Review of the Anatomy and Physiology

kyphosis

lordosis

lordosis

scoliosis

Genu varum

Genu valgum

Diagnostic Procedures1. Radiologic studies a. X-rays b. Computed tomography or CT scan Non- invasive procedure where a body part can be scanned from different angles with an x-ray beam and a computer calculates varying tissue densities and records a cross section image on paper done to determine extent of fracture in difficult to define areas

Diagnostic Proceduresc. Myelography Injection of radio opaque dye into subarachnoid space at posterior spine to determine level of disc herniation or site of tumor

Diagnostic Procedures2.

ArthrographyRadioopaque or air injected into joint cavity- outlines soft tissue structure and contour of joint

2.

Bone scanningParenteral injection of bone seeking radioactive isotope

2.

ElectromyographyGraphic presentation of the electrical potential of muscles

Diagnostic Procedures5.

Magnetic Resonance ImagingNoninvasive scanning technique that uses magnetism and radio frequency waves to produce cross-sectional images of body tissues on computer screen

5. Arthroscopy Endoscopic direct visualization of joint, especially knee

Diagnostic Procedures7.

ArthrocentesisNeedle aspiration of synovial fluid

Bone Biopsy or Muscle biopsy 8. Laboratory7.a. Uric acid b. Antinuclear antibody (ANA) for systemic Lupus Erythematosus c. Complement fixation (CF) for Rheumatoid Arthritis d. Calcium, Alkaline Phosphate, Phosphorus

arthroscopy

Musculo-Skeletal Therapeutic Modalities1. Reduction Realigning an extremity into anatomical positiona. Open- use of surgical methods b. Closed- use of non-surgical methods; manipulation

ORIF

Musculo-Skeletal Therapeutic Modalities2.

Immobilization Manual Skin- adhesive- plaster or adhesive is applied longitudinally on the lower extremities and an elastic bandage applied in an spiral motion

Musculo-Skeletal Therapeutic Modalities2. Bryants traction- indicated for children

aged 0-3 years not more than 40 lbs.1.Traction is always applied on both ends

Nursing Responsibility Nurse should be able to pass hand between the patients buttocks and mattress

Bryant traction

Knee slightly flexed

Buttocks slightly elevatated and clear of bed

Musculo-Skeletal Therapeutic ModalitiesBucks Extension Traction Indicated for older patients to those weighing over 40 lbs. Nursing Responsibility Only the affected extremity is placed on traction

Bucks Extension Traction

Musculo-Skeletal Therapeutic ModalitiesDunlop Traction Used in affectations of the upper extremities

Dunlop Traction

Nursing Care of Clients with Adhesive Traction1. Unwrap and wrap and elastic bandage at

least once a shift 2. Check skin integrity for allergic reactions to plaster 3. Note circulation, sensation and mobility of the affected extremities

Skin- non adhesive Uses canvass or cloth that is applied on the

patients skin Pelvic girdle traction

Applied like a girdle and connected to two ropes with weights that hangs at the foot part of the bed Indicated for low back pain

Head Halter Traction Applied on chin and occipital region connected to a hanger with weights that hangs at the head part of the bed Usually indicated for cervical spine affectations

Skin- non adhesive tractionCotrel Traction Combination of the head halter and pelvic traction used in scoliosis

Russell Traction Permits patient to move freely in bed and permits flexion of the knee and hip joint Bucks extension and the knee is suspended in a sling to which a rope is attached

Russell Traction

Nursing Care of Clients with nonadhesive tractionRest period are provided

Skeletal Traction Applied into a bone

Crutchfield Skeletal Traction Applied into the parietal; bonesIndicated for cervical spine affectations

Crutchfield Tong

Skeletal TractionBalanced Skeletal Traction Applied alone or with skeletal traction to promote patient mobility

Balanced Skeletal Traction

CERVICAL HALO TRACTION

BALKAN FRAME

THOMAS SPLINT WITH PEARSON ATTACHMENT

PELVIC TRACTION

PELVIC TRACTION

Principles of Care1. The patient should always be on either 2. 3. 4. 5.

supine or dorsal recumbent position There should always be an counteraction (patients weight) The line of deformity should be in line with the traction Traction should be continuous There should be no friction within the line of traction

WINDOWING A CAST

BIVALVING A CAST

FIBER GLASS CAST

b. Cast- Comparison of Cast MaterialsPlaster Synthetic Material Plastic of Paris, comprised of powdered calcium sulfate crystals impregnated into the bandages 24-48 hours Polyester and cotton, fiberglass or plastic. Polyester and cotton is impregnated with wateractivated polyurethane resin 7-15 mins of setting 15-30 mins for weight bearing

Drying time

Advantages

Less costly Less likely to indent into skin More effective for immobilizing severely Lighter in weight displaced bones Less restrictive Smooth surface Does not crumble Does not require expensive Nonabsorbent equipment for application Can be immersed in water

c. Braces Knight-taylors For thoraco-lumbar affectations Milwaukee For scoliosis

Nursing Care Use cotton clothing as barrier

d. Fixators RAEF Roger Anderson External Fixator Ilizarov device Indicated for comminuted fractures

3. Rehabilitation Active or dynamic program aimed at

enabling an ill or disabled to achieve the highest level of physical, mental, social, and economic self-sufficiency of which he is capable

Members of the Rehabilitation teama. a. a. a. a.

