Table of Contents

 

 

 

Chapter 1

Practice Settings for Orthopaedic Nursing   Susan C. Ruda, MS, RN, APN, ONC

1

 

Orthopaedic Nursing in an Acute Care or Extended Care Facility

3

 

Staff Nurse

3

 

Head Nurse/Unit Manager/Nursing Supervisor

5

 

Clinical Nurse Specialist (CNS)

5

 

Orthopaedic Nursing Outside the Hospital Setting

6

 

Office/Clinic Nurse

6

 

School Nurse

6

 

Home Health Nurse

7

 

Orthopaedic Nursing Practice Inside/Outside the Hospital and Nonhospital Settings

8

 

Nurse Practitioner (NP)

8

 

Case Manager

9

 

Academic Faculty

9

 

Nurse Researcher

10

 

Nurse Entrepreneur

10

 

Registered Nurse First Assistant (RNFA)

11

 

Bibliography

13

Chapter 2

Anatomy and Physiology   Linda L. Altizer, MSN, RN, ONC, FNE

15

 

Terminology

17

 

Bone

17

 

Skeletal Muscle

18

 

Joints

19

 

Skull

20

 

Shoulder Girdle

20

 

Upper Extremity

21

 

Wrist, Hand, and Fingers

22

 

Thoracic Cage

25

 

Spine - Vertebral Column

25

 

Pelvic Girdle

28

 

Lower Extremity

29

 

Bibliography

35

Chapter 3

Musculoskeletal Assessment   Kathleen L. Upham, MSN, RN, ONC

37

 

The Health History

39

 

Considerations Across the Life Span

41

 

General Techniques of Musculoskeletal Physical Examination

42

 

Assessing Sports Injuries

45

 

The Musculoskeletal Physical Examination from Head to Toe

47

 

The Quick Assessment

69

 

Changes with Age

70

 

Bibliography

70

Chapter 4

Diagnostic Studies   Rebecca Jo Fowler, MSN, RN, ONC

71

 

Blood

73

 

Urine

82

 

Radiographic Studies

84

 

Angiography

84

 

Arthrography

85

 

Bone Scan (Scintigraphy)

85

 

Computer Tomography (CT)/Computed Axial Tomography (CAT) Scan

86

 

Dual Energy Absorptiometry (DEXA)

88

 

Indium-WBC Scan

88

 

Magnetic Resonance Imaging (MRI)/Nuclear Magnetic Resonance (NMR)

89

 

Myelography

89

 

Thermography

91

 

X-ray (Radiographs, Roentgenograms)

91

 

Special Diagnostic Studies

93

 

Arthrometer

93

 

Arthroscopy

93

 

Bone Marrow Aspiration and Biopsy

94

 

Discogram (Diskogram)

95

 

Joint Aspiration

95

 

Lumbar Epidural Venogram

96

 

Nerve Conduction Studies/Electromyography (EMG)

96

 

Pulmonary Function Tests

97

 

Somatosensory Evoked Potentials (SSEP)

97

 

Bibliography

98

Chapter 5

Perioperative Patient Care   Susan Barnett, MSN, RN, CNOR, ONC, Louise Strickland, BN, RN, CNOR

99

 

Preoperative Assessment

101

 

Preoperative Teaching

102

 

Preoperative Planning

102

 

Intraoperative Implementation

103

 

Postoperative Evaluation, Reassessment, and Interventions

121

 

Discharge

125

 

Bibliography

126

Chapter 6

Effects of Immobility   Joan Larifear, MS, RN, ONC, C

127

 

Assessment

137

 

Common Therapeutic Modalities

137

 

Nursing Diagnoses, Outcomes, and Interventions

139

 

Home Care Considerations

141

 

Bibliography

141

Chapter 7

Pain   Donna M. Barker, MS, ANP-C, ONC, RN-C, Karen A. Sikorski, MS, UN, APN/CNS

143

 

Definitions and Types of Pain

145

 

Anatomy and Physiology of Pain

146

 

Physiologic Effects Associated with Unrelieved Pain

147

 

Epidemiology of Pain

148

 

Ethical Principles of Pain Management

149

 

Pain Management

149

 

Assessment

151

 

Nursing Diagnoses, Outcomes, and Interventions

157

 

Principles of Pharmacologic Management

159

 

Administration Routes

164

 

Conscious Sedation

171

 

Special Populations

171

 

Bibliography

172

Chapter 8

Complications   Nancy S. Morris, PhD, APRN, BC Barbara Levin, BSN, RN, LNCC, ONC

175

 

General Risk Factors

177

 

Increased Age

177

 

Comorbidity

177

 

Drugs

177

 

Additional Risk Factors

177

 

Delirium

177

 

Pressure Ulcer

180

 

