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Orthopedic Nursing

Orthopedic Nursing

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Published by silimaanghang
History and others..
History and others..

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Published by: silimaanghang on Dec 07, 2008
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Historical Background of Orthopedic Nursing
 The word ‘orthopedics’ was derived from the Greek words; orthos meaning straightor free of deformity and pais meaning child.Orthopedics also called orthopedic surgery medical specialty concerned with thepreservation and restoration of function of the skeletal system and its associatedstructures, i.e., spinal and other bones, joints, and muscles.Nicolas Andry, a professor of medicine at the University of Paris published atextbook in Orthopedics in 1741 concerning the following;1.Maintaining a straight child2.Straightening a deformed child3.Finding new ways to straighten deformed childIn 1728-1793, John Hunter contributed to the advancement of understandingfractures and other musculo-skeletal injuries.Orthopedics began in the 18th century with the pioneering efforts of Jean AndréVenet, who established an institute in Switzerland for the treatment of crippled children'sskeletal deformities.In 1834-1891, Hugh Owen Thomas, an Englishman specialized in the treatment of chronic joint disease, fractures and dislocations.In 1867-1948, Agnes Hunt, referred to as the Florence of Nightingale of OrthopedicCenter in Great Britain. The efforts of Sir Robert Jones and the massive casualties of World War I led to thefounding of many orthopedic training centers in the early 20th century.In 1840, William Little established the Royal Orthopedic Infirmary in Great Britain.In 1857, Anthonius Methyson of Holland described the plaster bandage.In 1866, the New York Orthopedic Dispensary was formed.A vastly increased knowledge of muscular functions and of the growth anddevelopment of bone was gained in the 19th century. Significant advances at this timewere the new operation of tenotomy (the cutting of tendons, which made correctingdeformities easier), the surgical correction of clubfoot, the invention of the Thomas splint(which provided better support for fractures of long bones in the limbs), and theintroduction of quick-setting plaster of Paris for use in orthopedic bandages.Modern orthopedics has extended beyond the treatment of fractures, brokenbones, strained muscles, torn ligaments and tendons, and other traumatic injuries to dealwith a wide range of acquired and congenital skeletal deformities and with the effects of degenerative diseases such as osteoarthritis. A specialty that originally depended on theuse of heavy braces and splints, orthopedics now utilizes bone grafts and artificial plastic joints for the hip and other bones damaged by disease, as well artificial limbs specialfootwear, and braces to return mobility to disabled patients. Orthopedics uses thetechniques of physical medicine and rehabilitation and occupational therapy in addition tothose of traditional medicine and surgery.
History of the Philippine Orthopedic Center
POC started in February 9, 1945 by PCAU General Hospital. The US Armyestablished the hospital in Mandaluyong, Rizal. It was then called as MandaluyongEmergency Hospital. Its main purpose is to help take care of the civilian casualties of war.But its function was not only as emergency basis seeing not only victims of wars but alsoall cases.In May 1945, the hospital was turned over to the Phil. Government. In August 1945,the Bureau of Health took over and only fracture cases and bone joint condition remained. The hospital kept functioning during those difficult years and it is attributed to theskill, ingenuity, dedication and foresight of the staff lead by Dr. Jose V. delos Santos. The hospital finally transferred to its present site in Quezon City.
Review of Structure and Function of the Musculo-skeletal System
I The BonesA.The human skeleton consist of two main division:1.Axial – body upright structurea) Skullb) vertebral columnc) ribs2.Appendicular – the body appendagesa) Armsb) hipsc) legsB.Four major bone type1.Long bones - length exceeds breadth and thickness2.Short bones - equal in main dimensions3.Flat bones – primary made up of cancellous bone tissue4.Irregular bonesC.Long Bones:1.Structurea)Diaphysis – shaft provides strength resist bendingb)Metaphysis – flared portion between diaphysis and epiphysisc)Epiphysis – end
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Primary cancellous bone
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Assist with bone developmentd)Epiphyseal plate/line – between metaphysis and epiphysis- Cartilage growth in length of diaphysis and metaphysise)Periosteum – connective tissue covering bone
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continues at the end of bone with joint capsule butdoes not cover articular cartilage2.Blood supplya)Nutrient artery – tunnel in the diaphysis of long boneb)Periosteal vessels – supply compmact bones with nutrients
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c)Metaphyseal and epiphyseal vessels – supply the spongybone and narrow of the epiphysisD.Functions1.Provides framework for the body2.Serves as lever for skeletal muscles3.Protects vital organs such as the brain, heart and lungs4.Stores calcium and release it to the blood stream according to the bodyrequirement5.Manufactures new blood cells in the red bone marrowII Cartilage1) Fibrocartilage – greatest tensile strength
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occurs in the intervertebral dics and in the symphysispubis2) Elastic cartilage – possesses firmness and elasticity
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occurs in the external air and in the Eustachian tube3) Hyaline cartilage – cushions most of the joints to help soften any impact
