CONCEPT: BASIC CARE & COMFORT

MUSCULOSKELETAL INJURIES
Match the type of trauma with its appropriate definition.
DEFINITION TRAUMA TYPE

___ Injury to the muscle tissue in the form of incomplete tears. Results from A. Dislocation
overstretching, overuse, or excess stress, causing bleeding into the muscle, pain,
B. Fracture
swelling, and muscle spasm. Treatment includes ice packs for the first 24 hours followed
by moist or dry heat, sling or crutches, and muscle relaxants. C. Sprain
D. Strain
___Any break in the continuity of the bone occurring in the shaft or diaphysis
(complete, incomplete, or bending, open or closed). Treatment includes realignment of
bone fragments, maintenance of realignment of bone fragments, maintenance of
realignment by immobilization, and restoration of function.

___ Injury involving the ligamentous structures surrounding a joint; tear or stretching of
the joint. Immobilization is crucial after swelling has subsided. Treatment includes
immobilization, cast application after swelling decreases, cold or heat, and correct
positioning.
INITIAL NURSING MANAGEMENT

FRACTURE Signs and Symptoms: PRIORITY ASSESSMENT:

P ain 1.
A bnormal motion
S oft tissue edema
C repitus (grating sound)
O bvious deformity
D iscoloration FOCUS OF ASSESSMENT:

COMPLICATIONS:

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 FRACTURE MANAGEMENT
REDUCTION-Return of a fractured bone to its alignment
CLOSED REDUCTION OPEN REDUCTION

-performed by -surgical intervention

manual manipulation
-fracture may be
-under local treated with internal
or general anesthesia fixation device

IMMOBILIZATION – prevention of movement

CAST –Rigid external device Nursing Management:
Use palm of hands to prevent
TYPES OF CAST Elevate extremity/__________exercise
Criteria Plaster of Paris Fiberglass Expose to facilitate- Air drying
Drying time Check proper application
Weight (Neurovascular Check)
Cost Maintain cleanliness
Observe proper skin care
Characteristics of a Dry Cast: P •
hard, white, shiny, with resonant sound, and cold to touch e
t
a
IMMOBILIZATION l
5 Important Principles of Maintaining Traction i
TRACTION 1. Maintain established line of pull. n
T –o exert a pulling force 2. Prevent friction. g
R –educe nerve compression 3. Maintain countertraction. • I
A –llows alignment t
4. Maintain continuous traction unless ordered
C –ontrols contractures / deformity otherwise. c
5. Maintain correct body alignment. h
T –o decrease muscle spasms
y
I –njured part is maintained in position ?
O –bserve if weights hang freely • D
N –o obstruction on pulley o
TYPES OF TRACTION n
SKIN TRACTION SKELETAL TRACTION ’
Description t
Maximum Weight ’
Duration s
Priority
-

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
1. _____________________ 1. _____________________

For fracture of cervical

For children with spine
congenital hip dysplasia

2. _____________________

For keeping the head

and neck still

2. _____________________
3. _____________________
Hip fracture and knee
injuries
For femur fracture

4. _____________________

3. _____________________ For femur fracture

Hip fracture and knee

injuries

IMMOBILIZATION
FIXATORS
TYPES OF FIXATOR
EXTERNAL FIXATOR INTERNAL FIXATOR
-external frame is used with -follows open reduction
multiple pins applied through
the bone -application of screws, plates, pins,
-provides more freedom with nails to hold the fragments in
movement alignment
- The nurse NEVER ADJUSTS
the clamps on the external -provides immediate bone strength
fixator frame. Rather, the
physician does so.

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 ASSISTIVE DEVICES
CRUTCHES CANE WALKER
Allowance from axilla to axillary bar: Position of the nurse during: Elbow angle:
-Ambulation
Distance:
Pressure is put on: -Transferring
C
Movement:
Complication: O
A
L
Elbow Angle: Handle should be level with:

Distance: Elbow Angle:

Distance:
Movement:

CRUTCH GAITS
TYPE DESCRIPTION WEIGHT BEARING

 Advance one crutch and opposite leg together

 Advance other crutch and opposite leg together

 Advance one crutch

 Advance opposite leg
 Advance other crutch
 Advance opposite leg

 Advance both crutches and bad leg forward

 Advance good leg while keeping body weight on
crutches

 Advance both crutches

 Lift both legs/ swing forward

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 -Up with the GOOD

-Good leg first, followed

by both crutches and the
bad leg
-Down with the BAD

-Bad leg first together with

both crutches, then followed
by the good leg

MUSCULOSKELETAL DISORDERS
1. Osteoporosis
 age-related metabolic disease
 bone demineralization results in the loss of bone mass
 yields – ____________bones which breaks easily

