NurseReview.Org Musculoskeletal System

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1. Slide 1: MUSCULO-SKELETAL SYSTEM Nurse Licensure Examination Review
2. Slide 2: Review of Anatomy and Physiology  The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints  The primary function of which is to produce skeletal movements
3. Slide 3: Muscles Three types of muscles exist in the body  1. Skeletal Muscles  Voluntary and striated  2. Cardiac muscles  Involuntary and striated  3. Smooth/Visceral muscles  Involuntary and NON-striated
4. Slide 4: TENDONS  Bands of fibrous connective tissue that tie bones to muscles
5. Slide 5: LIGAMENTS  Strong, dense and flexible bands of fibrous tissue connecting bones to another bone
6. Slide 6: BONES Variously classified according to shape,  location and size  Functions 1. Locomotion 2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition
7. Slide 7: JOINTS  Thepart of the Skeleton where two or more bones are connected
8. Slide 8: CARTILAGES A dense connective tissue that consists of fibers embedded in a strong gel-like substance
9. Slide 9: BURSAE  Saccontaining fluid that are located around the joints to prevent friction
10. Slide 10: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM The nurse usually evaluates this small part of the over-all assessment and concentrates on the patient’s posture, body symmetry, gait and muscle and joint function
11. Slide 11: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM  1. HISTORY  2. Physical Examination  Perform a head to toe assessment  Nurses need to inspect and palpate  The special procedure is the assessment of joint and muscle movement  Usually, a tape measure and a protractor are the only instruments
12. Slide 12: ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEM  Gait  Posture  Muscular palpation  Joint palpation  Range of motion  Muscle strength
13. Slide 13: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES  1. 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
14. Slide 14: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES  2. Arthroscopy  A direct visualization of the joint cavity  Pre-test: consent, explanation of procedure, NPO  Intra-test: Sedative, Anesthesia, incision will be made  Post-test: maintain dressing, ambulation as soon as awake, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort
15. Slide 15: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 3. BONE SCAN  Imaging study with the use of a contrast radioactive material  Pre-test: Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated  Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning  Post-test: Increase fluid intake to flush out radioactive material
16. Slide 16: ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM LABORATORY PROCEDURES 4. DXA- Dual-energy XRAY absorptiometry  Assesses bone density to diagnose osteoporosis  Uses LOW dose radiation to measure bone density  Painless procedure, non-invasive, no special preparation  Advise to remove jewelry
17. Slide 18: Common musculoskeletal problems The Nursing Management
18. Slide 19: Nursing Management of common musculo- skeletal problems PAIN  These can be related to joint inflammation, traction, surgical intervention  1. Assess patient’s perception of pain  2. Instruct patient alternative pain management like meditation, heat and cold application, TENS and guided imagery
19. Slide 20: Nursing Management PAIN  3. Administer analgesics as prescribed  UsuallyNSAIDS  Meperidine can be given for severe pain  4.Assess the effectiveness of pain measures
20. Slide 21: Nursing Management IMPAIRED PHYSICAL MOBILITY  1. Instruct patient to perform range of motion exercises, either passive or active  2. Provide support in ambulation with assistive devices  3. Turn and change position every 2 hours  4. Encourage mobility for a short period and provide positive reinforcements for small accomplishments
21. Slide 22: Nursing Management SELF-CARE DEFICITS  1. Assess functional levels of the patient  2. Provide support for feeding problems  Place patient in Fowler’s position  Provide assistive device and supervise mealtime  Offer finger foods that can be handled by patient  Keep suction equipment ready
22. Slide 23: Nursing Management SELF-CARE DEFICITS  3. Assist patient with difficulty bathing and hygiene  Assist with bath only when patient has difficulty  Provide ample time for patient to finish activity
23. Slide 24: Musculoskeletal Modalities Traction Cast
24. Slide 25: Nursing Management Traction  A method of fracture immobilization by applying equipments to align bone fragments  Used for immobilization, bone alignment and relief of muscle spasm
25. Slide 26: Traction  Skin traction  Skeletal traction
