(ncm 104)ortho sir pat lao 2

7/28/2019 (NCM 104)Ortho Sir Pat Lao 2

1/87

1111111
http://www.nysora.com/techniques/advanced/sciatic/000190.jpghttp://www.nysora.com/techniques/advanced/sciatic/000187.jpghttp://www.nysora.com/techniques/advanced/sciatic/000181.jpg


2/87


3/87


4/87

Preoperative

Offer support/encouragement Discuss:

Rehabilitation program & use of prosthesis

Upper extremity exercise such as push ups in bed

Crutch walking

Amputation dressing/cast Phantom limb sensation as a normal occurrence

Observe stump dressing for signs of hemorrhageand mark outside of dressing so rate of bleedingcan be assessed (tourniquet at bedside)


5/87

Prevent edema

Raise extremity with pillow support for first 24 h Prevent hip/knee contractures

Avoid letting patient sit in chair with hips flexedfor long periods of time

Have patient assume prone position several timesa day and position hip on extension Avoid elevation of stump after 24 hrs For BKA: hip & knee exercises For AKA: hip exercises

Pain medication as ordered (phantom limbpain)

Ensure that stump bandages fit tightly andare applied properly to enhance prosthesisfitting


6/87


7/87

Rheumatoid arthritis chronic systemic

inflammatory disease

destruction of connectivetissue and synovial

membrane within thejoints

weakens and leads todislocation of the jointand permanent deformity

Risk Factors exposure to infectious

agents

fatigue

stress


8/87

Signs and Symptoms Morning stiffness Fatigue Weight loss Joints are warm,

tender, and swollen

Swan neckdeformity-lateDiagnostic Studies X-ray Elevated WBC,

platelet count, ESR*,and positive RFTreatmentNo cure for RA

Swan neck deformity


9/87


10/87

Aspirin- mainstay of treatment, has bothanalgesic and anti-inflammatory effects

Nonsteroidal anti-inflammatory drugs(NSAIDs): Indomethacin (Indocin) Phenylbutazone (Butazoldin) Ibuprofen (Motrin) Fenoprofen (Nalfon) Naproxen (Naprosyn) Sulindac (Clinoril)

Immunosuppressives: Methotrexate Gold Standard for RA treatment Teratogenic


11/87

Gold compounds

Injectable form: sodium thiomalate,aurothioglucose; given IM once a week;

takes 3-6 months to become effective Oral form: auranofin- smaller doses are

effective; diarrhea is a common sideeffect

Corticosteroids

Intra-articular injections


12/87

Treatment Surgical Procedures: synovectomy,

arthrotomy, arthrodesis, arthroplasty

Nursing Management Advised bed rest during acute pain Passive ROM exercise of joints Splint painful joints Heat & Cold application Advised warm bath in the morning Protect from infection Advised well-balanced diet


13/87

Arthrotomy

Arthrodesis Arthroplasty
http://www.ortho-u.net/images/tssr30.jpg


14/87

Progressivedegeneration of thejoints as a result ofwear and tear affects weight-bearing joints andjoints that receive the

greatest stress, suchas the knees, toes,and lower spine.
http://rds.yahoo.com/S=96062883/K=Osteoarthritis+/v=2/l=IVI/*-http://www.arthritis-glucosamine.net/graphics1/cartilage.gifhttp://rds.yahoo.com/S=96062883/K=Osteoarthritis+/v=2/l=IVI/*-http://www.thirdage.com/health/adam/images/ency/fullsize/8882.jpg


15/87

Risk Factors aging (>50 yr) rheumatoid arthritis arteriosclerosis obesity trauma family historySigns and Symptoms Dull, aching pain,* tenderjoints fatigability, malaise crepitus cold intolerance* joint enlargement presence of Heberdensnodes or Bouchardsnodes weight loss


