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Applied Clinical Veterinary Nursing > Orthopaedic Patients > Flashcards

Orthopaedic Patients Flashcards

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1
Q

What history do we need to take about a possible orthopaedic patient?

A

Duration of lameness
Onset - acute/gradual? Any obvious triggers?
Progression - static? Deteriorating/improving?
Continuous / intermittent?
Effect of exercise/rest
Effect of ground surface e.g. grass vs concrete?
Which limb(s)?
Occupation?
Concurrent problems?

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2
Q

What can we observe about the stance of orthopaedic patients and what do these indicate?

A

Asymmetry - paw taking most weight is flatter/harder to lift up when standing
Kyphosis - shifting weight from pelvic to thoracic limbs
Scoliosis - shifting weight to one side
Frequent sitting - pelvic limb lameness
Frequent lying down - thoracic limb lameness
Angular limb deformities

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3
Q

What can we evaluate about a patient’s gait?

A

Stride length
Head nodding
Scuffing of nails
Ataxia, paraparesis, paraplegia (signs of neurological disease!)
Circumduction with stifle pain
Lateral sway/bunny hopping with hip pain
Head bobbing (sink to the sound side!) with thoracic limb lameness

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4
Q

What can we palpate when standing during an orthopaedic examination?

A

Asymmetry
Swelling
Muscle atrophy
Joint enlargement
Abnormal conformation

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5
Q

What can we examine when in lateral recumbency during an orthopaedic exam?

A

Joints - SPIRM (swelling/joint effusion, pain, instability, range of motion, manipulation)
Limbs - SAP (swelling, muscle atrophy, pain)

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6
Q

What tests can we perform to test the integrity of the cranial cruciate ligament?

A

Cranial draw test
Tibial compression test (tibial thrust)

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7
Q

How can we test for hip laxity/dysplasia?

A

Ortolani test

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8
Q

What further diagnostics can we perform once we have localised lameness?

A

Imaging - radiography, ultrasounds, CT/MRI
EMG
Arthrocentesis

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9
Q

What are the indications for arthrocentesis?

A

Persistent/cyclical fever
Lameness localised to a joint

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10
Q

How do we prepare for arthrocentesis?

A

Patient anaesthetised/sedated in lateral recumbency
Strict aseptic prep
Equipment - sterile hypodermic and spinal needles, 2.5-5ml syringes

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11
Q

How do we carry out arthrocentesis?

A

Use bony landmarks to guide needle
Do not move needle whilst aspirating
Blood aspirated from soft tissues - iatrogenic contamination streaks vs real change of pink fluid

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12
Q

What do we do with fluid aspirated during arthrocentesis?

A

Small volume - make a smear
Large volume - EDTA cytology, plain pot proteins, culture if infection possible

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13
Q

What does normal synovial fluid look like?

A

Viscous
Clear
Small volume

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14
Q

Describe how to take a sample from the scapulohumeral joint.

A

Gentle traction by assistant to open up joint
Needle inserted distal to acromion and directed perpendicular, slightly dorsal and medial

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15
Q

Describe how to take a sample from the cubital (elbow) joint.

A

Flex elbow to 45 degrees
Needle started from point level and perpendicular to epicondylar crest alongside anconeal process

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16
Q

Describe how to take a sample from the carpal joint.

A

Flex carpus to 90 degrees
Insert needle perpendicular to skin
Aspirate all joints
Avoid neurovascular bundle

17
Q

Describe how to take a sample from the MCP/MTP/IP joints.

A

Use needle with short bevel (spinal needle) to allow entire tip of needle to be within joint and avoid contamination

18
Q

Describe how to take a sample from the coxofemoral joint.

A

Hip abducted and internally rotated to open joint
Needle inserted from craniodorsal to greater trochanter, angled medially and caudoventrally

19
Q

Describe how to take a sample from the stifle joint.

