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Fractures: 

Open reduction with internal fixation: 

Pins, plates, screws, and/or rods are used internally to set the bone 

Perform neurovascular checks 

Check pain level 

Sensation (Numbness, tingling, or lack of sensation) 

Skin temperature, color, capillary refill time 

Check 5 Ps: Pain, Pulse, Pallor, Paresthesia, Paralysis 

Osteomyelitis: 

Bone infection 

Symptoms: swelling, warmth, tenderness, bone pain, tiredness, fever 

Causes: bacteria entering bloodstream, injuries, surgery 

Risk: deep wound, weakened immune system (diabetes), peripheral artery disease, sickle cell, dialysis, pressure injuries, drugs by needles, wound 

Complications: bone death/osteonecrosis, septic arthritis, impaired growth, long-term osteomyelitis/chronic osteomyelitis 

Diagnosis: no blood tests, xrays, MRI, CT, bone scan, bone biopsy 

Treatment: surgery (drain infected area, remove diseased bone/tissue, restore blood flow to the bone), medications (long-term antibiotic therapy) 

Teaching: stop smoking, avoid  

Leukemia:  

Most common childhood cancer (30%) 

Cancer of the body’s flood-forming tissues. Overgrowth of abnormal WBCs in the bone marrow, prevents growth of RBCs, platelets, and normal WBCs 

Bone marrow produces an excessive amount of abnormal WBCs which don’t function properly 

Symptoms: pallor, fatigue, SOB, swollen lymph nodes, enlarged liver/spleen, bone pain/tenderness, abnormal bleeding/bruising, fevers, frequent infections, decreased appetite 

Risk: previous cancer treatment, genetic disorders, exposure, smoking, family history 

Diagnosis: physical exam, blood tests, bone marrow tests 

Treatment: chemotherapy, targeted therapy, radiation, bone marrow transplant, immunotherapy 

Lymphoma: 

Hodgkin’s: 

Reed-Sternberg cells (large abnormal lymphocytes) 

Starts in the lymph nodes of the chest, neck, or armpits  

Spreads in a predictable day, easy to diagnose 

Symptoms: swollen lymph nodes, weight loss without trying, drenching night sweats, itchy skin 

Cause: unknown 

Risk: age (20s-65), family history, infections (HIV, EBV), weakened immune system 

Diagnosis: blood tests (viruses, LDH), CT, PET scans, lymph node/tissue biopsy, bone marrow aspiration and biopsy 

Treatment: chemotherapy, radiation, targeted therapy, immunotherapy, bone marrow transplant 

Teaching: hand washing, avoiding crowds, monitoring for fever, rest, avoid raw foods, protect from sun 

Non-Hodgkin's: 

Arises in various parts of the body, harder to detect 

Most common lymphoma 

Symptoms: swollen lymph nodes, chest pain, belly pain or swelling, night sweats, skin rash 

Affects: lymph nodes, lymph vessels, adenoids, tonsils, spleen, thymus, bone marrow 

Risk: age >60, family history, infections (HIV, EBV, H. pylori, more), weakened immune system. No way to prevent non-hodgkin!!!!! 

Diagnosis: blood tests (viruses, LDH), MRI, CT, PET, biopsy: lymph node, tissue, bone marrow. Lumbar puncture 

Treatment: “watch and wait,” chemotherapy, immunotherapy, targeted therapy, CAR-T cell therapy, bone marrow transplant, bone marrow stem cell transplant, radiation 

Teaching: hand washing, avoiding crowds, monitor for infection, prepare for fatigue, nausea, hair loss, potential infertility, eating healthy, exercise, rest. Call provider with fever/signs of infection, worsening pain, night sweats, unexplained weight loss, unusual bruising/bleeding 

Sickle cell: 

Inherited 

Red blood cells are shaped like sickles/crescent moons -> block blood flow 

can cause hypokalemia 

Symptoms:  

Can appear around 6 months of age 

Fatigue 

Episodes of pain 

Swelling of hands/feet 

Frequent infections 

Delayed growth or puberty 

Vision problems 

Diagnosis: blood test. Also included in newborn screening. Can also be sampled from amniotic fluid 

Treatment: managing pain episodes, preventing complications 

Medicine 

Blood transfusions 

Education: prevent infection 

Hemophilia: 

Risk of excessive bleeding, insufficient clotting factors 

Women carry the trait, men experience it 

Royal family is most notorious for this due to incest 

Neutropenia: 

Insufficient number of neutrophils 

WBC levels are low 

Higher risk of infection 

Nursing: monitor temperature, restrict sick visitors, no fresh plants/flowers, keep dedicated equipment in their room 

Treatment: medication: filgrastim. Helps to boost neutrophil count. Hint: FILL up on neutrophils  

Education: tell patient to check temp daily, report above 100 to provider, avoid crowds, avoid sick people, no raw food, no yard work, no change cat litter, wash dishes in hot water/dishwasher, wash toothbrush in dishwasher daily 

AML and ALL: 

AML (Acute Myeloid Leukemia):  

Fast-growing cancer of the blood and bone marrow 

Affects ages over 65 

ALL (Acute Lymphoblastic Leukemia):  

Fast-growing, rare blood cancer where the bone marrow produces too many immature white blood cells 

Difference between AML and ALL: AML affects myeloid cells and is most common in adults, while ALL effects lymphoid cells and is the most common childhood leukemia. HINT: pretend M in AML stands for mature, since it affects adults. 

