A course of study in orthopedic nursing

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Content A COURSE OF STUDY IN ORTHOPEDIC NURSING
A Thesis-
Presented to
the Faculty of the School of Education
University of Southern California
In Partial Fulfillment
of the Requirements for the Degree
Master of Science in Education
by
Dorothy Davis Millard
September 1946
UMI Number: EP55427
All rights reserved
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a note will indicate the deletion.
Dissertaton Publishing
UMI EP55427
Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author.
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s* 47
This thesis, w ritte n under the direction of the ^
C hairm an o f the candidate’s Guidance Com
mittee and approved by a ll members of the
Committee, has been presented to and accepted
by the F aculty of the School of Education in
partial fu lfillm e n t of the requirements fo r the
degree of M aster of Science in Education.
D ate ^0* 1946
Dean
Guidance Committee
C. C. Crawford
Chairman
Louis P. Thorpe
D. Welty Lefever
TABLE OF CONTENTS
CHAPTER PACE
I. THE PROBÎ»!...................................... 1
II. . THE PROCEDURE...................................... 6
III. . HOW TO ADMINISTER NURSING CARE TO THE
ORTHOPEDIC PATIENT IN GENERAL.....................11
1. How to win the patient’s confidence. ..... 18
8. How to maintain correct body alignment .... 14
3. How to prevent, detect, and treat
complications.......... ; ....................17
4. How to administer physical therapy........... 21
IF. HOW TO ADMINISTER NURSING CARE TO THE
ORTHOPEDIC OPERATIVE PATIENT.....................28
1. Hovf to prepare the patient preoperatively. , . 29
2. How to care for the patient postoperatively. . 31
If. IBOW TO AJIKIinCSTiBt NIGtSUR} CARE TO TÏDD
FRACTURE PATIMAT......................... 35
1. How to care for the traction patient..........36
8. How to care for the cast patient..............40
3. How to care for the patient with a skull
fracture.....................................45
VI. HOW TO ADMINISTER NURSING CARE TO THE PATIENT
WITH A JOINT INVOLVEMENT.........................51
1. How to care for the patient with rheumatic
fever.........................................58
Ill
CHAPTER pace
S. How to care for the patient with
tuberculosis of the spine.....................57
3. How to care for the patient with a
sacroiliac sprain................. 61
VII. HOW TO ADMINISTER NURSING CARS TO THE PATIENT
WITH AN AFFECTION OF THE SOFT TISSUES......... . 66
1. How to manage the patient with poliomyelitis . 67
2. How to manage the patient with cerebral
palsy..................... 72
3. How to care for the patient with lymphangitis
of the upper extremity........... 76
VIII. HOW TO ADMINISTER NURSING CARE TO THE PATIENT
WITH A SKELETAL NEOPLASM.........................84
1. How to care for the patient with a benign
tumor of the bone.............................85
2. Hov/ to care for the patient with a
malignant tumor of the bone...................88
IX. HOW TO ADMINISTER NURSING CARE TO THE PATIENT
WHO IS LEARNING TO WALK AGAIN.....................92
1. How to prepare the patient for crutch
walking. ................. 93
2. How to help the patient who v/alks on
crutches................... 95
BIBLIOGRAPHY..........................................100
CHAPTER I
THE PROBLEM
The project undertaken in this study v/as to plan a
course in orthopedic nursing which would insure adequate
preparation for the student nurse in the field of ortho
pedics. This need has been emphasized by the National
League of Nursing Education and other major nursing organ
izations.
After the passage of the Social Security Act which
made possible state programs for the care of crippled
children throughout the United States, the scarcity of
well-prepared nurses in the field of orthopedics became
apparent. The need for skilled and efficient nurses was so
imperative that the National League of Nursing Education in
A Curriculum Guide for Schools of Nursing^ revised the unit
on orthopedic nursing, in order to prepare the student more
adequately.
