Orthopaedic nursing
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Orthopaedic nursing · Jul 1999
Clinical Trial Controlled Clinical TrialImproving pain management after total joint replacement surgery.
To test the effects of implementing evidence-based postoperative pain management content and strategies on patient, provider (nurse and physician), and fiscal outcomes. ⋯ Methodical implementation of evidence-based pain management information changed practice and fiscal outcomes. Improvement in the patient perception of pain management was more difficult to achieve.
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Musculoskeletal trauma accounts for approximately 15% of all childhood injuries (Devito, 1996). Fractures are a common injury sustained with trauma. Due to anatomic, biomechanical, and physiologic differences between adult and pediatric bones, patterns of fractures change as a child's age increases. ⋯ This article discusses one common type of pediatric fracture, the supracondylar fracture. The etiology, incidence, classification system, and treatment of this fracture will be explained. In addition, potential complications and nursing management of a supracondylar fracture are included.
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Tarsal tunnel syndrome (TTS) is an often misdiagnosed and evasive compression neuropathy of the posterior tibial nerve and its branches (Muhammed et al., 1995). A variety of causes may lead to the development of this painful foot condition. An awareness of the anatomy and physiology of TTS will allow for its increased recognition and treatment. Nurses in clinical settings such as ambulatory centers, physician offices, and acute care settings (especially orthopaedics and rheumatology units) will be able to apply this information in their practices.
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To determine if elderly patients undergoing hip surgery became delirious postoperatively and, if so, whether age and/or time of day were related to delirium. ⋯ Current research literature notes that 10% to 50% of elderly postoperative patients experience delirium. Patients who have had femoral neck fractures can experience delirium three times more than patients having nonorthopaedic surgery. This study found that delirium in hip surgery patients is rare. A study of the more subtle components of delirium such as attention and memory might reveal less obvious changes in mental status following surgery. Type of orthopaedic surgery also might impact incidence of delirium. A comparative study between elderly total knee and total hip replacement patients would be interesting. Studying patients who have emergency hip surgery related to fracture in comparison to patients having elective hip surgery for degenerative conditions might identify other etiologies for delirium following hip surgery. Fatigue rather than time of day might be studied to observe whether it has a significant impact on mental status or delirium scores.