Nursing Practice III - V -​ Bend, look both sides of scapula → prominence of scapula

ORTHOPEDIC NURSING (asymmetrical) = SCOLIOSIS

Comprehensive Phase
●​ X-ray ⭐
-​ Confirmatory diagnostic test
Total bones: 206 — lesser bone as we age d/t fusion
Newborn bones: 270
-​ Have 4 coccyx which fuses as they age Complication: Pulmonary Impingement

⭐ Spine is connected to sternum in front while it is connected to

⬇️
compressed and are unable to fully utilize →
oxygen
⬇️
-​ Due to asymmetry of the spine, some parts of the lungs are
vital capacity →
thoracic at the back

Damaged bone: FRACTURE Management:

1. Milwaukee Brace
Sequence of Spinal Cord: -​ To reduce curvature
●​ Cervical -​ Used for 3 years with gradual adjustment
●​ Thoracic -​ Worn for 23 hours/day (1 hour removed for
●​ Lumbar
●​ Sacral
hygiene/swimming)
-​ Best exercise for spine abnormality: SWIMMING
heavy lifting
⭐ – no to
●​ Coccyx
-​ Used at the top of cotton shirt
Common bone:
●​ Sternum – also known as the breast plate ❌
-​ Harness/traction/braces concern is to prevent skin breakdown
Do not to apply anything on the skin unless until it is
prescribed
Xiphoid Process
-​ Cartilage under sternum
-​ Used as landmark to measure the length of GIT 2. Harrington Rod Insertion
(nose, ear lobes, xiphoid process or vice versa) -​ Also known as spinal fusion
●​ Clavicles – also known as the collarbone, shoulder girdle -​ Slight spine curvature can undergo surgery
●​ Scapula – also known as shoulder blades
-​ Located at the back of clavicle KYPHOSIS
-​ Posterior curvature of thoracic spine
SCOLIOSIS -​ Common to elderlies
-​ Lateral curvature of the spine -​ Naka kuba
-​ Asymmetrical shoulder and pelvis
-​ Sternum moves with the spine as the ribs are attached to it LORDOSIS
●​ Letter S curvature -​ Anterior curvature of lumbar spine
●​ Letter C curvature -​ Common to pregnant woman
-​ Naka liyad
Common: Female teenagers
Flat bones:
Physical Examination: ●​ Sternum
●​ Adams Forward Bend test ●​ Clavicle
Airah B. Bolinbough, RN
 ●​ Scapula located → if damaged = BRACHIAL PLEXUS
●​ Ribs PARALYSIS/CRUTCH PARALYSIS
●​ Skull -​ Weight of the patient is carried by the arms and hands
●​ Pelvis Joints:
-​ Different from bones
Long bones: -​ Where 2 bones is attached
●​ Humerus -​ Joints should be movable
●​ Radius
●​ Ulna Damage in joint: DISLOCATION
-​ Long bones of upper extremities
●​ Femur ●​ Balls and Socket
●​ Tibia -​ All joint movement is possible
●​ Fibula -​ Socket means ‘saksakan/butas’
-​ Long bones of lower extremities
○​ Shoulder
Greater Trochanter -​ Socket in shoulder is called Glenoid
-​ Site of landmark to measure the length of assistive devices -​ Ball is in humerus
-​ Bony prominence ○​ Hip
-​ Assistive devices cannot be borrowed because it personalized -​ Socket in hip is called Acetabulum
based on height -​ Ball is connected to femur
●​ Hinge
Posterior Iliac Crest -​ Flexion and extension joint movement only
-​ Best site for bone marrow aspiration ○​ Elbow
○​ Knee
Anterior Iliac Crest
-​ Secondary best site for bone marrow aspirator Connective Tissue:
-​ Connects structures of the body
<1 yr old: Best site for bone marrow aspiration is Tibia ●​ Tendons
-​ Connects bones to muscles
ASSISTIVE DEVICES -​ Muscles in front of femur is quadriceps
-​ All handles of the assistive devices should be at the level of -​ Muscles at the back femur is hamstring
greater trochanter -​ Muscles at the back of tibia and fibula is calf
●​ Walker -​ Muscles in front of humerus is biceps
-​ 4 point, 2 handles -​ Muscles at the back of humerus is triceps
●​ Cane ​ Tearing of tendons: sTrain
-​ 1 point, 1 handle
-​ Elbow at 20-30° flexion ●​ Ligaments
●​ Crutches -​ Connects bone to bone
-​ 1 point, 2 handles -​ Most common fracture: ___
-​ Distance from axilla 2-3 fingerbreadths to avoid placing -​ Carpals in hands, metatarsals in feet
the weight on the axilla where brachial plexus nerve is ​ Damaged ligaments: Sprain