26. Slide 27: Traction  Pulling force exerted on bones to reduce or immobilize fractures, reduce muscle spasm, correct or prevent deformities
27. Slide 30: 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
28. Slide 31: Nursing Management Traction: General principles  5. Observe and prevent foot drop  Provide foot plate  6. Observe for DVT, skin irritation and breakdown  7. Provide pin care for clients in skeletal traction- use of hydrogen peroxide
29. Slide 32: Nursing Management CAST  Immobilizing tool made of plaster of Paris or fiberglass  Provides immobilization of the fracture
30. Slide 33: Nursing Management CAST: types 2. Long arm 3. Short arm 4. Spica
31. Slide 34: Casting Materials  Plaster of Paris  Drying takes 1-3 days  If dry, it is SHINY, WHITE, hard and resistant  Fiberglass  Lightweight and dries in 20-30 minutes  Water resistant
32. Slide 35: Nursing Management CAST: General Nursing Care  1. Allow the cast to dry (usually 24-72 hours)  2. Handle a wet cast with the PALMS not the fingertips  3. Keep the casted extremity ELEVATED using a pillow  4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast
33. Slide 36: Nursing Management CAST: General Nursing Care 5. Petal the edges of the cast to prevent crumbling of the edges 6. Examine the skin for pressure areas and Regularly check the pulses and skin
34. Slide 37: Nursing Management CAST: General Nursing Care 7. Instruct the patient not to place sticks or small objects inside the cast 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses
35. Slide 38: Common Musculoskeletal conditions Nursing management
36. Slide 39: METABOLIC BONE DISORDERS Osteoporosis  A disease of the bone characterized by a decrease in the bone mass and density with a change in bone structure
37. Slide 40: METABOLIC BONE DISORDERS Osteoporosis: Pathophysiology  Normal homeostatic bone turnover is altered rate of bone RESORPTION is greater than bone FORMATION reduction in total bone mass reduction in bone mineral density prone to FRACTURE
38. Slide 41: METABOLIC BONE DISORDERS Osteoporosis: TYPES  1. Primary Osteoporosis- advanced age, post-menopausal  2. Secondary osteoporosis- Steroid overuse, Renal failure
39. Slide 42: METABOLIC BONE DISORDERS RISK factors for the development of Osteoporosis  1. Sedentary lifestyle  2. Age  3. Diet- caffeine, alcohol, low Ca and Vit D  4. Post-menopausal  5. Genetics- caucasian and asian  6. Immobility
40. Slide 43: METABOLIC DISORDER ASSESSMENT FINDINGS  1. Low stature  2. Fracture  Femur  3. Bone pain
41. Slide 44: METABOLIC DISORDER LABORATORY FINDINGS  1. DEXA-scan  Provides information about bone mineral density  T-score is at least 2.5 SD below the young adult mean value  2. X-ray studies
42. Slide 45: METABOLIC DISORDER Medical management of Osteoporosis  1. Diet therapy with calcium and Vitamin D  2. Hormone replacement therapy  3. Biphosphonates- Alendronate, risedronate produce increased bone mass by inhibiting the OSTEOCLAST  4. Moderate weight bearing exercises  5. Management of fractures
43. Slide 46: METABOLIC DISORDER Osteoporosis Nursing Interventions 1. Promote understanding of osteoporosis and the treatment regimen  Provide adequate dietary supplement of calcium and vitamin D  Instruct to employ a regular program of moderate exercises and physical activity  Manage the constipating side-effect of calcium supplements
44. Slide 47: METABOLIC DISORDER Osteoporosis Nursing Interventions  Take calcium supplements with meals  Take alendronate with an EMPTY stomach with water  Instruct on intake of Hormonal replacement
45. Slide 48: METABOLIC DISORDER Osteoporosis Nursing Interventions 2. Relieve the pain  Instruct the patient to rest on a firm mattress  Suggest that knee flexion will cause relaxation of back muscles  Heat application may provide comfort  Encourage good posture and body mechanics  Instruct to avoid twisting and heavy lifting
46. Slide 49: METABOLIC DISORDER Osteoporosis Nursing Interventions  3. Improve bowel elimination  Constipation is a problem of calcium supplements and immobility  Advise intake of HIGH fiber diet and increased fluids
47. Slide 50: METABOLIC DISORDER Osteoporosis Nursing Interventions  4. Prevent injury  Instruct to use isometric exercise to strengthen the trunk muscles  AVOID sudden jarring, bending and strenuous lifting  Provide a safe environment
48. Slide 51: Juvenile rheumatoid Arthritis  Definition:  AUTO-IMMUNE inflammatory joint disorder of UNKNOWN cause  SYSTEMIC chronic disorder of connective tissue  Diagnosed BEFORE age 16 years old
49. Slide 52: Juvenile rheumatoid Arthritis  PATHOPHYSIOLOGY : unknown  Affected by stress, climate and genetics  Common in girls 2-5 and 9-12 y.o.