It is only necessary to observe the meager instruc
tion in orthopedics in schools of nursing, to realize how
inadequately the subject has been treated. Too often the
approach to the orthopedic patient has been of an incidental
Committee on Curriculum, A Curriculum Guide for
Schools .of Nursing (New York: National League of ÿfursing
Education, 1937}, pp. 426-8.
nature. Obviously, the nurse regards the patient as an
enigma. The fact that there is a wealth of clinical
material at the student’s disposal and that she is strongly
motivated by the desire to be a good nurse, is no evidence
that she will learn how to give intelligent nursing care to
the orthopedic patient. These two factors, however, may
become effective stii^uli if they are sufficiently directe^
through classroom situations in which activities specific
to orthopedics are integrated with the laboratory experi
ences.
As Doctor Dewey states:
Practical activities may be intellectually narrow
and trivial; they will be so in so far as they are
routine, carried on under the dictates of authority,
and having in view merely some external result.2
He also states:
It is not the business of the school to transport
youth from an environment of activity into one of
cramped study of the records of other men’s learning;
but to transport them from an environment of relatively
chance activities (accidental in the relation they
bear to insight and thought) into one of activities
selected with reference to guidance of learning.'*
Because of this need it was the purpose of this
study to plan a course in orthopedic nursing based upon the
principles of functional education. In view of functional
John Dewey„ Democracy and Education. (New York:
Macmillan Company, 1917), p. 319.
2
Ibid.. p. 320.
learning, the acquisition of facts or structural knowledge
is not enough. Mere knowledge about nursing techniques
does not guarantee that the student will perform them
efficiently; classroom instruction must be integrated with
the clinical experience.
Again to quote Doctor Dewey:
.......There is no such thing./as genuine knowledge
and fruitful understanding except as the offspring of
doing....... Men have to do something to the things
when they wish to find out something; they have to
alter conditions. This is the lesson of the laboratory ^
method, and the lesson which all education has to learn.
The project here undertaken was to prepare the
student for her function in nursing. This study attempted
nine things:
(1) To acquaint the student with each major nursing
difficulty that she will encounter in orthopedics, and to
suggest why she needs to learn certain procedures in order
I
to overcome these difficulties. Some students may have
already recognized this need, but others will still be
unaware of it.
(S) To select the issues pertinent to each nursing
problem which require the most knowledge and practice, and
to point out the master keys in solving them.
(3) To list the unusual material and equipment
needed for the demonstrations, with the hope that it may
hbld. . p. 321.
be a time saver, as well as a guide, to the student or to
the instructor in preparation for the demonstrations*
(4) To plan for demonstrations related to the
nursing problem, to be done by a doctor, an instructor,
or a student, which present as lifelike a situation as
possible. By means of these demonstrations the student
observes how the nursing procedure is to be done on the
patient later. Nursing offers splendid opportunities for
teaching through demonstration, because of its practical
nature.
(5) To suggest clinical experiences that parallel
the classroom activities. Follow-up clinical work should
not be postponed, if the student is to gain the maximum
benefit from her classroom work. She will be more confi
dent and will be able to apply more adeptly the lessons
learned.
(6) To offer debatable issues to stimulate further
thought and to brmden the student’s outlook.
(7) To select visual aids which are applicable to
each problem. One well-chosen picture may be worth a
thousand words; it will^enrich the course by illustrating
essential features.
(8) To formulate a functional type of true-false
test as a final check in evaluating the student’s grasp
of the material presented.
(9) To supply sources of printed references which
are representative of the subject matter and are available
to the student*
From the facts mentioned in the above paragraphs,
that there is a need to set forth a basic and adequate
course of study in orthopedic nursing cannot be over
emphasized. This course was designed in an effort to meet
that need.
CHAPTER II
THE PROCEDURE
There are five steps of classification in the
procedure of this study: the limiting of the subject matter;
the compiling of the material for presentation; the select
ing of the demonstrations, the equipment, the visual aids,
and the laboratory procedures; the formulating of the
debatable issues and the true-false tests; and the adding
of the printed sources. Since there were problems specific
to each classification, they are considered individually.
First, it was necessary to review the revised book,
A Curriculum Guide for Schools of Nursing.^ as it relates
to the musculo-skeletal 83^stem for the scope of the subject
matter. In accordance with the new concept of nursing
education, orthopedic nursing, as is true of all nursing
specialties, is a fractional part of the total plan of
nursing care for any type of patient. It is suggested,
therefore, since only twenty-two hours are allotted to
orthopedic nursing, that the subject be covered adequately
in relation to other subjects such as tuberculosis, obstet
rics, and pediatrics. Because of this new trend in
1 Committee on Curriculum, A Curriculum Guide for
Schools of Nursing (New York: National League of Nursing
Education, 1937), pp. 426-8.
nursing education, the subject matter was treated more
liberally than if it were limited to the twenty-two hours.