Airah B. Bolinbough, RN
Management: Route: IV and Subcutaneous
1. Protect
2. Rest
3. Ice
⭐ Antidote: Protamine Sulfate
Thrombolytic can destroy all clots → malabnaw
na dugo → body will make more clots para
-​ Prevent bleeding (constriction), pain (numb the area), and lumapot = DIC
inflammation (shrinks cells/tissue) -​ Thrombolytic is only given within 3 hours
4. Compress after 3rd stage of stroke
-​ Uses elastic bandage, prevents swelling or inflammation Antidote: Aminocaproic Acid
5. Elevate
-​ Prevent edema by promoting venous return and prevent
internal bleeding
​ ​ ​ ⭐Warfarin is given for maintenance (home)
Route: Oral
6. Splint Antidote: Vitamin K
-​ For immobilization

⭐Sling ISCHEMIC STROKE

●​ Transient Ischemic Attack - within 24

⭐Crutches
-​ To protect the upper extremities hours only
●​ Reversible Ischemic Neurologic Deficit

⭐Relative
-​ To protect the lower extremities
rest
-​ Rest the affected extremity only for faster healing/recovery d/t
- paralysis disappear within 24 hours
●​ Stroke in Evolution
●​ Completed CVA

❌Bed faster circulation and perfusion on the affected extremity

rest
-​ Promote ambulation unless there is major surgery
●​ Use tape measure to measure the calf
-​ Early sign of DVT is inflammation or edema on the calf
-​ Associated with complications
Complication: Pulmonary Embolism
COMPLICATIONS OF IMMOBILITY
A. SKIN ULCERS/BED SORES Mngt:
Prevention: Turn q2 1.​ Elevate the lower extremities
2.​ Elastic stockings
B. DEEP VEIN THROMBOSIS
-​ Obstruction of clot in vein
3.​ Increased calcium
-​ Risk for osteoporosis due to
bones
⬇️ level of calcium in the
Assessment:
●​ (+) Homan’s Sign
-​ Dorsiflex the foot initiated by the patient → (+) pain in Mngt: ⬆️
-​ Risk for renal calculi
OFI to dilute the calculi
calf = (+) DVT
-​ Assessment only if patient is able to dorsiflex own feet C. CONTRACTURE & ATROPHY
-​ Contracture is fixations of the joints
-​ If (+), REFER ❗❗❗
(not applicable for paralyzed or GBS)
-​ Atrophy is muscle wasting
Mngt: Range of motion
⭐
-​ MD will prescribe, HEPARIN
Any clot case, HEPARIN is an anticoagulants
-​ 1st DOC in hospital D. PNEUMONIA/ATELECTASIS
Mngt: Deep breathing and Coughing
Airah B. Bolinbough, RN
 -​ Prevents fat embolism through replacement of ___

E. BOREDOM Complication:
Mngt: Give cellphone ●​ Fat embolism
-​ Complication of long bone fracture
NO HARM

❌
●​ Heat application - pain management
If there is or present bleeding, infection and inflammation
⭐ -​ Long bones contains yellow marrow
Immobilization and IVF is done to prevent fat embolism