Risk factors: S/S:

Old age Bone pain
Steroids, smoking Reduced height
Trauma Easily fractured
Endocrine problem Always falling
Oophorectomy – Removal of the ovaries Kyphosis
Pregnancy, poor posture
Over intake of caffeine and alcohol EXERCISE:
Race:
Renal failure – Renal Osteodystrophy Drug therapy
Obvious fracture history
Calcium and Vitamin D supplements
Small thin frame
Inadequate intake of Vitamin D and Calcium Biphosphonates
Sedentary lifestyle Alendronate (Fosamax) -
IBANDRONATE (BONIVA)
Risedronate (Actonel)
Calcitonin (Calcimar, Miacalcin)

Raloxifene (Evista) - estrogen receptor

modulator
Side Effect:
Bloating, weight gain, breast tenderness, DVT
risk
“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 ARTHRITIS
Types RHEUMATOID OSTEOARTHRITIS GOUTY ARTHRITIS

Chronic, systemic inflammatory Chronic, nonsystemic A form of arthritis in which

changes in joints and related degeneration of joint cartilage uric acid appears in excessive
Definition structures quantities in the blood and
may be deposited in joints and
other tissues
Autoimmune Degeneration Faulty purine metabolism
Causes

Gender – Female Age –Equal risk Male

Aging Genetics Obesity
Risk factors
Genetic Obesity Genetic
Smoking Alcohol

Hands and feet are affected Pain with activity Tophi formation
S/S Ulnar deviation Heberden’s Podagra
Swan neck deformity Bouchards Uric acid

FEATURE
C-reactive protein X-ray Arthrocentesis
Antinuclear Antibody (ANA) -narrowing of the joint spaces -withdrawal of synovial fluid
Rheumatoid Factor (RF) Normal synovial fluid:
Diagnosis
-most specific colorless or clear
Erythrocyte Sedimentation Rate Abnormal: cloudy
(ESR)
 NSAIDS N - Naproxen (Flanax), Colchicine (Colsalide)
 GLUCOCORTICOIDS: Nabumetone (Relafen) Prevents deposition of the
Dexamethasone, S - Sulindac (Clinoril) uric acid crystal
A - (Arcoxia), (Arthrotec)
Betamethasone
I - buprofen (Motrin)
Indomethacin (Indocin)
 DMARDS (Disease Modifying D – Diclofenac (Voltaren) Allopurinol (Zyloprim)
Anti-Rheumatic drugs) S – Salicylate Prevents synthesis of the uric
Etanercept (Enbrel) acid crystal
Adalimumab (Humira)
Management Auranofin (Ridaura)
Probenecid (Benemid)
NOTE: Promotes excretion of the
WOF: uric acid crystal

Common side effect: GI upset

MANAGEMENT:

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 MUSCULOSKELETAL SURGERIES

TOTAL HIP REPLACEMENT PREVENT DISLOCATION!

Position: ______________________ & _______________________

___ Keep the knees apart at all times.

___ Put a pillow under the knees while sleeping.
___ Never cross the legs when seated.
___ Avoid bending forward when seated in a chair.
___ DO NOT sit on soft chairs, rocking chairs, sofas, or stools.
___ Use a raised toilet seat at or above knee height.
___ Use regular toilet seat.
___ Put abduction pillow in between the legs when turning or getting out
of bed.
Signs & Symptoms of hip fracture: ___ Scoot to the edge of the bed or chair before standing.
___ DO NOT bend over, raise your legs, or cross your legs when you get
S dressed.
___ DO NOT bend or squat to wash your legs and feet. Use long-handled
E equipment to reach them.
___ DO NOT sit in the bottom of a regular bathtub; use a tub seat or
A bench.

