7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
1/66
- a chronic occlusive arterial disease thatmay affect the abdominal aorta or the LE.
The obstruction to blood flow with
resultant ischemia usually affects thefemoral, popliteal, aortic and iliac arteries - occurs most often in men ages 50-60 - caused by atherosclerosis
- Risk Factors: cigarette smoking,hyperlipidemia, hypertension, DM
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
2/66
1/18/2009 Noaharch Library 2
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
3/66
1/18/2009 Noaharch Library 3
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
4/66
B. Medical management:1. Drug therapy
a. Vasodilators: papaverine, Isoxsuprine Hcl (Vasodilan)*,
Nylidrin Hcl (Arlidin), nicotinyl alcohol (Roniacol)cyclandelate (Cyclospasmol)*, tolazoline Hcl (priscoline) toimprove arterial circulation; effectiveness questionable
b. Analgesics to relieve ischemic painc. Anticoagulants to prevent thrombus formation
d. Lipid reducing drug: cholestyramine, colesti[pol Hcl,dextrothyroxine sodium, clofibrate, gemfibrozil (Lopid)**,niacin, lovastatin (Mevacor), atorvastatin*
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
5/66
2. Surgery: bypass grafting, endarterectomy, ballooncatheter dilation, lumbar sympathectomy (to increaseblood flow), amputation may be necessary
C. Assessment findings:1. Pain both intermittent claudication* and rest pain,
numbness or tingling of the toes2. Pallor after 1-2 mins. Of elevating feet, and dependent
hyperemia/rubor; diminished or absent dorsalis pedis,posterior tibial and femoral pulses; shiny, taut skinwith hair loss on lower legs*
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
6/66
1/18/2009 Noaharch Library 6
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
7/66
1/18/2009 Noaharch Library 7
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
8/66
3. Diagnostic tests:a. Oscillometry may reveal decrease pulse volumeb. Doppler U/S reveals decreased blood flow through
affected vesselsc. Angiography reveals location and extent ofobstructive process
4. Elevated serum triglycerides; sodium
D. Nursing Interventions:1. Encourage slow, progressive physical activity
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
9/66
2. Administer medications as ordered3. Assist with Buerger-Allen exercises qid*
a. client lies with legs elevated above heart for 2-3
minsb. client sits on edge of bed with legs and feetdependent and exercises feet and toes upwardand downward, inward and outward for 3 minsc. client lies flat with legs at heart level for 5 mins
4. Assess for sensory function; protect client frominjury
5. Provide client teaching and discharge planning:stop cigarette smoking, diet, drug compliance,
exercise
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
10/66
1. Alteration in comfort ( pain)2. Impaired skin integrity
3. Altered tissue perfusion4. Anxiety5. Altered body image6. Impaired physical mobility7. Activity intolerance
1/18/2009 Noaharch Library 10
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
11/66
Encourage to Stop smoking Lose wt. and eat low fat Do not cross legs Elevate feet not above heart level
Do not stand & sit for long periods of time Do not wear restrictive clothing Keep affected extremity warm Inspect feet/extremity daily Avoid walking barefoot Avoid mechanical and thermal injuries Begin and maintain exercise Notify AP
Nursing intervention
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
12/66
- Acute inflammatory disorder affecting
medium/smaller arteries and veins of the LE.
Occurs as focal, obstructive process; results in
occlusion of a vessel with subsequent developmentof collateral circulation
- Most often affects men ages 25-40; disease is
idiopathic; high incidence among smokers
A. Medical management: same as arteriosclerosis
obliterans but only cessation of smoking is
effective treatment*
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
13/66
1/18/2009 Noaharch Library 13
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
14/661/18/2009 Noaharch Library 14
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
15/66
B. Assessment findings:1. Intermittent claudication*, sensitivity to cold (skin of
extremity may at first be white, changing to blue
then red)
2. Decreased or absent peripheral pulses (post. tibialand dorsalis pedis), ulceration and gangrene(advanced)
3. Diagnostic tests: same as arteriosclerosis obliterans
except no elevation in serum triglycerides
C. Nursing Interventions:
1. Prepare client for surgery
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
16/66
2. Provide client teaching and discharge planning
- drug regimen, avoidance of trauma to the
affected extremity, need to maintain warmth esp.
during cold weathers, importance of stoppingsmoking
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
17/66
B. Assessment findings:1. coldness, numbness, tingling in one or more digits;
pain (. By exposure to cold, emotional upsets,tobacco use)*
2. intermittent color changes (pallor, cyanosis, rubor);small ulcerations and gangrene tips of digits
C. Nursing interventions
1. provide client teaching concerning:- importance of stopping smoking; need tomaintain warmth; need to use gloves in handlingcold objects; drug regimen*
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
18/66
The head to the thigh bone(femur)deteriorates due to insufficient blood suppy.