50. Slide 53: Juvenile rheumatoid Arthritis Systemic JRA Pauci-articular Polyarticular FEVER MILD joint pain Morning joint and swelling stiffness and fever IRIDOCYCLITIS Salmon-pink Weight rash Bearing joints Five or more Less than 4 Five or more joints joints joints Anorexia, Very Good Poor prognosis anemia, fatigue prognosis
51. Slide 54: JRA  Symptoms may decrease as child enters adulthood  With periods of remissions and exacerbations
52. Slide 55: JRA Medical Management 2. ASPIRIN and NSAIDs- mainstay treatment 3. Slow-acting anti-rheumatic drugs 4. Corticosteroids
53. Slide 56: JRA Nursing Management 2. Encourage normal performance of daily activities 3. Assist child in ROM exercises 4. Administer medications 5. Encourage social and emotional development
54. Slide 57: JRA Nursing Management During acute attack:  SPLINT the joints  NEUTRAL positioning  Warm or cold packs
55. Slide 58: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS  The most common form of degenerative joint disorder
56. Slide 59: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS  Chronic, NON-systemic disorder of joints
57. Slide 60: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Pathophysiology  Injury, genetic, Previous joint damage, Obesity, Advanced age  Stimulate the chondrocytes to release chemicals chemicals will cause cartilage degeneration, reactive inflammation of the synovial lining and bone stiffening
58. Slide 61: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Risk factors  1. Increased age  2. Obesity  3. Repetitive use of joints with previous joint damage  4. Anatomical deformity  5. genetic susceptibility
59. Slide 62: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings  1. Joint pain  2. Joint stiffness  3. Functional joint impairment limitation  The joint involvement is ASYMMETRICAL  This is not systemic, there is no FEVER, no severe swelling  Atrophy of unused muscles  Usual joint are the WEIGHT bearing joints
60. Slide 63: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 1. Joint pain  Caused by  Inflamed synovium  Stretching of the joint capsule  Irritation of nerve endings
61. Slide 64: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Assessment findings 2. Stiffness  commonly occurs in the morning after awakening  Lasts only for less than 30 minutes  DECREASES with movement  Crepitation may be elicited
62. Slide 65: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Diagnostic findings 1. X-ray  Narrowing of joint space  Loss of cartilage  Osteophytes 2. Blood tests will show no evidence of systemic inflammation and are not useful
63. Slide 66: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Medical management  1. Weight reduction  2. Use of splinting devices to support joints  3. Occupational and physical therapy  4. Pharmacologic management  Use of PARACETAMOL, NSAIDS  Use of Glucosamine and chondroitin  Topical analgesics  Intra-articular steroids to decrease inflam
64. Slide 67: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions  1. Provide relief of PAIN  Administer prescribed analgesics  Application of heat modalities. ICE PACKS may be used in the early acute stage!!!  Plan daily activities when pain is less severe  Pain meds before exercising
65. Slide 68: DEGENERATIVE JOINT DISEASE OSTEOARTHRITIS: Nursing Interventions  2. Advise patient to reduce weight  Aerobic exercise  Walking  3. Administer prescribed medications  NSAIDS
66. Slide 69: Rheumatoid arthritis A type of chronic systemic inflammatory arthritis and connective tissue disorder affecting more women (ages 35-45) than men
67. Slide 70: Rheumatoid arthritis FACTORS: Genetic Auto-immune connective tissue disorders Fatigue, emotional stress, cold, infection
68. Slide 71: Rheumatoid arthritis Pathophysiology  Immune reaction in the synovium  attracts neutrophils  releases enzymes  breakdown of collagen  irritates the synovial liningcausing synovial inflammation edema and pannus formation and joint erosions and swelling
69. Slide 72: Rheumatoid arthritis ASSESSMENT FINDINGS  1. PAIN  2. Joint swelling and stiffness- SYMMETRICAL, Bilateral  3. Warmth, erythema and lack of function  4. Fever, weight loss, anemia, fatigue  5. Palpation of join reveals spongy tissue  6. Hesitancy in joint movement
70. Slide 73: Rheumatoid arthritis ASSESSMENT FINDINGS  Joint involvement is SYMMETRICAL and BILATERAL  Characteristically beginning in the hands, wrist and feet  Joint STIFFNESS occurs early morning, lasts MORE than 30 minutes, not relieved by movement, diminishes as the day progresses
