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To Preview the 5Th Edition An Introduction to Orthopaedic Nursing 5th Edition Production Credits Project Director: Tandy Gabbert, MSN, RN, ONC Copy Editor: Donna Polydoros, BA Creative Designer: Genevieve Gardner Editorial Coordinators: Jessica M. Scott, MFA and Jordan Winn, BSBA Legal Disclaimer An Introduction to Orthopaedic Nursing, 5th Edition, is intended to support and enhance knowledge of nurses new to and/or interested in care of orthopaedic patients. Information in this publication has been authored and peer-reviewed by experts in the field and reflects current evidence and research. The rapid pace of innovation and constant change in health care is evident across the care continuum and are closely scrutinized. Changes in best practices are inevitable as current strategies are replaced by those with better results. Individual providers, teams, and facilities are accountable for using their own knowledge and expertise when determining the course of action in a patient care situation. The National Association of Orthopaedic Nurses (NAON) as the publisher, the authors, the contributors, and the editors assume no liability for any injury or damage to persons or property from the use of instructions, products, methods, or other ideas in this book. Copyright ©2018 National Association of Orthopaedic Nurses 330 N Wabash, Suite 2000 Chicago, IL 60611 www.orthonurse.org All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage-and-retrieval system without the express written permission of the National Association of Orthopaedic Nurses. ISBN: 978-0-9790408-2-5 An Introduction to Orthopaedic FIFTH Nursing 5EDITION Chapter 1 Musculoskeletal Anatomy and Neurovascular Assessment ...................1 Chapter 2 Care of the Patient with Upper Extremity Problems .......................17 Chapter 3 Care of the Spine Patient ............................................33 Chapter 4 Care of the Patient with Knee Problems.................................55 Chapter 5 Care of the Patient with Hip, Foot and Ankle Problems . 83 Chapter 6 Care of the Patient with Traumatic Orthopaedic Injuries ..................101 Chapter 7 Pain Management . .119 Chapter 8 Complications Associated with Orthopaedic Surgeries ....................137 Chapter 9 Body Mechanics, Mobility Techniques, and Postsurgical Precautions .........165 Index ......................................................................179 Table of Contents i Authors Ericka Bergeron, BSN, RN Beverly A. Morris, MBA, RN, ANP-BC Nurse Manager Nurse Practitioner Consultant Dartmouth-Hitchcock Medical Center Chair - Data Safety Monitoring Board - Lebanon, New Hampshire Department of Anesthesiology University of California San Diego, California Rachel G. Blier, BSN, RN, ONC® Nurse Educator Dartmouth-Hitchcock Medical Center Brandi Oakley, DPT Lebanon, New Hampshire Senior Physical Therapist The Miriam Hospital Providence, Rhode Island Pamela A. Cupec, MS, BSN, RN, ONC®, CRRN, ACM-RN Orthopaedic Nurse Navigator Dorothy Pietrowski, RN, MSN, ACNP, ONC® UPMC Passavant Nurse Practitioner Pittsburgh, Pennsylvania Loyola University Medical Center Maywood, Illinois Roberta Goff, MSN, RN-BC, ACNS-BC, ONC® Mary Catherine Rawls, MS, RN-BC, Senior Clinical Informaticist CNL, FGNLA Clinical Informatics Clinical Specialist, Medical Specialties Munson Medical Center Dartmouth-Hitchcock Medical Center Traverse City, Michigan Lebanon, New Hampshire Barbara J. Levin, BSN, RN, ONC®, Dottie Roberts, EdD, MSN, MACI, RN, CMSRN, LNCC OCNS-C®, CMSRN, CNE Clinical Scholar Orthopaedic Trauma Unit Executive Director Massachusetts General Hospital Orthopaedic Nurses Certification Board Chair - Massachusetts Board of Registration in Chicago, Illinois Nursing Boston, Massachusetts Nicole Sarauer, APRN, CNS, ONC® Clinical Program Development CNS Matt Lowe, MDiv, MSN, ARNP, FNP-C, Twin Cities Orthopedics ONC®, CMSRN Twin Cities, Minnesota RN Clinical Educator for Medical / Surgical and Progressive Care Ocala Health System Ocala, Florida Conflict of Interest Each author and reviewer has been asked to disclose if he/she has received something of value (in excess of $500) from a commercial company or institution which relates directly or indirectly to writing and reviewing of this book. Those have been indicated with an asterisk (*) all others have no conflict of interest. NAON does not view the existence of these disclosed interests or commitments as necessarily implying bias or decreasing the value of the author or reviewers participation in our product. ii Authors, Reviewers & Editor Reviewers Carol Harvey, MSN, RN, CNS, ONC® Orthopaedic Clinical Nurse Specialist / Professor Emeritus Cypress College Department of Registered Nursing Cypress, California