16/87

Aspirin inhibits cyclooxygenase enzyme, diminishes the formation

of prostaglandins anti-inflammatory, analgesic, antipyretic action inhibit platelet aggregation in cardiac disordersAdverse effects Epigastric distress, nausea, and vomiting In toxic doses, can cause respiratory depression Hypersensitivity Reyes syndrome

Ibuprofen use for chronic treatment of rheumatoid and osteoarthritis less GI effects than aspirinAdverse effects dyspepsia to bleeding headache, tinnitus and dizziness


17/87

Indomethacin inhibits cyclooxygenase enzyme

more potent than aspirin as an anti-inflammatory agent

Adverse effects: nausea, vomiting, anorexia, diarrhea

headache, dizziness, vertigo, light-headedness, and mental confusion

Hypersensitivity reaction


18/87

Nursing Intervention Promote comfort: reduce pain, spasms,

inflammation, swelling Heat to reduce muscle spasm Cold to reduce swelling and pain

Prevent contractures: exercise, bed rest on

firm mattress, splints to maintain properalignment Weight reduction Isometric and postural exercisesNursing Diagnosis Pain related to friction of bones in joints Risk for injury related to fatigue Impaired physical mobility related to stiff,

limited movement


19/87

Metabolic disorder that

develops as a result ofprolonged hyperuricemia

Caused by problems insynthesizing purines or bypoor renal excretion of uricacid.

Acute onset, typicallynocturnal and usuallymonarticular, often involving

the first metatarsophalangealjointRisk Factors Men

Age (>50 years)

Genetic/familial tendency


20/87

Signs and Symptoms extreme pain swelling erythema of the

involved joints fever

TophiLaboratory Findings elevated serum uric

acid (>7.0 mg/dl)* urinary uric acid elevated ESR and WBC crystals of sodium

urate aspirated from atophus confirms thediagnosis*
http://rds.yahoo.com/S=96062883/K=Tophi/v=2/l=IVI/*-http://meded.ucsd.edu/isp/1994/im-quiz/images/tophi.jpghttp://rds.yahoo.com/S=96062883/K=Tophi/v=2/l=IVI/*-http://www.hopkins-arthritis.som.jhmi.edu/other/images/gout_fig7.gif


21/87

Allopurinol- a purine analog

- reduces the production of uric acid by competitively inhibiting uricacid biosynthesis which are catalyzed by xanthine oxidase.

Effective in the treatment of primary hyperuricemia of gout andhyperuricemia secondary to other conditions (malignancies).

Adverse effects: hypersensitivity reactions, nausea and diarrhea

Colchicine Effective for acute attacks Anti-inflammatory activity alleviating pain within 12 hours Adverse effects: nausea, vomiting, abdominal pain, diarrhea,

agranulocytosis, aplastic anemia, alopecia

Probenecid/Sulfinpyrazone uricosuric agents increases the renal excretion of uric acid Sulfinpyrazone used as a preventive agent. Adverse effects: nausea, rash & constipation


22/87

Maintain a fluid intake of at least 2000 to 3000 ml a day to avoidkidney stone. Avoid foods high in purine such as wine, alcohol, organ meats,sardines, salmon, anchovies, shellfish and gravy. Take medication with food. Have a yearly eye examination because visual changes can occurfrom prolonged use of allopurinol Caution client not to take aspirin with these medication because itmay trigger a gout attack and may cause an elevated uric acidlevels. Encourage rest and immobilize the inflamed joints during acuteattacks Avoid excessive alcohol intake Notify physician if rash, sore throat, fever or bleeding develops.