Amputation – removal of a diseased or damaged body part

Causes:
o
Bone cancer

Osteomyelitis

Peripheral Vascular Disease

Diabetes Mellitus

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 Complications of Amputation:
1. Bleeding
Bedside:

2. Contractures
How to prevent:
A. First 24-48 hours -
B. After 24-48 hours -

3. Phantom pain
4. Phantom sensation

Stump care:
Cleanse with mild soap and water
NO lotions, creams, oils
Elastic bandage
Residual sock – change daily

“Toughen” Residual Limb:

1. Massage
2. Soft pillow – Firm pillow – Hard surface (back of the chair)
Purpose: To apply direct pressure to the end of the stump in preparation for prosthesis

Nursing Diagnosis: Body Image Disturbance

CONCEPT: FUNDAMENTALS OF NURSING

CARDIO DRUGS: DOBUTAMINE AND DOPAMINE COMPUTATIONS

For DOBUTAMINE, the constants are:

single dose = 16.6 (translates to 250/250 or 500/500)
double dose = 33.3 (translates to 500/250 or 1000/500)

A patient weighing 182 lbs was ordered to be given DOBUTAMINE at 5mcg/kg/min. The preparation of DOBUTAMINE is 500 mg
in 250 ml of D5W. How many ml/hr should the patient receive?
Ans: _______ml/hr

For DOPAMINE, the constants are:

single dose = 13.3 (translates to 200/250 or 400/500)
double dose = 26.6 (translates to 400/250 or 800/500)

A patient weighing 176 lbs was prescribed DOPAMINE at 5 mcg/kg/min. The preparation of DOPAMINE is 400mg/250 ml in
D5W. How many ml will the nurse give in an hour? Round off to the nearest whole number.
Ans: _______ml/hr

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 ARTERIAL BLOOD GAS (ABG) NORMAL VALUES
Ph

PCO2

HCO3

PaO2
STEPS: O2 Sat
1.pH: This measures hydrogen ions. Normal pH = 7.35-7.45

2. pCO2= Partial Pressure of Carbon Dioxide: Although this is a pressure measurement, it relates to the
concentration of gaseous oxygen in the blood. A high pCO2 may indicate ACIDOSIS. A low pCO2 may indicate
alkalosis.

3. HCO3- = Bicarbonate: This measures the concentration of HCO3- ion only. High values may indicate ALKALOSIS
since bicarbonate is a base. Low values may indicate acidosis.

ABG PRACTICE TEST

1. pH= 7.50
PCO2= 45
HCO3= 28

2. pH= 7.20
PCO2= 50
HCO3= 22

3. pH= 7.30
PCO2= 48
HCO3= 29

4. pH= 7.30
PCO2= 35
HCO3= 20

5. pH= 7.48
PCO2= 48
HCO3= 30

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 Oxygen Therapy

Nasal Cannula Low flow oxygen:

Inaccurate oxygen delivery

Simple Face Mask

Inaccurate oxygen delivery

Partial rebreather Mask

Allows the inhalation of room air and exhaled air

Nonrebreather Mask High-flow enriched oxygen

Has reservoir bag (bag deflates 1/3 as the patient inhales)

Prevents the inhalation of room air and exhaled air

Venturi Mask
High-flow enriched oxygen
Accurate and constant oxygen delivery

POTASSIUM SODIUM

HYPOKALEMIA HYPERKALEMIA HYPONATREMIA HYPERNATREMIA

Muscles: Muscles:

FLUID VOLUME FLUID VOLUME

________ ________

ECG CHANGES: ECG CHANGES:

U S

S T

T I

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 MAGNESIUM CALCIUM

HYPOMAGNESEMIA HYPERMAGNESEMIA HYPOCALCEMIA HYPERCALCEMIA

MEDICAL ASEPSIS SURGICAL ASEPSIS

HANDWASHING CATHETER INSERTION
COLOSTOMY IRRIGATION INJECTION
NGT FEEDING STERILIZATION OF INSTRUMENTS
CATHETER REMOVAL ENDOTRACHEAL SUCTIONING
REMOVAL OF DRESSING REAPPLYING DRESSING

VITAMINS
FAT SOLUBLE WATER SOLUBLE
VITAMIN DEFICIENCY VITAMIN DEFICIENCY

A RETINOL B1 THIAMINE

D CALCIFEROL B2 RIBOFLAVIN

E TOCOPHEROL B6 PYRIDOXINE

K PHYLLOQUINONE/ B9 FOLIC ACID

PHYTOMENADIONE

B12 CYANOCOBALAMIN

C ASCORBIC ACID

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
 Total Parenteral Nutrition (TPN)

USES:

Non-functioning GIT
Bowel rest is needed
Cannot tolerate food by mouth

WOF:

A Things to remember:
Sterile Technique
H Change tubing -
Change dressing
I

PERSONAL PROTECTIVE EQUIPMENT (PPE) `

DONNING DOFFING

HOW TO OPEN A STERILE PACK

1. Handwashing
2. Open the flap
3. Open the flap
4. Open the flap
5. Drop the sterile package on the table

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
STOMA – surgically created opening to allow the exit of the urine or stool
Bacterial prophylaxis:
Post op color:
Healing:

ILEOSTOMY COLOSTOMY

Stool: Stool:

WOF: 1.