It was considered feasible, however, to approach the subject
on the basis of the problems which are peculiar to ortho
pedics, rather than on the basis of the individual patient
unit. Little or no attempt was made to include medication,
diet therapy, and other medical or surgical aspects of the
orthopedic patient which are, as pointed out previously, an
integral part of the nursing eare of every patient. In
addition, the California state requirements for accredited
schools of nursing^ were checked, in order that no required
subject matter be omitted. The scope of the study was
established in this manner.
In the second classification it was necessary to find
a suitable form of presentation. Under the guidance of
Doctor Claude C. Crawford, Professor of Education at the
University of Southern California, a functional style was
developed. In the process of compiling the material for
presentation, each nursing problem collected was converted
into a ”How to” form and written on a separate .slip of paper,
The next step was to organize the material. In sorting the
2
Bureau of Registration of Nurses, Requirements for
Accredited Schools of Nursing (Sacramento: State of
California, Department of Public Health, January 85, 1937).
8
slips, those pertaining to the same topic were placed in
the same pile from which the chapter titles and units were
selected. Later, these piles were reclassified into sub
ordinate issues from which the sub-problems emerged. This
breaking-down process was continued until the master keys
to solve the problems evolved. The sorting included
paralleling; the discarding of duplicate and irrelevant
material; and the eliminating of certain medical terms which
seemed to make the outline too specialized. After following
the described procedure, the material for presentation was
incorporated into lesson-plan outlines.
The problems were collected from many sources. A
beginning was made from the writer’s experience as a student
nurse, a staff nurse, and a student nurse instructor, which
made her cognizant of some of the problems in orthopedic
nursing. To broaden the outlook, interviews were held with
public health personnel, institutional nurses, student
nurses, orthopedic surgeons of the Huntington Memorial
Hospital at Pasadena, California, and supervisors in the
orthopedic services of the Los Angeles County General
Hospital and the Hollsrwood Children’s Hospital.
In addition to these sources, a number of textbooks
on orthopedic nursing, surgical nursing, and nursing in
other specialized fields were reviewed for content.and
further suggestions. Pertinent excerpts from The American
Journal of Nursing and : The American Medical Journal were
reviewed, together with brochures received on request from
The College of Medicine at the University of Iowa and the
Department of Nursing Education at Columbia University.
Former lesson-plan outlines were.also checked for any
suggestions or omissions. From all these sources the
problems relevant to orthopedic-nursing were collected.
In the third classification it was necessary to
select the demonstrations, the equipment, the visual aids,
and the laboratory procedures. The demonstrations were
selected primarily from the needs expressed by orthopedic
surgeons and nurses for a better understanding and more
skill in the performance of certain nursing tecchniques.
Because many of those techniques were not demonstrable in,
nor adaptable to the classroom, they were eliminated.
In those instances, visual aids were substituted. Each
demonstration was chosen in the light of simulating as
lifelike a situation as possible in relation to the patient,
and the equipment was selected with regard to its peculiar
ity to the demonstration alone. No attempt was made to list
every article required. The laboratory procedures were
selected in view of paralleling the classroom experiences,
in order that the student might identify and apply the lessons
10
learned in the classroom with the patient situation.
In the fourth classification debatable issues and
true-false tests were formulated as a means of checking
the student’s grasp of the material presented. Special
attention was given to questions which affect the safety
of the patient, since this principle cannot be stressed
too often among young students. The safety of the patient
receives the foremost consideration in every nursing tech
nique .
The last classification is concerned with sources.
The sources were not limited to student textbooks and
nursing Journals alone, but supplemented with books and
magazines reviewed from the doctors’ library at the
Huntington Memorial Hospital and the Los Angeles County
Medical Library. It was considered desirable to have a
wide representation of books treating on the various
phases of orthopedics. This would not have been possible
if the sources had been confined to the students’ library.
These references were classified as ’ ’ Nursing” and
’ ’ Advanced” at the end of each lesson unit, in accordance
with the arrangement of the Bibliography.
