n104 ortho lecture

8/22/2019 N104 ORTHO Lecture

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RESOURCE UNIT

Nursing Care Management 104

ORTHOPEDIC NURSING

I. OVERVIEW

. MUSCU!OS"E!ET! S#STEM

The musculoskeletal system is collectively the largest organ system in the body. Bony structures and

connective tissues account for approximately 25% of the body weight and the muscles account for

approximately 50% of the total body weight. The health and function of the musculoskeletal system areinterdependent with the rest of the body system !melt"er and Bare# $2&.

I. $%nes'arieb# 2002&

There are 20( bones in the human body. Bones are constructed of cancellous trabecullar or spongy& or

cortical compact& bone tissue. )ompact bone is dense and looks smooth and homogenous. !pongy bone is

composed of small needlelike pieces of bone and lots of open spaces.

*+,*-!!/

Bones are considered to be the framework of the body# however# besides contributing to the si"e and formof the body# bones are responsible for some bodily functions.

$. !upport to surrounding tissues and serves as framework of the bone.

2. *rotects the vital organs and other soft tissues.

. Blood cell formation or hematopoiesis occurs within the marrow cavities of certain bones.

1. Body movement by providing leverage and attachment of muscles.

5. !torage area for minerals# salts like calcium and phosphorous.

T- '34 6474!4-!

The skeleton is subdivided into two 2& ma8or divisions9 those that comprises the longitudinal axis of the

body are referred to as axial bones and those that comprises the limbs and girdles are called the appendicular

bones. $. 3xial bones : Body;s upright structure9 the bones that forms the longitudinal axis of the body9 B-!

Bones come in many si"es and shapes. The uni?ue shape of each bone fulfills a particular need.

$. @ong bones : bones in which the length exceeds the breadth and thickness9 shaped like rods# or shafts

with rounded ends.

e.g. humerus# radiusAulna# femur. tibiaAfibula.

PARTS OF LONG BONES

1.DIAPHYSIS (SHAFT)-BONES LENGTH, COMPOSED OF COMPACT BONE

2.PERIOSTEUM-FIBROUS CONNECTIVE MEMBRANE THAT COVERS AND PROTECTSTHE DIAPHYSIS

3.EPIPHYSEAL LINE-A THIN LINE THAT SPAN THE EPIPHYSIS, THE REMNANT OF THE

EPIPHYSIAL PLATE THAT CLOSES WHEN THE GROWING BONE HAS

REACHED ITS FULL LENGTH

2. !hort bones : bones that are generally cubed shaped and contain mostly spongy bones

e.g. metatarsal# metacarpals

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. >lat bones : thin flattened and usually curved. 4mportant site for hematopoiesis and fre?uently provide

vital organ protection. They are made of cancellous bone layered between compact bones.

e.g. skull bones# ribs# sternum

1. 4rregular bones A bones that do not fit in any of the above classification but have uni?ue shapes in

relation to their function. e.g. vertebrae# hipbone.

B- )@@!

Bones in order to continue its normal functioning must be maintained to its optimum health or condition.

!everal bone cells are involve to keep to its maximum functioning.

$. -steoblast : involved in bone formation by secreting bone matrix. 'atrix is a framework in which

inorganic mineral salts are deposited.

2. -steocytes : mature bone cells involved in the bone maintenance functions and are located in theosteons bone matrix unit&.

. -steoclasts : multinuclear cells involved in bone destruction# resorption and remodeling.

BONE MARROW

- A VASCULAR TISSUE LOCATED IN THE MEDULLARY (SHAFT) CAVITY OF LONG BONES

AND FLAT BONES.

. YELLOW MARROW-A STORAGE AREA FOR ADIPOSE TISSUE

!.RED MARROW-PRODUCED RED AND WHITE BLOOD CELLS LOCATED INSTERNUM, ILIUM, VERTEBRA AND RIBS

II. &%ints !melt"er Bare $2& 3n articulation or 8oint is a point of contact between bones# between cartilages and bones or between teeth

and bones. The scientific study of 8oints is termed arthrology.

)@3!!4>4)3T4- -> C-4T! !melt"er Bare $2&

The 8unction where bones of the body are 8oined together to allow a variety of movement is called 8oints or

articulation. o matter is the amount of possible# the point of contact between two or more bones is termed as

8oint

)lassification of 8oints is based on the amount of movement it can accomplish. $. !=3,TD,-!! : immovable 8oints.

!uture : unites the bones in the skull.

Eomphosis : a coneA shaped peg fits into a socket.

e.g. articulation of the teeth with the socket of the alveolar process of the maxilla and mandible.

!ynchondrosis : a cartilaginous 8oint in which the connecting material is a hyaline cartilage.

e.g. epiphyseal plate

2. 3'*D43,TD,-!! : slightly movable 8oints.

!yndesmosis : a fibrous 8oint in which there is considerably more fibrous connective tissue

than there is in the suture. The fibrous connective tissue forms an interosseous membrane or

ligament that permits some degree of flexibility and movement.

e.g. distal articulation between the tibia and fibula.

!ymphysis : the connecting material is broad# flat discs or fibro cartilage.

e.g intervertebral disc between the bodies of the vertebrae.

. 6=!3,TD,-!! : freely movable 8oints.

Ball and !ocket 8oints or !pheroid : a ballAlike surface fits into a cuplike depression. Bestexemplified by the shoulder and hip 8oint. *ermits full freedom of movement. Triaxial flexionA

extension9 abductionAadduction9 rotation&

Dinge 8oint or Einglymus : convex surface fits into a concave surface. *ermits bending in one

direction only and best exemplified By the elbows and knees. 'onoaxial flexionAextension&

!addle 8oints or !ellaris A articular surface of one bone is saddleAshaped# and the articular

surface of the other bone is shape like the legs of a rider sitting in a saddle. 3llows movement

in two planes at right angles to each other. The 8oint at the base of the thumb is a saddle 8oint.Biaxial flexionAextension# abductionAadduction.

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*ivot 8oint or Trochoid : rounded or pointed surface fits into a ring. >ormed partly by bone and

partly by ligament. )haracteri"ed by the articulation between the radius and ulna and between

the atlas and axis. 'onoaxial rotation&

Eliding 8oints or 3rthrodial : articulating surface are usually flat. 3llows for limited movement

in all directions and are located at the intercarpal and intertarsal 8oints.

)ondyloid or ellipsoidal 8oint : oval shaped condyle fits into an elliptical cavity. Coint between

the radius and carpals best exemplified this 8oint. Biaxial flexionAextension# abductionAadduction&

'-7'T! -> TD !=-743@ C-4T! Tortora# $(&

3. 3E+@3, : there is a decrease or increase at the angle between bones.

$. >lexion : there is a decrease in the angle between the surfaces of the articulating bones.

2. xtension : increase in the angle between the articulating bones.

. Dyperextension : continuation of extension beyond anatomical position.

1. 3bduction : movement of bone away from the midline.

5. 3dduction : movement of a bone towards the midline.

(. )ircumduction : a combination of flexionAextension and abduction in succession# in which the distalend of a part of the body moves in a circle

B. E@464E A the surface of one bone moves back and forth and from side to side over another surface.6uring the movement there is no angular or rotary motion.

). ,-T3T4- A movement of bone around its longitudinal axis# maybe medial towards the midline& or

lateral away from the midline&.

6. !*)43@ : occur at specific 8oints

$. 4nversion : movement of the soles inward so that they face each other.

2. version : movement of the soles outward so that they face away from each other. . 6orsiflexion : bending the foot in the direction of the dorsum upper surface&.

1. *lantar flexion : bending the foot in the direction of the plantar surface.

5. *rotraction : movement of the mandible or shoulder girdle forward on a plane parallel to the ground.

(. ,etraction : movement of the mandible or shoulder girdle backward on a plane parallel to the ground.

F. !upination : movement of the forearm in which the palm is turned anteriorly or superiorly.


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$. 4sometric contraction : the length of the muscles remains constant but the force generated by the

muscles is increased. .g. pushing against immovable wall.

2. 4sotonic contraction : characteri"ed by shortening of the muscle with no increased in tension within

the muscle.

T=*! -> '+!)@!

There are three & types of muscle tissues but differ in their cell structure# body location and how theyare stimulated to contract.

$. )ardiac muscleA involuntary muscle9 found only in the heart.

2. !mooth muscle : involuntary muscle9 found in the walls of hallow structure.

e.g. intestines

. !keletal muscle : voluntary muscle9 striated muscles

)D3,3)T,4!T4)! -> !G@T3@ '+!)@!

!keletal muscles are instrumental for the movement of the various parts of the body and it possesses

characteristics uni?ue from the two other muscles.

$. 3ttached to the skeleton at the point of origin and to the bones at the point of insertion.

2. Dave properties of contraction and extension# as well as elasticity to permit isotonic shortening and

thickening of the muscle& and isometric increased muscle tension& movement.

. )ontraction is innervated by nerve stimulation

SKELETAL MUSCLE FUNCTION

. FACILITATE OF VOLUNTARY BODY MOVEMENT BY CONTRACTION !. MAINTAINS BODY POSTURE

%. PRODUCE BODY HEAT

IV. Carti'age

3 dense connective tissue that consists of fibers embedded in a strong# gel like substance. )artilage is

avascular and lacks innervation.

-IS A NON-VASCULAR, SUPPORTING CONNECTIVE TISSUE COMPOSED OF VARIOUS

CELLS AND FIBERS

T=*!

>ibrous )artilage : forms the symphysis pubis and intervertebral discs.A D4T# T-+ED# >4,-+! T4!!+ >-+6 4 TD G

Dyaline )artilage : covers the articular bone where one or more bones meet at a 8oint&9 connects the

ribs to the sternum9 and appears in the trachea# bronchi and the nasal septum.

- PEALY, BLUE CARTILAGE THAT COVERS ATRICULAR BONE SURFACES

lastic )artilage : located in the auditory canal and the intervertebral discs9 it also cushions and

absorbs shock# preventing direct transmission to the bone.

