orthopedic ds (copy)

Sternum

breastplate bone located in the front of the chest.

Xiphoid process

cartilage below the sternum.

Clavicles

collarbones,
they make up the shoulder girdle.

Scapula

shoulder blade, it is a flat triangle-shaped bone.

Scoliosis

Lateral curvature of the spine

risk factor scoliosis

teenagers

complication scoliosis
primary priorty

pulmonary impingement.

diagnostic confirmatory test scoliosis

x-ray

Kyphosis

Posterior thoracic curvature, commonly seen in the elderly.

Lordosis

Anterior lumbar curvature, often seen during pregnancy.

A brace worn prior to rod insertion to lessen the curvature of scoliosis.

Milwaukee brace

milwaukee brace

worn for _ years
worn for _ hrs per day

worn for 3 years
worn for 24 hrs per day
* 1 hr for hygiene and swimming

priority mngt for

• brace

• cast

• harness

• traction

prevent skin breakdown

maintain skin integrity

negative interventions for

• brace

• cast

• harness

• traction

C ream
L otion
A lcohol
M oisturizer
P owder

O intment

Skeletal traction

uses pins to straighten the spine,

priority mngt for skeletal traction

prevent infection by pin care

pin care considerations

• sterile NSS (DOC)

  • hydrogen peroxide (alt)

• done every shift or 3x/day or q 8 hrs

Harrington rod insertion

Surgical procedure to straighten the spine.

Long bones

• Humerus

  • radius

  • ulna

• femur

  • tibia

  • fibula

Flat bones

Skull, sternum, scapula, ribs, and pelvis.

Ball and socket joint

• acromion process (head of humerus)

• acetabulum (opening of pelvis).

Hinge joint

• Elbow

• knees

Iliac crest

The upper portion of the pelvis

posterior iliac crest

best site for bone marrow aspiration.

anterior iliac crest

second best site for bone marrow aspiration

best site for bone marrow aspiration in PEDIA

tibia

Greater trochanter

Bone prominence attached to the femur
used to measure the HANDLE height of an assistive device.

assistive device measurements

• 2-3 fingerbreaths distance from axilla to axillary plate

• arm flexion 20-30

• weight bearing on arms or hands

assistive device complications

1. brachial plexus nerve compression

2. weakness in upper extremities

3. paralysis

Fractures

Break of continuity of bone, often characterized by shortening of a limb.

key characteristic of fractures

Shortening of a limb

Shortening of a limb in fractures caused by..

muscle spasm
(that cannot be relieved by a muscle relaxant)

treatment sequence in fractures

1. traction (relieve muscle spasm)

2. surgery (manual alignment)

3. cast

4. crutches

priority mngt fractures

1. immobilize (prevent Cx)

2. increase fluids (dilutes fat, replaces blood)

Fat embolism

Fat enters vena cava to heart to lungs

s/sx fat embolism

1. ALOC (earliest)

2. DOB, R. acid

3. petechiae in chest (classic)

cause of petechiae in fat embolism

compensatory mechanism:

thrombocytopenia

priority mngt fat embolism

1. high fowlers

2. O2 adm

3. morphine (DOC)

SADDER in fat embolism

Shortening of limb, adduction, external rotation

pelvic/hip fracture

red marrow involvement

s/sx bleeding

1. ALOC (early)

priorty mngt in bleeding

1. increased fluids

2. modified Trendelenburg

3. shock mngt

4. BT

SADDIR in bleeding

Shortening of limb, adduction, internal rotation

Connects bone to muscles

tendon

Connects bone to bone

ligament

tendon problem

sTrain

ligament problem

sPrain

strain mngt

• P rotect

• R est

• I ce

• C ompression

• E levate

• S prain

“protect” PRICES

immobilize extremity involved

complications of immobility

1. Brain: depression 

2. Blood: clotting, DVT 

3. Renal: calculi

4. Bone: osteoporosis 

5. Joints: contractures 

6. Lungs: pneumonia, atelectasis 

7. Skin: pressure ulcer

relative “rest” PRICES

promotes healing

“ice” PRICES

prevent bleeding (primary)
decrease inflammation and pain (secondary)

“compression” PRICE

prevents inflammation

“elevate” PRICE

promote venous return

“splint” PRICE

immobilizes affected extremity

mngt bleeding

arterial: tourniquet

venous: pressure

internal: elevate

sprain mngt

no HARM

H hot compress

A lcohol

R unning or activity

M assage

hot compress “no HARM”

alleviate pain (primary)

hot compress consideration

should be followed by COLD COMPRESS

hot compress contraindications

1. bleeding

2. swelling

3. infection

hot compress in hospital

need MD order

alcohol

running

massage

delay healing process

demineralization of bone

oteoporosis

risk factor osteoporosis

menopause

needed for calcium absorption

vit D

nedeed for calcium metabolism (to bone)

calcitonin

estrogen

exercise

normal calcium serum level

8.6 - 10 mg/dl
4.5 - 5.5 mEq/l

needed for calcium resorption (to blood)

PTH

best source calcium

sardines

best source vit D

tuna mackerel or salmon (TMS)

osteoporosis mngt

H hormonal replacement (estrogen)

O oral caclium and vit D

W weight-bearing exercise (walking, dancing, jogging)

osteoporosis DOC

Alendronate  (Fosamax)

Alendronate (Fosamax)

Inhibit the resorption of calcium

arthritis conditions

type	cause	best mngt
gouty	?	?
RA	?	?
OA	?	?

type	cause	best mngt
gouty	metabolic	diet modification
RA	autoimmune	medication
OA	degeneration	nsg mngt

Inflammation of synovial fluids

RA

RA risk factors

1. congenital

2. females

RA causes

1. autoimmune (primary)

2. Epstein Barr virus

RA dx

1. arthrocentesis

2. blood test

RA arthrocentesis result

cloudy, milky, or yellowish SF

RA pathophysiology

1. autoimmune reaction

2. release of COX 2 enzyme

3. inflammation

4. compression of nerves

5. pain

s/sx: symmetrical

RA

s/sx: morning stiffness
worsen with rest

RA

s/sx: sjoren’s syndrome

RA

sjoren’s syndrome

drying of eyes, buccal mucosa, and vagina

s/sx: felty’s syndrome

• anemia

• leukopenia

• thrombocytopenia

• splenomegaly

deformity: pannus

RA

deformity: bony ankylosis

RA

proximal interphalangeal (PIP) joint hyperextension and flexion of the distal interphalangeal (DIP) joint

swan neck

finger is flexed at the proximal interphalangeal joint (PIP) and hyperextended at the distal interphalangeal joint (DIP)

boutonniere

fingers to bend toward the outside of the hand

ulnar deviation

RA viral origin mngt

FRC

• fluids

• rest

• vit C

RA meds

1. NSAIDs

2. steroids

3. DMARDs

4. Celecoxib

5. chloroquine

6. methotrexate

first DOC RA, anti-inflamm

NSAIDs

anti-inflamm, more effective, more potent

for major organ affectation

steroids

delays progression of RA

DMARDs

also a NSAID, lesser GI irritant

celecoxib

lessen flaring of RA

chloroquine

given when medications are ineffective,
gold standard RA medication

methotrexate

adjunct medication of methotrexate

leucovorin

(lessen a/e methotrexate)

degeneration of articular cartilage

OA