The tip of the bone dies over a period of 1-3weeks.This will cause flattening of the top( ball)New blood supply will cause new bone
growth over the next 6 12 months
1/18/2009 Noaharch Library 18
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
19/66
1/18/2009 Noaharch Library 19
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
20/66
1/18/2009 Noaharch Library 20
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
21/66
Knee pain maybe the only symptoms Persistent thigh / groin pain Atrophy of the upper thigh
Slight shortening of the leg Stiffness of the affected part Difficulty of walking ( limping) Limited range of motion Synovitis causing limp and pain in the hip Flattening of the femoral head Lateral over growth of the femoral head
cartilage
1/18/2009 Noaharch Library 21
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
22/66
1. PE2. Arthrography
3. Venography4. MRI/CT scan5. Ultrasound6. Hip X ray
1/18/2009 Noaharch Library 22
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
23/66
1. Pain2. Anxiety
3. Fear4. Impaired physical mobility5. Activity intolerance6. Ineffective role performance7. Low self esteem8. Trauma9. Spiritual distress
1/18/2009 Noaharch Library 23
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
24/66
1. Care of patient requiring traction or spinecast.
2. Teaching and guidance to family3. Encourage participation to patient care4. Set for appropriate referals : PT, social
service, community health nurse5. Diversionary activities6. Exercise7. Emotional support
1/18/2009 Noaharch Library 24
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
25/66
Curving of the spine that causes bowing ofthe back. ( hunchback)
Research society defines kyphosis as spinemeasuring 45 degrees or greater on a xrayNormal spine has only 20 35 degrees ofcurvature in the upper back
1/18/2009 Noaharch Library 25
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
26/66
1. Postural and Structural2. Gibbus deformity
3. Hyperkyphosis4. Congenital5. Scheuermanns disease juvenile thoracic
Kyphosis unknown cause, familial tendency.Decrease intervertebral disc space andvertebral wedging resulting to curvature
onset is usually at the age of 5 to 12 and 15 years .
1/18/2009 Noaharch Library 26
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
27/66
1/18/2009 Noaharch Library
27
Postural and Structural
1. Hyperkyphosis
Gibbus deformity
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
28/66
Unknown Infection ( Tuberculosis)
Spinabifida Disc degeneration Pagets disease abnormal bone destruction
and new growth Polio Tumors Muscular dystrophy
1/18/2009 Noaharch Library 28
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
29/66
Spinabifida
1/18/2009 Noaharch Library 29
Polio
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
30/66
1. Gibbus formation,/ curvature of the spine2. Pain
3. Poor posture4. fatigue]5. Numbeness, paresthesia6. Muscle spasm7. Weakness of the back8. With mild scoliosis9. Bowel and bladder changes
1/18/2009 Noaharch Library 30
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
31/66
Neuro evaluation X ray
Bone scan MRI CT scan
1/18/2009 Noaharch Library 31
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
32/66
Care for patient wearing a brace Cast/ traction care
Use firm mattress Avoid prolong sitting Skin care Assess Cardiopulmonary status Medications: analgesic, antibiotics,
antianxiety Emotional support
1/18/2009 Noaharch Library 32
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
33/66
Is tuberculosis of the spine Also known as tuberculosis spondylitis.
Affects adult. It is secondary to an extra spinal source of
infection Progressive bone destruction leads to
vertebral collapse and kyphosis.( Gibbusformation)
1/18/2009 Noaharch Library 33
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
34/66
Presentation depends on the following :
Stage of the disease
Site : cervical, thoracic, lumbosacral) Presence of complication neurologic deficit
the reported average duration of Sx at thetime of diagnosis is 3-4 months
Back pain is the earliest and common sx.
1/18/2009 Noaharch Library 34
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
35/66
1/18/2009 Noaharch Library 35
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
36/66
Fever and weight loss 50 % of the cases has neurologic
abnormalities: spinal cord compression,paraplegia, paresis, impaired sensation caudaequina syndrome
Cervical spine TB is less common but more
serious complication :
Pain and stiffness, dysphagia or stridor, torticolis
1/18/2009 Noaharch Library 36
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
37/66
1. PE
1. spinal alignment
2. Neurologic exam2. Lab test
1. Mantoux test (PPD)
2. ESR
3. Bone exam(micro) AFB screening
3. Xray, Ctscan, MRI
1/18/2009 Noaharch Library 37
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
38/66
1. Independent:
1. Vital signs
2. Pain scale assessment3. Comfort measures : massage positioning
4. Inspect skin for abscess
5. I & O and nutritional intake6. Check traction setup
7. Active and passive ROM
8. Promote coughing & Breathing exercise1/18/2009 Noaharch Library 38
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
39/66
9. encourage verbalization of feelings
Collaborative : Medication
Multivitamins,
Diet: balanced diet of CHO, CHON
1/18/2009 Noaharch Library 39
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
40/66
condition in which the median nerveis compressed at the wrist.
Paresthesia and muscle weakness inthe hand May occur at night/waking up at night Most of the cause is idiopathic or
without specific cause.
1/18/2009 Noaharch Library 40
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
41/66
1/18/2009 Noaharch Library 41
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
42/66
1/18/2009 Noaharch Library 42
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
43/66
Can be associated with :
Trauma,
Pregnancy,
Rheumatoid arthritis
Acromegaly
Hypothyroidism. Work related
Genetic structural and biological
fracture1/18/2009 Noaharch Library 43
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
44/66
Diagnostic :
Blood pressure cuff for 1-2 minutes evokes pain
EMG delay in nerve motor conduction > 5 msec.