- YELLOW CARTILAGE- ELASTIC, FIBROUS CARTILAGE FOUND IN THE LARYN+

AND E+TERNAL EARV. Ten(%ns an( !igaments

a. Ten(%ns

Bands of fibrous connective tissue that attached muscle to the periosteum fibrous membrane

covering the bone&.

nables the bone to move when muscle contracts.

). !igaments

6ense strong# flexible bands of fibrous connective tissue that attached one bone to another.

)onnect 8oint ends articular ends& of the bones9 these bones can either limit or facilitate movement

and provide structural stability.

VI. $ursa

@ocated at friction points and around 8oints# between tendons# ligaments and bones.

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!mall synovial fluid sacs that act as cushions# decreasing stress on ad8acent structures.

.g. shoulders subacromial bursae9 knees prepatellar bursa

$. NURSING PROCESS3 thorough and comprehensive nursing assessment is vital in the making of ?uality nursing care to

the clientele. 4t is the fundamental basis of identifying nursing problem and interventions thus9 it must be

done with complete care. 4t is also imperative to consider the individuality and uni?ueness of each patient.!teps of the nursing process are universal but its application should be individuali"ed.

I. * SSESSMENT

The nursing assessment of the patient with musculoskeletal dysfunction includes an evaluation of

the effect of the problem on the client;s performance of normal functions. The nurse is concerned with

assisting persons with musculoskeletal problem $0 maintain general health# 2& fulfill activities of daily

living# and & manage treatment modalities.

3. ursing Distory$.& B4-E,3*D4)3@ 63T3 36 6'-E,3*D4) 63T3

H personal information enables individuali"ed care planning

H age and sex : suggest possible cause of musculoskeletal problem

H age :


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2.& *3!T D3@TD D4!T-,=

H *revious trauma# accidents surgery involving bones or 8oints

H previous accidents# resulting to fracture may predispose to degenerative changes.

a.& )hildhood and 4nfectious disease

H TB# poliomyelitis# inflammatory or degenerative arthritis# ricketsb.& 'a8or illness and hospitali"ations

$.& ask for past and present minor and ma8or in8uries# including/a. circumstances of in8ury

b. diagnosis of in8ury

c. treatment received

d. duration of treatment

e. current problems resulting from the in8ury

2.& 'usculoskeletal in8ury: fractures# sprains# strains# dislocation

.& ,esidual impairment from in8ury

: use of assistive device

c.& 'edications

$.& *rescribe meds

2.& -T)

.& Derbal

a. ,easonsb. 6ose and fre?uency

c. durationd. observed side effects

J corticosteroids : can cause necrosis of the femur head# septic arthritis and muscle

weakness.

J anticongalants : may produce hemarthrosis blood in the 8oints.&

J anticonvulsants : may cause osteomalacia

J phenothia"ines : produce gait disturbance

J potassium : depleting diuretics : may cause cramps and muscle weakness.

J 3mphetamines and caffeine : generali"ed weakness in muscle activityJ D,T Dormonal ,eplacement Therapy& : modify the effects of osteoporosis in post

menopausal women

.& >3'4@= D4!T-,=

A hereditary disease or diseases with familial disposition such as arthritis# osteoporosis and

gout.

1.& *!=)D-!-)43@

-ccupation : lifting or strenuous activity9 prolonged sitting.

36@ : limitations in activities of daily living.

xercise : recreational activity and exercise pattern.

utrition

A -besity : may cause low back pain due to stresses on weightAbearing

8oints

A 6ecrease 4ntake of )alcium : may cause deminerali"ation of the bone

and fracture.

A 3de?uate intake of protein# 7itamin 3 and 6 and )alcium is important.5.& *D=!4)3@ K3'43T4-

3. 4nspection

Body alignment and posture

)ontour# alignment length and symmetry

,ange of motion# crepitus# clicks and smoothness

Coint alignment# si"e# shape# stability# tenderness# heat and swelling

Eait# coordination rhythm# stride and balance

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'uscle discrepancies# hypertrophy# atrophy# spasms

B. *alpation

'uscle mass# shape si"e# contour# symmetry and firmness

'uscle strength# resistance and contractility

!+BC)T47 63T3 3!!!!'T

o *atient;s report of presence of pain# tenderness. Tightness and abnormal sensations.o 'ust be assessed and documented

1. Pain: common to patient with diseases and traumatic conditions of the muscles# bones

and 8oints.

!harp pain may result from bone infection with muscle spasm or pressure on a

sensory nerve. 'ost musculoskeletal pain are relieved by rest. *ain that

increases with activity may indicate 8oint sprain or muscle strain# whereas

steadily increasing pain suggests to a progression of an infectious processosteomyelitis a malignant tumor# or vascular complications.

*ain is variable and its assessment and nursing management should

beindividuali"ed. *ain and discomfort are important to the patient and must be

manage successfully. ot only is pain exhausting but if prolonged it can force

the patient to become increasingly preoccupied and dependent.

L Bone *ain : dull deep ache that is boring in nature.

L 'uscular *ain : sore and aching and is fre?uently referred to asMmuscle crampsN.

L >racture pain : sharp piercing pain and is relieved by immobili"ation.. 'tere( Sensati%ns

!ensory disturbances are fre?uently associated with musculoskeletal problems.

The patient may described the presence of paresthesia burning or tingling

sensation& and numbness. These sensations maybe due to a pressure on nerves or

circulatory impairment. !oft tissue swelling or direct trauma to these structures

can impaire their function.

$. NURSING DIGNOSES 2OR C!IENTS WITH MUSCU!OS"E!ET! DISORDERS!tein and Cacobson#$2&.

4dentification of nursing diagnoses for patient with musculoskeletal problems should be based on

the actual and behavioral manifestation of the patient. The nurse must be vigilant and religious in the

assessment of hisIher patient because nursing diagnoses changes as the patient;s respons1e to the treatment

changes.

The following are nursing diagnoses applicable to the patients with musculoskletal disorders#

however# individuality of the patient must be considered in the identifying specific diagnosis for each patient.

3nxiety related to changes in body integrity.

Gnowledge deficit related to therapeutic regimen

*ain related to musculoskeletal disorder.

3ltered peripheral tissue perfusion related to physiologic responses to in8ury# swelling or

increased pressure within a close space. 4mpaired physical mobility related to musculoskeletal impairment.

!elf care deficit

*otential for 4n8ury

*otential for infection

-ther diagnoses

$. Body image disturbance

2. *otential for 6isuse syndrome

F


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C. P!NNING ND IMP!EMENTTION

GO!S3 The goals of nursing management on patients with musculoskeletal disorder are geared

towards/

$. ,eduction of anxiety

2. +nderstanding of therapeutic regimen. ,elief of pain.

1. 'aintenance of ade?uate tissue perfusion5. 4mproved physical mobility

(. *revention of infection and in8ury

F. achievement of maximum level of health care

D. NURSING INTERVENTIONS

1. Re(u+e aniet5

3ssist patient in coping with problems associated with musculoskeletal dysfunction

and associated therapies.. Patient E(u+ati%n an( ,ami'5 tea+6ing

4ncreasing patient understanding foster active participation from the patient in the

development and implementation of therapeutic regimen.

4nclude explicit instructions that the patient understand indicating activities that may or

may not be performed. ducate patient about untoward signs and symptoms to be reported to the physician.

4mportance of followAup visit.

. Re'ie, %, Pain

+se of narcotic and other pain relievers.

,elieving pressures over bony prominences to eradicate pain and prevent further tissue

damage.

,elaxation techni?ues

4ntermittent application of ice pack at the site of in8ury for 20A0 minutes.

levate the in8ured area to prevent swelling.

4. Im7aire( tissue 7er,usi%n

)heck capillary refill or blanch test

!igns of diminished tissue perfusionL !kin cool to touch

L !kin appears dusky# pale or blue

8. Im7r%9e( m%)i'it5

Dealth maintenance

+ltimate restoration of function

4sometric exercise of immobili"ed extremities help to maintain muscle strength.

4nvolvement in 36@ : provides sense of independence and accomplishments.

xercise of nonAimmobili"ed muscles and 8oints

L Delps maintain strength and functionL 'inimi"es cardiovascular deterioration

L *revents disuse osteoporosis.:. Pre9ent in,e+ti%n

;. Pr%te+t 7atient ,r%m in


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. Re'ates 7'an ,%r +%ntinue( 6ea't6 management

6escribes planned treatment regimen

!tates sign and symptoms to be reported to the physician

'akes appointment for followAup care

. +6ie9es 7ain re'ie, an( i(enti,5 a77r%7riate +%m,%rt measures )ontrols discomfort with occasional oral medications

'oves with minimal discomfort

+ses positioning to increase comfort.

4. Maintain a(e?uate tissue 7er,usi%n an( sens%r5 ,un+ti%n

)ontrols swelling

6emonstrate motor function

6emonstrate normal capillary refill

,eports normal sensations

8. Dem%nstrate im7r%9e( 765si+a' m%)i'it5 an( a)i'it5 t% use assisti9e (e9i+e 7r%7er'5.

Transfers self independently or with minimal assistance

*articipates in activities of daily living

+ses mobility aids safely.:. N% signs %r s5m7t%ms %, s5stemi+ '%+a' in,e+ti%n.

;. Resumes n%rma' a+ti9it5

6emonstrate proper performance of rehabilitative exercises and safety precautions.

'aintains independence in self care.

*articipates in self care activities and 36@

C. !$ORTOR# ND DIGNOSTIC TESTS!melt"er and Bare# $2&

6iagnostic and laboratory studies are essential to aid the physician confirm the diagnosis of thepatient. >urther more# these examinations will help identify proper medical and nursing interventions and

management appropriate to the need of the patient.

*reparation of the patient for laboratory and diagnostic tests is the responsibility of the nurse.

*reparation for these studies includes assessment of the patient for indicators pregnancy# claustrophobia.

'etal implants# ability to tolerate re?uired positioning due to old age# disability# deformity& that may affect

patient undergoing the study. The nurse communicate to physician and the appropriate department

concerning identified problems related to completion of the prescribed diagnostic test !mellt"er and Bare#

$2&.

. !a)%rat%r5 stu(ies

)B) : provide information concerning the hemoglobin level fre?uently lower after bleeding

associated with trauma& and B) indicates possibilities of developing infection&.

