Orthopedic Nursing Flashcards
total bones in adult
206 bones
total bones in newborn
270 bones
breast plate
sternum
collarbone
clavicle
5 Flat bones
-sternum
-clavicle
-scapula
-skull
-pelvis
shoulder blade
scapula
lateral curvature of the spine
Scoliosis
common in female teenagers (screening ageg)
Scoliosis
confirmatory test for Scoliosis
X-Ray
Priority in patients with Scoliosis
Pulmonary Impingement (breathing)
test for Scoliosis when the patient’s body is lateral to the floor to determine if scapula is elevated and a/symmetrical
Adam’s Forward Bend Test
Main reason why the bones decrease as the age increases
Fusion of the bones
2 Management for Scoliosis
Milwaukee Brace
Harrington Rod Insertion
How many years is Milwaukee brace worn?
3 years
How many hours is Milwaukee brace worn?
23 hours
1 hour - hygiene and swimming
What is the priority on patients with Milwaukee Brace?
Prevent Skin Breakdown
Is it allowed to put lotions and creams to the skin of a patient with Milwaukee brace?
Do not apply anything on skin unless until prescribed!
-Brace not direct contact on skin
management for Scoliosis to lessen curvature and muscle spasms
Milwaukee Brace
Regions of the Spine
CTLSC
Cervical
Thoracic
Lumbar
Sacral
Coccyx
Posterior thoracic curvature of the spine
Kyphosis
[kpt]
curvature of the spine common in elderly
Kyphosis
curvature of the spine common in pregnant
Lordosis
Slip Disc
Herniated Nucleus Pulposus
anterior lumbar curvature of the spine
Lordosis
[lal]
Long Bones
Humerus, Radius, Ulna
Femur, Tibia, Fibula
long bones in the lower extremity
Femur, Tibia, Fibula
long bones in the upper extremity
Humerus, Radius, Ulna
4 Most Common Joints
Shoulder, Elbows, Hips, Knees
2 Ball and Socket Joint
Glenoid process
Acetabulum
Socket where humerus is connected
Glenoid process
Socket in pelvic girdle where femur is connected
Acetabulum
Elbows and Knees are which type of joints?
Hinge Joints
Shoulder and Hips are which type of joints?
Ball and Socket Joints
Joints that can only do flexion and extension
Hinge Joints
(elbows, knees)
Joints that can do range of motion, adduction/abduction, etc.?
Ball and Socket Joints
(Shoulder and Hips)
to fit or measure the length of the assistive device
Greater Trochanter
Bones that contain YELLOW MARROW
Long Bones
handle of the assistive device must be at the level of________, ______flexion.
Greater Trochanter,
20-30degree flexion
Priority when flat bones are affected
Flat bones: Bleeding
(red marrow)
Bones that contain RED MARROW that produces RBCs
Flat bones
Priority when long bones are affected
Long bones: Respiratory/Breathing
(yellow marrow consist of fats that may cause pulmonary embolism)
most common fracture in elderly
Hip Fracture
ball and socket away from center
Abduction
“aBukaka”
Why is there a need to promote extension of extremity?
To prevent contractures or fixation of joints (dikit)
ball and socket towards the center
Adduction
“aDikit”
Best position for Hip Fracture to prevent dislocation of joints
Abduction / Place pillows
Patient with Hip fracture:
____mattress
____toilet seat
-firm mattress
-high toilet seat
type of bed and position for patient with Hip Contractures
Soft Bed
Prone before sleep
(to promote extension)
Best position
Abduction and Extension
where is weight given when using crutches
hands or arms
how many inches shall be the placement of axillary bar of the crutch in relation to the axilla
2-3 inches below axilla
What is the complication common in crutches?
Crutch Paralysis /
Brachial Plexus Paralysis
Best site for bone marrow aspiration
Posterior ileac crest
Secondary best site for bone marrow aspiration
Anterior ileac crest
site of bone marrow aspiration for 1 year old
Tibia
connects the bones to muscles
Tendons
connects the bone to bone
Ligaments
damage of tendons
sTrain
damage of ligaments
sprain
white, avascular tissue that covers the bones
cartilage
damage of cartilage
Osteoarthritis
damage of bones
Fractures
Common Injury Management
PRICE
“Splint”
X HARM
PRICE
Protect
Rest
Ice
Elevate
X HARM
No:
Heat Application / Warm Compress
Alcohol
Running Activity
Massage
TO PROTECT affected upper extremities
Sling
TO PROTECT affected lower extremities
Crutches
Rest the affected extremity
(not so restrictive)
Purpose: promote HEALING
Relative Rest
used to support and immobilize, and promote extension
Splinting
such as when coughing, or IV insertion site
Complication of Bed Rest
Immobility
How to prevent pressure ulcers or bedsores
turn the patient every 2 hours
How to prevent Deep Vein Thrombosis
wear elastic compression stockings
Management for Deep Vein Thrombosis
(+) Homan’s sign
NEVER Massage
Refer to the Doctor!