CHAPTER III
HOW TO ADMINISTER NURSING CARE TO THE
ORTHOPEDIC PATIENT IN GENERAL
There are certain aspects of orthopedic nursing which
are applicable to almost every type of patient and you will
need to be familiar with them. Perhaps you are wondering
why you failed to win the confidence of the orthopedic patient
^ ' ^ o matter how skillful a nurse you may be, unless you are
capable of inspiring a sense of security by meeting the
patient’s special needs, you cannot hope to help him.
This is particularly true of the chronically ill person.
Yet it is a part of your responsibility to assist him
in readjusting to a new pattern of life.
Likewise, it is important that you are able to
recongnize abnormal body mechanics and to detect the compli
cations which are characteristic of the orthopedic patient.
Furthermore, since physical agents assume such a
major role in the restoration of weakened muscles and
stiffened joints, it is essential that you are able to
apply the more simple forms of heat and water therapy.
Because these abilities are so desirable in orthopedic
nursing, this chapter is designed' to prepare you for them.
IB
1. HOW TO WIN THE PATIENT’S CONFIDENCE
Sub-problems :
A. How to show gentleness;;to the patient.
1. How to speak.
2. How to handle the patient.
B. How to help the chronic patient to readjust.
1. How to develop good mental hygiene.
2. How to, obtain financial aid.
3. How to provide for further education.
4. How to give instructions for home care.
5. How to keep the patient’s faith in his doctor.
Equipment for demonstrations:
Demonstrations ;
A. A demonstration lecture by a full-time bedside school
teacher.
B. A demonstration lecture by a qualified occupational
therapist.
C. A demonstration lecture by a public health nurse.
D. A demonstration lecture by a social service worker.
E. A demonstration lecture by a worker from the field of
vocational rehabilitation.
Laboratory procedures :
A. Assist the social service worker in the program of
rehabilitation.
13
B. instruct the patient who is going home.
C. Assist at the orthopedic clinic.
Debatable issues;
A. In caring for the young orthopedic patient, should you
protect him more than any other sick child?
B. In caring for the orthopedic patient, how much sympathy
should you extend to him?
C. In discussing the patient's condition with him, should
you prepare him for a possible permanent deformity,
or foster his hope for complete restoration?
Visual aids:
A. Exhibits of articles suitable for occupational therapy.
Sources :
Nursing; Day 465-8; Funsten-Calderwood 10-20;
Sever 1-8.
14
8. HOW TO MAINTAIN CORRECT BODY ALIGNMENT
Sub-problems :
A. How to apply normal body mechanics in orthopedic
nursing.
1* How to locate abnormal joint function.
8. How to detect abnormal muscle function.
B. How to develop good posture in the patient.
1. How to maintain good body alignment in the side,
prone, and supine bed positions.
8. How to maintain good body alignment in the armchair
or wheelchair.
3. How to maintain good body alignment while standing
or walking.
4. How to maintain good body alignment during other
physical activities.
Equipment for demonstrations:
A. Gatch bed.
B. Armchair and wheelchair.
C. Pillows and sandbags.
D. Full-length mirror.
Demonstrations;
A. The correct bed position for the patient.
B. The correct sitting position for the patient in an arm
chair or wheelchair.
15
0. Line drawings on the blackboard by a student, illus
trating good bed posture in the face-lying, the back-
lying, and the side-lying positions.
D. The correct way to pick up dropped articles, or to
lift and carry a heavy object.
Laboratory procedures:
A. Place the patient in the correct sitting position in
an armchair or a wheelchair.
B. Place the bed patient in the corregt side, prone, or
supine position.
Debatable issues:
A. In the correct sitting position, should the weight of
the body be borne on the tuberosities of the ischia,
or on the mid-thighs?
B. In the correct standing position, should the knees be
extended, or slightly flexed?
C. When the body is in correct alighment in the erect
position, should the sternum or the chin be the part
.of the body which is held farthest forward?
D. In the correct back-lj^ing position when one pillow is
used, should it be placed under the shoulders and head,
or under the head?
E. In the correct back-lying position if pillows are used
under the head, should one, two, or three pillows be
used?
16
F. In the correct face-lying position, should a flat
pillow be placed under the chest, or under the abdomen?
