MUSCULOSKELETAL

PROBLEMS

Outline

Biology of bones
Fracture
Spinal injury & nursing care
Joints

Biology of bones

Fracture
Break of the bone
Types:
Closed (simple):
bone does not
penetrate the skin
Open
(Compound): bone
penetrate the skin

May be
complicated with
soft tissue injuries

Fracture healing

Management of fractures
CONSERVATIVE

SURGICAL FIXATION

Casts

Internal / External
fixation

Care of fractures
Traction, reduction
Immobilization
At least 6 to 8 weeks

Wound care
Physiotherapy
Partial weight bearing
gradually to full weight
bearing
Regaining range of motion
Muscle strengthening

SPINAL INJURY
&
NURSING CARE

Anatomy
5 sections

Cervical (7)
Thoracic (12)
Lumbar (5)
Sacral (5)
Coccyx (1)

Anatomy of the Spine

Functions
Spine
Protection
Motion

Function of spinal
cord: part of
central nervous
system
Motor
Sensory
Autonomic

Spine Injury
Bone : fracture,
spondylolisthesis (slipped)
Soft tissue : ligament
sprain, muscle strain,
disc problems

Spine injury
Spinal cord: complete/ incomplete
contusion/ compression/ severed
Infections / tumour/ neuron disease/
cord syndromes etc

Complications
Late
Autonomic dysreflexia ( T6 lesions)
Infection : skin, bladder, lungs
Decubitus ulcer
Malnutrition & dehydration
Deep vein thrombosis
GI : constipation, cholecystitis,
cholelisthiasis
Contractures, spasticity

Nursing Care
Major objectives
Prevent secondary complications
Facilitate maximal functional recovery
Support for patient & family
Educate patient & family in all aspects
of the care needed to maintain his/her
wellbeing

Nursing care in convalescence

home
Posturing
Support injured spine
Maintain limbs & joints in functional
position
Avoid deformity & contractures
Reducing incidence of spasticity

Relieve pressure

Posturing
How ?
Many ways need
to suit patient &
availability and skill
of nursing staf
Bed
Pillows
Balloons / gloves
filled with water

Lifts and Turns

Straight lifting
For transferring & lifting patient to the
side of the bed for nursing care

Lifts and Turns

Log roll
For carrying out nursing care
For lateral positioning

Pelvic twist
Suitable for
tetraplegic
Must NOT be
used in
thoracolumbar
lesions

Posturing
Important note!
In all lifts and turns, the person holding
the head is in charge of the timing and
coordination
Frequency of turns determined by
patients tolerance
Initially 2 to 3 hourly
With increasing intervals as long as no
markings

Care of the limbs

Legs
i. supine
Avoid hyperextension of the knees
Keep feet in line with the hips
Hold foot at 90o using foot boards/ pillows
Avoid pressure on the heels

ii. Side
-

Lower leg should be extended

Upper leg slightly flexed
-

Lying on pillow & not over the lower leg

Care of the limbs

Arms
Supine
joints need to be placed in full range of
positions
Hands & arms must always be supported

Side
Both arms positioned forward, supported on
pillows
Underlying shoulder protected from pressure
by gently pulled forward/ axillary pillow

Skin and Pressure

Examine & relieve pressure regularly
Skin inspection daily
Aware of hazards of sensory loss

Keep clean bath, fingernails, toe

nails, hair
Avoid damage
Conscious of pressure
Risk higher in times of physical/ emotional
stress, depression, tiredness & intercurrentr
illnesses

Treat minor abrasions/ injuries

Skin and Pressure

Braden scale : predicting pressure
sore risk
Sensory perception
Moisture
Activity
Mobility
Nutrition
Friction & shear

Bladder management
Prevent urinary tract infection
Managing fluid balance
Patient education how to care for
bladder

Bladder management fluid

management
Intermittent
catheterization
(CIC)
Aim: output <
500 mls/6
hours
If volume >
600 mls/6
hours reduce
intake or
perform more
frequent
catheterization

Bladder management fluid

management
Suprapubic
catheterization (SPC)
Aim: output of 3 L/day
To maintain capacity, clamp
catheter daily to achieve a
volume of 300 mls

Indwelling catheter (CBD)

Aim: output of 3 L/day
To maintain capacity, clamp
catheter daily to achieve a
volume of 300 mls

Bowel care
Upper motor neuron lesion
Reflex emptying after suppositories or
digital stimulation
May not need laxatives if diet appropriate

Lower motor neuron lesion

Flaccid
Manual evacuation & laxatives usually
required but may be able to empty using
abdominal muscles
Suppositories inefective

JOINTS
Formed when
two ends of a
bone come
together
Holds the bones
together and
allow movement

Types of joint

Arthritis
Means joint inflammation
Refers to more than 100 rheumatic
diseases and other conditions that
can cause pain, stiffness and
swelling in the joints
Can afect any type of joints, but
most commonly afect synovial joints