23/87

COMPARING ARTHRITIS

Rheumatoid Osteoarthritis Gouty

Etiology Autoimmune

+ Rh factor

Degenerative

senescence

Metabolic orfamilialpurinemetabolism

Incidence 35-45 women Men or more inwomen

Men over 40

Signs andsymptoms

Subcutaneaousnodules

Morning stiffness

Swan neckdeformity

Heberdens nodule Tophi

Areasaffected

Joints of hands Weight bearingjoint

Great toe

Management

Aspirin, NSAIDs

Paraffin bath

Symptomatic Colchicine

Avoid purine

dietAllopuyrinol


24/87

Bacterial Infection ofthe bone and softtissue

Staphylococcus aureus

is the most commonpathogen. Hemolytic

streptococcus

Other organismsinclude Proteus,Pseudomonas and E.Coli
http://rds.yahoo.com/S=96062883/K=Osteomyelitis/v=2/l=IVI/*-http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/9712.jpg


25/87

Risk Factors

poorly nourished, elderly orobese

impaired immune systems

chronic illnesses

long term corticosteroid therapy

Open wound

infection
http://rds.yahoo.com/S=96062883/K=Osteomyelitis/v=2/l=IVI/*-http://www.microsurgeon.org/images/osteomyelitis_debridement.jpghttp://rds.yahoo.com/S=96062883/K=Osteomyelitis/v=2/l=IVI/*-http://www.microsurgeon.org/images/osteomyelitis.jpg


26/87

Organism reaches the bone throughan open wound

Infection causes bone destruction

Bone fragment necrose -sequestra

New bone cells form over thesequestrum during healing

resulting in nonunion


27/87

Clinical Manifestation area appears warm, swollen and

extremely painful ( localized edema)

systemic manifestations (fever,chills, tachycardia) Bone pain Muscle spasm


28/87

Diagnostic Studies X-ray

Bone Scan Blood and wound culture

Bone Biopsy


29/87

1. Antibiotics : Cefazolin and Clindamycin

2. Analgesic : Oxycodone,

1. 1015 mg of oxycodone produces ananalgesic effect similar to 10 mg of morphine

3. Vital Signs and Neurovascular status

4. Diet : High calorie, vitamin C and DCalcium

5. Activity : bed rest6. Heat therapy

7. Antipyrectic : aspirin, acetaminophen


30/87

1. Monitors the neurovascular status of the affectedextremity

2. Elevation reduces swelling and associateddiscomfort

3. Pain is controlled with prescribed analgesics andother pain-reducing techniques

4. Must be protected by immobilization devices andavoidance of stress on the bone

5. The patient must understand the rationale of forthe activity of restriction

6. Encourage patient to have a full participation inADLs within the physical limitations to promotegeneral well-being


31/87

Monitor the patients response to antibiotic therapy

Observes the IV access for evidence of phlebitis, infection, orinfiltration,

With long term intensive antibiotic therapy (monitors thepatient for sign of infection like oral or vaginal candidiasis,loose or fouling-smelling stool

If surgery is necessary (take measures to ensure adequatecirculation to the affected area (wound suction to prevent

accumulation, elevation of the area to promote venousdrainage, avoidance of pressure on the grafted area) tomaintain needed immobility, and to ensure the patientsadherence of to weight bearing restrictions.

Changes dressings using aseptic technique (to promote

healing and to prevent cross-contamination

Diet high in protein and Vitamin C (promotes a positivenitrogen balance and healing

Encourage adequate hydration as well


32/87

Promote comfort

Immobilized affected bone by maintainingsplinting. Elevate affected leg Administer analgesics as needed.Control infectious process Apply warm, wet soaks 20 min. several

times a day. Administer antibiotics as prescribed. Use aseptic technique when dressing the

wound.Encourage participation in ADL within thephysical limitations of the patient.


33/87

a reduction in bone density and a change inbone structures

bones become previously porous, brittle and

fragile

bones fracture easily under stresses thatwould not break in normal bone


34/87

Incidence- women older than 80 years old of age is 84%.

The average 75 years-old woman has lost 25%of her cortical bone and 40% of her trabecular

bone.


