7.

ASSESS
2
TRACTION - use of a pulling force to treat muscle
and skeleton disorders.

TYPES
1. MANUAL – the hand directly applies the pulling
force
2. SKIN – applied through the skin
3. SKELETAL – through pins or wired inserted to
the
bones

COMPARTMENT SYNDROME
• CAUSE/S
FRACTURES • MANIFESTATIONS
TYPES
a. Simple (close) - a fracture where the bone is broken, but MANAGEMENT
he skin is intact. 1. BIVALVE
2. FASCIOTOMY
b. Compound (open)
- a fracture where the broken bone is exposed. That is
dangerous because of increased chances of infection. OSTEOMYELITIS
• CAUSE
For open fractures, cover with gauze, then immobilize • MANIFESTATIONS

CAUSES MANAGEMENT
COMMON KINDS 1. Antibiotics
A. Complete 2. Pain relief
PRINCIPLES: 3. Debridement
- A fracture in which bone fragments separate completely.

B. Incomplete OSTEOPOROSIS: RISK FACTORS

- A fracture in which the bone fragments are still partially • AGE >60
joined. • LOW BODY WEIGHT
• RACE E.G. CAUCASIANS, ASIANS
1. Spiral fracture • SEDENTARY
- A fracture where at least one part of the bone has been • LOW DIETARY CALCIUM
twisted. • SMOKING, ROH
• DECREASED ESTROGEN LEVELS
2. Comminuted fracture
- A fracture in which the bone has broken into a number of OSTEOPOROSIS
• Splint them where they lie.
pieces.
• Splint from above and below the joints of MANIFESTATIONS
fractured part. 1. LOW BACK PAIN
3. Transverse fracture 2. DOWAGER’S HUMP
- A fracture that is at a right angle to the bone's long axis. CASTS 3. FRACTURES
4. DECREASED HEIGHT
4. Greenstick TYPES
- A fracture in which one side of a bone is broken while the a. Plaster – plaster of paris MANAGEMENT
other is bent b. Nonplaster 1. EXERCISES/safety
2. DIET - Ca, fiber, protein, vit D
MANAGEMENT MANAGEMENT 3. AVOID ROH and CAFFEINE
1. SPLINT 1. DRY 4. MEDICATIONS
REDUCTION 2. HANDLING
2. IMMOBILIZATION 3. POSITION • Biphosphonates
3. REHABILITATION 4. DRAINAGE/STAIN - alendronate (Fosamax)
5. PETAL
6. PRURITUS • Calcitonin
 • Calcium supplements • mobility • Keep a pillow between your legs while in bed.
• Muscle relaxants • Your hips should not be lower than your knees.
• NSAIDS Put firm pillows on any low chairs to build up the
• Estrogen receptor modules (SERMS) e.g. height.
Evista • When coming up to stand, push up from non-
operated leg side of the chair.
GOUTY ARTHRITIS/GOUT DJD – Degenerative Joint Disease (Osteoporosis)
• Serum uric acid - <7mg/dL RISK FACTORS
• Purine metabolism • Adults, obesity DO NOT…
• Big toe is swelling • Weight-bearing joints • Cross your legs
st • Sit on low chair……
1 metatarsal-phalangeal joint
• HEBERDEN’S NODULES • Spin or twist on the affected/ operated leg
- are hard or bony swellings that can develop in • Put on your own your shoes, stockings, socks …..
the distal interphalangeal joints formed by calcific spurs
use of your long handled shoehorn
of the articular cartilage and associated with
osteoarthritis • Pick up any object off the floor…use your reacher

