WESLEYAN UNIVERSITY- PHILIPPINES

CABANATUAN CITY
CONAMS

NCM 116- Care of the Clients with Problems in Nutrition, and Gastrointestinal,
Metabolism and Endocrine, Perception and Coordination(Acute and Chronic)

Concept: Orthopedic Nursing

General Objective: At the end of 8 Hours of lecture-discussion via simulation
activities, the Level 3 students will be able to formulate a comprehensive nursing
care plan in the care of clients with problems in perception and coordination.
Week 1: Day 1:
Specific Objective:
1.Appreciate the history and development in the field of orthopedic
nursing.
2.Identify the different parts and functions of musculoskeletal system.
3.Identify the different laboratory procedures and diagnostic examinations
in assessing clients with musculoskeletal problems.
4. Recognize the various musculoskeletal problems with corresponding
signs and symptoms and nursing management.
ORTHOPEDIC NURSING:
 Week 1: Day 1:

INTRODUCTION:

The challenge in caring for the orthopedic patient is in carrying out

basic nursing care procedures while understanding and working with
orthopedic devices used in the treatment of musculoskeletal
diseases and injuries. This requires basic knowledge on the
anatomy and physiology of the Musculoskeletal System and other
major body system. It is also important that nursing students should
know how to avoid self - injury while caring for orthopedic patients by
understanding and applying principles of good body mechanics. To
avoid self-injury, those engaged in orthopedic nursing must also
understand and apply principles of good body mechanics.
HISTORY OF ORTHOPEDIC NURSING

The history of nursing began in London in the late 1800s with

the reform of unsanitary conditions by Florence Nightingale.
During the same period, the United States was bitterly fighting
the Civil War. Nursing had not developed as a profession, and
most of the duties performed by nurses were conducted by men.
Casualties of war required rehabilitation and care. Crippled
children were left to die because they were considered a burden
to society. Dr. James Knight founded the Hospital for the
Ruptured and Crippled in his home on Second Avenue
The history of nursing and orthopaedic surgery dates back to the
late 1800s. Both developed out of societal need, advances in
medical science, and a will to help those afflicted with disease.
Crippling disorders have plagued mankind since the beginning of
time. These unfortunate people had no recourse except begging
for survival. The same premise exists today in all disciplines of
medicine
The Beginning of the Modern Nursing Movement
 1860- Florence Nightingale –
 established the first school of nursing at St. Thomas Hospital in
London.
 She used her knowledge of mathematics to interpret data collected
during her service in the Crimean War. Through statistical analysis she
proved that the incidence of preventable deaths was caused by
unsanitary conditions and that with improvement in sanitary methods,
the death rate would decrease.
History of Orthopedic in the Philippines
 
The Philippine Orthopedic Center (POC) was established on February 9,
1945 as a special government hospital then known as the Philippine Civilian
Affairs Unit No.1 General Hospital (PCAU 1). 

Major Francisco Roman- an army surgeon and the first Hospital Chief.
 In May, it was renamed as the Mandaluyong Emergency Hospital.
 In August, the Bureau of Health took over its management and
reorganization measures were initiated reducing patient bed capacity as
well as manpower; such characteristics shaped the true personality of the
hospital as a Center of orthopedics and trauma.
 By 1947, Dr. Jose V. Delos Santos assumed and soon the adoption of the
name, National Orthopedic Hospital
 Two years later, a four – year Residency Program in orthopedics and
anesthesia was started.
 Dr. Benjamin V. Tamesis (3rd Hospital Chief) continued on the programs.
 In 1956, a 5 – year residency program in orthopedics and traumatology
was instituted in 1963, the hospital site was transferred to Maria Clara
cor. Banawe St., Quezon City and soon it was a pioneer in establishing
a comprehensive rehabilitation program (Physical Therapy,
Occupational Therapy, Artificial Limb and Brace Center.)

