(ncm 104) ortho sir pat lao 3

7/28/2019 (NCM 104) Ortho Sir Pat Lao 3

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- a chronic occlusive arterial disease thatmay affect the abdominal aorta or the LE.

The obstruction to blood flow with

resultant ischemia usually affects thefemoral, popliteal, aortic and iliac arteries - occurs most often in men ages 50-60 - caused by atherosclerosis

- Risk Factors: cigarette smoking,hyperlipidemia, hypertension, DM


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B. Medical management:1. Drug therapy

a. Vasodilators: papaverine, Isoxsuprine Hcl (Vasodilan)*,

Nylidrin Hcl (Arlidin), nicotinyl alcohol (Roniacol)cyclandelate (Cyclospasmol)*, tolazoline Hcl (priscoline) toimprove arterial circulation; effectiveness questionable

b. Analgesics to relieve ischemic painc. Anticoagulants to prevent thrombus formation

d. Lipid reducing drug: cholestyramine, colesti[pol Hcl,dextrothyroxine sodium, clofibrate, gemfibrozil (Lopid)**,niacin, lovastatin (Mevacor), atorvastatin*


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2. Surgery: bypass grafting, endarterectomy, ballooncatheter dilation, lumbar sympathectomy (to increaseblood flow), amputation may be necessary

C. Assessment findings:1. Pain both intermittent claudication* and rest pain,

numbness or tingling of the toes2. Pallor after 1-2 mins. Of elevating feet, and dependent

hyperemia/rubor; diminished or absent dorsalis pedis,posterior tibial and femoral pulses; shiny, taut skinwith hair loss on lower legs*


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3. Diagnostic tests:a. Oscillometry may reveal decrease pulse volumeb. Doppler U/S reveals decreased blood flow through

affected vesselsc. Angiography reveals location and extent ofobstructive process

4. Elevated serum triglycerides; sodium

D. Nursing Interventions:1. Encourage slow, progressive physical activity


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2. Administer medications as ordered3. Assist with Buerger-Allen exercises qid*

a. client lies with legs elevated above heart for 2-3

minsb. client sits on edge of bed with legs and feetdependent and exercises feet and toes upwardand downward, inward and outward for 3 minsc. client lies flat with legs at heart level for 5 mins

4. Assess for sensory function; protect client frominjury

5. Provide client teaching and discharge planning:stop cigarette smoking, diet, drug compliance,

exercise


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1. Alteration in comfort ( pain)2. Impaired skin integrity

3. Altered tissue perfusion4. Anxiety5. Altered body image6. Impaired physical mobility7. Activity intolerance



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Encourage to Stop smoking Lose wt. and eat low fat Do not cross legs Elevate feet not above heart level

Do not stand & sit for long periods of time Do not wear restrictive clothing Keep affected extremity warm Inspect feet/extremity daily Avoid walking barefoot Avoid mechanical and thermal injuries Begin and maintain exercise Notify AP

Nursing intervention


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- Acute inflammatory disorder affecting

medium/smaller arteries and veins of the LE.

Occurs as focal, obstructive process; results in

occlusion of a vessel with subsequent developmentof collateral circulation

- Most often affects men ages 25-40; disease is

idiopathic; high incidence among smokers

A. Medical management: same as arteriosclerosis

obliterans but only cessation of smoking is

effective treatment*


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B. Assessment findings:1. Intermittent claudication*, sensitivity to cold (skin of

extremity may at first be white, changing to blue

then red)

2. Decreased or absent peripheral pulses (post. tibialand dorsalis pedis), ulceration and gangrene(advanced)

3. Diagnostic tests: same as arteriosclerosis obliterans

except no elevation in serum triglycerides

C. Nursing Interventions:

1. Prepare client for surgery


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2. Provide client teaching and discharge planning

- drug regimen, avoidance of trauma to the

affected extremity, need to maintain warmth esp.

during cold weathers, importance of stoppingsmoking


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B. Assessment findings:1. coldness, numbness, tingling in one or more digits;

pain (. By exposure to cold, emotional upsets,tobacco use)*

2. intermittent color changes (pallor, cyanosis, rubor);small ulcerations and gangrene tips of digits

C. Nursing interventions

1. provide client teaching concerning:- importance of stopping smoking; need tomaintain warmth; need to use gloves in handlingcold objects; drug regimen*


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The head to the thigh bone(femur)deteriorates due to insufficient blood suppy.