●​ Alcohol Early sign: ALOC

●​ Running ●​ Restlessness
●​ Massage ●​ Confusion
-​ These 3 delays the healing process
⭐ ●​ Disorientation)
ALOC first before DOB
COMPARTMENT SYNDROME Brain detects low oxygen → send signal to lungs →
-​ Bleeding inside the muscle hyperventilate → DOB
-​ Cartilage is involved, no color because no blood circulation
Late Sign: DLOC
Osteoarthritis - damage in cartilage Classic sign: Petechiae
Gouty arthritis - crystal in joints DOC: Morphine Sulfate
Rheumatoid arthritis - inflammation of joints If with hypoxia, place in high fowler’s first before
administering medications

⬇️
Fracture (break of limb)
●​ Bleeding
-​ Flat bone fracture
⭐ Traction
Sign of fracture: Shortening d/t muscle spasms or the -​ Flat bones contains red marrow as they produce
continuous contraction of muscle
-​ Leads to overlap of fractured bone ​ ⭐
RBC
RBC life span: 120 days
-​ Moving increases the circulation → Bleeding
-​ Muscle spasm is not relieved by muscle relaxant, only traction is
effective
​ ⬇️
ORIF/OREF
2. IVF
-​ Blood loss replacement
-​ Prevents fat embolism by diluting the fat globules
-​
⬇️
To reduce fracture because it cannot be aligned anymore

CAST TRACTION
-​ To protect during healing
⬇️
Assistive Device
-​
-​
Pulling force
Purpose is to reduce muscle spasm and to immobilize and
prevent fracture
-​ To protect the affected area during ambulation
Component of Traction:
Management: ●​ Splint – immobilizes the traction
1. Immobilize the patient to prevent further complication ●​ Rope – maintains the tension

Airah B. Bolinbough, RN
 ●​ Pulley – responsible for the direction of the pull -​ Important tool is wrench to loosen or remove bolt when

⭐ ●​ Sandbag – contains weight

Foot of the patient should not touch the bed as the patient will serve
as the counter traction ❗
Management:
the px is having DOB

Wag pakialaman ang traction ❗

1. Ropes, pulley, and sandbags should hang freely all the time
TYPES OF TRACTION: 2. Alignment
A. SKIN ​ Misalignment will cause pain d/t compression of the nerves
-​ Uses light materials 3. Pin care (Skeletal Traction)
●​ Bandage -​ Sterile NSS/Hydrogen Peroxide
●​ Straps -​ Always done once per shift; if 3 shifts the 3 times — should be
●​ Adhesives done with or without signs of infection
-​ Prevents skin breakdown because skin is intact in this type of ●​ Refer if there is exudate discharge

-​ ❌
traction
Anything applied to skin
-​ 5-7 lbs sandbag weight
4. Increase fluids
-​ Prevent renal calculi
5. Overhead trapeze
-​ For changing position and workout the upper body muscle
TYPES OF SKIN TRACTION in preparation for rehab
●​ Russells - tibia and fibula fracture 6. Isometric exercise
●​ Bucks - fracture is in femur -​ Contraction and relaxation of muscles;
●​ Bryant's - buttocks slightly elevated off the bed and knees -​ No joint movement therefore preventing muscle atrophy
slightly flexed Isotonic exercise
●​ Halter - strap that is placed in the chin, usually used for -​ Involves movement of joints, extension and flexion
cervical fractures 7. Footboard
-​ Prevent footdrop/plantar flexion contracture (form of
B. SKELETAL contractures)
-​ Uses screw, rods, and pins -​ Assist to dorsiflex and plantar flex the foot of the patient then
-​ Drilled on the outer layer of bone called Periosteum place foot board
-​ Prevents infection thru pin care Other type of contracture: Hip contracture (elderly)
-​ 15-40 lbs weight of sandbag -​ No treatment except surgery (total hip replacement)
-​ Promote extension, No flexion
TYPES OF SKELETAL TRACTION -​ Parkinson’s disease is at risk of hip contracture
●​ Balance Suspension Traction (BST) Management:
-​ AKA Thomas Splint with Pearson Attachment ●​ Prone position to extend hip
-​ Sandbag is usually 40lbs due to this heavy weight, ●​ Extend the arms to prevent frozen shoulders
another traction is applied called Pearson attachment 8. Neurovascular assessment
-​ Usually accompanied by trapeze to change position -​ Assessment of nerve function and circulation (more
-​ To reduce pulling force and reduce muscle spasms important)