71. Slide 74: Rheumatoid arthritis ASSESSMENT FINDINGS  Joints are swollen and warm  Painful when moved  Deformities are common in the hands and feet causing misalignment  Rheumatoid nodules may be found in the subcutaneous tissues
72. Slide 75: Rheumatoid arthritis Diagnostic test  1. X-ray  Shows bony erosion  2. Blood studies reveal (+) rheumatoid factor, elevated ESR and CRP and ANTI-nuclear antibody  3. Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow containing numerous WBC and inflammatory proteins
73. Slide 76: Rheumatoid arthritis MEDICAL MANAGEMENT  1. Therapeutic dose of NSAIDS and Aspirin to reduce inflammation  2. Chemotherapy with methotrexate, antimalarials, gold therapy and steroid  3. For advanced cases- arthroplasty, synovectomy  4. Nutritional therapy
74. Slide 77: Rheumatoid arthritis MEDICAL MANAGEMENT GOLD THERAPY:  IM or Oral preparation  Takes several months (3-6) before effects can be seen  Can damage the kidney and causes bone marrow depression
75. Slide 78: Rheumatoid arthritis Nursing MANAGEMENT 1. Relieve pain and discomfort  USE splints to immobilize the affected extremity during acute stage of the disease and inflammation to REDUCE DEFORMITY  Administer prescribed medications  Suggest application of COLD packs during the acute phase of pain, then HEAT application as the inflammation subsides
76. Slide 79: Rheumatoid arthritis Nursing MANAGEMENT 2. Decrease patient fatigue Schedule activity when pain is less severe Provide adequate periods of rests 3. Promote restorative sleep
77. Slide 80: Rheumatoid arthritis Nursing Management 4. Increase patient mobility  Advise proper posture and body mechanics  Support joint in functional position  Advise ACTIVE ROME
78. Slide 81: Rheumatoid arthritis Nursing Management 5. Provide Diet therapy  Patients experience anorexia, nausea and weight loss  Regular diet with caloric restrictions because steroids may increase appetite  Supplements of vitamins, iron and PROTEIN
79. Slide 82: Rheumatoid arthritis 6. Increase Mobility and prevent deformity:  Lie FLAT on a firm mattress  Lie PRONE several times to prevent HIP FLEXION contracture  Use one pillow under the head because of risk of dorsal kyphosis  NO Pillow under the joints because this promotes flexion contractures
80. Slide 83: Hot versus Cold HOT Cold Use to RELIEVE joint Use to control stiffness, pain and inflammation and pain muscle spasm After acute attack ACUTE ATTACK
81. Slide 84: Gouty arthritis A systemic disease caused by deposition of uric acid crystals in the joint and body tissues  CAUSES:  1. Primary gout- disorder of Purine metabolism  2. Secondary gout- excessive uric acid in the blood like leukemia
82. Slide 87: Gouty arthritis  ASSESSMENT FINDINGS  1. Severe pain in the involved joints, initially the big toe  2. Swelling and inflammation of the joint  3. TOPHI- yellowish-whitish, irregular deposits in the skin that break open and reveal a gritty appearance  4. PODAGRA
83. Slide 88: Gouty arthritis ASSESSMENT FINDINGS  5. Fever, malaise  6. Body weakness and headache  7. Renal stones
84. Slide 89: Gouty arthritis DIAGNOSTIC TEST  Elevated levels of uric acid in the blood  Uric acid stones in the kidney
85. Slide 90: Gouty arthritis  Medical management  1. Allupurinol- take it WITH FOOD Rash signifies allergic reaction   2. Colchicine For acute attack 
86. Slide 91: Gouty arthritis Nursing Intervention 1. Provide a diet with LOW purine  Avoid Organ meats, aged and processed foods  STRICT dietary restriction is NOT necessary 2. Encourage an increased fluid intake (2- 3L/day) to prevent stone formation 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
87. Slide 92: Gouty arthritis Nursing Intervention 6. Position the affected extremity in mild flexion 7. Administer anti-gout medication and analgesics
88. Slide 93: Fracture A break in the continuity of the bone and is defined according to its type and extent
89. Slide 94: Fracture mechanical Stress to bone   Severe bone fracture  Direct Blows  Crushing forces  Sudden twisting motion  Extreme muscle contraction
90. Slide 95: 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
91. Slide 97: 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
92. Slide 99: Fracture TYPES OF FRACTURE  1. Comminuted fracture A fracture that involves production of several bone fragments  2. Simple fracture A fracture that involves break of bone into two parts or one