Drug of Choice for Deep Vein Thrombosis
Heparin
Management for Contractures (flexor)
Range of Motion (ROM)
Management for Boredom
Give Cellphone
How to prevent pneumonia
Coughing and Deep breathing
When the calcium cannot enter the bones leading to what electrolyte imbalance and disease condition
Hypercalcemia
Osteoporosis
Nursing management for Osteoporosis
Increase OFI (can have renal calculi)
Turn every 2 hours
Indication for Ice
-Swell (shrinks tissue)
-Pain (numbness)
-Prevent bleeding (vasoconstrict)
bleeding in the VEIN
Apply Direct Pressure on wound
(+) Internal Bleeding
ELEVATE!!!
DO NOT give ice.
(Can coagulate blood)
bleeding in the ARTERY
Apply Tourniquet before the wound ;
If possible, cauterize
Nursing Management for Hemophilia
Elevate
Do NOT apply HEAT / WARM COMPRESS if:
- 3.
[BSI]
- Bleeding tendencies
(e.g. may cause rupture) - Swelling (bc further swell)
- Infection (bc further spread)
Indication for Elastic Bandage
For Swelling
(more effective than ice)
Nursing Management for Hemarthrosis
Elevate
Indication for Elevate
For Edema
(promote venous return)
Dysmenorrhea management
Can apply heat/warm compress
Management for Pain
Heat application / Warm Compress
Alcohol can ____ healing process
delay
demineralization of the bone
Osteoporosis
2 hormones that helps in calcium regulation
Calcitonin , Estrogen
common in menopausal women
Osteoporosis
Normal Calcium Level
8.6 -10 mg/dL
4.5 - 5.5 meq/L
Fracture that is caused by underlying disorder
Pathological fracture
Needed for Calcium absorption
Vitamin D
Best site for Calcium Absorption
Ileum
3 needed for Calcium Metabolism
Calcitonin, Estrogen, Exercise
hormone produced by the parathyroid gland that releases calcium by bones into the bloodstream
Parathormone
↑ calcium levels
hormone produced by the thyroid gland that lowers calcium levels in the blood (not in the bones).
Calcitonin
↓calcium levels
responsible for bone resorption where bone tissues are broken down and calcium will go into the circulation
Osteoclasts
2 manifestations of Hypercalcemia
Osteoporosis
Renal Calculi
responsible for production of new bone tissue that allows calcium to go into the bones
Osteoblasts
b= Build
most common CAUSE of Hypercalcemia
Bed Rest
cheek twitching seen in pts with Hypocalcemia
Chvostek Sign
most dangerous complication of Hypocalcemia
laryngeal spasm (closure of larynx)
–> respiratory occlusion/arrest
sign of Hypercalcemia
Signs related to kidney (e.g. low back pain)
-so need to increase OFI
carpopedal spasm seen in pts with Hypocalcemia
Trousseau’s Sign
(more definitive)
2 MAIN CAUSES OF HYPOCALCEMIA
- Post Thyroidectomy
- Renal Failure
DOC for Post Thyroidectomy
Calcium Gluconate
DOC for Renal Failure
Amphojel
(antacid with phosphate binder properties)
which is more dangerous
Hypocalcemia vs Osteoporosis
Hypocalcemia
-so calcium in BLOOD is more important than going into bones
Best sources of Calcium
Sardines and Dairy Products (milk, cheese, yogurt, ice cream)
Which is better source of calcium: sardines or dairy products
Sardines
BQ TIP:
Things to consider upon choosing the best Diet (Philippine setting)
- LOWER PRICE
- AVAILABILITY (Luzon - Mindanao)
Best source of vitamin D
Food (tuna, mackarel, salmon)
Activates vitamin D synthesis
Sunlight
where is activated vitamin D stored?
Kidney
How to prevent Osteoporosis
[HOW]
Hormonal Replacement of Estrogen
Oral Calcium & Vitamin D intake should be increased
Weight bearing exercises (walking, dancing jogging)
Drug of Choice for Osteoporosis
Alendronate (Fosamax)
-inhibits resorption of Ca (calcium will not be released from bones)
more rare but severe deficiency in Vitamin D
Softening of bones associated with bone pain
Osteomalacia
Nursing management for Osteomalacia
Bed rest
the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency
Rickets
Parathormone : Calcium
Directly Proportional
↑Parathormone : ↑Calcium
Phosphorus : Calcium
Inversely Proportional
↓Phosphorus: ↑Calcium
Hyperparathyroidism:
Hypercalcemia
2 manifestations of Hyperparathyroidism
Hyperparathyroidism: Hypercalcemia
-Osteoporosis
-Renal Calculi
Hypophosphatemia:
Hypercalcemia
Hyperphosphatemia:
Hypocalcemia
inflammation of joints
Arthritis
which is more dangerous, Hyperphosphatemia or Hypophosphatemia?