●​ Halovest 6 P’s
-​ Halo means ‘ring’ that is connected to vest Vascular Function
-​ Drill at Periosteum of skull ●​ Pulselessness
-​ To prevent movement of neck and spinal cord
Airah B. Bolinbough, RN
 -​ wave of the heart beat
-​ White/grayish color
-​ Assess the most distal pulse on the affected area
-​ Pulse deficit → REFER
Conventional Fiberglass - di mabilis mabasag
●​ Pallor
-​ Should be 1-2 seconds of capillary refill time Dries within 48-72 hours Dries within 20-30 minutes
●​ Poikilothermia
-​ Comparison of bad leg and good leg (basis) Heavy Light
-​ If bad leg is colder, there if insufficient oxygenated blood
supply Damp cloth Wash with water
Nerve Function
●​ Pain
-​ Check the alignment or ask the pain scale CAST CARE
●​ Paresthesia 1. Direct air current
-​ Compromised sensory nerve → REFER 2. Handle the cast while its wet using palms, not with any hard object
●​ Paralysis 3. Elevate it with pillows to promote venous return
-​ Compromised motor nerve → REFER 4. Hot spot may indicate infection → REFER
5. If itchiness occur, use blower at cool setting
SURGERY If not relieved → REFER for prescription of antihistamine
●​ Open Reduction Internal Fixation (ORIF) 6. Petal the cast – hibla ng cast can cause skin irritation, cut it using
-​
●​ Open
Opens the fracture → places rods → reduces fracture
Reduction External Fixation (OREF)
scissors
-​ Do not pile ❌
-​ Small hibla, place adhesive tape inside and out
-​ Opens the fracture → places rods inside and with
external fixation ____
●​ Close reduction ASSISTIVE DEVICE
-​ Manually alignment of ball and socket if dislocated ●​ Walker
-​ No anesthesia Who: Used and is made for the elderly
-​ Most stable assistive device
-​ No bad leg or good leg to be considered
DISLOCATION
​ ​ How: Walker → walk → walker → walk
💡
●​ Abduction – away from the center
ABukaka
-​ In hip fracture, position the px on abduction for easier
●​ Cane
Who: Designed for clients with stroke d/t paralysis
-​ Assistive device made to be used by one side of
entry of ball to socket therefore preventing dislocation
the body because paralysis is present
💡
●​ Adduction – toward the center
ADikit
-​ Prevents contractures
​
leg
​ How: Cane (unaffected) → lean → bad leg → good

●​ Crutches
Who: For pilay
CAST ​
TYPES OF CRUTCHES
PLASTER SYNTHETIC ●​ 4 point gait
-​ Sinemento -​ Partially weight bearing
How: Crutches → left leg → crutches → right leg
Airah B. Bolinbough, RN
 ●​ 2 point gait
-​ Partially weight bearing
How: Right crutches + left leg → left crutches +
right leg

●​ 3 point gait
-​ Non-weight bearing
-​ Crutches carries the weight
How: 2 Crutches + affected leg (lifted) →
unaffected leg

●​ Swing to
-​ Full weight bearing
How: 2 Crutches → 2 legs

●​ Swing through
-​ Full weight bearing
-​ Lumagpas sa crutches and legs
How: 2 Crutches → 2 legs

DESCENDING STAIRCASE
How: Crutches → bad leg → good leg

ASCENDING STAIRCASE
How: Good leg → crutches + bad leg

Airah B. Bolinbough, RN