ORTHOPEDIC CONDITIONS

ARTHRITIS
 Rheumatoid Arthritis
o Chronic Disorder -> no cure; lifelong
o Systemic disorder, inflammatory disorder
o Inflammation and destruction of the synovial membrane
o Bilateral Affectation -> both sides are affected; if meron sa right, meron
din sa left
o Stages:
 1) Synovitis -> bones and cartilage erode
 2) Pannus
 3) Fibrous ankylosis
 4) Bony ankylosis
o CAUSE
 Autoimmune
o RISK FACTORS
 Gender = Women
 Age = Middle Age (40s)
 Family History
 Cigarette Smoking
 Excessive weight -> more strain on the joints
o SIGNS AND SYMPTOMS
 Early: morning stiffness (>30 mins)
 Joint pain and redness
 Fever, fatigued, and weakness
 Anorexia, weight loss, and anemia
 Late: ↓ ROM; joint deformities (swan neck)
o DIAGNOSTIC
 ↑ ESR Erythrocyte Sedimentation Rate (Normal male: 1-13; female:
1-20)
 (+) Rheumatoid factor
 X-ray = joint deterioration
o MANAGEMENT
 Physical Mobility
 Provide ROM exercises (when px is pain free; not with pain
because pain means active inflammation -> needs rest)
 Balance rest and activity
 Active inflammation: rest the affected joint (splint)
  Avoid weight bearing activities on affected joint
Comfort
 Application of hot and cold compress on the affected joint
(no more than 20 minutes)
 NSAIDs
o Teratogenic (not allowed for pregnant patients)
o Causes fluid retention therefore contraindicated for px
with CHF
o Cause bronchoconstriction therefore contraindicated
for asthma
o Nephrotoxic = monitor kidney function test (BUN
(normal 10-20) and Crea (normal 0.6-1.2)
o Should be taken with meal to prevent peptic ulcer
disease
 Naproxen
 Salicylates
 Aspirin
 Indomethacin
 Ibuprofen
 Ketorolac (via IV or oral) -> only NSAID that
can be given via IV
o PHARMACOLOGIC MANAGEMENT
 Goal -> delay RA
 DMARDs -> Disease Modifying Anti Rheumatic Drugs -> they don’t
cure RA, they slow down the progression of RA
 Anakinra
 Adalimumab
o Can cause neurological side effects; tingling, dizziness
 Azathioprine
o Can be immunosuppressant
 Cyclosporine
o Can be immunosuppressant
 Hydroxychloroquine
o Can cause retinal damage; notify doctor if visual
disturbances occur
 Methotrexate
 Sulfasalazine
 Steroids -> should be taken with meals; immunosupressant
o Prednisone
o Hydrocortisone
OSTEOARTHRITIS
 Degenerative joint disease
 Chronic, degenerative disease of the cartilages
 Affects the weight bearing joints -> they receive the greatest stress
o Knee, hip, spine, hands
 Unilateral Affectation
 CAUSE
o Unknown
o Wear and Tear
 RISK FACTORS
o Age = advancing age
o Gender = Female
o Excessive weight
o Joint injuries
 SIGNS AND SYMPTOMS
o Morning stiffness (< 30 minutes)
o ↑ Joint pain after activity (usually afternoon/evening)
o ↓ Joint pain after rest (morning)
o Late= Heberden’s & Bouchard’s nodes (hand)
o ↓ ROM
 MANAGEMENT
o Physical Mobility
 Provide ROM exercise
 Balance rest and activity
o Comfort
 Application of hot and cold compress
 NSAIDs
 Steroids
o Nutrition
 Maintain normal weight
 Encourage well balanced diet

GOUTY ARTHRITIS
 Deposition of urate crystals in the joints, and other body tissues
 Abnormal level of uric acid in the body
 Metabolic disorder
 Problem with purine metabolism
  Purine -> uric acid
 Food high in purines (Uric Acid)
o Organ meat
o Beans
o Seafood
o Beer
o Gravy
o Nuts
 RISK FACTORS
o Diet high in purine
o Age
o Male = 30 Y/O
o Female = after menopause, 50 years old
o Gender - Women
o Excessive weight
 MEDICATIONS
o Thiazide
o ACE inhibitors
o Beta blockers
 SIGNS AND SYMPTOMS
o Intense joint pain (commonly big toe) but can occur in any joint
o Redness/warmness on the affected joint -> usually occurs at night
o Chronic = deposition of uric acid in the skin and urinary tract (stones)
 MANAGEMENT
o Diet = low purine
o ↑ fluid intake
o Weight reduction
o Pain = bed rest (elevate affected extremity)
o Hot and cold compress
o NSAIDs/Colchicine
o Allopurinol -> instruct patient to increase oral fluid intake; minimize
exposure to sunlight because patients get hypersensitivity to light; annual
eye exam because it causes eye damage; don’t take large doses of
vitamin C because it increases risk for stone formation; don’t take aspirin
because it will further cause uric acid to elevate