A

Stifle partially flexed
Needle inserted lateral to patella ligament, midway between patella and tibial tuberosity, angled caudomedially until it hits bone

20
Q

Describe how to take a sample from the femoropatella joint.

A

Stifle extended
Needle inserted at angle between patella and femur towards proximal

21
Q

Describe how to take a sample from the tarsal joint.

A

Joint partially flexed
Palpate and manipulate joint to feel the articulation
Angle needle perpendicular to skin into joint
Fluid obtained from craniolateral or caudolateral aspect of joint

22
Q

What are the stages of healing?

A

Post-op (24-48hrs)
Regeneration phase (day 5 - 3 weeks+)
Remodelling phase (6 weeks - 1 year)

Bone healing occurs in regeneration and remodelling phases

23
Q

Describe care for patients in the post-op stage of healing.

A

Consider pain, oedema, healing tissues
Analgesia
Cryotherapy
Rest
Easy movement only (non-weightbearing/supported weightbearing)

24
Q

Describe care for patients in the regeneration phase of healing.

A

Still fragile, new collagen fibres and bone calluses forming
Controlled lead exercise
Passive/active ROM exercise

25
Q

Describe the remodelling stage of healing.

A

Consolidation = cellular to fibrous tissue, strength and alignment
Maturation = vascularity returns and metabolic rate returns to normal
Introduce active exercise e.g. hydrotherapy

26
Q

How can we manage patients with cruciate disease?

A

Surgery = TPLO/TTA and lateral suture
Obesity common factor - weight-loss programme
Hydrotherapy can be used but must be stopped immediately post-op when stitches in place
Active exercise

27
Q

What factors affect what rehabilitation we offer to fracture patients?

A

Degree of fracture(s) and site
Pre-existing disease
Degree of soft tissue damage
Presence of open wounds

28
Q

How can we rehabilitate fracture patients?

A

Adequate analgesia
Restricted exercise
Cold compress
Minimal PROM exercises
Supportive dressing?

29
Q

How can we nurse patients with external fixators?

A

Can be difficult to apply treatments!
Cold compress parts of limb
Massage/PROM
Active exercises useful due to reluctance to flex/extend limbs esp. distal limb

30
Q

How can we nurse patients who have had joint surgery?

A

Cryotherapy immediately post-op
Pressure dressing 12-24hrs
PROM/massage
Adequate analgesia

31
Q

What care should we provide for THR/elbow/knee replacement patients?

A

Walked slowly in controlled manner
Kept settled and calm - consider mild sedation
Clear signage - must be handled by experienced staff

32
Q

How can we rehabilitate patients with tendon injuries?

A

PROM after 3 weeks’ rest
Exercise limited for 3-6 weeks
Tendon still not full strength at 6 weeks!

33
Q

What are the main considerations around rehabilitation?

A

Return to function (weightbearing, ROM, muscle-building), minimise stress on surgical site
Requires full understanding of condition
Subjective vs objective
Continually assessed and altered to suit stages of healing
Multimodal analgesia

34
Q

Describe cryotherapy.

A

Early application effective - initial 72hr period
Vasoconstriction
Analgesic effect
Reduced tissue oedema
15mins 3x daily ideal

35
Q

Describe heat/warm therapy.

A

Temp. of 46 degrees C sufficient
Care - reduced sensation, risk of burns!
Before exercise = increased blood flow = increased elasticity

36
Q

Describe the benefits of massage.

A

Increased blood flow = improved oxygen supply = aid removal of waste products = helps muscle work more efficiently, alleviates pain
Venous and lymphatic return
Mobilises adhesions
Prepares muscles for exercise and aids recovery after exercise

37
Q

List some assisted physiotherapy exercises.

A

Assisted standing
Weight shifting
Side bending, cervical flexion/extension
Balance boards/swiss balls
Muscle stimulation

38
Q

List some active physiotherapy exercises.

A

Slow walks
Stair climbing
Sit to stand, down to sit
Treadmill walking

39
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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