G# In the correct stooping position, should the body bend
from the hips with the knees extended, or bend with
hips and knees flexed?
Visual aids;
A. Posture charts ^illustrating the right and the wrong
way to lie in bed, sit, stand, bend, and carry or
move heavy objects.
B. Films: "Posture in Nursing Activity” and "Functional
Activities” by the United States Department of Education.
Sources:
Nursing: Day 471-4; Fash-Powel 41-190; Funsten-
Calderwood £0-40; ____ 20-1; Sever 398-404;
Stevenson 11-17.
17
3. HOW TO PREVENT, DETECT, AND TREAT COMPLICATIONS
Sub-problems :
A. How to prevent and treat ischemic contractures,
1. How to treat the pain.
2. How to treat a feeling of "pins and needles.”
3. How to treat excessive edema.
4. How to test for patency of blood flow.
5. How to treat coldness in the extremities.
6. How to treat color changes.
7. How to treat loss of sensation and disturbance of
motion.
B. How to prevent and detect infections.
1. How to time the frequency of checking the temperature,
pulse, and respiration.
2. How to detect an invisible area of infection.
3. How to dress a draining sinus.
4. How to prevent a cross-infection among patients.
C. How to prevent and treat decubitus ulcers.
1. How to relieve pain of a burning and stinging
character.
2. How to treat skin discolorations.
3. How to treat a break in the skin continuity.
4. How to treat a necrotic area.
5. Hov7 to promote healing.
18
D. How to prevent conditions due to prolonged immobiliza
tion in one position.
1. How to prevent hypostatic pneumonia.
2. How to prevent renal calculi.
3. How to prevent neurological changes.
4. How to prevent pulmonary emboli.
E. How to manage weakened extremities.
1. How to support the joints.
2. How to apply orthopedic appliances correctly.
3. How to check for an outgrown appliance.
Equipment for demonstrations :
A. Braces with automatic locks.
B. Dunlop sling.
C. Aeroplane, Thomas, and Hodgen’s splints.
D. Walking caliper.
Demonstrations :
A. An outline on the blackboard by a student on the early
and the late symtoms of a decubitus ulcer.
B. An outline on the blackboard by a student listing the
symptoms of gas gangrene.
C. An outline on the blackboard by a student on the pre
cautionary measures to take inthe prevention of an
ischemic contracture.
D. An outline on the blackboard by a student on the
nursing care of the patient with thrombo-phleb it is.
19
1. àn outline on the blackboard by a student on the
nursing measures in the care of the patient with
osteomyelitis.
F. The application of various types of slings, splints,
braces, and other orthopedic appliances.
Laboratory procedures :
A. Care for the patient with a decubitus ulcer.
B. Assist at the orthopedic clinic in removing and
replacing slings, splints, braces, and other appliances.
Debatable issues:
A. In case of circulatory impairment, is it better to make
a window over: the pressure area, or to split the cast
longitudinally?
B. In caring for the chronic cpmplainer, should you ever
ignore any of his personal complaints?
C. As long as the cardinal sysptoms of circulatory
impairment are not.visible, should you regard or
disregard the patient’s subjective complaints as to
his affected part?
D. In caring for the orthopedic patient, should you take
his temperature, pulse, and respiration at the
routine time, or more frequently?
E. In splitting a cast because of a pressure area, should
you cut only the plaster bandage, or the plaster
bandage and the underlying soft bandages next to the
skin?
20
Visual aids;
A. Pictures showing a Volkmann’s contracture.
B. X-ray films of chronic and acute osteomyelitis.
C. Pictures of a gangrenous infection.
D. Pictures of various slings, splints, braces, and
other orthopedic appliances.
Sources :
Nursing; Cabot-Giles 202-8; Day 476-7, 488-9;
lliason-Ferguson-Farrand 447-50, 479-81, 209-12;
Emerson-Tayor 688-90; Evans 969-74; Felter-West
19-22, 27-73; Funsten-Calderwood 159-72, 328-32,
458-61; Harbin 961-9; Lockwood-Woldfer 330-5; Night
ingale 113-8; Sever 256-60.
Advanced; Campbell 54-104; Christopher 138-46;
Magnuson 10-14, 105-6, 147; Orr; Watson-Jones
130-3, 158-60.
