: consent, explanation of
anemia procedure, NPO
“ Usual site is the sternum and iliac crest “ Intra-test: Sedative, Anesthesia,
“ Pre-test: Consent incision will be made
“ Intratest: Needle puncture may be painful “ Post-test: maintain dressing,
“ Post-test: maintain pressure dressing and ambulation as soon as awake, mild
watch out for bleeding soreness of joint for 2 days, joint rest
for a few days, ice application to relieve
discomfort

ASSESMENT OF THE ASSESMENT OF THE

MUSCULO-SKELETAL SYSTEM MUSCULO-SKELETAL SYSTEM
LABORATORY PROCEDURES LABORATORY PROCEDURES
3. BONE SCAN 4. DXA- Dual-energy XRAY absorptiometry
“ Imaging study with the use of a contrast
“ Assesses bone density to diagnose
radioactive material
“ Pre-test: Painless procedure, IV radioisotope is
osteoporosis
used, no special preparation, pregnancy is “ Uses LOW dose radiation to measure bone
contraindicated density
“ Intra-test: IV injection, Waiting period of 2 hours “ Painless procedure, non-invasive, no special
before X-ray, Fluids allowed, Supine position for
scanning
preparation
“ Post-test: Increase fluid intake to flush out “ Advise to remove jewelry
radioactive material

Common musculoskeletal
problems

The Nursing Management

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Nursing Management of common musculo-
skeletal problems Nursing Management
PAIN PAIN
“ These can be related to joint inflammation, “ 3. Administer analgesics as prescribed
traction, surgical intervention
“ Usually NSAIDS
“ 1. Assess patient’s perception of pain
“ Meperidine can be given for severe pain
“ 2. Instruct patient alternative pain
management like meditation, heat and cold “ 4.
Assess the effectiveness of pain
application, TENS and guided imagery measures

Nursing Management Nursing Management

IMPAIRED PHYSICAL MOBILITY SELF-CARE DEFICITS
“ 1. Instruct patient to perform range of motion “ 1. Assess functional levels of the patient
exercises, either passive or active
“ 2. Provide support in ambulation with
“ 2. Provide support for feeding problems
assistive devices “ Place patient in Fowler’s position
“ 3. Turn and change position every 2 hours “ Provide assistive device and supervise
“ 4. Encourage mobility for a short period and mealtime
provide positive reinforcements for small “ Offer finger foods that can be handled by
accomplishments patient
“ Keep suction equipment ready

Nursing Management Musculoskeletal Modalities

SELF-CARE DEFICITS
“Traction
“ 3. Assist patient with difficulty bathing
and hygiene “Cast
“ Assist with bath only when patient has
difficulty
“ Provide ample time for patient to finish
activity

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Nursing Management Traction
Traction “ Skin traction
“ A method of fracture immobilization by
applying equipments to align bone “ Skeletal traction
fragments
“ Used for immobilization, bone alignment
and relief of muscle spasm

Traction
“ Pulling
force exerted on bones to
reduce or immobilize fractures,
reduce muscle spasm, correct or
prevent deformities

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

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Nursing Management Nursing Management
Traction: General principles CAST
“ 5. Observe and prevent foot drop “ Immobilizing tool made of plaster of
“ Provide foot plate Paris or fiberglass
“ 6. Observe for DVT, skin irritation and “ Provides immobilization of the fracture
breakdown
“ 7. Provide pin care for clients in skeletal
traction- use of hydrogen peroxide

Nursing Management Casting Materials

CAST: types “ Plaster of Paris
1. Long arm “ Drying takes 1-3 days
“ Ifdry, it is SHINY, WHITE, hard and
2. Short arm
resistant
3. Spica
“ Fiberglass
“ Lightweight and dries in 20-30 minutes
“ Water resistant

Nursing Management Nursing Management

CAST: General Nursing Care CAST: General Nursing Care
“ 1. Allow the cast to dry (usually 24-72
hours) “5. Petal the edges of the cast to
“ 2. Handle a wet cast with the prevent crumbling of the edges
PALMS not the fingertips “6. Examine the skin for
“ 3. Keep the casted extremity
ELEVATED using a pillow pressure areas and Regularly
“ 4. Turn the extremity for equal check the pulses and skin
drying. DO NOT USE DRYER for
plaster cast

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 Nursing Management
CAST: General Nursing Care
“7. Instruct the patient not to
Common Musculoskeletal
place sticks or small objects conditions
inside the cast
“8. Monitor for the following: pain, Nursing management
swelling, discoloration, coolness,
tingling or lack of sensation and
diminished pulses