A3'43!# D'-,,D3E# 4>)T4-!# -*@3!T4) )-64T4-!# !@#

3@@,E4!# !T,!!

)oagulation !tudies : performed to determine bleeding tendencies.

!, : elevated in !@ and arthritis.

+ric acid : detects abnormally high levels of uric acid in the blood Eout&

ormal value/ 'ale : .5 :F.5 mgIdl

>emale : 2.< : (.< mgIdl

,heumatoid >actor : detects antibodies indicating possible rheumatoid arthritis# lupus or

scleroderma. Blood level of greater than $/


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ALALINE PHOSPHATASE STUDIES

-IDENTIFY INCREASE IN OSTEOBLASTIC ACTIVITY AND INFLAMMATORY

CONDITIONS

CREATININE PHOSPHOINASE

-ELEVATION MAY IDENTIFY SELETAL MUSCLE NECROSIS, ATROPHY OR

TRAUMA

LACTATE DEHYDROGENASE -ELEVATION INDICATES SELETAL MUSCLE DAMAGE

SERUM CALCIUM STUDIES -IDENTIFIES BONE LOSS DENSITY

C-REACTIVE PROTEIN TEST- SEVERITY AND COURSE OF INFLAMMATOTY PROCESS

SUCH AS A BACTERIAL INFECTION OR RHEUMATIC DISEASE

$. Diagn%sti+ Stu(ies

1. @/R# OR ROENTGENOGRPH#A an electromagnetic radiation of extremely short wavelengths

which pass through matter to varying degrees depending on its density.

A !T,+)T+,# 4TE,4T=# TKT+, -, 6!4T= *,-B@'# 64!3!

*,-E,!!4- 36 4>>4)3)=

*+,*-!/

6one primarily to detect bone fracture.

+,!4E 3)T4-/3ssesses the patient;s level of exposure to radiation.

. $ONE SCN/the examination of the bone using ultrasonography# computeri"ed tomography# ',4 or

scintigraphy.

- DETECTS SELETAL TRAUMA AND DISEASE

*+,*-!/

6etects bone tumors# metastatic growths# bone in8ury or degenerative bone disease# osteomyelitis.

*,-)6+,/

3n 47 in8ection or oral dose of radioisotope is given and after interval time for a substance to beabsorbed by the bone# the area is scanned by a scintillation camera.

+,!4E 3)T4-/

$. xplain the purpose and procedure.

2. )heck for allergies and pregnancy. . 4nstruct patient to lie still during the procedure.

1. 4nstruct the patient to void immediately before the procedure.

5. 3ll metals should be removed from the area to be scanned.

(. Tell the client that the isotopes are eliminated from the body in (A21 hours.

. RTHROSCOP# A inspection of 8oint cavity with an arthroscope enabling performance of

percutaneous surgery such as meniscectomy and biopsy to be performed.

*+,*-!/

4nspect the interior aspect of the 8oint# usually a knee# to diagnose problems of the patella#

meniscus and synovium. 3lso used to evaluate the progress of arthritis or effectiveness of

treatment.

*,-)6+,/

3fter in8ection of local anesthesia# an incision is made# and the arthroscope is introduced into the

interior of the 8oint9 instrument for tissue biopsy or surgical procedures maybe passed through thearthroscope.

+,!4E 3)T4-!/

$. xplain the purpose and procedure.

2. 3dminister sedative prior to the procedure as ordered.

. 3pply pressure dressing for 21 hours.

1. 3pply ice packs immediately post procedure period.

5. 3ssess for swelling# circulation# and sensation periodically to detect complications.

(. 4nstruct patient to limit activities for several days.

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4. RTHROCENTESIS / aspiration of synovial fluid# blood or pus through a puncture needle.

*+,*-!/

*erformed to extract synovial fluid for analysis and reduce swelling.

*,-)6+,/ 3 needle is inserted into the 8oint space and synovial 8oint is aspirated.

+,!4E 3)T4-!/ $. xplain the purpose and procedure.

2. 4f large amount of fluid is aspirated# immobili"e the 8oint by an elastic bandage.

. 3pply ice packs to relieve pain and reduce swelling.

1. 4f corticosteroid is in8ected into the 8oint# administer analgesic as ordered.

8. M#E!OGRPH# / a speciali"ed method of KAray examination to demonstrate the spinal canal thatinvolves the in8ection of a radiopa?uecontrast medium into the subarachnoid space.

INECTION OF CONTRAST AGENT INTO SUBARACHNOID SPACE OF THESPINE TO DETECT HERNIATION, TUMOR, AND CONGENITAL OR DEGENERATIVE

CONDITION OF THE SPINAL CANAL

*+,*-!/

6one to determine disc herniation# spinal stenosis narrowing of the spinal canal& or the site ofthe tumor.

*,-)6+,

@umbar puncture is done to withdraw a small amount of )!># which is replaced with a

radiopa?ue dye.

+,!4E )3,/$. xplain procedure and purpose.

2. !ecure consent.

. )heck for iodine allergy.

1. Geep on *- after li?uid breakfast.

5. 4f waterAbased dye amipa?ue& is used# place the patient on sei"ure precaution. levate the

head of the bed to prevent upward dispersion of the dye# which causes meningeal irritations.

(. 4f oilAbased dye pantopa?ue& is used# position patient flat on bed

:. E!ECTROM#OGRPH# BEMG* A a continuous recording of the electrical activity of a muscleby means of electrodes inserted into the muscle fibers. The tracing is displayed on a oscilloscope.

AMEASURES MUSCLE ELECTRICAL IMPULSES FOR DIAGNOSIS OF MUSCLE OR

NERVE DISEASE

*+,*-!/

'easures and records activity of contracting muscle in response to electrical stimulation.

*,-)6+,/

eedles electrodes are inserted in affected muscles and as muscle are stimulated# the electrical

impulses generated by the muscle contains are amplified and displayed on an oscilloscope9

tracing are made on graph paper.

+,!4E 3)T4-/ $. xplain procedure and purpose.

2. !ecure consent.

.3void stimulants and sedatives before the procedure. 1.xplaine that there will be slight discomfort when the electrodes are inserted.

5.4nstruct the patient that he will be asked to relax and contract the muscles.

;. $IOPS# A the removal of a small piece of living tissue from an organ or part of the body for

microscopic study.- STUDIES BONE, SYNOVIUM, OR MUSCLE TISSUE

*+,*-!/

Bone biopsy done to detect tumor cells. 'uscle biopsy done to obtain tissue for cellular

analysis.

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*,-)6+,/

+nder local anesthesia# a piece of bone or muscle is excised and sent for pathologic analysis.

+,!4E 3)T4-/

$. xplain procedure and purpose.

2.Eive medication as ordered to relieve discomfort after the procedure.. 3pply ice packs to decreased swelling.

1.-bserve for bleeding.5. *erform circulation and sensation check distal to the area biopsied

Ot6er (iagn%sti+ stu(ies

$.)-'*+T6 T-'-E,3*DD= )T& !)3 : useful in orthopedic diagnosis by revealing tumors of

the soft tissues or in8uries to the ligaments or tendons. 4t is helpful in identifying the location and

extent of areas difficult to define.-SHOW SOFT TISSUE, BONE, AND SPINAL CORD IN 3-DIMENTIONAL, CROSS-SECTIONAL

IMAGES

2. '3ET4) ,!-3) 4'3E4E ',4& : a nonAinvasive# special imaging techni?ue that uses

magnetic fields# radio waves and computers to demonstrate abnormalities e.g. tumors or narrowing of

tissue pathways through bones& bone of soft tissue such as muscle# tendon and cartilage.

-. ALLOWS STUDY OF SOFT TISSUE IN MULTIPLE PLANES OF THE BODY

+,!4E 3@,T/ )ontraindicated to pregnant woman# claustrophobic# patterns with unstablevital sign# patients with metal implants.

.3E4-E,3*D= -, 3,T,4-E,3*D= 3ngiography is the study of the vascular structures. 3rteriography is the study of the arterial system.

3 radiopa?ue contrast medium into the selected artery and serial films are taken of the supplied

arterial system. The procedure is useful for determining the amount of an extremity to be computed.

1.64E4T3@ !+BT,3)T4- 3E4-E,3*D= 6!3& : uses computer technology to demonstrate the

arterial system from a venous catheter access. 7enogram is a study of a venous system fre?uently used

to detect venousAthrombosis.

5.64!)-E,3*D= : study of the intervertebral discs in which a contrast medium is in8ected into the disc

and its distribution is noted.(.3,TD,-E,3*D= : in8ection of a radiopa?ue substance or air into the 8oint cavity in order to outline

softAtissue structures and the contour of the 8oint. The 8oint is put on its range of motion while a series

of radiograph is taken. 3rthrography is useful in identifying acute or chronic tears of the 8oint capsuleor supporting ligaments of the knee# shoulders# ankle# hip or wrist. 4f a tear is present# the contrast

medium will reach out of the 8oint and will be evident on the radiograph.

-INECTION OF RADIOPAUEOR AIR INTO THE OINT CAVITY TO IDENTIFY ACUTE OR

CHRONIC TEARS OF OINT CAPSULE OR SUPPORTING LIGAMENTS FOR THE NEE,

SHOULDER, ANLE, HIP OR WRIST.

+,!4E 3)T4-/

$.4mmobili"e the 8oints for $2 to 21 hours.

2.)ompression elastic bandage is applied for 2 to 5 days or as prescribed.

.*rovide comfort measure as prescribed.

F.TD,'-E,3*D= : measures the degree of heat radiating from the skin surface. 4nflammatory

conditions such as arthritis and infections# as well as neoplasm are detected.


13/62

OPEN REDUCTION-INVOLVES REDUCTION AND ALIGHNEMENT OF FRACTURE THRU

SURGICAL OPENING.

INTERNAL FIXATION-INVOLVES STABILI/ATION OF REDUCED FRACTURE WITH

SCREWS,PLATES, NAILS OR PINS.

BONE GRAFT-INVOLVES PLACEMENT OF BONE TISSUE FOR HEALING, STABILI/ATION,

OR REPLACEMENT.