• BOUCHARD’S NODULES Ambulation assistive devices

• Anti-gout - allopurinol • Crutches
- are hard, bony outgrowths or gelatinous cysts on
• Uricosuric agent - probenecid the proximal interphalangeal joints. They are a sign
• Canes
• walkers
of osteoarthritis, and are caused by formation
Rheumatoid arthritis of calcific spurs of the articular (joint) cartilage.
- Autoimmune; genetic predisposition
- Synovitis – pannus formation – tissue ankylosis – bony ankylosis Hip fractures
- Females > males SIGNS AND SYMPTOMS disalignment
- Small to medium joints/ symmetrical (small fingers) o shortening
- Remissions and exacerbations o pain upon leg movement
o hip and groin pain
Medications
1. antiarthritics e.g. Infliximab(Remicade) DIAGNOSIS: Hip xray
2. Antibiotics
MANAGEMENT
3. Cytotoxic e.q. methotrexate 1. Preop
4. Disease modifying antirrheumatic meds
(DMARDs) e.g. hydroxichloroquine (plaquenil) a. Buck’s traction
5. Gold salts e.g. myochrysine - the most common type of Straight traction
6. NSAIDS - the lower portion of the injured extremity is placed in
a cradle-like sleeve
NURSING RESPONSIBILITIES - this sleeve is harnessed to itself and a weight is hung
• Heat and cold applications from the bottom of the traction frame. It is a form of
• Range of motion exercises skin traction
• Isometric exercises
b. Medications
Acute RA
1. Immobilize SURGERY
2. Moist cold application for no more than 30 • Internal fixation
minutes • Prosthetic joint placement
3. Start ROM, if there is less pain
Move joints within point of pain 2. Post op:
• Flat on bed with hip abducted
• Turn to unaffected side
Chronic RA
• Assess for bleeding and shock
• Morning stiffness
• Ambulate early..no weight bearing
• Hot compress/hot water immersion
• rehabilitation
• Then, start ROM to prevent ankylosis and to
promote
 • *As Ca increases, perm and the ability of • ADRENAL STEROIDS
potassium to diffuse out and sodium to diffuse • ROLE OF THE SKIN
into the cell decrease; impulse transmission and • ASSESSMENT OF HYDRATION
muscle contraction decrease • BEHAVIOR – conscious, alert
• Stimulate depo and contraction *dehydrated – anxious, agitated, exhausted, tearful
• CALCIUM *overhydrated – apprehensive if resp affected
• Influences cell adhesion and helps to maintain IC • POSTURE – norma;
connections *dehy – slumped, weak
• Needed for release of ACETYLCHOLINE, *overhy – comfortable sitting than recumbent
secretion of glands, bone formation, blood • HYDRATION ASSESSMNET
coagulation • SKIN – smooth, firm, pink-tinged
FLUID AND ELECTROLYTE DYNAMICS • MAGNESIUM *dehy- dry, shrunken, wrinkled, pallor or gray
WATER DISTRIBUTION • Participates in the metabolic activities of the cells *overhy- red, glistening over edematous area
ADULT BODY – approx 45-60 % by taking part in the activation of variety of • HYDRATION ASSESSMENT
VARIABLE FACTORS: enzyme systems • FACE – bright, alert
– FAT • Has inhibitory effect on skeletal muscle similar to *dehy – apathetic, expressionless, cheek and eye socket sunken
– GENDER that of Ca *overhy – edema between eyelids
– AGE • PHOSPHATE • BODY – NORMAL
• Makes replication of cell possible; for growth *dehy – loose skin at skin folds
FLUID DISTRIBUTION • Necessary to maintain ATP level thus, energy *overhy – edema – visible, dependent
• EXTRACELLULAR (ecf) – 45% levels • HYDRATION ASSESSMENT
• INTRACELLULAR (icf) – 55% • Bone metabolism • WEIGHT - normal
• ECF • WATER GAIN *dehy –