METABOLIC BONE METABOLIC BONE

DISORDERS DISORDERS
Osteoporosis Osteoporosis: Pathophysiology
“ A disease of the bone characterized by “ Normal homeostatic bone turnover is
a decrease in the bone mass and alteredÆ rate of bone RESORPTION is
density with a change in bone structure greater than bone FORMATIONÆ
reduction in total bone massÆ
reduction in bone mineral densityÆ
prone to FRACTURE

METABOLIC BONE METABOLIC BONE

DISORDERS DISORDERS
Osteoporosis: TYPES RISK factors for the development of
Osteoporosis
“ 1. Primary Osteoporosis- advanced
“ 1. Sedentary lifestyle
age, post-menopausal
“ 2. Age
“ 2. Secondary osteoporosis- Steroid
“ 3. Diet- caffeine, alcohol, low Ca and Vit D
overuse, Renal failure
“ 4. Post-menopausal
“ 5. Genetics- caucasian and asian
“ 6. Immobility

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METABOLIC DISORDER METABOLIC DISORDER
ASSESSMENT FINDINGS LABORATORY FINDINGS
“ 1. Low stature “ 1. DEXA-scan
“ 2. Fracture “ Provides information about bone mineral
“ Femur
density
“ T-score is at least 2.5 SD below the young
“ 3. Bone pain
adult mean value
“ 2. X-ray studies

METABOLIC DISORDER METABOLIC DISORDER

Medical management of Osteoporosis Osteoporosis Nursing Interventions
“ 1. Diet therapy with calcium and Vitamin D 1. Promote understanding of osteoporosis and
the treatment regimen
“ 2. Hormone replacement therapy
“ Provide adequate dietary supplement of
“ 3. Biphosphonates- Alendronate, risedronate calcium and vitamin D
produce increased bone mass by inhibiting “ Instruct to employ a regular program of
the OSTEOCLAST moderate exercises and physical activity
“ 4. Moderate weight bearing exercises “ Manage the constipating side-effect of
“ 5. Management of fractures calcium supplements

METABOLIC DISORDER METABOLIC DISORDER

Osteoporosis Nursing Interventions Osteoporosis Nursing Interventions
“ Take calcium supplements with meals 2. Relieve the pain
“ Instruct the patient to rest on a firm
“ Take alendronate with an EMPTY
mattress
stomach with water
“ Suggest that knee flexion will cause
“ Instruct on intake of Hormonal relaxation of back muscles
replacement “ Heat application may provide comfort
“ Encourage good posture and body
mechanics
“ Instruct to avoid twisting and heavy lifting

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METABOLIC DISORDER METABOLIC DISORDER
Osteoporosis Nursing Interventions Osteoporosis Nursing Interventions
“ 3. Improve bowel elimination “ 4. Prevent injury
“ Constipation is a problem of calcium “ Instruct to use isometric exercise to
supplements and immobility strengthen the trunk muscles
“ Advise intake of HIGH fiber diet and “ AVOID sudden jarring, bending and
increased fluids strenuous lifting
“ Provide a safe environment

Juvenile rheumatoid Arthritis Juvenile rheumatoid Arthritis

“ Definition: “ PATHOPHYSIOLOGY : unknown
“ AUTO-IMMUNE inflammatory joint disorder
of UNKNOWN cause
“ Affected by stress, climate and genetics
“ SYSTEMIC chronic disorder of connective
tissue
“ Common in girls 2-5 and 9-12 y.o.
“ Diagnosed BEFORE age 16 years old

Juvenile rheumatoid Arthritis JRA

Systemic JRA Pauci-articular Polyarticular “ Symptoms may decrease as child
enters adulthood
FEVER MILD joint pain Morning joint
and swelling stiffness and “ With periods of remissions and
fever exacerbations
Salmon-pink IRIDOCYCLITIS Weight
rash Bearing joints
Five or more Less than 4 Five or more
joints joints joints
Anorexia, Very Good Poor prognosis
anemia, fatigue prognosis

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JRA JRA
Medical Management Nursing Management
1. ASPIRIN and NSAIDs- mainstay 1. Encourage normal performance of
treatment daily activities
2. Slow-acting anti-rheumatic drugs 2. Assist child in ROM exercises
3. Corticosteroids 3. Administer medications
4. Encourage social and emotional
development

DEGENERATIVE JOINT
JRA DISEASE
Nursing Management OSTEOARTHRITIS
During acute attack: “ The most common form of degenerative
“ SPLINT the joints joint disorder
“ NEUTRAL positioning
“ Warm or cold packs