ARTHROPLASTY-INVOLVES OINT REPAIR THROUGH SMALL ARTHROSCOPE TO AVOIDINCISION

JOINT REPLACEMENT-INVOLVES THE EPLACEMENT OF OINT SURFACE WITH METAL

OR PLASTIC MATERIALS0 TOTAL HIP REPLACEMENT INVOLVES REPLACEMENT OF THE

BALL AND SOCET OF A SEVERELY DAMAGED HIP OINT0 TOTAL NEE REPLACEMENT REPLACEMENT OF TIBIA, FEMORAL AND PATELLAR OINT SURFACES

TENDO TRANSFER-INVOLVES MOVEMENT OF A TENDON INSERTION TO IMPROVE

FUNCTION

TENOTOMY-INVOLVES CUTTING TENDON

FASCIOTOMY-INVOLVES REMOVAL OF MUSCLE FASCIA, RELIEVING CONSTRICTION

OSTEOTOMY-INVOLVES ALIGNMENT OF BONE BY REMOVAL OF WEDGE

FRACTURES

II. P!NNING ND IMP!EMENTTION. HE!TH PROMOTION

1. E@ERCISE Aaims to achieve the maximum body function for each particular individual.

Is%metri+ Eer+ise A these are exercises wherein the client exerts force without

changing the length of the muscles. 4t helps in maintaining muscle tone.Eam7'e.

$. G'utea' mus+'e setting A done by contracting and relaxing the buttocks.

2. ua(ri+e7s setting Aperformed by pressing the popliteal space against the

mattress.

Is%t%ni+ Eer+ise A the muscle contracts9 it is used to promote muscle strength.

Eam7'e: lifting.

. PROPER $OD# MECHNICS A the safe use of muscles of the body to accomplish mechanicaltasks.

$. Bend knees to lift ob8ects from the floor

2. +se wide base of support by placing the feet $2A$< inches apart when moving ob8ects.

. *ulling is easier than pushing.

1. ork is best accomplished at the center of gravity.

5. orking at the waist level is most efficient.. DIET: 3 balance diet is important in maintaining bones or muscles for optimum activity and must

contain ade?uate sources of phosphorus# calcium and 7it 6 for bone growth and prevention

of osteoporosis.

Ca'+ium Afor bone and teeth formation# blood clotting muscle activity and nerve

function.,egular 4ntake : 00mgs

*hosphorous : for bone and teeth formation# important in energy transfer# componentof nucleic acid.

,egular 4ntake : 00mgs

7itamin 6 : *romotes )alcium and phosphorous absorption9 >or bone and teeth

formation.,egular 4ntake : (.5 mcg

1. ,4!G '33E'T

$. 4nformation in the use of seat belts# helmets# and other safety devices and the avoidance of

driving if drinking alcoholic beverages.

$


14/62

2. ,ugs must be secure. !tairways lit and clear of debris

. +se of body mechanics to protect risk of in8ury.

$. HE!TH MINTENNCE ND RESTORTION

1. CSTS

4. 6efinition

)3!T : form of support obtained as a gypsum rendered anhydrous by calcinations# which when mixed

with water# swells# sets and forms rapidly a hard cement. *-) 'anual&

44. *urposes +ntalan# 2005& $. >or immobili"ation

2. To prevent and correct deformity

. >or support

1. >or elevation

5. To obtain a mold of the limb to serve as a model for making an artificial limb.

444. )asting materials *-) 'anual&

$. !tockinet A comes in contact with the patient;s skin.

2. adding !heet . Eau"e bandage

1. *laster of *aris : traditional cast

a. takes 21 : F2 hours to dry

b. precautions must be taken until cast is dry to prevent dents which may cause pressure areas.

c. !igns of a dry cast : shiny white# hard# resistant.

d. 'ust be kept dry since water can ruin a plaster cast.

5. !ynthetic castA e.g. fiber glass

a. strong# light weight# sets in about 20 minutes.b. can be dried using cast dryer or hair blow dryer on cool setting9 some synthetic cast needs special

lamp to harden.

c. water resistant9 however# if cast becomes wet# must be dried thoroughly to prevent skin problems

under the cast.

47. )ast 6rying : *laster )ast *-) 'anual&$. +se palms of hands# not fingertips to support cast when moving or lifting clients.

2. Turn patient every two 2& hours to reduce pressure and promote drying.

. 6o not cover the cast until it is dry may use fan&.1. 6o not use heat lamp or hair dryer on plaster cast.

7. )ast Techni?ue

$. indowing : putting a hole on the cast on the site of an open wound of a casted extremity for the

purpose of visuali"ation# inspection# dressing as well as the application of medication.

2. Bivalving : cutting the cast into halves from the upper portion to Othe bottom for the purpose of

relieving possible tightness# for xAray and inspection of the casted extremity.

. ,einforcing : application of plaster of *aris for the purpose of regaining strength in of wetting the cast

which resulted to the instability of the cast.

74. Types of )asts B+) 'anual&

3. T,+G )3!T!

$. )ollar )ast : affection of the cervical spine.

2. Body )ast A affection of the lower lumbar spine

. ,i""er;s Cacket : for scoliosis M!N type or for thoracoAlumbar spine affection.

1. 'inerva )ast : for scoliosis# upper dorsal and cervical spine affection.

5. !houlder !pica : affections of the shoulder 8oints and shaft of the humerus.

B. )3!T! -> TD +**, KT,'4T4! B+) 'anual&

$1


15/62

$. @3)) : @ong 3rm )ircular )ast

A affections of radius and ulna.

2. !3)) : !hort 3rm )ircular )ast

A affection of the wrist 8oints# metacarpals and phalanges.

. 'unster or >uenster cast : affections of radiusA ulna with good callus formation.1. Danging cast : affection of the shaft of the humerus

5. 3irplane cast : for the affection of the neck of the humerus and shoulder 8oint(. >unctional cast : for the affection of the 'Irdof the humerus with good callus formation.

).& )3!T -> TD @-, KT,'4T4! B+) 'anual&

$. @@)) : @ong @eg )ircular )ast

A for the affection of the tibia and fibula

2. !@)) : !hort @eg )ircular )astA for the affection of the ankle 8oints# metatarsals and phalanges of the feet.

*TB )ast : *atella Tendon Bearing )ast

A for the affection of the tibia fibula with good callus formation.

. PuadrilateralI4schial eight Bearing )ast : fracture of femur with callus formation

1. Dip !pica )ast : affection of the hip and femur

a. !ingle Dip !pica : one hip @ or ,& and one $& femur.

b. $ Q Dip !pica : Both hips @ and ,& and one $& femur.

c. 6ouble Dip !pica A Both hips @ and ,& and two 2& femurs.2. *antalon )ast : for pelvic fractureIinstability as in malgaine fracture.

. )ast Brace A for the affection of upper portion of the tibiaAfibula andIor lower portion of the femurwith good callus formation.

1. alking cast : for the affection of the ankles and toes with good callus formation.

5. 6elvit )ast : for tibiaAfibula affection with good callus formation to allow dorsiflexion and planter

flexion of the toes.

(. Basket )ast : for affection of the knee with massive in8ury that needs fre?uent dressing.

F. )ylinder )ast : for the affection of the knee.

rog )ast A congenital hip dislocation. )D6&

. 4nternal Board ,otator : for patient who had undergone *artial ,eplacement Dip *rosthesis*,D*& or Total Dip *rosthesis to prevent internal or external rotations of the legs.

2. 'O!DS

3.& 6efinition'-@6! : use for splinting the affected parts of the body wherein there in an open wound#

inflammation# abrasion# swelling or infection. *-) 'anual&

A being applied posteriorly.

B.& Types of molds *-) 'anual&

$. !3*' : !hort 3rm *osterior 'old

A for affection of wrist and fingers with infection and inflammation.

2. @3*' : @ong 3rm *osterior 'old

A for affection of radiusAulna with open wound# swelling. !ugar Tong : for compound fracture of the humerus with open wound# inflammation and infection.

1. @@*' : @ong @eg *osterior 'old

A for the affection of tibiaAfibula with infection and inflammation.5. !@*' : !hort @eg *osterior 'old

A for affection of ankle and toes with infection and open wound.

(. )ylinder mold : for the affection of kneeIpatella with swelling and infection.

F. ight splint : for post polio with residual paralysis.

MNGEMENT O2 PTIENT WITH CST ND MO!DS *-) 'anual&

3. 3!!!!'T

$5


16/62

$. *erform neuromuscular checks to area distal to cast.

a. ,eport absent diminished pulse# cyanosis or blanching# coldness# lack

sensation# inability to move fingers or toes# excessive swelling.

b. ,eports complaint of burning# tingling or numbness.

2. ote any odor from the cast that may indicate infection.. ote any bleeding on cast in a surgical client.

1. )heck for Mhot spotsN that may indicate inflammation under the cast.

B. E,3@ )3,

$.4nstruct client to wiggle toes or fingers to improve circulation.

2. levate affected extremity above heart level to reduce swelling.

.3pply ice bags to each side of the cast if ordered

Cast Care

3ssess for/

$. )irculatory stasis : by making that there is ade?uate circulation to points distal to the cast. The fingers

or toes pressed to see if they blanch followed by capillary filling. 6igits with ade?uate

circulation are warm and have healthy color. 4t should not be so tight that the nurse

cannot insert one or 2 fingers between the body and the chest.

2. *ressure on nerves : by asking the client to wiggle his digits# separate them and flex them in a dorsal

plantar direction. 3ny numbness or tingling is indicative of abnormal pressure on the

nerves.. dema : this can be prevented by elevating the foot of the bed. !lings may also be used to maintain

the involved part in elevation. !welling that cannot be relieved by poisoning should bereported to the physician.

4f the limb is casted# it may be necessary to bivalve the cast : cut it from top to

bottom and separate the plaster to increase the width of the cast to relieve pressure.

hen swelling has subsided# the window is reinserted and secured.

1. Bleeding : check vital signs. 3rea should be circled to detect further bleeding. ,estlessness may be a

sign of an impending shock.