The tip of the bone dies over a period of 1-3weeks.This will cause flattening of the top( ball)New blood supply will cause new bone

growth over the next 6 12 months



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Knee pain maybe the only symptoms Persistent thigh / groin pain Atrophy of the upper thigh

Slight shortening of the leg Stiffness of the affected part Difficulty of walking ( limping) Limited range of motion Synovitis causing limp and pain in the hip Flattening of the femoral head Lateral over growth of the femoral head

cartilage



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1. PE2. Arthrography

3. Venography4. MRI/CT scan5. Ultrasound6. Hip X ray



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1. Pain2. Anxiety

3. Fear4. Impaired physical mobility5. Activity intolerance6. Ineffective role performance7. Low self esteem8. Trauma9. Spiritual distress



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1. Care of patient requiring traction or spinecast.

2. Teaching and guidance to family3. Encourage participation to patient care4. Set for appropriate referals : PT, social

service, community health nurse5. Diversionary activities6. Exercise7. Emotional support



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Curving of the spine that causes bowing ofthe back. ( hunchback)

Research society defines kyphosis as spinemeasuring 45 degrees or greater on a xrayNormal spine has only 20 35 degrees ofcurvature in the upper back



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1. Postural and Structural2. Gibbus deformity

3. Hyperkyphosis4. Congenital5. Scheuermanns disease juvenile thoracic

Kyphosis unknown cause, familial tendency.Decrease intervertebral disc space andvertebral wedging resulting to curvature

onset is usually at the age of 5 to 12 and 15 years .



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Postural and Structural

1. Hyperkyphosis

Gibbus deformity


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Unknown Infection ( Tuberculosis)

Spinabifida Disc degeneration Pagets disease abnormal bone destruction

and new growth Polio Tumors Muscular dystrophy



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Spinabifida


Polio


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1. Gibbus formation,/ curvature of the spine2. Pain

3. Poor posture4. fatigue]5. Numbeness, paresthesia6. Muscle spasm7. Weakness of the back8. With mild scoliosis9. Bowel and bladder changes



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Neuro evaluation X ray

Bone scan MRI CT scan



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Care for patient wearing a brace Cast/ traction care

Use firm mattress Avoid prolong sitting Skin care Assess Cardiopulmonary status Medications: analgesic, antibiotics,

antianxiety Emotional support



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Is tuberculosis of the spine Also known as tuberculosis spondylitis.

Affects adult. It is secondary to an extra spinal source of

infection Progressive bone destruction leads to

vertebral collapse and kyphosis.( Gibbusformation)



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Presentation depends on the following :

Stage of the disease

Site : cervical, thoracic, lumbosacral) Presence of complication neurologic deficit

the reported average duration of Sx at thetime of diagnosis is 3-4 months

Back pain is the earliest and common sx.



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Fever and weight loss 50 % of the cases has neurologic

abnormalities: spinal cord compression,paraplegia, paresis, impaired sensation caudaequina syndrome

Cervical spine TB is less common but more

serious complication :

Pain and stiffness, dysphagia or stridor, torticolis



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1. PE

1. spinal alignment

2. Neurologic exam2. Lab test

1. Mantoux test (PPD)

2. ESR

3. Bone exam(micro) AFB screening

3. Xray, Ctscan, MRI



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1. Independent:

1. Vital signs

2. Pain scale assessment3. Comfort measures : massage positioning

4. Inspect skin for abscess

5. I & O and nutritional intake6. Check traction setup

7. Active and passive ROM

8. Promote coughing & Breathing exercise1/18/2009 Noaharch Library 38


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9. encourage verbalization of feelings

Collaborative : Medication

Multivitamins,

Diet: balanced diet of CHO, CHON



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condition in which the median nerveis compressed at the wrist.