2.

____Odor ____Odor

____Swimming ____Swimming

____Irrigation ____Irrigation

Avoid gas forming foods: broccoli, cauliflower,

asparagus, eggs, beans, root crops, cabbage

STOMA IS STARTING TO FUNCTION:

FOR BOTH: CHANGING THE POUCH –

EMPTYING THE POUCH –

COLOSTOMY IRRIGATION

Fill container with:

Hang it:
Put on:
Lubricate the cone then insert:
Irrigate:
Wait for stool evacuation:

CLEANSE!

Discard pouch:

Patient is ready: Patient looks at his stoma

Active participation
Asks about the equipment

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
POINTS TO REMEMBER:
GLASGOW COMA SCALE

Glasgow Coma Scale Score

(max 15, lowest 3)

Interpretation of Symptoms:
Severe: 8 or less
Moderate: 9-12
Mild: 13 or more

POST MORTEM CARE

1. Document any auxiliary equipment.
2. Put on gloves.
3. Place the client in supine, arms at sides and head on pillow.
4. Then, position the patient in semi-fowlers position.
5. Remove all contraptions.
6. Collect all the client’s valuables to prevent loss.
7. Clean the body.
8. Cover the body up to the chin with clean sheet.
9. Offer emotional support and comfort.
10. After the family leaves, remove the towel from under the chin of the patient.
Pad the chin, and wrap chin strap under the chin and tie them loosely on top of the head.
11. Fill out identification tags.
12. Place the shroud or body wrap. Then, transfer to morgue stretcher.
13. Cover the shroud with a clean sheet.
14. Take the body to the morgue.

PROVIDING BED PAN

1. If allowed, elevate the head of the bed slightly.
2. Rest the bedpan at the edge of the bed.
3. Ask the patient to raise the buttocks and insert the bed pan.
4. If the patient can’t raise his buttocks, lower the head of the bed and help the patient roll onto one side.
5. Position the bed pan properly against the buttocks, and help the patient roll back on the bed pan.
6. Raise the head of the bed to 30 degrees.

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”
ADMINISTERING ENEMA

1. Fill the enema bag with warm water and solution.

2. Hang it on the stand.
3. Position the client in left side lying.
4. Drape the patient with the buttocks exposed.
5. Lubricate the enema nozzle.
6. Watch the bag until its empty and remove the nozzle.
INSERTING NGT

1. Explain the procedure.

2. Hand hygiene.
3. Position: high fowler’s.
4. Wear clean gloves.
5. Measure the distance to insert tube and mark it with a small piece of tape.
6. Lubricate the end of the tube with water soluble lubricating jelly.
7. Carefully insert the tube into a more patent nostril.
8. When the tube reaches nasopharynx, resistance will be felt.
9. Ask the patient to slightly lower the head then rotate the tube to 180 degrees.
10. After the tube is correctly advanced, remove the tape and mark the tube
11. Anchor the tube.
12. Check for placement.
13. Apply tape on the client’s nose.
14. Attach the NG to wall suction if applicable.
15. Remove gloves.
16. Wash hands.

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY FEEDING (PEG)

1. Explain the procedure.

2. Wash hands.
3. Provide privacy.
4. Assemble the materials.
5. Position : semi fowler’s.
6. Wear clean gloves.
7. Place a towel on the abdomen.
8. Check for placement.
Bowel sounds
Unclamp
Aspirate gastric residual (less than or equal to 100ml (return)
9. Pinch the proximal end of the feeding tube (prevents air from entering clients stomach)
10. Flush with 30ml of water.
11. Administer the feeding.
12. Flush with 60ml of water.
13. Reclamp.

“The more you express gratitude for what you have, the more things you’ll have to express gratitude for.”