21
4. HOW TO âDMHJISTER PHYSICAL THERAPY
Sub-problems :
A. How to give an ifra-red lamptreatment.
1. How to select the conditions for treatment.
2. How to prepare the patient.
3. How to place the lamp.
4. How to time the duration of the treatment.
B. How to give an ultra-violet lamp*, treatment.
1. How to protect the patient's eyes.
2. How to drape the patient.
3. How to place the lamp.
4. How to time the duration of the treatment.
5. How to build up the mazium tolerance for radiation.
6. How to prevent complications.
0. How to give a diathermy treatment.
1. How to select conditions for treatment.
2. How to prepare the patient.
3. How to apply the pads.
4. How to time the duration of.the treatment.
D. How to administer heliotherapy.
1. How to expose the body without injury.
2. How to keep the patient's daily sun chart.
1. How to give a massage treatment.
1. How to prepare the patient.
B2
E* How to select the type of stroke.
3. How to prevent complications.
F. How to give corrective exercises.
1. How to give passive exercises.
E. How to give assistive exercises.
3. How to give active exercises.
4. How to give resistive exercises.
G. How to train weakened muscles.
1. How to keep the patients attention.
E. How to instruct the patient.
H. How to care for the pool patient.
1. How to dress the patient for the water.
E. How to care for draining sinuses.
3. How to prevent complications.
Equipment for demonstrations;
A. Infra-red lamp.
B. Ultra-violet lamp and goggles.
C. Diathermy machine.
Demonstrations :
A.. An infra-red lamp treatment by a physical therapist.
B. An ultra-violet lamp treatment by a physical therapist.
C. A diathermy treatment by a physical therapist.
D. Return demonstrations by students.
E. The charting on the blackboard by a student on the
treatment and the condition of the part being treated.
23
F. A demonstration lecture by a doctor on the medico-legal
aspects of physical medicine.
Laboratory procedures:
A. Assist with an infra-red, ultra-violet, and diathermy
treatment in the physical therapy department.
B. Assist in the care of the pool patient in the physical
therapy department.
C. Chart on the nurse’s record sheet the treatment, the
condition of the part being treated, and any other
significant date.
Debatable issues;
A. In an infra-red treatment, should you judge the duration
of the treatment by the clock, or by the reaction of the
skin?
B. In giving exercises under water, should you give assistive
or passive exercises?
C. In a pool treatment, should the temperature of the water
be tepid, warm, or cool?
D. In administering a physical therapy treatment, should
you always solicit and accept the patient's statement
as to his comfort?
Visual aids;
A. Pictures illustrating the administration of an infra-red,
an ultra-violet, and a diathermy treatment.
B. A Rollier chart, showing the method of administering
heliotherapy.
24
Sources :
Nursing: Day 503-8; Lewin 336-6; Sever 264-73.
25
TRUEi-PALSE TEST ON CHAPTER III
Directions ; Mark true or false the statements below
by encircling the appropriate letter.
T E 1. The feet of the patient should be kept at
right angles to the legs.
T F 2. In the prevention of external rotation of the
hip, you should place a long narrow sandbag
or a rolled blanket along the outer side of
the legs, extending from the upper margin of
the pelvis to the mid-thigh.
T F 3. In the supine and the prone positions, the
knees should be slightly flexed and maintained
at a 5-degree angle.
T F 4. It is desirable to place pillows between the
legs of the patient who is restricted to the
supine and the prone positions, in order to
prevent hip adduction.
T F 5. The patient's position should be changed fre
quently, if the formation of renal calculi
is to be prevented.
T F 6. It is good plan, to turn the patient in order
to combat edema of the dependent parts, which
so frequently results in neurological changes.
26
T F 7. As long as the cardinal symptoms of circula-
— tory impairment are not visible and the tem
perature is normal, it is better to disregard
the patient's subjective complaints regarding
his affected part, lest he become a chronic
complainer,
T F 8. The temperature, pulse, and respiration of the
orthopedic patient should be taken every four
hours while awake.
T F 9. In the correct sitting position, the weight of
the body should be borne on the tuberosities
of the ischia.
T F 10. In the administration of physical therapy, you
should consider every patient as a potential
medico-legal case.