35/87

Age1. Post-menopause

2. Advance age

3. Low testosterone in men

4. Decreased calcitonin

Nutrition1. Low calcium intake

2. Low vitamin D3. High phosphate intake

4. Inadequate calories


36/87

Physical exercise Sedentary

Lack of weight-bearing exercise Low weight and body mass index

Lifestyle choices Caffeine

Alcohol Smoking

Lack of exposure to sunlight

Medications

Corticosteroids

Antiseizure medications Heparin

Thyroid Hormone


37/87

Back pain.

Loss of height and stooped posture.

A Curved upper back (dowager's hump). Fracture : hip, spine and wrist.

Compression fractures


38/87

1. Primary Osteoporosis : women after menopause (usually after 45 and 55

years) later in men.

2. Secondary Osteoporosis medications or other conditions and disease that

affect bone metabolism.


39/87

Predisposes to low bone

mass

Genetics-Caucasian or Asian-Females

-Family history-Small frameAge-Post-menopause-Advance age-Low testosterone in men-Decreased calcitoninNutrition-Low calcium intake-Low vitamin D-High phosphate intake-Inadequate calories

Hormones

(estrogen, calcitonin,and testosterone)inhibit bone loss.

Reduces nutrients

needed for the boneremodeling


40/87

Physical Exercise-Sedentary-Lack of weight-bearing exercise-Low weight and body mass indexLifestyle Choices-Caffeine-Alcohol-Smoking-Lack of exposure to sunlightMedications-Corticosteroids-Antiseizure medications-Heparin-Thyroid Hormone

Reducesosteogenesis inbone remodeling

Affects calciumabsorption andmetabolism

Bones needed

stress for bone

maintenance.


41/87

Dual-energy X-ray Absorptiometry (DEXA)-Means of measuring bone mineral densities

(BMD)

Two xray beams with differing energy levels are

aimed at the patient bones.X ray. Serum calcium Serum phosphataseUrine calcium excretion


42/87

1. Hormone replacement therapy (HRT)1. Raloxifene (Evista) preserving BMD w/o

estrogenic effect on the uterus ( prevention and

treatment for osteoporosis

2. Bishosphonates

3. Alendronate - inc. bone mass by inhibiting

osteoclast function.

4. Calcitonin


43/87

Nursing Diagnosis

1. Deficient knowledge about the osteoporotic

process and treatment regimen

2. Acute pain related to fracture and musclespasm

3. Risk for constipation related to immobility or

development of ileus

4. Risk for injury:additional fractures related to

osteoporosis


44/87

Nursing Inteventions

Promoting and Understanding of Osteoporosis and the

Treatment Regimen

1. Adequate dietary or supplemental calcium (1200-

1500 mg/day) and vitamin D

2. Regular weight-bearing exercise

3. Modification of lifestyle like cessation of smoking,

reduce the use of caffeine and alcohol4. Help to maintain bone mass

5. Instruct to take the calcium supplements with meals

6. Teach patient to drink adequate fluids to reduce the

risk of renal calculi7. For Alendronate users, it must be taken on an empty

stomach with water and the patient must not

consume foods or liquids for 30-60 minutes.


45/87

Relieving Pain1. Rest in bed in a supine position or side-

lying position several times a day. Themattress should be firm and non-sagging.

2. Intermittent local heat and back rubspromote muscle tension

3. Instruct to move the trunk as a unit andavoid twisting.


46/87


47/87

primary malignant neoplasm of bones

Also known as Osteogenicsarcom

Occurs between 10-25 years of age, with Paget's

disease and exposure to radiation.

Exhibits a moth-eaten pattern of bone destruction.

Most common sites: metaphysis of long bones

especially the distal femur, proximal tibia andproximal humerus.


48/87

Risk Factors

Cause is unknown. family history / inherited cancers :

Li-Fraumeni SyndromeRetinoblastoma

being tall for specific agePrevious treatment with radiation for another cancer

That usually occurs in children younger than 4 yrs.