5. *ain : *ain medications *,. *osition to relieve any discomfort. +nusual pain could be attributed to

a tight cast should be reported to the physician.(. 4nfection : evidenced by odors and elevated temperature. The cast should be maintained clean and

dry. )ast may be wiped with a damp cloth and powdered cleanser. The use of water

and sponging should be avoided so that the plaster is not softened# when the cast dried#shellac maybe applied to keep it protected and clean.

J o protective covering should be put on until the cast is dried# to avoid mildew.

J The skin under the cast often becomes dry itches. hen the nurse bathes a client# it is important to

wash under the cast to massage the skin with rubbing alcohol# because F0% isopropyl rubbingalcohol& strengthens the skin and prevent skin breakdown. !ome physicians may insert a strip of

gau"e under the cast. The gau"e scratchier maybe used to gently massage the skin. 3 vacuum or

3septo syringe may be used to blow air through the cast to provide relief from itching.

).& -B!,73T4-

$. !igns of impaired circulation on toes and fingers

a. color : cyanosis

b. temperature : coldness of the skinc. movement : loss of function

d. sensation : numbnesse. pulsation : pulseless in extremity

f. severe pain

g. marked swelling

2. erve damage due to pressure in the nerve as it passes over a bony prominences.

a. pain increasing# persistent and locali"ed

b. anesthesia A numbness

c. feeling of deep pressure

$(


17/62

d. paresthesia

e. motor weakness or paralysis

. 4nfection# tissue necrosis due to skin breakdow

1. *ressure on axilla# elbow# wrist and metacarpal# iliac crest# trochanter# groin# knee# ankle and

metatarsals6. )3!T )-'*@4)3T4-!

J eurovascular )ompromise : characteri"ed by changes in neurovascular status.$. C%m7artment s5n(r%me: a condition of marked increase in venous pressure ormal value : $5A25

mmDg& brought about because of constriction of edematous tissue within the muscle compartment.

J S$ 4 S5"6*"$/ edema# increase pain or passive movement.

J )onstriction is caused by unyielding facial coverings over muscles. ith trauma# bleeding andinflammatory changes in8ured tissue# venous pressure rises as venous return is compromised by the

traumas and decrease actual inflow toward ischemia. @onger than (R ischemia lead toward

permanent tissue damage.

J 4ntervention to lessen venous pressure

$. elevation : $ to 2 pillows

2. cutting the cast

. surgical fascietomy : which permits the edematous muscles to expand

J levation of in8ured limb to heart level increase 7, usually& through gravity because loss venousinterstitial pressure need the MpushN of elevation to flow faster toward the heart.

2. Cast s5n(r%me: a series of events caused by loss of blood flow through the superior mesenteric artery#

resulting in severe small intestinal ileus at times# small bowel ischemia obstruction.

J This results from excessive bending or kinking of the artery because of the patients position in the

body or hips spica cast# although it can also occur in persons in other type of cast.

J 6ecreased blood supplies leads to stasis# increased intestinal putrefaction and ileus. 4leus alonecan also be caused by the excessive air swallowing aerophagic& in an anxious or nervous patient. 4n

this second situation# the patient need not be in a body or spica cast.

J !Is/

$. feeling of being blocked

2. fullness in the stomach

. as if the cast is too tight that they cannot take a deep breath

1. nausea5. if the syndrome cautioner# vomiting# vital signs become elevated dysphea.

J ,x/ bivalving the cast. ext 47;s# sedative# surgical resection of the ischemic bowel.

.

6. )@4T T3)D4E! 36 64!)D3,E *@34E

$. 4sometric exercises when cleared with physician

2. ,einforcement of instruction given on crutch walking.

. 6o not wet cast9 wrap cast in plastic bag when bathing or take a sponge bath. 1. 4f a cast had already dried and hardened does become wet# may use blow dryer on low setting over

wet spots9 if large area of plaster cast becomes wet# call the physician. 5. 6o not scratch or insert foreign bodies under cast9 may direct cool air from blow dryer under cast

for itching.

(. ,ecogni"ed and report signs and impaired circulation or infection.

F. )ast cleaning

a.& )lean surface of plaster cast with a slightly damp clothes9 mild soap may be used for synthetic

case.

b.& To brighten cast a plaster cast# apply white shoe polish sparingly.

$F


18/62

Cast Rem%9a'

J The cast is removed when healing has occurred. 3n electric cast saw is used to remove a cast.

This saw vibrates against the plaster to separate it# but will not vibrate when in contact with the

skin.J The skin beneath the cast is fre?uently dry with flakes of dead skin when the cast is removed9

wash the area with mild soap# taking care not to irritate the tender skin. !everal washing is moreeffective than one vigorous bath. @anolin can be used top soften the skin.

J 'uscle may be weak without the support from the cast# and initially the client may have aches

and pains. !ome physicians may bivalve the cast several days before cast removal so that the client

can begin active and passive ,-'. There may be some swelling as circulation is reestablished9

elastic bandages may use to minimi"e swelling.

P+4*'T >-, )3!T ,'-73@ *-)&

)ast !preader : widen the cast

Trimming knife : smoothen the edge of the cast

!tryker cast cutter : used to bivalve the cast manually

)ast !cissor : used to cut the wadding sheet and stockinette during cast removal.lectric )ast cutter

: used in windowing and bivalving of cast but is electrically operated.

. TRCTION

4. 6efinition

T,3)T4-A the act of pulling and drawing which is associated with counter traction. *-)

'anual&

A the patient;s body weight serves as the counter traction. *-) 'anual&

44. 4ndicationsIpurposes +ntalan# 2005&$. >or immobili"ation.

2. To prevent and correct deformity.

. >or support1. To reduce muscle pain and spasm.

5. To reduce fracture.

(. To maintain good alignment.

444. Basic concepts on traction. 3dopted from Eapu"# 2001&

T A Trape"e bar overhead is used to raise and lower the upper body.

, A ,e?uires free hanging weights

3 A 3nalgesics is given to relieve pain.

) A )heck the patient;s circulation.

T A Temperature monitoring

4 A 4nfection prevention.

- A -utput and intake monitoring. A utritionIappropriate diet.

! A !kin must be checked fre?uently.

47. )lassification of Traction +ntalan# 2005&

$. 'anual Traction : 7%* 66&'4 * 8' !*45 !5 8' 84$ *9 8' *6'7*7. A '"6*775

"'$#7' $*"'"'$ '"6&*5'4 %'7:%& $6' ;#75 *7 4#7 %$ 66&%*.

2. !keletal Traction : 7%* 66&'4 * 8' !*'$


19/62

b. -verhead traction : for supracondylar fracture of the humerus.

c. DaloApelvic traction : for scoliosis. The patient is allowed to ambulate.

d. DaloA femoral traction :for scoli osis.

e. )rutchfield tong traction : for cervical spine affection.

f. 7inke skull caliper traction : for cervical spine affection for patientswith bigger body built.

g. Balance !keletal Traction : femoral affection

674)!/ *-) 'anual&

3. *ins and ires : indicated for the affection of long bones.

A pins are heavier than wires.

e.g. ,adiusAulna9 tibiaAfibula9 humerus9 femur

B. Tongs : indicated for the upper dorsal# cervical spine.$. )rutchfield Tong : inserted at the parietal region outer table of the skull.

2. 7inke !kull )aliper : inserted at the temporal region outer table of the skull.

. !kin traction : the application of a pulling force to the skin from where it is transmitted to the

muscles and then to the bones

T=*!

$. 3dhesive type : traction applied to the skin with the use of elastic bandage# adhesive tape and

spreader.

a. 6unlop traction : supracondylar fracture of the humerus

b. Buck;s extension traction : affections of hip and femur.

c. Bryant traction : affection of hip and femur among children below six (& years old.

d. Sero degree traction : Aaffection of neck and head of the humerus.

2. onAadhesive type : traction applied to the body with the use of canvas# laces# buckles and leather.a. Dead halter traction : affection of the cervical spine

b. Dammock suspension traction : affection of the pelvis.

c. *elvic girdle traction : affections of the lumbar spine such as in D*# low back pain.

d. )otrel traction : combination of head halter and pelvic girdle strap. 4ndicated for scoliosis

4. Un+'assi,ie( t57e %, tra+ti%na. Boot cast traction : for flexion contracture of hip and knee.

SUMMR# O2 TRCTIONS

$. 0A0 6E,!!

2. -verhead

traction. DaloApelvic

traction

1. DaloAfemoral

5. B!T

(. 6unlop

traction

F. Sero 6egree4)3T4-

!keletal

!keletal

!keletal!keletal

!keletal

skin:adhesiveskinAadhesive

skinAadhesive

skinAadhesive

skinAnonAadhesive

skinAnonAadhesiveskinAnonAadhesive

skinAnonAadhesive

unclassified

464)3T4-

A fracture of supracondylar and shaft of the femur

A supracondylarfracture of the humerus

A scoliosisA scoliosis

A affection of the femur

A supracondylar fracture of the humerus.A affection of neck and head of the humerus.

A affections of hip and femur.

A affection of hip femur of children below ( years old.

A cervical spine affection

A affection of the lumbar spineA scoliosis

A affection of the pelvis

A flexion contracture of hip and knee.

$


20/62

$0. Dead halter

$$.*elvic girdle

$2.)otrel traction

$. Dammock !uspension

$1. Boot )ast

7. *rinciples of traction *-) 'anual& $. *atient should be in dorsal recumbent position.

2. @ine of pull should be in line with the deformity.

. Traction should be continuous.

1. 3void friction.5. *rovide counter traction.

74. -bservations to be made in *atients with traction *-) 'anual&

$. The patient should be free from/

a. impaired circulation of the extremities

b. respiratory distress

c. deformity like footdrop# contacture of 8oints.

d. !igns of infection. e. !kin complications

2. Bone alignment and position of extremity in which the purpose of traction is

being accomplished.

. *atients comfort. Traction should never be a source of undue discomfort.

1. *rovisions of exercise.

5. *rovisions of supportive therapy.

(. )heck nutritional status of the patient.

F. very complaint of the patient should be investigated.7'"5.

!. T* =*< 8' 56' *9 7%*.

%. T* =*< 8'


21/62

4. T* 7'4#%' "#$%&' 6 4 $6$".

'. T* 7'4#%' 97%#7'.