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firm yet flexible
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occurs also in the part of the nasal system, larynx, tracheaand in the bronchial ringIII Ligaments and TendonsLigaments – strong cords of fibrous tissue- joint capsule provides the primary connection between the bones,but ligament bind the joints more firmly Tendons – firm cords of fibrous tissue that extend from the muscle to theperiosteum- connects muscle to each other to other tissueIV Skeletal musclea.Muscles can be long and tapered, short and blunt, triangular, quadrilateral orirregular.b.Muscle fiber arrangement varies1.In some muscles, the fiber runs parallel to the muscles long axis2.In others, the fibers are oblique and bipennate like the feather of a quillpin3.Fibers curve cut from a narrow attachment at the muscles and to forma trianglec.Main functions1.Prime mover – directly brings about a desired motion2.Antagonist muscles that directly opposes the movement underconsideration3.Fixation – generally stabilizes a joint or its part thereby maintainingposition while prime mover actsV Joints3 Basic Joint Types1.Fibrous – composed of fibrous tissue, tightly, connecting the articular surfaces of two bones2 typesa)sutures – permits no movementb)syndesmosis – permits minimal movement between bones2.Cartilagenous joints connect two bones with cartilage, allowing only slightmovement.3.Synovial joints, the most common joint type, have the most complex structure andpermit maximum mobility. These joints include the followinga)joint capsuleb)synovial membranec)articular cartilaged)synovial cavity
FRACTURES
A. Fracture is a break in the continuity of the bone. In adults this break is usually completein that the periosteum and the cortical tissue on both sides are completely severed.In pathology, a break in a bone, caused by stress. Certain normal and pathologicalconditions may predispose bones to fracture. Children have relatively weak bones becauseof incomplete calcification, and older adults, especially women past menopause, developosteoporosis, a weakening of bone concomitant with aging. Pathological conditionsinvolving the skeleton, most commonly the spread of cancer to bones, may also causeweak bones. In such cases very minor stresses may produce a fracture. Other factors, suchas general health, nutrition, and heredity, also have effects on the liability of bones tofracture and their ability to heal.An incomplete break or greenstick fracture is mere common in children. Bone broken isbent but securely hinged at one side.A complete fracture occurs when periosteum and cortical tissue completely severed onboth sides of bone.
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B. Fracture bone fragments are labeled according to relationship to the cortex of the body.1.distal – away from2.proximal – here toC. Causes of fracture1.In normal bones, fracture occurs when more stress is placed upon a bone that isable to absorb such as:a)Direct blow or crushing formb)Twisting force (torsion a severe twisting of a broken bone at a side differentfrom where the force was actually applied.c)Powerful contractions – highly developed muscles contract so violently thatmuscles tear from bone sometimes pulling a small piece of bone with it.d)Fatigue and stress bone breaks after repeated stress2.Bones weakened by a disease or tumors and subject to pathological fracturesClassification of fracturesBroad classification1.Open fracture2.Closed fracture
Principles of Fracture Treatment
A.Reduction or realignment of bone fragmentsB.Maintenance or realignment by immobilizationC.Restoration of function
A. Reduction
1.Closed reduction – is accompanied by application of plaster cast after thefracture4 have been aligned with or without the use of anesthesia, toinclude the joint above and below the fracture line.2.Open reduction – immobilization is done by nails, screws, pins, wires orrods which are inserted with or without plates. Such devices stay in thepatient indefinitely unless they produce symptoms after healing takesplace.
B. Immobilization
The most important phase in obtaining the union of fracture fragments.a.Castb.Tractionc.Braced.Fixation devicesa.Internal fixation devicesb.External fixation devices
CARE OF PATIENT IN CAST
 Plaster Cast – is temporary immobilization device, which is made of gypsum sulfate,rendered anhydrous by calcification when mixed with water swells and forms into hardcement.FUNCTIONS1.To immobilize2.To prevent or correct deformity3.To support, maintain and protect realigned bone4.To promote healing and early weight bearing* Cast can be applied to the extremities, to the trunk and to the extremity and trunk as inspicas.It can be applied to encase the whole area where it should be applied or it can be appliedas a splint or mold.*Complications of cast1.Neurovascular compromise2.Incorrect fracture alignment3.Cast syndrome, superior mesenteric arterya.Occurs with body castb.Traction on superior mesenteric artery causes decrease in blood supply tobowelc.Signs and symptoms, abdominal pain, nausea and vomiting4.Compartment syndrome – is a condition in which increases pressure within limitedspace, compromises circulation and function of the tissue within that space.
Principle in application of plaster cast
1.A cast is applied with padding firstPadding materials include the following – wadding sheet, roll cotton, stockinet felt.It can be applied as a combination like stockinet and wadding sheet.2.Apply it to the joint above and joint below the injured part.3.Apply it in circular motion and mold it as you do the procedure by the palm.4.Support it with the palm
Contraindications of plaster cast application
1.Pregnancy2.Skin diseasesFor Circular Cast Application
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