DEGENERATIVE JOINT DEGENERATIVE JOINT

DISEASE DISEASE
OSTEOARTHRITIS OSTEOARTHRITIS: Pathophysiology
“ Chronic, NON-systemic disorder of “ Injury, genetic, Previous joint
joints damage, Obesity, Advanced age Æ
Stimulate the chondrocytes to
release chemicalsÆ chemicals will
cause cartilage degeneration,
reactive inflammation of the synovial
lining and bone stiffening

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DEGENERATIVE JOINT DEGENERATIVE JOINT
DISEASE DISEASE
OSTEOARTHRITIS: Risk factors OSTEOARTHRITIS: Assessment findings
“ 1. Increased age “ 1. Joint pain
“ 2. Joint stiffness
“ 2. Obesity
“ 3. Functional joint impairment limitation
“ 3. Repetitive use of joints with previous
“ The joint involvement is ASYMMETRICAL
joint damage
“ This is not systemic, there is no FEVER, no
“ 4. Anatomical deformity severe swelling
“ 5. genetic susceptibility “ Atrophy of unused muscles
“ Usual joint are the WEIGHT bearing joints

DEGENERATIVE JOINT DEGENERATIVE JOINT

DISEASE DISEASE
OSTEOARTHRITIS: Assessment findings OSTEOARTHRITIS: Assessment findings
1. Joint pain 2. Stiffness
“ Caused by ‰ commonly occurs in the morning after
“ Inflamed synovium awakening
“ Stretching of the joint capsule ‰ Lasts only for less than 30 minutes
“ Irritation of nerve endings ‰ DECREASES with movement
‰ Crepitation may be elicited

DEGENERATIVE JOINT DEGENERATIVE JOINT

DISEASE DISEASE
OSTEOARTHRITIS: Diagnostic findings OSTEOARTHRITIS: Medical management
1. X-ray “ 1. Weight reduction

“ Narrowing of joint space “ 2. Use of splinting devices to support joints

“ Loss of cartilage “ 3. Occupational and physical therapy

“ Osteophytes “ 4. Pharmacologic management

2. Blood tests will show no evidence of “ Use of PARACETAMOL, NSAIDS

systemic inflammation and are not “ Use of Glucosamine and chondroitin

useful “ Topical analgesics

“ Intra-articular steroids to decrease inflam

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DEGENERATIVE JOINT DEGENERATIVE JOINT
DISEASE DISEASE
OSTEOARTHRITIS: Nursing OSTEOARTHRITIS: Nursing
Interventions Interventions
“ 1. Provide relief of PAIN “ 2. Advise patient to reduce weight
“ Administer prescribed analgesics
“ Aerobic exercise
“ Applicationof heat modalities. ICE
“ Walking
PACKS may be used in the early acute
stage!!! “ 3. Administer prescribed medications
“ Plan daily activities when pain is less “ NSAIDS
severe
“ Pain meds before exercising

Rheumatoid arthritis Rheumatoid arthritis

“A type of chronic systemic inflammatory FACTORS:
arthritis and connective tissue disorder Genetic
affecting more women (ages 35-45) Auto-immune connective tissue disorders
than men
Fatigue, emotional stress, cold, infection

Rheumatoid arthritis Rheumatoid arthritis

Pathophysiology ASSESSMENT FINDINGS
“ Immune reaction in the synovium Æ “ 1. PAIN
attracts neutrophils Æ releases “ 2. Joint swelling and stiffness-
enzymes Æ breakdown of collagen Æ SYMMETRICAL, Bilateral
irritates the synovial liningÆcausing “ 3. Warmth, erythema and lack of
synovial inflammation edema and function
pannus formation and joint erosions and “ 4. Fever, weight loss, anemia, fatigue
swelling “ 5. Palpation of join reveals spongy tissue
“ 6. Hesitancy in joint movement

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Rheumatoid arthritis Rheumatoid arthritis
ASSESSMENT FINDINGS ASSESSMENT FINDINGS
“ Joint involvement is SYMMETRICAL “ Joints are swollen and warm
and BILATERAL
“ Painful when moved
“ Characteristically beginning in the
hands, wrist and feet “ Deformities are common in the hands

“ Joint STIFFNESS occurs early morning,

and feet causing misalignment
lasts MORE than 30 minutes, not “ Rheumatoid nodules may be found in
relieved by movement, diminishes as the subcutaneous tissues
the day progresses