Constipation

182

 

Hemorrhage, Significant Blood Loss

183

 

Pulmonary Embolism (PE)

186

 

Deep Vein Thrombosis (DVT)

189

 

Fat Embolism Syndrome (FES)

192

 

Compartment Syndrome (Acute and Crush Syndrome)

195

 

Delayed Union/Nonunion

200

 

Nosocomial Surgical Site Infections (SSI)

201

 

Hospital-Acquired Pneumonia (HAP)

203

 

Postoperative Nausea and Vomiting (PONV)

205

 

Postoperative Urinary Retention (POUR)

206

 

Bibliography

208

Chapter 9

Infections   Karen E Zorn, BSN, RN, ONC

211

 

Osteomyelitis

213

 

Septic Arthritis

216

 

Prosthetic Joint Infections

219

 

Bone and Joint Tuberculosis (TB)

220

 

Skin and Soft Tissue Infections

222

 

Nosocomial Infections

223

 

Bibliography

225

Chapter 10

Therapeutic Modalities   Cathleen E. Kunkler, MSN, RN, ONC

227

 

Traction

238

 

External Fixators

241

 

Continuous Passive Motion (CPM) Machine

247

 

Braces/Orthotics/Orthoses

248

 

Ambulating Devices and Techniques

250

 

Wheelchairs

254

 

Bibliography

256

Chapter 11

Pediatrics/Congenital Disorders   Debbie Hawk, RN, ONC, CNOR, RNFA, Susan Bailie, MPH, RN, ONC

259

 

Metatarsus Adduttus

261

 

Clubfoot (Talipes Equinovarus)

261

 

Developmental Dysplasia of the Hip (DDH)

267

 

Physical Abuse (Battered Child Syndrome / Shaken Baby Syndrome / Inflicted Injury)

270

 

Torsional Problem

275

 

Genu Varus/Genu Valgus

278

 

Legg-Calve-Perthes (LCP) Disease

281

 

Osgood-Schlatter Disease

283

 

Leg Length Discrepancies

287

 

Blount’s Disease (Tibia Vara)

289

 

Achondroplasia

291

 

Arthrogryposis Multiplex Congenita (AMC)

293

 

Slipped Capital Femoral Epiphysis (SCFE)

296

 

Pediatric Fractures

298

 

Osteogenesis Imperfecta (01)

300

 

Myelomeningocele

304

 

Cerebral Palsy (CP)

310

 

Duchenne’s Muscular Dystrophy

318

 

Neurofibromatosis

322

 

Bibliography

326

Chapter 12

Arthritis and Connective Tissue Disorders   Dottie Roberts, MSM, MACI, RN, CMSRN, OCNS-C

327

 

Juvenile Rheumatoid Arthritis

329

 

Systemic Onset JRA

331

 

Polyarticular Onset Juvenile Rheumatoid Arthritis

335

 

Pauciarticular Onset Juvenile Rheumatoid Arthritis

336

 

Rheumatoid Arthritis (RA)

336

 

Osteoarthritis

341

 

Polymyalgia Rheumatica (PMR)

346

 

Rheumatic Fever

348

 

Gout

349

 

Lyme Disease

352

 

Seronegative Spondyloarthropathies

354

 

Ankylosing Spondylitis (AS)

354

 

Reactive Arthritis (ReA)

356

 

Psoriatic Arthritis

358

 

Systemic Sclerosis (SS)

359

 

Polymyositis (PM) and Dermatomyositis (DM)

362

 

Systemic Lupus Erythematosus (SLE)

364

 

Fibromyalgia Syndrome (FS)

368

 

Bibliography

370

Chapter 13

Metabolic Bone Conditions   Kathleen A. Geier, MS, RN, FNP, CNS, ONC

373

 

Anatomy and Physiology

375

 

Primary Hyperparathyroidism

376

 

Secondary Hyperparathyroidism

380

 

Tertiary Hyperparathyroidism

380

 

Hypoparathyroidism

380

 

Osteomalacia

383

 

Osteoporosis

385

 

Paget’s Disease (Osteitis Deformans)

389

 

Rickets

391

 

Bibliography

393

Chapter 14

Trauma   Ann Butler Maker, MS, RN, APNC, ONC

395

 

Strains

397

 

Sprains

401

 

Dislocations and Subluxations

402

 

Fractures

414

 

Spinal Fractures

425

 

Bullet Injuries, Blast Injuries, Puncture Wounds, Crush Injuries

427

 

Bibliography

431

Chapter 15

Tumors of the Musculoskeletal System   Colleen R. Walsh, MSN, RN, ONC, CS, ACNP-BC

433

 

Bone Metastasis

454

 

Multiple Myeloma

456

 