Paresthesia and muscle weakness inthe hand May occur at night/waking up at night Most of the cause is idiopathic or

without specific cause.



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Can be associated with :

Trauma,

Pregnancy,

Rheumatoid arthritis

Acromegaly

Hypothyroidism. Work related

Genetic structural and biological

fracture1/18/2009 Noaharch Library 43


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Diagnostic :

Blood pressure cuff for 1-2 minutes evokes pain

EMG delay in nerve motor conduction > 5 msec.



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Treatment:

1. Resting / splinting 1-2 weeks

2. Corticosteroids (bethamethasone/hydrocortisone)

3. NSAID

4. Surgical decompression resecting the carpal

tunnel ligament



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an umbrella term encompassing a group ofnon progressive, non contagious motor

conditions that cause physical disability inhuman development, chiefly in the variousareas of body movement\

Cerebral cerebrumPalsy refers to disorder movementDamage in motor control centers of

developing brain



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can occur during pregnancy 75% 5 % during child birth 15 % after birth Neuromuscular disorder



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It is cause by Cerebral anoxia,hemorrhage

Maternal infection Rubella Maternal drug ingestionRadiation Maternal diabetes Malnutrition



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Forcep delivery, breech presentation,placenta previa and abruptionplacenta

Abnormal vitals from anesthesiaProlapsed cord Multiple birth



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Spastic - Common type 70% - 80 %

Hypertonic and have neuromuscularcondition from damage to thecorticospinal tract or to motor cortex..

a) Spastic Hemiplegia

b) Spastic diplegia

lower ext. less inupper. ( strabismus) scissor gait

c) Spastic tetraplegia all 4 limbs, leat

likely to walk1/18/2009 Noaharch Library 51


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Ataxic

Damage to cerebellum

Less common form cerebral palsy 10%

Hypotonia and tremors

Visua;l and auditory

Hypotonic



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Athetoid/dyskinetic Mixed muscle tone.

Trouble in holding self uprigth, steadyposition for sitting /walking.

Unable to hold objects

of the people with CP have athetoid



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1. Deformities and contractures (permanently

fixed , tight muscle and joints.2. Spasticities

3. Unstable gait, problems with balance.

4. Night sweat

5. Constipation in children

6. dysphagia

7. drooling

8. glossoptosis9. Scissor gait

10. Toe walking

11. Weakness/one arm



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EEG Neuro-imaging Cytogenic



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Physical Occupational therapy Speech language therapy Surgery Diazepam, Baclofen, and Dantrolene.Adaptiive devices : braces/splints



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JamesTaylor andson

J&J artificial limb andbrace


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1. Assist in locomotion, communicationand educational opportunities

2. Institute high calorie diet3. Plan activities that involve gross

motor skills4. Provide safe environment



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Deformity occurs in utero.Approximately 1:1000 birthBoys are twice likely to be affectedHereditaryAlso known as Talipes equinovarus isthe most common.

http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D1


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http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D1http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D1


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Mechanical forcePlacental exposure to drugs/infection Hereditary

3 classical definition requires thesecomponent1. Plantar flexion of the foot at the ankle

joint

2. Inversion deformity of the heel

3. Turning of the foot1/18/2009 Noaharch Library 62


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Manipulation of the foot Straps and splints Casting Corrective surgery Denis browne splint



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Help parents and child deal with griefand emotional problems

Teach parents the prescribedexercises

Urge the parents that the child mustwear corrective shoes

(ncm 104) ortho sir pat lao 3

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