P h h i


49/87

1.Osteosarcoma occurs mainly in the metaphyses oflong bones, sites of active epiphyseal growth.Distal femurProximal tibiaProximal humerus1.As a tumor of mesenchymal cells, osteosarcoma

demonstrates production of osteoid cells.2.It is a bulky tumorthat extends beyond the bone the

bone into a soft tissue.3.This may encircle the bone and destroy the

trabeculae of affected area.4.Osteosarcoma disseminates through bloodstream,usually to the lung.

5.Other sites of metastatic spread include otherbones and visceral organs

Pathophysiology:


50/87

High grade mesenchymaltumorDistal femurProximal tibia

Proximal humerusFormation of

osteoid

Lungs, bones,visceral organs

Metastasize throughblood streams

Bulky tumor thatdestroys trabeculaeof diseased area

Predisposing Factors


51/87

Clinical Manifestation local signs pain ( dull,

aching and intermittent innature), swelling, limitationof motion

palpable mass near the endof a long bone

systemic symptoms:

malaise, anorexia, andweight loss

Diagnostic Findings Biopsy- confirms the

diagnosis

X-ray MRI Bone Scan Increase alkaline

phosphatase


52/87

Radiation Chemotherapy (methotrexate(leucovorin/Adriamycin) Cytoxan, Ifosfamide Surgical management

amputation limb salvage procedures

Prognosis: poor prognosis (rapid growth rate)


53/87

Promote understanding of the diseaseprocess and treatment regimen

Promote pain relief Prevent pathologic fracture Assess for potential complications(infection, complications of immobility). Encourage exercise as soon as possible(1st or 2nd post-op day)


54/87

a plastic surgery

that involvesremoval of thehead of the femurfollowed by

placement of aprosthetic implant


55/87


56/87

Teach client how to use crutches

Teach client mechanics of transferring.

Discuss importance of turning and positioning post-op.

Place affected leg in an abducted position and straightalignment following surgery

Prevent hip flexion of more than 90 degrees.

Apply support stockings

Advise client to avoid external/internal rotation of affectedextremity for 6 months to 1 year after surgery

Instruct client to avoid excessive bending, heavy lifting,jogging, jumping

Encourage intake of foods rich in Vitamin C, protein, and

iron. Administer prescribed medications.

Metallic implant


57/87

Infection Hemorrhage Thrombophlebitis Pulmonary embolism Prosthesis dislocation Prosthesis loosening


58/87

condition in which

the head of thefemur is

improperly seatedin the acetabulum,or hip socket, ofthe pelvis.

Congenital ordevelop after birth


59/87

Neonates: laxity of theligaments around thehip, allowing thefemoral head to bedisplaced from theacetabulum uponmanipulation.

Implementation: Splinting of the hipswith Pavlik harness tomaintain flexion andabduction and externalrotation (neonatalperiod) Pavlik harness
http://images.google.com/imgres?imgurl=www.musckids.com/health_library/orthopaedics/images/1harnessff.gif&imgrefurl=http://www.musckids.com/health_library/orthopaedics/ddh.htm&h=500&w=530&prev=/images%3Fq%3DDysplasia%2Bof%2BHip%26start%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DN


60/87

Infants Asymmetry of the gluteal and

thigh skin folds when thechild is placed prone and thelegs are extended against theexamining table. Limited range of motion inthe affected hip. Asymmetric abduction of theaffected hip when the child isplaced supine with the kneesand hips flexed. apparent short femur on theaffected side
http://images.google.com/imgres?imgurl=www.orthoweb.be/brochures/pediatric/images/pavlik.jpg&imgrefurl=http://www.orthoweb.be/brochures/pediatric/pavlik_uk.htm&h=244&w=163&prev=/images%3Fq%3DDysplasia%2Bof%2BHip%26start%3D20%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DN