9. T* " **4 &"'

3.ssem)'e t6e e?ui7ment nee(e(.3. *3,T! -> TD -,TD-*64) B6

$. Bed with fracture board2. >irm mattress

. Bed elevator or shock block

1. Balkan frame

.@ :'7%& !7$

!.2 8*7?*& !7$

%.1 %#7:' !74.2 %7*$$ !7$

'.1 4*& !7

9. 3 6#&&'5$

. %&"6$ * 8*&4 !7$ *'8'7

8 .*:'7 8'4 76'?'

B. P+4*'T >-, B!T

$.Thomas splint2. *earson;s attachment

. ,est splint1. >oot rest or foot board

5. 5 clips or safety pins

(. )ord sashes

. L*- 88 7*6'

!. L*'7- 7%* 7*6'

%. L*'$ $#$6'$* 7*6'

F. eight bags

. T7%*


22/62

3dopted from B+) -rthopedic 'anual&

4. tta+6e( t6e T6%mas s7'int an( Pears%ns atta+6ment t% t6e rest s7'int

8. 77'5 s'ings %n t6e T6%mas s7'int an( Pears%ns atta+6ment.

*,4)4*@!/

$. ot to tight and not too loose

2. -ne inch distance between each slings.

to promote aeration or ventilation.

. *opliteal and heel portion should be free from any slings.

1. !mooth and right side should come in contact with the patient;s skin.

5. Two longer and wider slings should be in the thigh portion and the three shorter and smaller

slings should be in the leg portion.

D- T- 3**@= TD !@4E!.

$. !tart from the medial to the lateral side.

2. !ecure both ends together.

. >an fold nicely on the lateral side.

1. !ecure with clip or pin.

:. tta+6 t6ig6 r%7e at t6e me(ia' u7rig6t %, t6e T6%mas s7'int it6 a s'i7 -n%t an( tem7%rari'5

an+6%r at t6e s+re %, t6e Pears%ns atta+6ment.

)-!46,3T4-!/

$.anchor rope at the leather portion to avoid slippage.2..Gnot should be away from the patient;s skin.

;.Trans,er a,,e+te( etremit5 t% t6e assem)'e( T6%mas s7'int an( Pears%ns atta+6ment.

4!T,+)T4- T- TD *3T4T

$. Dold on to the trape"e

2. >lex the unaffected extremity . 3t the count of three# to lift the buttocks and the affected extremity.

)-!46,3T4-!I3)T4-!

$.Three & manpower is needed

. F7$ * $'7 8' 667#$.

!. S'%*4 * 66&5 8' "#& 7%*.

c. T874 * $$$ 8' 99'%'4 '>7'"5.

2.The whole apparatus should be inserted under the affected extremity.

. 'anual traction should only be released upon the completion of traction weight on the third

pulley.

1. 3t the count of three# simultaneously the three & man power should do their 8ob

=. C6e+- t6e a'ignment %, Pears%ns s+re it6 t6e -nee


23/62

$. ,ope should be attached to the !teinman;s pin holder to run along the third pulley. +se a

slipknot.

2. 3ttached the prescribed weight.

. )heck the principles of sling applications and make the necessary ad8ustments.

1. )heck the alignment.

5.Traction weight should be at bed level

10. 77'5 sus7ensi%n eig6t.

)-!46,3T4-!I3)T4-!

$. -ne end of the thigh rope should be attached to the lateral aspect of the ischial ring of the

Thomas splint with a slipknot.

2. 3ttached suspension rope on the mid part of the thigh rope# run along the first pulley# insertsuspension weight# hang it on the first pulley# run the suspension rope to the second pulley#

then under the rest splint# anchor the rope to the Thomas splint with a clove hitch knot and

another clove hitch knot to the *earson;s attachment. )onsume the remaining knot9 close it

with a knot to secure it.

. Dang the suspension weight on the rope between the first and the second pulley.

1. Be sure to maintain the traction rope inside and the suspension rope outside.

11. Rem%9e t6e rest s7'int

1. 77'5 ,%%t 7e(a'.

CONSIDERTIONSCTIONS

$ .+se ribbon knot in tying.

2.The two 2& shorter cord in the Thomas splint and the two 2& longer cord should be anchored

in the *earson;s attachment.

. )ord should not come in contact with the patient;s skin.1. The longer cords should be anchored between the first and the second slings passing under

the first sling.

$. )heck the principles of traction.*,4)4*@! -> T,3)T4-

$. *atient should be in dorsal recumbent position

2. @ine of pull should be in line with the deformity.

$stpulley should be in line with the thigh.

2ndpulley should be in line with the knee or *earson;s screw.

rdpulley should be in line with the $stand the 2ndpulley.

. There should always be a continuous traction. mphasi"ed the importance of manualtraction.

1. *rovide counter traction. The patient;s body weight serves as the counter traction.

5. 3void friction.

'TD-6! T- 37-46 >,4)T4-

a. ,ope should be running along the groove of the pulley. b. Gnots should be away from the pulley.

c. eights should be hanging freely.

d. -bserve for the wear and tear on the ropes and bags.

2


24/62

$1. )heck the efficiency of traction)-!46,3T4-!I3)T4-!

$. 3sk the patient to hold on to the trape"e.

2. >lex the unaffected extremity.

. !wing the patient to and fro and side to side.

18. Dis+uss nursing +are in 7atients it6 $ST.

3. 3ssessment : assess level of understanding and consciousness.B. *rovisions of general comfort.

$. !kin care : head to toe. >ocus on the sponging

of the affected extremity.

D- T- !*-EU

!tart at the anterior portion of the

thigh.

,emove sling one at a time then

sponge# soap# rinse# dry and replace the sling. ,emove the next sling.

,emove foot board# sponge and replace.

2. )hanging of linens.

. *rovide bedpan as needed. !erve bedpan at

the unaffected side# provide pillow to support the back of the patient and provide privacy.

1. 6o perineal care.). *revent potential complications.

$. +,T4 : prevent possibilities of hypostatic

pneumonia.

A bronchial tapping#deep breathing and coughing exercises.2. Bedsores : good perineal care# proper skin

care# turning patients every 2 hours# lift the buttocks once in a while.

. +rinary and Gidney problems : good perineal

care# increase fluid intake.

1. Bowel complications : related to fear of the

apparatus# lack of privacy# inade?uate fluid intake# ineffective perineal care.

5. *in site infection : observe for signs and

symptoms of infection. @oosening pin tract# pus draining# foul smelling discharges# fever.

-bserve proper aseptic techni?ue and proper referral.(. 6eformity : contracted knee# atrophy ofmuscles# foot drop# 8oint contractures.

6. *rovisions of exercises

$. ,-' with the use of the trape"e.

2. 6eep breathing exercises.

.!tatic ?uadriceps exercises. 4nstruct the patient to alternately relax and contract the

?uadriceps muscles. 3lways start with the unaffected extremity .

1. Toe pedal exercises.

. utritional status : appropriate for the patient.

$. Digh fiber : prevent constipation.

2. 4ncrease fluid intake

. 7it ) : boast the resistance of the patient.

1. 4ncrease )alcium : for bone healing.

5. 7it 6 : promote absorption of )alcium.

(. Digh protein : for repair of tissues.

>. *sychological supportA related to fear of the unknown# fear ofdeath# fear of the apparatus# fear of losing 8ob# financial related fear.

E. *rovision of !upportive and 6iversional therapy : offer book

to read# something to listen to such as radio# provide tv# discover interest.

D. !piritual aspect : know the religion# encourage relatives to give

spiritual communion# chaplain visit.

21


25/62

Rem%9a' %, $ST. *-) 'anual&

$.3pply the rest splint.

2. Dang securely suspension weight on the first pulley.

. ,emove the knot on the *earson;s attachment and Thomas splint. )ompletely remove the

suspension weight.1 'anual traction on the !teinman;s pin holder.

5. ,emove the traction weight from the rdpulley.

(. !ecure the traction rope on the rest splint# then clove hitch knot on the Thomas splint and

*earson;s attachment. )onsume remaining rope.

Summar5 %, t6e Ste7s in t6e 77'i+ati%n %, $a'an+e

S-e'eta' Tra+ti%n

$. )heckIsee doctor;s order.

2. 4nform the patient about the procedure and purpose of traction.

. 3ssemble the needed e?uipment.

1. 3ttach rest splint on Thomas splint and *earson;s attachment.

5.3pply slings on the Thomas splint and *earsons attachment

(. 3ttached thigh rope at the medial upright.

F. Transfer extremity to the assembled Thomas splint and *earson;s attachment.


26/62

$1. )heck the efficiency of traction.

$5. 6iscuss nursing care of patient with traction.

1. $RCES

3. 6>44T4- B,3) : 'echanical support for weakened muscles# 8oints and bones in rehabilitation as supporting

body weight9 control involuntary movements# to prevent and correct deformities *-) 'anual&

B. *+,*-!! *-) 'anual&

$. immobili"ation 2.control involuntary movement

. support

1. permits patient to walk without fatigue

5. prevent and correct deformities

(. maintain body alignment

).T=*!

$. !hant" collar brace : for cervical spinal affection

2. *hiladelphia collar brace : for cervical spinal affection.. 'ilwaukee Brace : for scoliosis

1. =amamoto Brace : for scoliosis

5. Cewett Brace : affection of the lower thoracic spine or *ott;s disease in dorsoAlumbar spine affection.

(. Taylor brace : affection of the upper thoracic spine or *ott;s disease in thoracic spine affection.F. >orrester Brace : affection of the cervicoAthoracoAlumbarAspine.


27/62

standard point or pilot point. The holding power of the screw in bones is most dependent on the density and

?uality of the bone. Bone is either cortical or cancellous and screws have been developed for each structural

need

C. P!TES

*lates are devices# which are fastened to the bone for the purpose of providing fixation. They are

protection or neutrali"ation Vplates# buttress plates# compression plates and tendon tension band plates. Theshape of the plate is an adaptation of the plate to the local anatomy and does not denote any function. Thus#

straight and angled blade plates can function as protection plate# tension band plates or buttress plates.