Hyperphosphatemia
-because it also equates to Hypocalcemia (which is more dangerous)
autoimmune arthritis
Rheumatoid Arthritis
degenerative type of arthritis
Osteoarthritis
metabolic (food) arthritis
Gouty Arthritis
causative pathogen of Rheumatoid Arthritis
Epstein Barr Virus
common in females children
Rheumatoid Arthritis
Inflammation of Synovial Fluids
Rheumatoid Arthritis
classic sign of Rheumatoid Arthritis
Morning Stiffness
Worsen with rest
Rheumatoid Arthritis
normal characteristic of Synovial Fluid
clear
confirmatory diagnostic tool for Rheumatoid Arthritis
Arthrocentesis:
(+) cloudy synovial fluid
known as moveable joints
Synovial joints
Blood test results for Rheumatoid Arthritis
(+) Rheumatoid Factor: Multiple Joint Affected
(+) Anti-nuclear Antibodies (ANA): Autoimmune
(-) Anti-nuclear Antibodies (ANA): Not autoimmune, Epstein Barr
↑ ESR: Severity
early sign of nerve compression
(+) Pain
later sign of nerve compression
Numbness
best management for autoimmune RA
Steroids
best management for virus-causing RA
(virus is self-limiting)
- Increase OFI
- Adequate rest
- Vitamin C
best management for bacteria-causing RA
Antibiotic
which is more dangerous RA —cause is viral or bacteria?
Bacteria because virus is self-limiting
symmetrical (bilateral), systemic
Rheumatoid Arthritis
dryness in eyes, buccal mucosa, and vagina
seen in patients with RA
Sjogren’s Syndrome
anemia, leukopenia, thrombocytopenia, and splenomegaly
seen in patients with RA
Felty’s Syndrome
late sign of anemia
pallor
normal RBC count
RBC : 4-6 million/microliter
normal WBC count
WBC: 4,000-11,000
management for anemia
REST
Low WBC
Leucopenia
classic sign of anemia
fatigue
Low RBC
Anemia
Nursing diagnosis for Leucopenia [RA]
Risk for infection
- no fever
Management if:
Fever
↑WBC
(+) infection
REFER!
Management for Leucopenia
Avoid crowded places
Avoid fresh food
Avoid raw food
Low platelets
Thrombocytopenia
Nursing diagnosis for Thrombocytopenia
Risk for bleeding
Signs of Bleeding
-bruising
-ecchymosis
-hematoma
-petechiae
relieve constipation and avoids valsalva maneuver
stool softeners (e.g. Dulcolax)
Management for Thrombocytopenia
Avoid intrusive/invasive procedures
Avoid contact sports
Avoid Valsalva maneuver
Stool Softener
normal platelet count
Platelet: 150,000 - 450,000 cells/microliter
management for constipation
- Increase fiber
- Increase oral fluid intake
- laxative
x Enema - bowel preparation
enlargement of the spleen
Splenomegaly
[RA Deformity]
thickening of synovial fluid
Pannus Formation
[RA Deformity]
fixation of joints
Bony Ankylosis
fingers are bent abnormally - deformity in RA
Swan’s Neck
hyperextension of the thumb - deformity in RA
Boutonniere
Ulnar Deviation
Ulnar Deviation: Upper in
Normal ulna: upper out
Ulna
Upper In
UTIN
Ulna, Tibia: IN
Radial, Fibula: OUT
Tibia
Lower In
Fibula
Lower Out
Radial
Upper Out
Aspirin is contraindicated to ___________
Rheumatoid Arthritis
immunosuppressant and anti-inflammatory drug used in patients with RA
Steroids
could be long term effect of taking steroids for RA
-Edema (+aldosterone)
-Hyperglycemia (+ cortisol)
-Infection (↓immune system)
anti-inflammatory drug used in patients with RA
NSAIDs
side effect of NSAIDs
GI irritation
when to take NSAIDs
give with meals
(bc can cause GI irritation)
Effect of Aspirin if given to patients with RA
-Thrombocytopenia
-Reyes’ Syndrome
(serious condition that causes swelling in the liver and brain)
More potent the drug, _______
more risky adverse reactions
drug for RA that can lessen the progression of RA and can avoid deformity
DMARDS (Disease Modifying Anti-Rheumatoid Drugs)
Swan’s neck
Boutonniere
Rheumatoid Arthritis
drug for RA that can lessen the flare ups (sudden swelling)
Chloroquine
drug for RA that is a COX-2 Inhibitor that is LESSER GI irritant.