Bibliography

457

Chapter 16

The Shoulder   Anita Nivens, PhD, RN, APRN-BC

459

 

Tendinitis (Impingement Syndrome)

461

 

Rotator Cuff Tears

463

 

Arthritis of the Shoulder

468

 

Instability of the Shoulder

472

 

Adhesive Capsulitis

475

 

Fractures of the Shoulder

476

 

Sprains, Strains, and Contusions

478

 

Sprengel’s Deformity

479

 

Congenital Dysplasias or Hypoplasia of the Glenoid

480

 

Referred Visceral Somatic Pain

480

 

Bibliography

480

Chapter 17

Hand and Wrist   Sharon G. Childs, MS, APRN-BC, NP/CS, ONC

483

 

Dupuytren’s Disease

485

 

Mallet Finger (Jersey Finger)

486

 

Trigger Thumb/Finger

489

 

De Quervain’s Tenosynovitis

490

 

Ganglion

491

 

Carpal Tunnel Syndrome (CTS)

492

 

Replantation

493

 

Arthroplasty

499

 

Finger Fractures - Bennett’s and Rolando’s

501

 

Boxer’s Fracture

502

 

Scaphoid Fracture

503

 

Bibliography

504

Chapter 18

The Spine   Margaret Hickey, MS, MBA, RN, ONC Mary Faut Rodts, DNP, CNP, ONC, FAAN

507

 

Spine Assessment: An Overview

509

 

Assessment

509

 

Radiographic Evaluation

509

 

Conservative (Nonsurgical) Treatment

510

 

Surgical Intervention

510

 

Scoliosis

510

 

Kyphosis

513

 

Herniated Nucleus Pulposus

522

 

Spinal Stenosis

526

 

Degenerative Disc Disease

527

 

Spondylolysis and Spondylolisthesis

528

 

Failed Back Syndrome

529

 

Bibliography

531

Chapter 19

The Hip, Femur, and Pelvis   Luann M. Theis, MSN, RN, ONC, Barbara Kahn, BS, RN, ONC

533

 

Hip Fractures

535

 

Hip Arthroplasty

540

 

Hip Dislocation

544

 

Hip Girdlestone Pseudarthrosis (Resectional Arthroplasty)

546

 

Hip Arthrodesis

547

 

Proximal Femoral Osteotomy

548

 

Femoral Fractures

549

 

Pelvic Fracture

551

 

Bibliography

554

Chapter 20

The Knee   Jack Davis, BS, RN, ONC Nancy Abbate, RN, ONC

555

 

Arthritis of the Knee

557

 

Overview

557

 

History and Physical Assessment

557

 

Common Therapeutic Modalities

557

 

Nursing Diagnoses, Outcomes, and Interventions

559

 

Home Care Considerations

559

 

Office Practice Considerations

559

 

Meniscal Tears

559

 

Anterior Cruciate Ligament Injuries

564

 

Medial Collateral Ligament Injuries

566

 

Posterior Cruciate Ligament Injuries

567

 

Extensor Mechanism Disorders/Injuries

568

 

Chondromalacia of Patella

570

 

Tendonitis and Bursitis

571

 

Discoid Meniscus

572

 

Osteochondritis Dissecans in Children

572

 

Bibliography

573

Chapter 21

Foot and Ankle   Norns Burton, MSN, RNCS ONC C. Daniel Tierney, RN, C

575

 

Anatomy

577

 

Bones

577

 

Joints

577

 

Ligaments

577

 

Tendons

577

 

Retinaculum

577

 

Calcaneal Fat Pad

577

 

Arches

579

 

Blood Supply

579

 

Nerves

579

 

Assessment of the Foot and Ankle

579

 

History

579

 

Physical Examination

579

 

Diagnostic Tests

579

 

Ankle Sprains

580

 

Achilles Tenosynovitis

582

 

Achilles Rupture

584

 

Plantar Fascitis

585

 

Verruca Plantaris (Plantar Wart)

587

 

Fractures

587

 

Pes Planus

589

 

Pes Cavus

590

 

Charcot Foot

591

 

Foot Drop

591

 

Rheumatoid Arthritis (RA)

592

 

Hallus Valgus (Bunion Deformity)

593

 

Amputations

594

 

Interdigital Neuroma

595

 

Ingrown Toonails

595

 

Mallet Toe Deformity

596

 

Hammer Toe Deformity

597

 

Claw Toe Deformity

597

 

Corn

598

 

Onychomycosis

599

 

Diabetic Foot

599

 

Bibliography

602

Chapter 22

The ONCB Certification Exam: Strategies for Success   Lynn M. Stover, DSN, RN, SANE

603

 

Bibliography

606

 

NAON Certification Preparation Materials

606

 

Index

607