61/87

Implementation Traction and/or

surgery to releasemuscles andtendons

Following surgery,positioning and

immobilization in aspica cast untilhealing is achieved.
http://rds.yahoo.com/S=96062857/K=+spica+cast/v=2/SID=w/l=II/R=3/*-http://images.search.yahoo.com/search/images/view?back=http%3a//images.search.yahoo.com/search/images%3fsrch=1%26p=%2bspica%2bcast%26ei=UTF-8%26n=20%26fl=0&h=231&w=428&imgurl=showcase.netins.net/web/eulemaraja/img8.jpg&name=img8.jpg&p=+spica+cast&rurl=http://showcase.netins.net/web/eulemaraja/page5.html&type=&no=3&tt=65http://rds.yahoo.com/S=96062857/K=+spica+cast/v=2/SID=w/l=II/R=1/*-http://images.search.yahoo.com/search/images/view?back=http%3a//images.search.yahoo.com/search/images%3fsrch=1%26p=%2bspica%2bcast%26ei=UTF-8%26n=20%26fl=0&h=719&w=899&imgurl=www.ucsf.edu/orthopaedics/patientedu/img/ddh4.jpg&name=ddh4.jpg&p=+spica+cast&rurl=http://www.ucsf.edu/orthopaedics/patientedu/peds_ddh.html&type=&no=1&tt=65


62/87

The walking child minimal to

pronouncedvariation in gait with

lurching toward theaffected side;positiveTrendelenburg sign

Positive Barlow orOrtolanis maneuverOrtolanis maneuver Barlow maneuver


63/87

Caring forPatient with
http://www.gamasutraexchange.com/Previews/Content_on_10_8_2001_16_16_50%5Cbone_thumb.jpgDD4B6947-A91F-4B2A-8E420366AA969116.jpgLarge.jpg


64/87

Osteomalaciainvolves softeningof

the bones caused bya deficiency of vitamin Dor problems with themetabolism of this

vitamin.
http://www.capitolmarket.net/photosh1/bone.jpghttp://www.capitolmarket.net/photosh1/bone.jpg


65/87

In children, the

condition is calledrickets and isusually caused by adeficiency of

vitamin D .


66/87

In adult, the conditionis usually caused by:

1. Inadequate dietaryintake of vitamin D

2. Inadequate exposureto sunlight (ultravioletradiation)

3. Malabsorption ofvitamin D
http://www7.nationalacademies.org/germanbeyonddiscovery/VitaminD_7-2.jpghttp://www.msd.com.hk/images/health_info/disease_info/osteoporosis/e_picture6b_1a.gifhttp://www.capitolmarket.net/photosh1/bone.jpghttp://www.capitolmarket.net/photosh1/bone.jpg


67/87

Other conditions:1. Hereditary or acquired disorders

of vitamin D metabolism

2. Kidney failure and acidosis ,3. PO4 depletion associated with

low dietary intake or kidneydisease

4. Side effects ofmedications usedto treat seizures .


68/87

Risk factors are related tothe causes.

In the elderly, there is anincreased risk for those whotend to remain indoors andwho avoid milk because oflactose intolerance

The incidence is 1 in 1000people.
http://images.google.com/imgres?imgurl=www.cambridge-nutritional.com/Girl%2520drinking%2520milk.jpg&imgrefurl=http://www.cambridge-nutritional.com/new_page_1.htm&h=764&w=670&prev=/images%3Fq%3Ddrinking%2BMILK%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26oe%3DUTF-8%26sa%3DGhttp://www.capitolmarket.net/photosh1/bone.jpghttp://www.capitolmarket.net/photosh1/bone.jpg


69/87

Deficiency of activated VITAMIN D

(Calcitriol)

Decreased absorption, malabsorption or excessive loss ofCALCIUM

Inadequate

MINERALIZATION of bone

SOFTENING of the

BONE


70/87

diffuse bone pain , especially in the hips muscle weakness

symptoms associated with low calcium1. numbness around the mouth & of

extremities2. Carpopedal spasms3. Bowing of legs4. Waddling or limping GAIT5. Decrease in height/ Spinal Deformities (i.e.