Contraindicated to pt with cardiac disease.
Celecoxib
GOLD STANDARD drug for Rheumatoid Arthritis
Methotrexate (antimetabolites)
-have adverse reactions so give last
-kill normal cells
-hepatotoxic
signs of Hepatotoxicity
Nausea and vomiting (earliest)
RUQ pain
Jaundice with pruritus
drug to lessen the side effects of Methotrexate
Leucovorin
Management for (+) pruritus [bilirubin on skin] due to hepatotoxicity of Methotrexate
-Cold compress
-Increase OFI
wear and tear of weight bearing joints
Osteoarthritis
- joint disorder, not bone!
degeneration of cartilage
-(non-inflammatory)
Osteoarthritis
Diagnostic test for Osteoarthritis
X-Ray:
-narrowing of the joint spaces
-osteophytes formation (new bone growth in compensation)
common in athletes, hardworking people (overused)
Osteoarthritis
localized, asymmetrical
Osteoarthritis
most common type of arthritis
Osteoarthritis
[Osteoarthritis]
Distal interphalangeal nodes “DIP”
Heberden’s Nodes
H: High
grating sound on Osteoarthritis
Crepitus
[Osteoarthritis]
Proximal interphalangeal nodes “PIP”
Bouchard’s Nodes
B:below
Worsen with work
-rest until pain subsides
Osteoarthritis
common in males and hereditary
Gouty Arthritis
abnormal purine metabolism
Gouty Arthritis
Asymmetrical, big toe “podagra”
Gouty Arthritis
When is gouty arthritis more painful?
at NIGHT!
-Cold: solidification of crystals
confirmatory for Gouty Arthritis
Arthrocentesis: presence of joint crystals –> TOPHI
[Gouty Arthritis]
_______: food (protein)
Uric acid: blood
Purine
Management for Gouty Arthritis
Decrease Purine Diet!!!
Avoid: organ meat, legumes, sardines, anchovies, alcohol, shellfish (crab, shrimp, lobster, seahorse, starfish, prawn)
most painful arthritis
Gouty Arthritis
acute attack of Gouty Arthritis
5-10 days
chalk stone (white) deposits on the joints that affect movement
Tophi
inflammation of big toe
Podagra
Gout Medications Drug of Choice
Allopurinol: Zyloprim
(anti-gout) -dissolves uric acid
3 Gout Medications
- Allopurinol : Zyloprim
(anti-gout) -dissolves uric acid - Benemid : Probenecid
(anti-inflamm) - dissolves crystals/tophi - Colchicine : Novocolchine
(during acute attack)
(+) diarrhea: Refer
for acute attack of Gouty Arthritis
Colchicine : Novocolchine
(+) diarrhea: Refer
Contraindicated: Allopurinol
Neurovascular Assessment
6Ps
Pulselessness
Pallor
Poikilothermia
Pain
Paresthesia
Paralysis
nursing intervention for Allopurinol and Benemid
increase fluid intake
to prevent renal stones
Traction: ______
pulling
Pain on traction
✅Skeletal traction
❌Skin Traction
❌Pin sites
When is traction indicated
Prior / before surgery
Normal capillary refill
1-2 seconds
Pulse Deficit
Apical pulse rate - peripheral pulse rate = pulse deficit
Apical Pulse: 100bpm
Affected periphery: 80 bpm
Pulse Deficit: 20bpm
Bad leg (affected) is warmer than good leg (unaffected)
Infection
Refer all 6Ps of NVA except:
Pain
Principle of Traction:
Foot of the client should not touch the ____
foot of bed
distance of crutches
6-10 inches
distance of cane
4-6 inches
Elderly; Parkinson’s
Walker
1 foot affected
Crutches
2 feet affected
Wheelchair
Stroke
with “hypertension”
with “hemiparesis / hemiplegia”
Cane
most stable assistive device
walker (4 foot parts)
least stable assistive device
Cane (only 1 foot part)
How to use walker
Walker
Walk
Walker
Walk
How to use Cane
Weakness: Left
Cane: Right
Cane
Lean
Bad leg
Good leg
How to Use Crutches Downstairs
Crutches
Bad leg
Good leg
How to Use Crutches Upstairs
Good leg
Crutches + Bad leg
duration of drying of Fiberglass cast
20-30 minutes
duration of drying of Plaster of Paris cast
48-72 hours
To which patient shall you give sardines?
a. Osteoporosis
b. Gouty Arthritis
✅Osteoporosis
❌Gouty Arthritis
complete opposite of Osteoporosis
Rheumatoid Arthritis
RA: systemic, symmetrical
OA: localized, asymmetrical