93. Slide 100: Fracture ASSESSMENT FINDINGS  1. Pain or tenderness over the involved area  2. Loss of function  3. Deformity  4. Shortening  5. Crepitus  6. Swelling and discoloration
94. Slide 101: Fracture ASSESSMENT FINDINGS 1. Pain  Continuous and increases in severity  Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone
95. Slide 102: Fracture ASSESSMENT FINDINGS 2. Loss of function  Abnormal movement and pain can result to this manifestation
96. Slide 103: Fracture ASSESSMENT FINDINGS 3. Deformity  Displacement, angulations or rotation of the fragments Causes deformity
97. Slide 104: Fracture ASSESSMENT FINDINGS 4. Crepitus  A grating sensation produced when the bone fragments rub each other
98. Slide 105: Fracture  DIAGNOSTIC TEST  X-ray
99. Slide 106: Fracture EMERGENCY MANAGEMENT OF FRACTURE  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
100. Slide 107: Fracture EMERGENCY MANAGEMENT OF FRACTURE  5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination  6. DO NOT attempt to reduce the facture
101. Slide 108: Fracture MEDICAL MANAGEMENT  1. Reduction of fracture either open or closed, Immobilization and Restoration of function  2. Antibiotics, Muscle relaxants and Pain medications
102. Slide 109: Fracture General Nursing MANAGEMENT  For CLOSED FRACTURE  1. Assist in reduction and immobilization  2. Administer pain medication and muscle relaxants  3. teach patient to care for the cast  4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain
103. Slide 110: Fracture General Nursing MANAGEMENT  For OPEN FRACTURE  1. Prevent wound and bone infection  Administer prescribed antibiotics  Administer tetanus prophylaxis  Assist in serial wound debridement  2. Elevate the extremity to prevent edema formation  3. Administer care of traction and cast
104. Slide 111: Fracture  FRACTURE COMPLICATIONS  Early  1. Shock  2. Fat embolism  3. Compartment syndrome  4. Infection  5. DVT
105. Slide 112: Fracture  FRACTURE COMPLICATIONS  Late  1. Delayed union  2. Avascular necrosis  3. Delayed reaction to fixation devices  4. Complex regional syndrome
106. Slide 113: Fracture  FRACTURE COMPLICATIONS: Fat Embolism  Occurs usually in fractures of the long bones  Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure  Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs
107. Slide 114: Fracture  FRACTURE COMPLICATIONS: Fat Embolism  Onset is rapid, within 24-72 hours  ASSESSMENT FINDINGS  1. Sudden dyspnea and respiratory distress  2. tachycardia  3. Chest pain  4. Crackles, wheezes and cough  5. Petechial rashes over the chest, axilla and hard palate
108. Slide 115: Fracture  FRACTURE COMPLICATIONS: Fat Embolism  Nursing Management  1. Support the respiratory function  Respiratory failure is the most common cause of death  Administer O2 in high concentration  Prepare for possible intubation and ventilator support
109. Slide 116: Fracture  FRACTURE COMPLICATIONS: Fat Embolism  Nursing Management  2. Administer drugs  Corticosteroids  Dopamine  Morphine
110. Slide 117: Fracture FRACTURE COMPLICATIONS: Fat Embolism   Nursing Management  3. Institute preventive measures  Immediate immobilization of fracture  Minimal fracture manipulation  Adequate support for fractured bone during turning and positioning  Maintain adequate hydration and electrolyte balance
111. Slide 118: Fracture  Early complication: Compartment syndrome  A complication that develops when tissue perfusion in the muscles is less than required for tissue viability
112. Slide 119: Fracture  Early complication: Compartment syndrome  ASSESSMENT FINDINGS  1. Pain- Deep, throbbing and UNRELIEVED pain by opiods  Pain is due to reduction in the size of the muscle compartment by tight cast  Pain is due to increased mass in the compartment by edema, swelling or hemorrhage
113. Slide 120: Fracture  Early complication: Compartment syndrome  ASSESSMENT FINDINGS  2. Paresthesia- burning or tingling sensation  3. Numbness  4. Motor weakness  5. Pulselessness, impaired capillary refill time and cyanotic skin
114. Slide 121: Fracture  Early complication: Compartment syndrome  Medical and Nursing management  1. Assess frequently the neurovascular status of the casted extremity  2. Elevate the extremity above the level of the heart  3. Assist in cast removal and FASCIOTOMY
115. Slide 122: Strains Excessive stretching of a muscle or  tendon  Nursing management  1. Immobilize affected part  2. Apply cold packs initially, then heat packs  3. Limit joint activity  4. Administer NSAIDs and muscle relaxants
116. Slide 123: 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