D. C%mm%n Har(ares an( In(i+ati%ns

$. 4li"arov xternal >ixatorA indicated for malAunion or nonAunion of long bones and for bonelengthening.

2. ,oger 3nderson xternal >ixator ,3>& : for comminuted fracture of the long bone.

.Dybrid xternal >ixator : )ombination of 4li"arov and ,3> external fixators with delta frame.

4ndicated for unstable# comminuted fracture and periarticular fracture of the knee 8oint and ankle

8oint.

1. 4' ail :indicated for the fracture of the 'Irdof the femur# tibia or fibula.

5. 4' ail xtractor : ,emoval of 4' nails.

(. >emoral and Tibial component : >or Total Gnee ,eplacement 3rthroplasty.F. 3ntibiotic Beads : indicated for bone infection# e.g. -steomyelitis

racture of the distal tibia.

$. Bone *late : affection of radius and ulna.

$1. Doffman >ixator : 4ndicated for pelvic fracture.$5. Dip !pacer : ,eplacement for hip prosthesis once infection set in9 resembles a hip prosthesis but

contains antibiotic.

$(.)irclage iring : indicated for fracture of the patella.$F. Eigli !aw : for amputation.

$ixator : indicated for the fracture of the mandible.

2$. 4nterdental wiring : >racture of the mandible.

:. SSISTED !OCOMOTION A 'aybe needed for clients with difficulty maintaining balance. Before

beginning assisted locomotion# patient should do exercises that strengthen weightAbearing muscles of the

uninvolved limbs. 3ctive and passive ,-' can be done initially to maintain muscle strength. @ater#

exercises to develop muscles that will be used for ambulation are performed. *ush up and pull ups using the

over head trape"e help develop the biceps and triceps. Puadriceps can the strengthened with straight leg

raises and ?uadriceps setting exercises.. These exercises should be done for 5 minutes every hour. Before

walking with assistance# the client should dangle his legs and then stand at the bedside in supportive shoes toachieve sense of balance.

ssisti9e De9i+es ,%r Wa'-ing *otter *erry $& 'usculoskeletal anomalies may temporarily or permanently cause impairment in the locomotion of the

patients. 3ssistive devices are introduce to patients to assist them in moving. Dowever# proper choice of the

device must be given consideration to fit the need of the patient.

. CNE: used to providewide base of support andbalance. hen one cane is used for balance it should

be held in the hand opposite the involved leg. )ane should be measured from the floor to the waist of the

client and tip should be covered with a rubber cup to prevent slipping on the floor.

2F


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*urposes/

a. To assist the client walk with greater balance and support with less fatigue.

b. To relieve pressures on weight bearing 8oints

c. To provide forces to push and pull the forward or to restrain the forward

motion of the patient while walking.

Techni?ues for walking with canes

a. Dold the cane on the hand opposite the affected extremity good side&.b. 3dvanced the cane at the same time the affected limb is moved forward.

c. Geep the cane fairly close to the body to prevent leaning.

d. 4f the client is unable to hold the cane on the opposite hand# the cane may

be carried on the same side and advanced it when the affected leg is

advanced.

e. To go up and down the stairs/

!et up on the unaffected extremity

Then place the cane and the affected extremity on the step.

,everse this procedure for descending steps.

The strong legs goes up first and comes down last.

Eood leg up9 bad leg down&

Types/ !ingle# tripod cane# ?uadripod cane

$. W!"ER A used primarily to provide balance for clients who can bear weights although they may be

used when only partial or limited weight bearing is permitted with the involved leg

$. 3 mechanical device with four legs for support.

2. ursing )are/ Teach the client to hold upper bars of walker at each side# then to move walker

forward and step into it.

C. CRUTCHES

Teaching the client the proper use of crutches is an important nursing responsibility.

$. 3ssure *roper length

a. hen client assumes erect position# the top crutch is 2 inches below the axilla# and the tip of

each crutch is ( inches in front and to the side of the feet. 2 inches towards the front and 1

inches to the sides&

b. )lients elbow should be slightly flexed when hand is on the hand grip 0 degrees&. c. eight should not be borne by the axilla# but on the palms of the hands to prevent crutch palsy

),+T)D *3@!= : paralysis of the extensor muscle of the hand and arm due to pressure

against the axillary region pressing the radial nerve&.

2. )rutch Eaits

a. >our point Eait : used when weight bearing is allowed on both extremities.

$. 3dvance right crutch

2. !tep forward with left foot

. 3dvance left crutch

1. !tep forward with right foot

b. Three point Eait : used when weight bearing is allowed on one extremity only.

$. 3dvance two 2& crutches and affected extremity several inches maintaining good balance.

2. 3dvance the unaffected leg to the level of the crutches9 support the weight of the body onthe hands.

c. Two point Eait : typical walking pattern9 an acceleration of four 1& point gait.

$. 3dvanced right crutch and left leg together.

2. !tep forward moving left crutch and right leg together.

d. !wing to Eait : used for clients with paralysis of both lower extremities who are unable to

lift feet from the floor.

$. Both crutches are advanced forward. 2. )lient swings forward so that the feet will be at the level of the crutch.

e. !wing through Eait : same indications as of swing to gait.

2


29/62

$. Both crutches are placed forward.

2.)lient swings body pass through the level of the crutches

III. COMMON HE!TH PRO$!EMS

. NEONTE ND IN2NT

1. C'u),%%t

)lubfoot is a congenital deformity of the foot usually with ankle involvement characteri"ed by a

twisting out of a normal position that is unable to be manipulated into a different position. The deformity is

typed and named according to the position of the foot .

Talipes varus : foot inversion

Talipes valgus : foot eversion

Talipes e?uinus :plantar flexion

Talipes calcaneus A dorsiflexion

'ost cases of talipes are combination of these with the most common deformity known as Talipes

e?uinovarus inversion and plantar flexion of the foot&.

*athophysiology/

Eenetic >actor nvironmental factor

3rrested development of 3bnormal position in the utero

mbryo in early stages ,estricted movement in the utero

+nilateral or Bilateral6eformity of foot and ankle

2


30/62

Talipes ?uinovarus Talipes calcaneovalgus

most common&

>oot pointed downward and inward >oot pointed upward and outwardplantar flexion and inversion& dorsiflexion and eversion&

'anipulation and taping

or

!uccessive casting to

accommodate growth

or!urgical correction

ursing diagnoses/

$. 4mpaired physical mobility related to musculoskeletal impairment talipes deformity&

2. ,isk for impaired skin integrity related to physical immobili"ation by cast s internal factors of

altered circulation# sensation by cast pressure.

. 6elayed growth and development related to effects of physical disability immobili"ation&1. Gnowledge deficit related to lack of information about condition.

T!IPES EUINOVRUS

The heel cord 3chilles; tendon& is tight# causing the heel to be drawn up toward the leg. This

position is referred to as Me?uinesN and it is impossible to place the foot flat on the ground. !ince thecondition starts in the first trimester of pregnancy# the deformity is often ?uite rigid at birth.

T4-@-E=/

The cause is unknown. >or idiopathic clubfoot# a heredity factor can be found approximately 20% of

the cases.

D=*-TD!! '-!T 46@= 3))*T6

$. 3rrested or anomalous development of this particular part of the embryo in first trimester of pregnancy.

2. 3t about rdmonth of intrauterine life# foot occupies normally an e?uinovarus

position.

. 3bnormality of the relative maturity and length of the muscles as well as

variation in their tendon insertions.

)@44)3@ '34>!T3T4-/

$. The heel is drawn up# the entire foot below the talus is inverted and the anterior half is adducted.2. The medial border of the foot if concave# the later border is convex and there is a transverse case

across the level to bear weight normally.

. 'uscles of the leg ?uickly before fatigued and soon show marked atrophy.

1. *ain is experienced by patients where arthritis changes developed.

5. There is some degree of stiffness.

'64)3@ '33E'T

$. xercise

0


31/62

2. )asting cast is changed periodically to change angle of foot&.

. 6ennis Brown !plint bar shoes& : metal bar with shoes attached to the bar at specific angle.

1. !urgery and casting for several months.

+,!4E 4T,7T4-!$. *erform exercise as ordered

2. *rovide cast care or care for child in a brace.. )hild who is learning to walk must be prevented from trying to stand9 apply restraint if necessary.

1. *rovide diversional activities.

5. 3dapt care routines as needed for cast and brace.

(. 3ssess toes to be sure cast is not too tight.

F. *rovide skin care.


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hen the heads is in stretched position# it should be held there for $0 seconds. !hould be

done1A( times per day with 20 repetitions of each exercise each time.

!upport the head with sandbag in the corrected position when lying.

4f correction is not instituted early surgery is done after $< months of age.

Traction or bracing after surgery

3ctive and passive exercise after surgery.

$. CHI!D

1. !egg/ Ca'9e Pert6es DiseaseB-stoechondritis deformans&A a disease of the femoral head occurring in children between A$2 years old.

A cause is unknown but it is characteri"ed by necrosis of the femoral head which

results from an impaired circulation of the femoral epiphysis extending to the

acetabulum.

!T3E!/

!tage $. 373!)+@3, : necrosis and degeneration of the femoral head

!pontaneous interruption of the blood supply to the upper femoral

epiphysis

Bone forming cells in the epiphysis die and bone ceases to grow.

!light widening of the 8oint space occurs.

!welling of the soft tissues around the hips occur.

!tage 2. ,73!)+@3,4S3T4- : bone absorption and vasculari"ation

Erowth of new vessels supplies the area of necrosis# both bone resorption

and deposition occurs

The new bone is not strong and pathologic fractures may occur.

3bnormal forces on the weakened epiphysis may produce progressive

deformity

!tage . ,*3,3T47 : new bone formation with ossification

The head of the femur gradually reforms

ucleus of the epiphysis breaks up into a number of fragments with cyst

like fragments between them ew bone starts to develop at the medial and lateral edges of the

epiphysis which becomes widen

6ead bone is removed and is replaced with new bone which gradually

spreads to heal the lesions.!tage 1. ,E,3T47 : reformation of the femoral head to a sphere

ithout treatment head of the femur flattens and becomes mushroom

shaped# incongruity between the head of the femur and acetabulum

persists

)omplete recovery# head of the femur becomes spherical# acetabulum

becomes normal

'34>!T3T4-!