 In 1982, pursuant to Batas Pambansa Blg. 301, it acquired a new

name, National Orthopedic Hospital and Rehabilitation Center
• 
 In 1987, Dr. Rafael S. Recto was appointed as the 5th Medical Director
and in two (2) years’ time
• 
 NOH – RMC was renamed as Philippine Orthopedic Center by virtue of
RA 8766. 
Review of the Musculoskeletal Systems:
STRUCTURE
1. Bones composed the musculoskeletal
2. Muscles system
3. Joints
Discussion:
4. Bones
Functions:
a. Provide structure
b. Give protection
c. Serve as levers
d. Store calcium
e. Produce blood cells
 206 bones – make up the axial skeleton (head and trunk) and the
appendicular skeleton (extremities, shoulders, and hips)
 Osseous tissue
2 types:
a. Compact bone – hard and dense and makes up the shaft and outer
layers
b. Spongy bone- contains numerous spaces and makes up the ends
and centers of the bone
Compact bone and Spongy bone
 Bone tissue is formed by active cells called osteoblasts and broken
down by cells referred to as osteoclasts
 Bones contain red marrow that produces blood cells and yellow
mallow composed mostly of fat
• Periosteum
 Covers the bones
 Contains osteoblasts and blood vessels that promote nourishment
and formation of new bone tissues
Shapes of bones:
1. Short bones – carpals
2. Long bones – humerus, femur
3. Flat bones – sternum, ribs
4. Bones with an irregular shape- hips vertebrae
2. Skeletal Muscles
Three Types of Muscles:
a. Skeletal
b. Smooth
c. cardiac
Short bones-carpals
Long bones –Humerus
Flat bones- sternum, ribs
Bones with irregular shape-hips vertebrae
• The musculoskeletal system is made up of 650 skeletal (voluntary)
muscles which are under conscious control
• Made up of long muscle fibers (fasciculi) that are arranged together
in bundles and joined by connective tissue, skeletal muscles attach
to bones by way of strong, fibrous cords called tendons
Functions of Skeletal Muscles:
1. Assist with posture
2. Produce body heat
3. Allow the body to move
Musculoskeletal System
Discussions:
ANTERIOR SURFACE:
1. The skull is a bony structure that forms the
head in vertebrates.
It supports the structures of the face and provides a protective cavity for
the brain
composed of two parts: the cranium and the mandible.
* cranium-part of the skull consisting of the bones enclosing the brain
* 8 cranial bones
*Mandible -or lower jaw, is the bone that forms the lower part of the skull,
and along with the maxilla (upper jaw), forms the mouth structure
>Movement of the lower jaw opens and closes the mouth and also allows
for the chewing of food. 
2. Clavicle- or collarbone
is a long bone that serves as a strut between the shoulder blade and the
sternum (breastbone)
There are two clavicles, one on the left and one on the right. 
the only long bone in the body that lies horizontally.
3. Sternum - or breastbone is a long flat bone located in the central part of
the chest
> It connects to the ribs via cartilage and forms the front of the rib cage,
thus helping to protect the heart, lungs, and major blood vessels from
injury.
4.Humerus -is a long bone in the arm that runs from the shoulder
to the elbow.
It connects the scapula and the two bones of the lower arm,
the radius and ulna, and consists of three sections.
5. Ribs -are the long curved bones which form the rib cage, part of the
axial skeleton. 
6. Vertebral column- also known as the spinal column, is the
central axis of the skeleton in all vertebrates. 
> provides attachments to muscles, supports the trunk, protects
the spinal cord and nerve roots and serves as a site for
haemopoiesis.
Illustration:
7.Pelvic Girdle - is composed of the appendicular hip bones (ilium,
ischium, and pubis) oriented in a ring, and connects the pelvic region of
the spine to the lower limbs.
The pelvic spine consists of the sacrum and coccyx.
8. Radius –Ulna -  are the bones of the forearm. 
The forearm contains two bones—the radius and the ulna—that extend
in parallel from the elbow, where they articulate with the humerus to the
wrist, where they articulate with the carpals.
9.Carpals -  are the eight small bones that make up the wrist (or carpus)
that connects the hand to the forearm. 
> The term "carpus" is derived from the Latin carpus and the Greek
καρπός (karpós), meaning "wrist".
10. Metacarpals- form the intermediate part of the skeletal hand
located between the phalanges of the fingers and the carpal
bones of the wrist which forms the connection to the forearm. 
11.Phalanges- are the bones that make up the fingers of the
hand and the toes of the foot.
There are 56 phalanges in the human body, with fourteen on
each hand and foot.
Three phalanges are present on each finger and toe, with the
exception of the thumb and large toe, which possess only two.
12. Femur - is the only bone located within the human thigh
> It is both the longest and the strongest bone in the human
body, extending from the hip to the knee
Functions of Femur:
1. For weight bearing and stability of gait.
2. An essential component of the lower kinetic chain.
3. The upper body's weight sits on the 2 femoral heads.