Cathleen E. Kunkler, MSN, RN, ONC, CNE Director of Nurse Education Corning Community College Corning, New York Mary Catherine Rawls, MS, RN-BC, CNL, FGNLA Clinical Specialist, Medical Specialties Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Melanie H. Simpson, PhD, RN-BC, OCN, CHPN, CPE Pain Management Team Coordinator The University of Kansas Health System Kansas City, Kansas Christopher Thibault, DPT Rehabilitation Manager Orlando Regional Medical Center - Orlando Health Orlando, Florida Editor Michael E. Zychowicz, DNP, ONP-C, FAAN, FAANP Professor and Director of the MSN Program Duke University School of Nursing Durham, North Carolina Preface iii Preface Caring for patients in their most vulnerable patient handling and applicable post-surgical moments is a sacred trust. Providing the highest precautions. Each chapter begins by presenting quality nursing care based on current evidence the learner objectives and key terms and is a compelling responsibility. Today’s definitions specific to the content. complicated healthcare landscape mandates a rapid pace of change to accommodate the most The interventions of orthopaedic nurses up-to-date regulations, evidence, and best correlate directly to optimal patient outcomes. practices. Caring for patients with varied This truth is detailed as concepts unique to musculoskeletal conditions requires a specialized orthopaedic patient care are explored – rapid body of knowledge and expertise. Skilled and mobilization, preventing and detecting knowledgeable nurses are empowered to complications, patient and family education, provide excellent care, intervene to prevent appropriate equipment and techniques, injuries and complications, and maintain safety conservative and surgical management of for the staff and for the patient. It is with these various conditions. The reviews of internal and thoughts in mind that we offer the fifth edition external fixation, as well as traction, reflect a of NAON’s An Introduction to Orthopaedic Nursing. comprehensive presentation of the many options for treatment of fractures. The target audience for this manual is the bedside nurse providing direct patient care in a Great thought and research was put into the clinical setting. It is a solid reference for others production of this manual. I commend the in the continuum of care - clinical nurse editor, authors and reviewers, experts in their specialists, bedside care providers, nurse field, for their hard work and dedication to practitioners, educators, and students. This produce this excellent reference and resource. manual continues to be a learning tool for nurses The orthopaedic nurse is required to be both new to the orthopaedic environment, as well as caring and technically expert. The nurse must those who wish to brush up on less frequently be armed with advanced critical thinking and seen conditions. It is a solid reference for a team make decisions that result in excellent patient to develop competencies, policies and protocols. outcomes. We pray this reference supports you in those endeavors. Arranged in a chapter format to afford quick referencing, this edition is spiral bound to Take care, accommodate extensive use. The manual begins Tandy Gabbert, MSN, RN, ONC with an overview of musculoskeletal anatomy Director of Education, and the foundational neurovascular assessment. National Association of Orthopaedic Nurses The following chapters then discuss conditions related to different locations – upper extremity, Contact Hours spine, knee, and hip/foot/ankle. Conditions related to traumatic injury are detailed, followed NAON will offer contact hour opportunities for by an updated chapter on the management of this new edition. Post-test questions for each pain in the orthopaedic patient. Complications chapter will be available in the NAON Online common (and less common) to the orthopaedic Store in 2018. For questions, please contact the patient population are discussed, with the final NAON National Office at [email protected] chapter addressing patient mobilization, safe or 1 (800) 289-6266. iv An Introduction to Orthopaedic Nursing, 5th Edition Chapter 1 Musculoskeletal Anatomy and Neurovascular Assessment Nicole Sarauer, APRN, CNS, ONC® Objectives ◾ Describe the micro- and macroscopic structure, function, and types of bone. ◾ Identify the neurovascular and musculoskeletal components of a comprehensive assessment. ◾ Identify assessment parameters for a nursing history and assessment. ◾ Describe potential patient outcomes that may occur secondary to abnormal neurovascular findings. Key Terms Blanch: to lose color; to assess the Epiphyses: the ends of a bone that lie Medullary cavity: a marrow-filled integrity of the
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