1/18/2009 Noaharch Library 44
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
45/66
Treatment:
1. Resting / splinting 1-2 weeks
2. Corticosteroids (bethamethasone/hydrocortisone)
3. NSAID
4. Surgical decompression resecting the carpal
tunnel ligament
1/18/2009 Noaharch Library 45
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
46/66
an umbrella term encompassing a group ofnon progressive, non contagious motor
conditions that cause physical disability inhuman development, chiefly in the variousareas of body movement\
Cerebral cerebrumPalsy refers to disorder movementDamage in motor control centers of
developing brain
1/18/2009 Noaharch Library 46
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
47/66
1/18/2009 Noaharch Library 47
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
48/66
can occur during pregnancy 75% 5 % during child birth 15 % after birth Neuromuscular disorder
1/18/2009 Noaharch Library 48
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
49/66
It is cause by Cerebral anoxia,hemorrhage
Maternal infection Rubella Maternal drug ingestionRadiation Maternal diabetes Malnutrition
1/18/2009 Noaharch Library 49
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
50/66
Forcep delivery, breech presentation,placenta previa and abruptionplacenta
Abnormal vitals from anesthesiaProlapsed cord Multiple birth
1/18/2009 Noaharch Library 50
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
51/66
Spastic - Common type 70% - 80 %
Hypertonic and have neuromuscularcondition from damage to thecorticospinal tract or to motor cortex..
a) Spastic Hemiplegia
b) Spastic diplegia
lower ext. less inupper. ( strabismus) scissor gait
c) Spastic tetraplegia all 4 limbs, leat
likely to walk1/18/2009 Noaharch Library 51
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
52/66
1/18/2009 Noaharch Library 52
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
53/66
Ataxic
Damage to cerebellum
Less common form cerebral palsy 10%
Hypotonia and tremors
Visua;l and auditory
Hypotonic
1/18/2009 Noaharch Library 53
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
54/66
Athetoid/dyskinetic Mixed muscle tone.
Trouble in holding self uprigth, steadyposition for sitting /walking.
Unable to hold objects
of the people with CP have athetoid
1/18/2009 Noaharch Library 54
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
55/66
1. Deformities and contractures (permanently
fixed , tight muscle and joints.2. Spasticities
3. Unstable gait, problems with balance.
4. Night sweat
5. Constipation in children
6. dysphagia
7. drooling
8. glossoptosis9. Scissor gait
10. Toe walking
11. Weakness/one arm
1/18/2009 Noaharch Library 55
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
56/66
EEG Neuro-imaging Cytogenic
1/18/2009 Noaharch Library 56
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
57/66
Physical Occupational therapy Speech language therapy Surgery Diazepam, Baclofen, and Dantrolene.Adaptiive devices : braces/splints
1/18/2009 Noaharch Library 57
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
58/66
1/18/2009 Noaharch Library 58
JamesTaylor andson
J&J artificial limb andbrace
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
59/66
1. Assist in locomotion, communicationand educational opportunities
2. Institute high calorie diet3. Plan activities that involve gross
motor skills4. Provide safe environment
1/18/2009 Noaharch Library 59
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
60/66
Deformity occurs in utero.Approximately 1:1000 birthBoys are twice likely to be affectedHereditaryAlso known as Talipes equinovarus isthe most common.
1/18/2009 Noaharch Library 60
http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D17/28/2019 (NCM 104) Ortho Sir Pat Lao 3
61/66
1/18/2009 Noaharch Library 61
http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D1http://images.google.com.ph/imgres?imgurl=http://www.abdn.ac.uk/orthopaedics/graphics/talipes_clubfoot.jpg&imgrefurl=http://www.abdn.ac.uk/orthopaedics/res_ctev.shtml&usg=__SgR6Edg9s1-jK4p-7NhxMF9JIsM=&h=288&w=420&sz=61&hl=tl&start=4&um=1&itbs=1&tbnid=FwwqXCYsYgF4fM:&tbnh=86&tbnw=125&prev=/images%3Fq%3Dclubfoot%26hl%3Dtl%26rlz%3D1W1ADFA_en%26sa%3DN%26um%3D17/28/2019 (NCM 104) Ortho Sir Pat Lao 3
62/66
Mechanical forcePlacental exposure to drugs/infection Hereditary
3 classical definition requires thesecomponent1. Plantar flexion of the foot at the ankle
joint
2. Inversion deformity of the heel
3. Turning of the foot1/18/2009 Noaharch Library 62
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
63/66
Manipulation of the foot Straps and splints Casting Corrective surgery Denis browne splint
1/18/2009 Noaharch Library 63
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
64/66
1/18/2009 Noaharch Library 64
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
65/66
1/18/2009 Noaharch Library 65
7/28/2019 (NCM 104) Ortho Sir Pat Lao 3
66/66
Help parents and child deal with griefand emotional problems
Teach parents the prescribedexercises
Urge the parents that the child mustwear corrective shoes