T F 11. When active exercise is ordered, you should
assist the patient to perform the movements.
T F 12. You should always solicit and accept the
patient's statement as to his comfort in the
administration of a phjrsical therapy treatment,
T F 13. In the correct back-lying position, the pillow
should be placed well under the shoulders.
T F 14. When passive exercises are ordered, you should
encourage ifche patient to make voluntary move
ments .
27
T F 15» A mottling of red spots over the treated area
following an infra-red exposure is of no
significance and need not be reported.
T F 16. In the administration of a short wave diathermy
treatment you should select tables, chairs,
and mattresses with no wire or metal parts.
T F 17. Massage is one type of physical therapy
which may be given without an explicit and
signed order by the doctor.
T F 18. When the patient is lying in a prone position
you should place a pillow under his chest to
assist in keeping the body in good alignment.
T F 19. In caring for the young orthopedic patient
you should protect him more than any other
sick child.
T F 20. Two pillows, one placed partly under the
shoulders and one placed under the head,
provide the greatest comfort for the patient.
T F 21. In case of a pressure area, when the cast^is
cut the full length it is not necessary to
cut the underlying soft bandages touching
the skin.
CHAPTER IV
HOW TO ADMINISTER NURSING CARE TO THE
ORTHOPEDIC OPERATIVE PATIENT
The day of operation is a momentous event in the
life of any surgical patient. In some respects it is an
even more dramatic occasion in the'life of the orthopedic
operative patient. It is a time of mingled hope and fear:
hope for the restoration of a lost motion, fear of an
unsuccessful operation and the long period of immobiliza
tion.
As a nurse you will need to recognize that the
approach to the orthopedic operative patient is psycho
logically different from the approach to the ordinary
surgical patient whose condition is acute. It is assumed
that you are already familiar with the general preoperative
care, the postoperative care, and the risks which accompany
any surgical patient. Therefore, only nursing problems
which are peculiar to the orthopedic operative patient are
presented in .the following chapter.
29
" 1. HOW TO PREPARE THE PATIENT PREOPERATIVELY
Sub-problems ;
A* How to win the patient’s confidence.
1. How to approach the patient.
2. How to answer the patient’s questions.
B. How to prepare the operative site for bone surgery.
1. How to shave, cleanse, and disinfect the skin.
2. How to apply the sterile dressings.
3. How to do the repeat skin preparations.
4. How to prevent contamination of the sterile field.
C. How to check the patient’s chart for significant items,
1. How to examine the special laboratory reports.
Equipment for demonstrations :
A. The skin preparation tray.
B. Sterile gloves and forceps.
C. Sterile dressings and towels.
Demonstrations :
A. The skin preparation on a student.
B. The application of the sterile dressings on a student.
Laboratory procedures:
A* Prepare the operative site of the patient.
B. Care for the preoperative patient.
Debatable issues;
A. Should you always tell the patient the truth, or is a
"white fib" ever justifiable?
30
B. In doing a skin preparation, should you report, or
disregard an abrasion of the skin before covering it
with the sterile dressing?
C. If you contaminate the operative site while giving
bedside care to the patient, should it or should it
not be reported?
Visual aids;
Sources:
Nursing: Funsten-Oalderwood 65-6, 68-74; Grabel 1241-3.
Advanced: Campbell 124-6.
31
2. HOW TO CARE FOR THE PATIENT POSTOPERAT IVELY
Sub-problems :
A. How to prepare the standard surgical equipment*
1* How to prepare the anesthetic bed*
2* How to select the appliances peculiar to the various
types of orthopedic surgery.
B. How to prevent complications.
1. How to treat the patient in pain.
2. How to prevent wound infections.
3. How to manpge the patient with the symptoms of a
fat embolism.
4. How to detect a hemorrhage when the surgical
dressings are not yisible.
5. How to treat the patient with edematous and
cyanotic fingers and toes.
6. How to manage the patient with loss of motion
and diminishing sensation.
7. How to restrict or encourage the patient’s activity.
C. Hov/ to chart on the nurse’s record sheet.
1. How to list the initial setup of appliances.
2. How to locate and describe the pain.
3. How to explain the condition of the extremities.
Equipment for demonstrations ;
32
Demonstrations ;
A. An outline on the blackboard by a student on the
preparation made for receiving the orthopedic patient
from the operating room.