OSTEOPOROSIS
 Metabolic disease characterized by bone demineralization (calcium loss)
 Fragile bone -> at risk for fractures
 Most commonly in the wrist, hips, and spine
 CAUSES AND RISK FACTORS
o Gender = Female
o Age = more than 50 (menopausal age)
o Family history
o Small body frames
o Medications
 Steroids
 Aluminum containing antacids
 Anti-seizure medications
o Conditions
 Eating disorders
 Hyperparathyroidism -> ↑ PTH
 Celiac disease and IB (Inflammatory Bowel Disease)
 Renal failure
o Lifestyle
 Sedentary
 Alcohol/smoking
 SIGNS AND SYMPTOMS
o Back pain (after bending, lifting, or stooping)
o Hip/pelvic pain
o Kyphosis (dowager’s hump) -> ↓ in height
o At risk for fracture
 MANAGEMENT
o Safe environment
o Position household items to ensure unobstructed walkways
o Eliminate rugs/wirings
o Install handlebars
o Wear non-skid footwear
o Use assistive devices -> canes
 MEDICATIONS
o Calcitonin
o Bisphosphonates (Alendronate, Ibandronate) -> instruct the patient to
stand/sit for at least 30-60 minutes after taking meds to prevent
regurgitation of stomach content to the esophagus
 o Raloxifene -> contraindicated for px with thromboembolic events, clot
formations, DVT; should be discontinued 72 hours prior to prolonged
immobilization periods
 RISK FACTORS
o DM (non-healing wound)
o Buerger’s disease
o Severe gouty arthritis
o Trauma injuries
 TYPES
o Above the knee
o Below the knee
 POST OP
o Monitor bleeding
o Monitor phantom limb pain
o To prevent hip contractures, do not elevate the remaining limb on a
pillow, instead use foot of the bed
o For below the knee amputation, discourage prolonged sitting to prevent
knee contractures
o For above the knee amputation, prevent internal/external rotation of the
remaining limb
 REHAB
o Instruct/assist on the use of assistive devices (canes/crutches)

INJURIES
 STRAIN
o Excessive stretching of a muscle or tendons
o MANAGEMENT
 Cold/hot compress
 Limit activity
 NSAIDs
 Muscle relaxation
 SPRAINS
o Excessive stretching of a ligament
o Cause severe pain and swelling of the injured area
o MANAGEMENT
 “RICE”
 Rest
 Ice compress
  Compression bandage
 Elevate the affected area
o For moderate sprains -> casting
o For severe sprains -> ligament tear -> repair through surgery
 FRACTURE
o Break in the continuity of the bone
o Caused by
 Traumatic
 Twisting
 Diseases
 Osteoporosis
 Osteopenia
 Osteomalacia
o Types
 Closed (simple)
 Open (compound)
 Complete (pwede closed or open)
 Greenstick (Incomplete fracture)
 Oblique -> runs at an angle opposite the bone (slant yung hati
nya)
 Displaced fracture -> hindi na magkatapat yung bone
 Non-displaced
 Comminuted -> nadurog na yung bone, creating tiny fragments of
bone
o SIGNS AND SYMPTOMS
 Pain over the injured area/tenderness
 ↓ loss of muscle strength or function in the injured area
 Neurovascular impairment
 10 mins after the injury -> numbness, tingling sensation in
the affected area, skin is cold to touch, edema formation
o MANAGEMENT
 Immobilized (splint)
 Assess the neurovascular status
 Check pulse, temp, numbness/tingling sensation
 Casting -> closed, greenstick or non-displaced fractures
 Plaster of Paris -> heavy, can’t get wet, cheap
 Fiberglass -> light weight, can get wet, expensive
 Keep the casted extremity elevated
 Allow cast to dry
o Plaster -> 24-72 hours
 o Fiberglass -> few minutes
 Handle a wet plaster cast -> use the palm (never use the
fingers) because it will create pressure points
 Dry -> turn the casted extremity every 1-2 hours; use hair
dryer in cool setting
 Monitor neurovascular status
o WOF severe pain unrelieved by med -> compartment
syndrome -> notify physician
 Petal the cast edges -> so skin won’t get irritated
 Plaster cast get wet -> dry -> dry dryer in cool setting
 Itching under the cast -> use hair dryer in cool setting
 Reduction
 Closed
o Non-surgical approach -> manual manipulation of the
fractured area
 Open
o Surgical intervention
o May be treated with fixation devices
 External -> more risk for infection due to the
pins
 Pin care -> never use povidone iodine
(betadine) might cause rusting of the pins
 If one of the pins loosens, stabilize the area,
then ask another nurse to notify the doctor
 Internal -> freedom of movement; suture care
 Traction
 Exertion of pulling force in 2
o Types
 Skeletal traction
 Skin traction
 Non surgical
 Elastic bandage
 Foam boot
 Sling
 Ensure that weight ha
o COMPLICATIONS FOR FRACTURES
 Fat embolism -> might progress to pulmonary embolism
 Restless (↓ LOC)
 Sudden onset of DOB and chest pain
o MANAGEMENT
  Notify
 Admin O2
 Position: high fowlers
 Compartment syndrome
 Severe pain unrelieved by pain meds
 Loss of sensation (numbness)
 Pulselessness
 MNGT
o Notify
o Prepare = bivalving
 Infection
 Fever
 Tachycardia
 ↑ WBC and ESR
 MGT
o Notify
o Prepare = antibiotics

CRUTCHES
 Measurements: Crutch pad -> 2-3 finger widths
 Hand grip -> at the same level of the wrist (arms should be slightly flexed at 20-
30 degrees)
 Crutch tip -> 6 to 10 inches diagonally from the front of the foot
 Going up the stairs
o Move the unaffected leg first, then move the affected leg with the
crutches
 Going down the stairs
o Move the crutches first, then move the affected leg, then the unaffected
leg
 Types of Gaits
o 2 point gait -> the crutch on the affected side and the unaffected foot are
moved at the same time
o 3 point gait -> both crutches move together; followed by the unaffected
leg
o 4 point gait -> the right crutch is advanced then the left foot, left crutch
then the right foot
o Swing-to gait -> both crutches are advanced forward, then both legs are
lifted and advanced forward, then both legs are lifted and advanced past
the crutches
CANE
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