KYPHOSIS)

k
http://www.capitolmarket.net/photosh1/bone.jpg


71/87

In children, symptoms ofricketsinclude:

delayed sitting, crawling, and walking; pain whenwalking; and the development ofbowlegs orknock-

knees.
http://www.capitolmarket.net/photosh1/bone.jpg


72/87

1. Bone biopsy: (+) increase in osteoid

2. Bone X-ray or CT scan of lumbosacral spineshows demineralization.

3. Studies of the vertebrae: (+) compression fx

4. Low serum vitamin D level

5. Low serum calcium &phosphate levels

6. Elevated ALP (Alkaline Phosphatase)


73/87

1. Adequate dietaryintake of dairy

products that arefortified withvitamin D

2. Adequate exposure

of the body tosunlight


74/87

Oral supplementsof vitamin D ,calcium, and

phosphorus
http://www.capitolmarket.net/photosh1/bone.jpghttp://www.msd.com.hk/images/health_info/disease_info/osteoporosis/e_picture6b_1a.gifhttp://www.orthocenter.net/images/ArticleClipArt/OsteoporosisPictures/milk_animated.gifhttp://www.capitolmarket.net/photosh1/bone.jpg


75/87

Large doses of Vitamin Dwith exposure to sunlightmay be indicated inpeople with intestinal

malabsorption .
http://www.capitolmarket.net/photosh1/bone.jpghttp://www.ec-securehost.com/fft/images/3340.jpghttp://www.karlloren.com/adelle-davis/images/bd05493_.gif


76/87

Monitoring of blood levelsofphosphorus andcalcium may be indicatedwith some underlying

conditions. Braces or surgery to

correct deformities

30
http://www.capitolmarket.net/photosh1/bone.jpghttp://www.widemedia.com/fashionuk/news/2001/09/03/tubes.gif


77/87

30

Protrusion of the nucleus of the disk into thefibrous ring of the disk with subsequent nervecompression

May occur in any portion of the vertebralcolumn

Signs & Symptoms1. Pain

2. Sensory changes3. Loss of reflex

4. Muscle weakness

77


78/87


79/87

30


80/87

30

1. Cervical Pain/ Stiffness head, neck & upper extremities Paresthesia, numbness

Weakness

2. Lumbar Low back pain radiating to the buttocks and leg Postural deformity of the spine

(+) Straight-Leg Raise test

Weakness & Asymmetric reflexes

Sensory loss

Nursing Alert: Perform repeated assessments ofsensorimotor

functions/ reflexes to determine progression of condition80


81/87

30
http://www.safetyline.wa.gov.au/institute/level2/course17/lecture48/images/l48_01.jpg


82/87

30

Alleviating pain1. Anti-inflammatory drugs, muscle

relaxants, and narcotic analgesics2. Use ofbed boards under the mattress3. Bed restsupine or low fowlers or side

lying position with slight knee flexion andpillows between knees.

4. Moist heat application5. Relaxation techniques

Nursing Interventions

82


83/87

Surgical incision of part of posterior arch ofvertebrae and removal of protruded disc Nursing InterventionPreoperative

Teach patient log rolling and use of bedpanPostoperative Position as ordered Lower spinal surgery- flat Cervical spine surgery: slight elevation of

head of bed Proper body alignment- cervical spinal

surgery: avoid flexion of neck and applycervical collar


84/87

Avoid: Acute hip flexion (bending, stooping, crossing the

legs

Prolonged sitting/standing

Running, jogging, horseback riding Back- strengthening exercises

Prone position

Walk in seawater

Lie in side- lying with hip flexion


85/87


86/87

Patient teaching and Discharge Planning Wound care

Good posture and proper body mechanics

Activity level as ordered

Recognition and reporting of complications such aswound infection, sensory or motor deficits


87/87

(ncm 104)ortho sir pat lao 2

Documents