NU 350 Orthopedics

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1

What are bursae and what is their function?

Covering where any tendon or ligament go over a bone. Cushion with synovial membrane and synovial fluid on the inside. It keeps the tendon from being eroded from friction.

2

What is bursitis and where are the most common places it affects?

Inflammatory response caused by trauma, repeated friction, or other syndrome. Most common are the shoulder, elbow, knees, and trochanter. Can also get it on the buttocks on the ischial tuberosities. If you sit really hard on it, you’ll have a lot of pain there.

3

What are the main methods of treatment for bursitis? What are the goals of treatment of bursitis?

Methods: NSAIDs and aspirin (ibuprofen, aleve, celebrex prescription). Long-term therapy can cause stomach ulcers. Don't want to give if a hx of them. Take with food.

Ice, no more than 20 min at a time, use a towel underneath, never put on skin.

Rest. Stop repetitive motion that caused the bursitis.

Steroid injections if above are not effective. Must clean well with betadine and alcohol. Doctor will aspirate fluid first, should be clear yellow. Cloudy means infection. Steroids make infection worse.

Surgery - Bursectomy is rare.

4

How do you prevent bursitis?

Decrease repetitive motion. If unavoidable, rest and ice afterward.

Treat accompanying syndrome causing the bursitis.

Runners/tennis players/etc must replace tennis shoes every 3 months.

Bikers replace the seat of the bike.

5

Etiology and common sites of a sprain?

Etiology and common sites of a strain?

Sprain is an injury to ligaments. Cause is a twisting or wrenching injury where bones go the opposite direction from each other.

Common sites are the wrist, ankles, knee, and shoulder.

Strain is a stretching of the muscle or fascia. Fascia line muscles, keep them in a compartment.Repetitive strains can be associated with carpel tunnel.

Common places are the back, wrist shoulder, and foot.

6

How do we initially treat sprains and strains?

RICE. First thing to do is immobilize. Rest.

Ice, for no longer than 20 min.

Compression, don't over do it though, start at the ankles and come up.

Elevation, above the level of the heart.

Don't ever use heat, except for strain on the back.

7

Etiology of a knee sprain? How do we diagnose?

The knees are held together by 4 ligaments. Many times cartilage is torn there too. Cartilage is called meniscus in the knee.

We diagnose by arthroscopic surgery.

8

How to care for post-op menisectomy?

RICE. Rest.Depending on the surgery, reduce ambulation or up to a week. Don't stop walking on crutches when it feels better, go by what the doctor says. Must know weight bearing status.

Ice 20 min, 3-4 times a day.

Compression dressing and Elevation.

Do not get sutures wet. If necessary put a dressing on the site and change it after the shower.

Most with knee surgeries need physical therapy. Depends on condition of knee, surgery, patient.

Usually with menisectomy, they recover fairly quickly. With cartilage or ligament repair, takes much longer. 6-8 months.

9

Describe the procedure of reconstructing a knee ligament.

Take a new ligament (sometimes a cadaver ligament, or a strand from your own quad or hamstring tendon) and feed it through holes they've drilled in the femur. Anchor it with screws.

10

What are the essentials of nursing care for any knee surgery?

Neurovascular status, 5 P's. Pain out of proportion to what you expect. Tibial and Pedis pulses. Pallor in the repaired leg compared to other extremities. Parasthesia in the leg and foot. Paralysis of the leg.

RICE.

Pain control. These surgeries are very painful.

Must know weight bearing status.

Keep sutures dry.

Physical therapy to rehab the knee.

11

Common effects of repetitive strains?

Carpel tunnel syndrome, plantar fasciitis, rotator cuff injury, tenosynovitis/tendonitis, lateral epicondylitis (tennis elbow), achilles tendonitis.

12

How to treat inflammatory conditions such as strains?

Neurovascular status checks. 5 P's.

Rest, Ice, Elevation, Bracing. Not compression. Bracing is to give them rest.

NSAIDs

Steroids

Surgical release

13

What is a hallmark assessment finding for carpal tunnel syndrome (CTS)? Etiology of this finding?

The thumb, index, and middle finger going numb and tingling. If the whole hand goes numb, it's probably coming from their neck.

The median nerve is compressed by the volar carpal ligament that gets too tight due to repetition. Causes the parasthesia.

14

What are other diagnostic tests we can perform for CTS?

Tinel's sign - Tap them on the wrist. If hand tingles and goes numb, the Tinel's sign is positive.

Phalen's sign - When they put their wrists together with hands bending downward for a minute, they have numbness and tingling.

Can do a nerve conduction test, EMG.

15

Treatment for CTS?

Neurovascular checks are a must. 5 P's

Night time splints to hold them in functional position while they sleep.

Ergonomics, correct body positioning.

NSAIDs to reduce inflammation

Steroid shots in the wrist.

Many people need surgery to cut the ligament if symptoms persist for over 6 months.

16

Etiology of plantar fasciitis?

Fascia of the foot gets inflamed. Most common complain is that the first step out of bed in the AM or the first step after sitting for a while hurts.

17

How to treat plantar fasciitis?

Stretching using a golf ball or can of food.

RICE. Except not compression. Bracing instead.

Can do steroid shots.

Usually goes away after two years.

18

Etiology of rotator cuff injury? How long to recover from surgery?

Tear in the group of tendons and muscles that cause your shoulder to rotate different ways.

Takes 6 months to a year to recover from surgery.

19

Difference between dislocation and subluxation?

Dislocation - Complete removal of the bone from its socket.

Subluxation - Partial disturbance of the bone from the socket.

20

How to treat dislocation and subluxation?

Requires immobilization and relocation to the hospital. Do not try to put it in place by yourself!

Check neurovascular status! 5 P's. Many times these injuries won't have a pulse.

If a finger, might have a fracture. More reason to relocate to the hospital.

21

Symptoms of hip dislocation?

Pain, internally rotated, affected leg is shorter than the other leg.

22

How to treat shoulder dislocation?

Doctor applies axial traction to the shoulder while the nurse applies countertraction to the body with a towel.

23

Nursing care of the dislocated/subluxated hip and shoulder?

Neurovascular status, 5 P's

RICE

Know weight bearing status

Immobilization

Physical therapy