Rheumatoid arthritis Rheumatoid arthritis

Diagnostic test MEDICAL MANAGEMENT
“ 1. X-ray “ 1. Therapeutic dose of NSAIDS and
“ Shows bony erosion Aspirin to reduce inflammation
“ 2. Blood studies reveal (+) “ 2. Chemotherapy with methotrexate,
rheumatoid factor, elevated ESR and
antimalarials, gold therapy and steroid
CRP and ANTI-nuclear antibody
“ 3. For advanced cases- arthroplasty,
“ 3. Arthrocentesis shows synovial fluid
that is cloudy, milky or dark yellow synovectomy
containing numerous WBC and “ 4. Nutritional therapy
inflammatory proteins

Rheumatoid arthritis Rheumatoid arthritis

MEDICAL MANAGEMENT Nursing MANAGEMENT
GOLD THERAPY: 1. Relieve pain and discomfort
“ USE splints to immobilize the affected
“ IM or Oral preparation
extremity during acute stage of the
“ Takes several months (3-6) before disease and inflammation to REDUCE
effects can be seen DEFORMITY
“ Can damage the kidney and causes “ Administer prescribed medications
bone marrow depression “ Suggest application of COLD packs during
the acute phase of pain, then HEAT
application as the inflammation subsides

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Rheumatoid arthritis Rheumatoid arthritis
Nursing MANAGEMENT Nursing Management
2. Decrease patient fatigue 4. Increase patient mobility
“Schedule activity when pain is “ Advise proper posture and body
less severe mechanics
“Provide adequate periods of rests “ Support joint in functional position
“ Advise ACTIVE ROME
3. Promote restorative sleep

Rheumatoid arthritis Rheumatoid arthritis

Nursing Management 6. Increase Mobility and prevent
5. Provide Diet therapy deformity:
“ Lie FLAT on a firm mattress
“ Patients experience anorexia,
nausea and weight loss “ Lie PRONE several times to
prevent HIP FLEXION contracture
“ Regular diet with caloric
“ Use one pillow under the head
restrictions because steroids
because of risk of dorsal kyphosis
may increase appetite
“ NO Pillow under the joints because
“ Supplements of vitamins, iron
this promotes flexion contractures
and PROTEIN

Hot versus Cold Gouty arthritis

HOT Cold “A systemic disease caused by
deposition of uric acid crystals in the
joint and body tissues
Use to RELIEVE joint Use to control
“ CAUSES:
stiffness, pain and inflammation and pain
muscle spasm “ 1. Primary gout- disorder of Purine
After acute attack ACUTE ATTACK metabolism
“ 2. Secondary gout- excessive uric
acid in the blood like leukemia

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Gouty arthritis Gouty arthritis
“ ASSESSMENT FINDINGS ASSESSMENT FINDINGS
“ 1. Severe pain in the involved joints, “ 5. Fever, malaise
initially the big toe
“ 6. Body weakness and headache
“ 2. Swelling and inflammation of the joint
“ 7. Renal stones
“ 3. TOPHI- yellowish-whitish,
irregular deposits in the skin that
break open and reveal a gritty
appearance
“ 4. PODAGRA

Gouty arthritis Gouty arthritis

DIAGNOSTIC TEST “ Medical management
“ Elevated levels of uric acid in the blood “ 1. Allupurinol- take it WITH FOOD
Rash signifies allergic reaction
“ Uric acid stones in the kidney
z

“ 2. Colchicine
“ For acute attack

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 Gouty arthritis Gouty arthritis
Nursing Intervention
Nursing Intervention
1. Provide a diet with LOW purine
6. Position the affected extremity in mild
“ Avoid Organ meats, aged and processed foods
flexion
“ STRICT dietary restriction is NOT necessary
2. Encourage an increased fluid intake (2-
7. Administer anti-gout medication and
3L/day) to prevent stone formation analgesics
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

Fracture Fracture
“A break in the continuity of the bone “ Severe mechanical Stress to bone Æ
and is defined according to its type and bone fracture
extent “ Direct Blows
“ Crushing forces
“ Sudden twisting motion
“ Extreme muscle contraction

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

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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

Fracture Fracture
TYPES OF FRACTURE ASSESSMENT FINDINGS
“ 1. Comminuted fracture “ 1. Pain or tenderness over the involved area

“A fracture that involves production of “ 2. Loss of function

several bone fragments “ 3. Deformity

“ 2. Simple fracture “ 4. Shortening

“A fracture that involves break of bone into “ 5. Crepitus

two parts or one “ 6. Swelling and discoloration

Fracture Fracture
ASSESSMENT FINDINGS ASSESSMENT FINDINGS
1. Pain 2. Loss of function
“ Continuous and increases in severity “ Abnormal movement and pain can
“ Muscles spasm accompanies the result to this manifestation
fracture is a reaction of the body to
immobilize the fractured bone