Arthritis: 

Term for many conditions affecting the joints 

Causes swelling of the joints 

Osteoarthritis: cartilage breaks down. Most common type. Damage to the cartilage.  

Rheumatoid arthritis: autoimmune disease where the immune system attacks the joints, beginning with the joint lining (synovial membrane). Leads to inflammation and tissue damage 

Gout: caused by uric acid crystals in the joints due to high levels of uric acid in the blood 

Infections or underlying conditions such as psoriasis or lupus can cause other types of arthritis 

Symptoms: pain, stiffness, swelling, darkening of the skin around the joint, decreased ROM 

Risk factors: family history, age, your sex, previous joint injury, excess weight 

Complications: difficulty walking, keeping proper posture, changes in joint alignment/shape 

Diagnosis: laboratory tests, x-rays, CT, MRI, ultrasound 

Treatment: NSAIDS, counterirritants, steroids, DMARDS (disease-modifying antirheumatic drugs), PT, surgery (joint repair, joint replacement, joint fusion) 

Education: weight loss, exercise (swimming/water aerobics), heat and cold therapy, assistive devices, quit smoking, avoid activities that involve high impact and repetitive motion (running, jumping, tennis, tennis, high-impact aerobic exercises) 

HIV:  

Damages the immune system 

Destroys white blood cells called CDF T cells (becomes AIDS when count is lower than 200) 

If left untreated, can become AIDS 

Spread through contact with genitals, contact with blood, childbirth and breastfeeding 

Symptoms: fever, headache, muscle aches/join pain, rash, sore throast/mouth sores, swollen lymph glands/nodes, diarrhea 

Complications: pneumocystis pneumonia (PCP), thrush (candidiasis), TB, wasting syndrome, kidney disease, liver disease, cytomegalovirus, and more 

Diagnosis: blood test (antigen-antibody tests), antibody tests, nucleic acid tests (NATs). To stage disease: CD4 T cell count, viral load/HIV RNA, medicine resistance 

Treatment: no cure. Take antiretroviral therapies (ART) which is usually a mix of two or more medicines from several classes that lowers the amount of HIV in the blood. NNRTIs, NRTIs, PIs, integrase inhibitors, entry or fusion inhibitors 

Education: eat healthy, avoid raw meat, eggs, and more, get vaccinations 

Avoid: St. John’s wort, garlic supplements, red yeast rice extract 

Electrophoresis tests for:  

Blood disorders: sickle cell, thalassemia, hemolytic anemia 

Cancers: multiple myeloma, lymphomas, leukemias 

Immune system disorders 

Kidney/liver disease 

Nutritional issues: malnutrition/malabsorption 

Pneumonia vaccine covers 20 strains of strep 

Prevents ear infections, sinus infections, etc. 

Flu and pneumonia vaccines together prevent RSV and croup 

Lupus: 

Body's immune system attacks its own tissues and organs 

Symptoms: inflammation that affects joints, skin, kidneys, blood cells, brain, heart and lungs. Butterfly rash that gets worse in the sun (not everyone gets this rash).  

Causes: sunlight, infections, medicines. Hard to diagnose 

Risk factors: sex (more common in women), age (15-45), race (Black, Hispanic, Asian American) 

Treatment: NSAIDS, antimalarial drugs, corticosteroids, immunosuppressants 

Education: regular checkups (don’t wait for symptoms to get worse), sun protection, regular exercise, don’t smoke, healthy diet, vitamin D and calcium supplements, coping and support 

Traction: 

Skeletal traction: 

Applied through distal femoral or proximal tibial pin 

Complications: pin-track infections, muscle wasting, bed sores 

Pin-site care: apply gauze as a dressing around the pin. Should only be changed when saturated 

Education: assisted active mobilization and chest physiotherapy should start from the first day. Patients can use a trapeze bar to lift themselves 

Skin traction: 

Weight over the end of the bed 

If used over 24 hours: balanced skin traction will allow for better comfort and control of the fracture through allowance of a slight flex in the knee and hip, and elevation of the extremity 

Prevent blisters: traction needs to be applied without folds or creases in the adhesive, and the bandage should be nonelastic. Bandages should be applied spirally.  