• IVF • FROM EXTERNAL ENVIRONMENT *overhy –
• ISF – Ingestion (1600 ml) • TEMPERATURE – normal
• TCF – THE PRODUCT OF DIFFUSION AND – From food (800 ml) *Elevated if hypertonic dehydration /Decreased if hypotonic
SECRETION FROM THE CELLS – Oxidation of foodstuff and body dehydration
– E.g. CSF, AQUEOUS HUMOR, tissues • HYDRATION ASSESSMENT
SALIVA, PANCREATIC JUICES, – Tube feedings • PULSE – NORMAL
BILE, INTESTINAL JUICES, – Parenteral fluids • RESPIRATION – NORMAL
THYROID SECRETION, SEMEN • FLUID LOSS • BLOOD PRESSURE - NORMAL
• ELECTROLYTES • URINE (1400ml) **obligatory loss (400-600 ml) *dehydration – pulse increased, resp increased, BP decreased
• Active chemicals that constantly break down and • INSENSIBLE – evap of exp air(350), skin *overhydration – pulse – slightly increased, bounding; resp – may
combines in water diffusion (350), feces (200) be increased with DOE; BP – may be increased
• CATIONS – Na, K, Ca, Mg • TOTAL OBLIGATORY LOSS (1300 – 1500) • FLUID IMBALANCES
• ANIONS – Cl, HCO3, PO4, S04, organic acids REGARDLESS OF INTAKE • TONICITY
• FUNCTIONS OF ELECTROLYTES • SWEATING 100 ml – ISOTONIC EXCESS
• VITAL ROLE IN WATER DISTRIBUTION by • AVERAGE 24HR I and O – ISOTONIC DEFICIT
determining the OSMOTIC PRESSURE of • 2400 ml – HYPERTONIC SYNDROME
various fluids • Output is roughly equal to fluid intake if balance – HYPOTONIC SYNDROME
• TRANSMISSION OF IMPULSES – nerve cells is to be maintained – ISOTONIC DEPLETION
carry impulses, muscle cells move, and gland cells • BASIC PRINCIPLES OF MOVEMENT • ECF DEPLETION
secrete e.g. Na-K pump • OSMOSIS • GI losses, hemorrhage, NGT suctioning, repeated
• ACID-BASE BALANCE • DIFFUSION enemas
• SODIUM • ACTIVE TRANSPORT • WEIGHT LOSS (most sen ind); weakness,
• maintains tonicity(conc of substance dissolved in • FILTRATION lethargy, IS depletion – poor skin turgor, dry skin,
water) of the ECF and therefore, water movement • PINOCYTOSIS dry and sticky mm
between compartment • FLOW • Low BP, High pulse, oliguria, shock
– Affects neuromuscular and myocardial • HYDROSTATIC PRESSURE • ISOTONIC EXCESS
impulse transmission • COLLOID OSMOTIC PRESSURE • Gain of isotonic fluids IVF and ISF
• POTASSIUM • ROLE OF KIDNEY • Excessive intake of electrolyte solution
• PRIMARY ICF CATION • HORMONAL INFLUENCES ON F and E • Too rapid infusion of NSS
• MAINTAINS TONICITY OF ICF BALANCE • Compromised renal function
• Affects IMPULSE TRANSMISSION IN • ADH • Insufficient excretion of fluid and electrolytes e.g.
SKELETAL muscle AND MYOCARCIUM • ALDOSTERONE CHF, renal failure, increased aldosterone, cerebral
• CALCIUM • PTH damage, cortisone therapy
• CONTROLS cell membrane permeability by • THYROCALCITONIN • DEFECTS
lining the pores of the cell esp skeletal muscle • GROWTH HORMONE
• INTAKE – LACK of SODIUM; excess water
intake
• OUTPUT – exce loss of NA with water
• ALDOSTERONE – hypoaldosteronism
• ADH - SIADH
• HYPOTONIC SYNDROME
• HYPONATREMIA resulting from –
– Loss of sodium in excess of
water(hypertonic loss)
– Gain of water in excess of sodium
(hypotonic gain
• HYPOTONIC SYNDROME
• CELLS are bathed in a less concentrated fluid
than ICF..water is drawn to the cell…
swells**water intoxication/icf volume excess
• Cell function disrupted
• s/s confusion, lethargy, headache, anorexia, n and
v, abdo cramps, diarrhea, gen weakness..if severe,
coma
• s/s develop when serum sodium falls below 125
mEq/L
• HYPOTONIC SYNDROME
• INTAKE – inadeq sodium ingestion, excessive