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Fracture Fracture
ASSESSMENT FINDINGS ASSESSMENT FINDINGS
3. Deformity 4. Crepitus
“ Displacement, angulations or rotation of “ A grating sensation produced when the
the fragments Causes deformity bone fragments rub each other

Fracture Fracture
“ DIAGNOSTIC TEST EMERGENCY MANAGEMENT OF FRACTURE
“ X-ray “ 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

Fracture Fracture
EMERGENCY MANAGEMENT OF MEDICAL MANAGEMENT
FRACTURE “ 1. Reduction of fracture either open or
“ 5. Open fracture is managed by closed, Immobilization and Restoration
covering a clean/sterile gauze to of function
prevent contamination “ 2. Antibiotics, Muscle relaxants and
“ 6. DO NOT attempt to reduce the Pain medications
facture

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 Fracture
Fracture
General Nursing MANAGEMENT
General Nursing MANAGEMENT “ For OPEN FRACTURE
“ For CLOSED FRACTURE
“ 1. Prevent wound and bone infection
“ 1. Assist in reduction and immobilization
“ Administer prescribed antibiotics
“ 2. Administer pain medication and muscle
relaxants “ Administer tetanus prophylaxis
“ 3. teach patient to care for the cast “ Assist in serial wound debridement
“ 4. Teach patient about potential complication “ 2. Elevate the extremity to prevent edema
of fracture and to report infection, poor formation
alignment and continuous pain
“ 3. Administer care of traction and cast

Fracture Fracture
“ FRACTURE COMPLICATIONS “ FRACTURE COMPLICATIONS
“ Early “ Late
“ 1. Shock “ 1. Delayed union
“ 2. Fat embolism “ 2. Avascular necrosis
“ 3. Compartment syndrome “ 3. Delayed reaction to fixation devices
“ 4. Infection “ 4. Complex regional syndrome
“ 5. DVT

Fracture
Fracture “ FRACTURE COMPLICATIONS: Fat
“ FRACTURE COMPLICATIONS: Fat
Embolism
Embolism
“ Onset is rapid, within 24-72 hours
“ Occurs usually in fractures of the long
bones “ ASSESSMENT FINDINGS

“ Fat globules may move into the blood “ 1. Sudden dyspnea and respiratory
stream because the marrow pressure is distress
greater than capillary pressure “ 2. tachycardia
“ Fat globules occlude the small blood “ 3. Chest pain
vessels of the lungs, brain kidneys and “ 4. Crackles, wheezes and cough
other organs “ 5. Petechial rashes over the chest, axilla
and hard palate

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 Fracture Fracture
“ FRACTURE COMPLICATIONS: Fat “ FRACTURE COMPLICATIONS: Fat
Embolism Embolism
“ Nursing Management “ Nursing Management
“ 1. Support the respiratory function
“ 2. Administer drugs
“ Respiratory failure is the most common
“ Corticosteroids
cause of death
“ Administer O2 in high concentration “ Dopamine

“ Prepare for possible intubation and “ Morphine

ventilator support

Fracture
Fracture “ Early complication: Compartment
“ FRACTURE COMPLICATIONS: Fat Embolism syndrome
“ Nursing Management
“ A complication that develops when
“ 3. Institute preventive measures tissue perfusion in the muscles is less
“ Immediate immobilization of fracture than required for tissue viability
“ Minimal fracture manipulation
“ Adequate support for fractured bone during
turning and positioning
“ Maintain adequate hydration and electrolyte
balance

Fracture Fracture
“ Early complication: Compartment syndrome “ Early complication: Compartment syndrome
“ ASSESSMENT FINDINGS “ ASSESSMENT FINDINGS
“ 1. Pain- Deep, throbbing and UNRELIEVED “ 2. Paresthesia- burning or tingling sensation
pain by opiods
“ 3. Numbness
“ Pain is due to reduction in the size of the
muscle compartment by tight cast “ 4. Motor weakness
“ Pain is due to increased mass in the “ 5. Pulselessness, impaired capillary refill
compartment by edema, swelling or time and cyanotic skin
hemorrhage

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Fracture Strains
“ Early complication: Compartment
syndrome “ Excessive stretching of a muscle or
“ Medical and Nursing management
tendon
“ Nursing management
“ 1. Assess frequently the neurovascular
status of the casted extremity “ 1. Immobilize affected part
“ 2. Apply cold packs initially, then heat
“ 2. Elevate the extremity above the
level of the heart packs
“ 3. Limit joint activity
“ 3. Assist in cast removal and
FASCIOTOMY “ 4. Administer NSAIDs and muscle
relaxants

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

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