Take an x-ray to check for acceptable fracture alignment 

Straight skin traction: add padding under the patient’s calf to keep the heel from pressing in the bed 

Balanced skin traction: orthopedic bed or bed with a Balkan beam frame 

Bryant’s Traction: 

A type of skin traction for femoral fractures or developmental hip abnormalities in children under 18 months  

Short-term treatment while waiting for surgery 

Complications: circulatory complications, skin irritation, nerve palsy 

Nursing: ensure weight hangs freely, and that child is not pulling themselves up. Ensure hips are slightly elevated off the bed. Conduct hourly neurovascular checks. Never lift, remove or adjust the weights.  

Buck’s traction: 

Temporary skin traction used to stabilize femoral or hip fractures, reduce muscle spasms 

Weights should hang freely, and the bed should remain at a low angle 

Complications: skin breakdown, neurovascular impairment, compartment syndrome, muscle wasting, DVT 

Nursing care: keep low fowler’s position (30 degrees), ensure patient does not slip down the bed, check the skin under the boot regularly, neurovascular assessments, that heel of the foot does not touch the bed, the weight hangs freely 

Pavlik harness: 

Soft splint for infants with developmental dysplasia of the hip (DDH) 

Complications: skin breakdown (esp in groin, behind the knee, shoulder, or leg), treatment doesn’t work, compresses nerves in leg or shoulder, bone breakdown (avascular necrosis), flattening of the back of the femoral head, downward dislocation of the knee, subluxation of the knee 

Care: keep baby’s skin clean and dry. Change diapers often, use leak-proof ones. In the beginning, keep them in it all the time. Sponge baths instead of full baths. Go to doctor for harness adjustment as baby grows. Ultrasounds to follow hip joint development.  

Casts: 

Split (bivalve):  

Allows room for swelling. Sides are taped with cloth medical tape. Cast is secured from the inside at the top and bottom so if the tape is peeling it’s okay 

You can buy more tape and tape it again yourself 

Everything looks good at the follow-up appointment: doctor may apply a new layer of casting to close the cast 

Short arm cast: 

For forearm and wrist fractures 

Goes from below the elbow to the hand 

Other use: hold the forearm, wrist muscles, tendons in place after surgery 

Long arm cast: 

For upper arm, elbow, or forearm fractures 

Goes from upper arm to the hand 

Other use: to hold the arm or elbow muscles and tendors in place after surgery 

Shoulder spica cast: 

For shoulder dislocations or after shoulder area surgery 

Applied from around the trunk of the body, the shoulder, arm, and hand 

Short leg cast: 

For lower leg fractures, ankle fractures, severe ankle sprains and strains 

Other: hold the leg/foot muscles and tendons in place after surgery 

Goes from below the knee to the foot 

Can be walked on once fracture is stable enough to bear weight 

Not appropriate for most children under the age of 3 who may kick it off 

Leg cylinder cast/long leg cast: 

Knee or lower leg fractures, knee dislocations, or after surgery on the leg/knee 

Goes from upper thigh to ankle/foot 

Applied with knee bent to avoid walking 

Unilateral hip spica cast (single hip spica): 

For thigh/femur fractures 

Hold hip/thigh muscles and tendons in place after surgery 

Goes from chest to foot of affected leg 

One-and-one-half spica cast: 

Thigh/femur fractures 

Hold the hip/thigh muscles and tendons in place after surgery 

From chest to foot on one leg, and to the knee on the other side with a bar placed betweeen both legs to keep the hip and legs immobile 

Bilateral hip spica cast (double hip spica): 

Pelvis, hip, thigh/femur fractures 

Hold hip/thigh muscles and tendons in palce after surgery 

Long leg: applied from the chest to the feet with a bar between both legs to keep the hip and leg immobile 

Short leg: applied from the chest to the thighs/knees 

Abduction A-frame cast: 

Hold hip muscles and tendons in place after surgery  

From upper thighs to the feet with a bar between both legs to keep the legs and hips immobile 

Cast care: 

Use assistive devices for moving around (crutches, walkers, wagons, wheelchairs, kneeling scooters (adolescents) 

Keep it clean and dry (put bags over it and tape them around to protect from splashing) 

Elevate and apply ice for the first 24 hours 

Handle with palms to avoid denting until the cast is dry 

Check the cast often for cracks or breaks. Contact the doctor if it is 

Cover the cast to prevent food spills and crumbs from entering it 

Do not scratch the skin under the cast 

Do not put anything in the cast including powder or lotion 

Use a hair dryer on cool to relieve hot itchy skin 

Elevate the cast above the heart to decrease swelling 

Move fingers/toes to promote circulation 

Keep genital area as clean as possible 

Use a diaper/sanitary napkin around the genital area to prevent leakage/splashing of urine 

If the cast has gotten wet contact physician to get it changed 

Fiberglass and plaster casts are more urgent to be seen if wet 

When to call doctor: 

Fever greater than 101 

Increased pain 

Increased swelling above/below the cast 

Numbness/tingling 

Drainage/foul odor 

Cool/cold fingers/toes