water intake (infusion of elec-free sol, near-
drowning fresh water)
• OUTPUT – exc loss of sodium with water – NGT
irrigation with plain water, wasting diseases and
burns, renal loss thru inability to conserve
sodium/diuresis
• HYPOTONIC SYNDROME
• ALDOSTERONE – inadequate aldosterone effect
e.g. adrenal cortical insufficiency
• ADH – excessive effect
• HYPERTONIC SYNDROME
• Hypernatremia due to loss of water in excess of
sodium (hypotonic loss) or a gain of sodium in
excess of water (hypertonic gain)
• HYPERTONIC SYNDROME
• THE cell is surrounded by a solution that is more
concentrated than the fluid the cell
• The increase in ECF osmotic pressure PULLS
WATER OUT of the cells…SHRINKS/crenation
• HYPERTONIC SYNDROME
• S/S extreme thirst, confused, stuporous, comatose
• Skin and mm dry, erythematous
• Tissue turgor fairly normal unless ECF is greatly
decreased
• Hyperpnea, hypotension, tachycardia, elev temp,
oliguria with osmotic diuresis
• POTASSIUM
• DEPRESSES myocardium and stabilizes the
normal polarized cardiac cell
• LOW K - increases myocardial irritability or
instability which may precipitate AUTOMATIC
FIRING OF CELLS - thus cardiac arrhythmia
• Weak, irregular pulse, increases digitalis toxicity
• Hypokalemia: causes
• Inade intake
• Abn loss via kidney e.g. k-wasting diuretics, • HYPERMAGNESEMIA
tubular wastage in chronic renal disease • > 3 meq/L – increased intake – Mg-based
• Abn loss via GIT – diarrhea, ngt suction, vomiting antacids, cathartics
• Alkalosis • Inability to excrete Mg- renal insufficiency
• Hyperaldosteronism, Cushing • Profound depression of myocardium, peripheral
• Leakage of ICF >tissue trauma, drainage neuromuscular function, CNS depression
• HYPOKALEMIA S/S
• Anorexia, nausea, decreased intes motility,
neuromusc weakness (starts in legs), resp
weakness, post hypotension
• HYPERKALEMIA
• High-K intake
• Inability to excrete K via normal route
• ACIDOSIS
• Hypoaldosteronism
• Release of IC K e.g. rapid massive use of protein
• Hyperkalemia: effects
• Increased myocardial depression
• Disrupted conduction of skeletal muscle,
flaccidity, weakness, cramping
• HYPOCALCEMIA
• Inadequate intake
• Increased Ca loss via kidney (chronic renal
insuff), decreased absorption GIT (diarrhea,
malabsorption syndrome, inad Vit D)
• Decreased PTH
• Metabolic alkalosis – poor ionization in alkalotic
medium/shift of ionized Ca to bound Ca
• HYPOCALCEMIA
• <4.8 Meq/L
• Paresthesia, spasm of skeletal and smooth muscle
(nervous system more excitable, discharge
spontaneously)
• TETANY –
• HYPERCALCEMIA
• > 5.2 meq/L – excessive intake –
• Increased GI absorption – exc Vit D intake
• Inc Ca release from bone – immobility, metastatic
bone disease, increased PTH
• Acidosis – shift of bound Ca to ionized Ca
• S/S HYPERCALCEMIA
• NORMAL – Ca allows sodium to enter the cell
enhancing depolarization
• EXCESS – gate is BLOCKED --decreased
permeability..sedative or depressant effect on
central and peripheral nervous systems, =tire
easily, lethargy, weakness, hypotonia, depressed
or absent DTR, headache
• Stimulates heart increasing contractility .
.arrhythmias
• GI s/s – anorexia, nausea and vomiting,
constipation because of dehydration and
hypotonia, abdominal bloating, decreased BS
• Psychiatric s/s
• HYPOMAGNESEMIA
• <1.5 meq/L – decreased ingestion (chronic
alcoholism, fasting, failure to absorb)
• Increased loss – renal damage, hemodialysis