Patient Key member of health team Rehabilitation nurse Develops plan of patient care Physician Makes medical diagnosis; directs team Physiatrist Physician specialist in physical medicine Physical Therapist Teaches or supervises patient in prescribed exercise program

Members of the Rehabilitation teamf.

PsychologistHelps patient or family explore feelings

g. Occupational Therapist Helps develop skills for home and work situations g. Social Worker Assists patient and family adjust socio-economically g. Vocational Counselor Tests patients interest and aptitudes g. Rehabilitation Engineer Uses technology in designing or constructing devices to help the handicapped

Transfer and Assistive Devices1.

transferring a client from bed to stretcherstretcher must be perpendicular to bed

1.

transferring a client from bed to wheelchairthe wheelchair must be parallel to the head of the bed

1.

CanesHeight of cane is from floor to waist level Cane is held by opposite the affected extremity

Transfer and Assistive Devices4. Crutches Height of crutch is from floor to axilla minus 2 inches Patients weight is borne by the palm, of the hand and not on the axilla When going upstairs, unaffected leg first When going upstairs, affected leg first

Crutch-walking techniques

Two point gait (two alternate gait) Three point gait Four point gait Swinging crutch gaits Both legs are lifted off the ground simultaneously and swung forward while patient pushes up on crutches

Swing-to gait Lift and swing body up to crutches Swing-through gait Lift swing body beyond crutches

Exercisesa. Isometric Alternate contraction and relaxation of the muscle without moving the joint a. Done on the affected extremity b. Isotonic Range of motion exercises Done on the unaffected extremity

Heat or Cold Application in TraumaCold Application first 24 hours To decrease hemorrhage To relieve pain To reduce inflammation Heat Application After 24 hours To relieve pain from muscle spasms To reduce swelling by increasing circulation To promote healing by increasing oxygenation

4. Orthopedic Operative Proceduresa. Arthrotomy

Surgical opening into a joint a. Arthrodesis Fixation of a joint a. Spinal fusion Surgical removal of 1 or more vertebra and fusing them together

4. Orthopedic Operative Proceduresd. Hip replacement

Placement of prosthesis on the hip joint Indication Hip fracture Inability to move leg voluntarily Shortening and external rotation of the leg

Nursing Management on Hip ReplacementAvoid positioning on the operative site Maintain abduction of hip Pillows between legs Provide chair with firm, non-reclining seat and arms

Nursing Management on Hip ReplacementAvoid hip flexion beyond 60 degrees for 10 days Avoid hip flexion beyond 90 degrees from day 10 to 2 months Avoid adduction of the affected leg beyond midline for 2 months Partial weight bearing status for 2 months

TraumaContusion Injury to the soft tissue produced by blunt force

Sprain Injury to the ligamentous structures caused by wrenching or twisting Forcible hyperextension of a joint with tissue damage like whiplash injury

TraumaStrain Tearing of musculotendenous unit caused excessive stretching Dislocation Joint articulating surfaces are partially separated No longer in anatomical contact Fractures Break on continuity of bone

Nursing Assessment1. Pain Increasing until immobilized 1. Loss of function 2. Localized swelling or discoloration 3. Deformity 4. Crepitus Grating sound

General Classifications of Fractures1. Simple or closed Skin is intact over fracture site 1. Compound or open With an external wound in contact with the underlying fracture 1. Complete Entire cross section is displaced 1. Incomplete Portion of cross section undisplaced

General Classifications of Fractures1. Greenstick One side broken and other bent 1. Transverse Straight across the bone 1. Oblique Angle or slanting across the bone 1. Spiral Twisting or coils around shaft 1. Comminuted Splintered into several fragments

General Classifications of FracturesDepressed Fragments are drived-in; facial or skull Compression Fractured bone compressed by another bone; vertebra Impacted Fractured bones are pushed into each other (telescoped) Displaced Fragments are separated from fracture line Linear Fracture parallel with long axis

COMPARING ARTHRITIS Rheumatoid Etiology Autoimmune + Rh factor 35-45 women Osteoarthritis Degenerative senescence Men or more in women Gouty Metabolic or familial, purine metabolism Men over 40

Incidence

Signs and symptoms

Subcutaneaous nodules Heberdens nodule Morning stiffness Bouchards nodule Swan neck deformity Weight bearing joint (hips, wrist, spine) Symptomatic

Tophi

Areas affected Joints of hands Management Aspirin, NSAIDs Paraffin bath

Great toe

Colchicine Avoid purine diet Allopurinol