Coint dysfunction with 8oint pain or ache

@imp that is continuous or intermittent

6ecreased ,-'

*ainful gait

3trophy of thigh muscle

'uscle spasm

T,3T'T

Eoal/

2


33/62

$. to reduce hip irritability

2. achieve and maintain ,-'

. prevent the ball from extruding or collapsing

!urgical Treatment

$. Tenotomy : surgery to release an atrophied muscle that has shortened tolimping

2. -steotomy : cutting the bone to repositioningA surgical realignment of the femur so that the head of the femur

is securely contained the acetabulum.

A re?uires (A< weeks of a hip spica cast after surgery and may be

preceded by traction.

'64)3@ )3,

@/R#A reveals changes in the femoral head and hip from a flattened

appearance !tage $& and to a mottled appearance progressing to increased bone

density and normali"ation of the rounded appearance of the femoral head.

MRI: useful early in the disease to detect changes.

A later in the disease# ',4s are useful in assessing containment of the

femoral head in the acetabulum.

)(u+ti%n Tra+ti%n Aused to increase the ,-' in a child who has developedlimitedhip motion from pain and spasm.

Seria' Casting A casting of the hip in an abducted position with weekly cast

changes using a progressively longer bar until the full rang of abduction is

achieve. )asting may also contains the femoral head in the acetabulum.

'64)3T4-!/

NSID A given to relieve mild to moderately severe pain.

+,!4E 643E-!!

4mpaired physical mobility related to musculoskeletal impairment femoral head&

,isk for impaired skin integrity related to physical immobili"ation# pressure or

appliance and altered circulation# sensation.&

6elayed growth and development related to effects of immobili"ation. 6eficient knowledge related to lack of information about the disease.

+,!4E 4T,7T4-!/

)aring for the child re?uiring traction or a spica cast.

valuating the home and providing guidance to the family regarding the child;s

home care.

nabling the child to participate in as many activities of life as possible.

*roviding emotional support to the child and his family because of the long term

nature of the illness.

. &u9eni'e R6eumat%i( rt6ritis

/a chronic inflammatory disease that involves the synovium of the 8oints resulting ineffusion and eventual erosion and destruction of the 8oint cartilage.

/it is classifierd into different types and characteri"ed by remission and exacerbations# with

the onset most common between 2A5 and A$2 years of age.

T57es3

$. *auciarticular 3rthritis : involves only few 8oints# usually less than five.2. *olyarticular 3rthitis : involves many 8oints# usually more than four


34/62

. !ystemic 3rthritis : involves the presence of arthritis and associated with high

temperature# rash and effects on other organs such as heart# lungs# eyes and those

located in the abdominal cavity.

*athophysiology3utoimmunologic response

)hronic inflammation of synovial membrane

7asodilation Coint ffusion

4ncreased blood flow Thickened# hyperemic cellular

4ncreased capillary membrane pannus& permeability

rosion# destruction# fibrosi

armth of articular cartilage

,edness

*ain

4ridocyclitis ,educed 8oint !tructural changes,ash or mucocutA motion

aneous lesions *ericarditis Coint instability

7asculitis 3dhesions 'uscle atrophy

>ever between !tretched ligaments

'alaise 8oint surfaces

3nkylosis of 8oint >ibrous tissue irreversible

destructive changes

'edical 'anagement/

3ntiAinflammatories !346& A for analgesia# antipyretic action as well as antiAinflammatory and antirheumatic effects. 3ctions thought to be the inhibition of

prostaglandin synthesis. 'ay be used in combination with steroids and gold salts.

3ntiAinflammatories !teroids& : prednisone 6eltasone& given *- to suppress

inflammatory responses and reactions# also reduces antibody titers and inhibits

phagocytosis and release of allergic substances.

3ntirheumatics : to inhibit collagen formation to alter immune response and inhibit

prostaglandin synthesis in the treatment of rheumatic diseases.

)ytotoxics : to treat rheumatoid arthritis when response to other antiAinflammatory drugs

are not effective if the disease is severe and debilitating.

Coint KAray : reveals widened 8oint spaces with nlater 8oint destruction and effusion#

evidence of osteoporosis and inflammation at the affected 8oint sites.

!, : reveals increases in systemic type but may be decreased or increased depending onthe degree of inflammation.

3ntinuclear antibodies : reveals presence in F5% of rheumatoid factor with a positive

result in 25%9 positive or negative result depending on the type of arthritis.

,heumatoid >actor : reveals presence in those with later onset type with positive results in

pauciarticular type.

)B) : reveals increase B) in the earlier stages.

!ynovial >luid )ulture A reveals absence of infectious process and confirms absence of

other conditions by 8oint aspiration of fluid for examination.

1


35/62

)ommon ursing 6iagnoses

$. 4mpaired physical mobility related to musculoskeletal impairment# pain and

discomfort.

2. ,isk for impaired skin integrity related to external factor or physical immobili"ation.. 6elayed growth and development related to effects of physical disability.

1. Dyperthermia related to illness of inflammation5. 4mbalance nutrition less than body re?uirements related to inability to ingest food.

C. DO!ESCENT

1. S+%'i%sis

!coliosis is a lateral curvature of the spine. 4t can be classified as either functional or structured.

!coliosis is common among girl adolescents.

T=*!/

IDIOPTHIC SCO!IOSIS/+G-

A4>3T4@/ 0A9 C+74@/ A$09 36-@!)T/ $0A+*9 D4ED 4)46) T- >'3@ F/$

CONGENIT!/+G-9 T=* 4A >34@+, -> 7,TB,3@ B-6= >-,'3T4-9

T=* 44A>34@+, -> !E'T3T4-

NEURO/MUSCU!R SCO!IOSIS/6+ T- +,-'+!)+@3, )-64T4-#A

),B,3@ *3@!=I -A3'B+@3T-,=I 6=!T,-*D=

)3+!!/

)ause is unknown

)ondition affecting the neuromuscular system

3bnormal development of the bone in the spine

*artial unilateral failure

of formation wedgevertebrae&

)omplete unilateral

failure of formationDemivertebra&

+nilateral failure of

segmentationcongenital bar&

Bilateral failure of

segmentation blockvertebrae&

$. >unctional or *ostural : a.k.a. M)N curve

o fixed deformity of the spinal column

6ue to posture9 can be corrected voluntarily and disappears when child lies down

ot progressive2. !tructural and progressive : a.k.a. M!N curve

4diopathic

!tructural change of the spine does not disappear with position change

'ore aggressive intervention are needed

!4E! 36 !='*T-'!

$. *hysical characteristic

*oor posture

5


36/62

4ncrease or decrease thoracic kyposis or lumbar lardosis

@eg length discrepancy

+neven shoulder : right side is higher than the left

!capular prominence

Truncal imbalance

@ump on the back

+neven breast si"e

2. 7isuali"ation of deformity

. Back pain

,4!G >3)T-,!/

3ge

>amily members who had scoliosis

6elayed puberty and menarche in girls

*3TD-*D=!4-@-E=

*,64!*-!4E >3)T-,! *,)4*4T3T4E >3)T-,!3ge *resence of other diseases

!ex ature of living

Eenetic

>ailure of vertebral body

>ailure of segmentation

-steopathic conditions such as fracture#

bone disease# arthritis and infection

spinal irradiation and nerve root irritation

vertebral column develops curvature

changes in the thoracic case# ribs and sternum

lead to rib hump

!)-@4-!4!

(


37/62

)@3!!4>4)3T4- -> )+,73T+,

$. '4@6 A20R A W10R

X examined every months9 exercise program may strengthen torso muscle heel lift may also help.

2. '-6,3T : 10R A W(0R

X!pinal exercises9 braces. !7, A X(0R

Xlateral curvature progresses Xspinal fusion

643E-!T4) *,-)6+,

$. 3dams forward bending test

2. KAray of the spine in an upright position : show characteristic curvature.

. ',4# 'yelograms# Tomogram# )T scan : indicated for children with severe curvature who haveknown or suspected spinal column anomaly before management is made.

1. *ulmonary function test : for compromised respiratory status.

5. !coliometry : measurement of the curvature of the spine )obb;s method&

!)-@4-'T, : device use in scoliometry

(. 3rthrography : identify acute or chrnic tears of 8oint capsules or supporting ligaments.

'64)3@ '33E'T

$. -bservation : periodic physical and radiographic examination to detect curve progression.2. Bracing : to prevent progression of curve with the use of 'ilwaukee or yamamoto brace.

BRACE MANAGEMENT-PREVENT CURVE PROGRESSION0 FAITHFUL

COMPLIANCE0 23 HOURSDAY0 BRACING FOR SELETAL IMMATURE CHILDREN

WITH CURVES 2-@ DEGREES

. Traction : DaloApelvic9 haloAfemoral# cotrel

1. )ast : 'inerva9 ,i"""er;s 8acket

5. !urgery : spinal fusion9 D,49 stryker frame

(. xercise therapy has been promoted to help maintain flexibility in the spine and prevent muscleatrophy during prolonged bracing.

+,!4E 643E-!! 4mpaired physical mobility related to musculoskeletal impairment )urvature of the spine&.

,isk for impaired skin integrity related to physical immobili"ation# traction or brace and altered

sensation and circulation# surface electrical stimulation.

6elayed growth and development related to effects of immobili"ation and restricted movement from

spinal curvature..

Gnowledge deficit related to lack of information about correction of functional or structural

scoliosis.

6isturbed body image related to biophysical and psychosocial factors of spinal deformity.

+,!4E 4T,7T4-/

$. TeachIencourage client to exercise as ordered.

2. *rovide cast or traction care.

. 3ssist with modifying clothing for immobili"ation devices1. *rovide care for the client with D,4.

5. 3d8ust diet for decreased activityT57es %, )ra+es3

$%st%n %rt6%sis/for low thoracic and thoracolumbar curves

Mi'au-ee/thoracic or double ma8or curves. !tandard brace has neck ring wI chin rests

C6ar'est%n $en(ing )ra+e/night time usage

Surgi+a' C%rre+ti%ns/

F

n104 ortho lecture

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