13.Patella - also known as the kneecap, is a flat, circular-triangular bone

which articulates with the femur (thigh bone) and covers and protects the
anterior articular surface of the knee joint. 
> function: allow for smooth movement of the knee in flexion
and extension, and also protects the anterior surface of the knee
joint.
14.Tibia and Fibula - The lower leg is made up of two bones: the tibia
and fibula.
The tibia is the larger of the two bones.
Function: It supports most of the weight and is an important part of
both the knee joint and ankle joint.

POSTERIOR SURFACE:
1.Scapula - also known as the, is a flat triangular bone located at the back
of the trunk and resides over the posterior surface of ribs two to seven
Function: plays an important role in stabilizing the other bones involved in
the rhythm of shoulder motion.
2. Cervical bone - are the thinnest and most delicate bones.
2.Spinal Cord - is a long, fragile tubelike structure that begins at the end of
the brain stem and continues down almost to the bottom of the spine.
Like the brain, the spinal cord is covered by three layers of tissue
(meninges).
The spinal cord and meninges are contained in the spinal canal, which
runs through the center of the spine.
vertebrae protect the spinal cord.
The vertebrae are separated by disks made of cartilage, which act as
cushions, reducing the forces generated by movements such as walking
and jumping.
The vertebrae and disks of cartilage extend the length of the spine and
together form the vertebral column, also called the spinal column.
Cerebrospinal fluid (CSF) is a clear, colorless body fluid found in the
brain and spinal cord. 
Functions of CSF:
assists the brain by providing protection, nourishment, and waste
removal
3.Ileum -  is a blade-shaped bone found superior to the hip joint. It
consists of the two main parts: the body and ala (wing). The body of ilium
is a smaller, inferior, part that contributes to the formation of the
acetabulum.
4.Ischium -forms the lower and back part of the hip bone 
5. Pubis - is the lowest and most anterior portion of the hip bones of the
pelvis
PARTS OF THE LONG BONE:
Assessment:
1.Physical Assessment: Method: Interview/Inspection, Palpation,
Percussion and Auscultation
Gathering of subjective and objective data
Sources: primary source: patient
secondary source:relative
2.Laboratory Test: specimen used: blood, urine or feces
CBC, hgb, hct, BT, PT, PTT, BT, > Arthrocentesis
Na, K, Ca
BUN crea
FBS
Lipid profile
Kidney Function Test
3.Diagnostic Procedure:
a.X-ray-valuable for detecting abnormalities in
bone and are taken to evaluate painful, deformed,
or suspected abnormal areas of bone.
b. (MRI) - Magnetic Resonance Imaging
give much more detail than conventional x-rays
and may be done to determine the extent and exact
location of damage. These tests can also be used
to detect fractures that are not visible on x-rays.
3. CT Scan
is useful if MRI is not recommended or unavailable.
CT exposes people to ionizing radiation 
The amount of time a person spends undergoing CT is much less than
for MRI
MRI is more expensive than CT 
4. Ultrasonography
>is being used more and more frequently to identify inflammation in and
around joints and tears or inflammation of tendons.