B. An outline on the blackboard by a student on the first
duties of the nurse when the patient returns from the
operating room.
C. A drawing of the nurse's record sheet on the blackboard
by a student, with the charting of the necessary items
about a hypothetical postoperative patient.
D. A list on the blackboard by a student on the possible
postoperative complications for which the nurse must
be alert.
Laboratory procedures:
A. Prepare an anesthetic bed for the orthopedic patient.
B. Assemble the appliances for each special type of
orthopedic surgery.
C* Care for the postoperative patient immediately following
the operation.
D. Chart on the nurse's record sheet the postoperative
notes.
Debatable issues :
A. In case of a fat embolism occurring in the patient
after operation, should you remove th^cast immediately,
or administer heart stimulants and artificial respira
tion?
33
B. If the patient questions you regarding the restoration
of normal function, should you evade the issue, refer
him to his doctor, or assure him that restoration is
certain?
C. If the patient is having convulsions due to the
irritation or the stretching of the nerves, should
you remove the cast‘immediately, or administer
sedatives?
Visual aids;
Sources ;
Nursing: McBride-Sink 51-63; Funsten-Calderwood 67-9,
74-80.
Advanced: Campbell 134-6; Watson-lones 133.
34
TRUE' FALSE TEST ON CHAPTER IV
Directions : Mark ture or false the statement below, by
encircling the appropriate letter.
T F 1. The patient with a fat embolism should be
immobilized at once.
T F 2. During hospitalizaion the temperature, pulse,
and respiration of the orthopedic postoperative
patient should be taken every four hours while
awake.
T F 3. In case of convulsions due to a fat embolism,
you should remove the cast immediately.
T F 4. Any abrasion of the. skin occuring at the time
of the preoperative skin preparation should be
reported before covering the area with the
sterile dressing.
T F 5. In case of convulsions in the postoperative
patient, due to the stretching of a nerve,
you should remove the cast immediately,
T F 6. Pain accompanied by an elevation of temperature
on the fc&th postoperative day may be indica
tive of an infection, and the cast should be
split at once.
T F 7. You should take measures to prevent the compli
cations of a fat embolism, if convulsions
appear between the third and sixth days after
surgery.
CHAPTER Y
HOW TO ADMINISTER NURSING CARE
TO THE FRACTURE PATIENT
Do you look upon the fracture patient as the least
satisfactory to care for? Does the necessity for constant
immobilization and the presence of complicated apparatus
make it seem impossible for you to contribute to his
comfort? Are you lacking in confidence in your own nursing
skills to care for him adequately? It is obvious that the
fracture patients compose a considerable number of the
patient personnel in any general hospital. Therefore,
skill in the care of the traction patient, the cast patient,
and'the patient with a skull fracture, is a desirable and
enviable technique. They will tax your ingenuity and be a
challenge.
The units of this chapter are concerned with the
problems you will meet in the care of the traction, the
cast, and the skull fracture patient* Since the principles
involved in the care of the traction and the cast patients
are essentially the same and applicable to every type of
traction and cast, the Ruseell method of traction and the
hip spica cast are selected as the means of solving your
problems. It is to prepare you for the care of these
fracture patients that this chapter is designed.
86
1. HOW TO CARE FOR THE TRACTION PATIENT
Sub-problems ;
A. How to prepare for the initial traction setup.
1. How to prepare the Catch bed,
2. How to equip the traction cart,
B. How to assist in the application of traction,
1, How to alleviate muscle spasm in the fracture seat,
2, How to prevent friction and irritation to bony
prominences,
3, How to obtain the desired pull on the leg,
4, How to hang the weights free of touching objects,
5, How to prevent displacements due to gravity,
6, How to prevent too much abduction,
7, How to obtain counter traction,
C. How to maintain efficient traction during the nursing
procedures,
1. How to change the patient's position,
2, How to bathe and massage the patient’s back,
5. How to change the bed linen,
4, How to instruct the patient to lift himself upon
the bedpan,
D. How to prevent complications,
1. How to keep the traction continuous.
2. How to maintain the traction in a straight line.
37
3. How to maintain counter traction.
4. How to keep the pulley system functioning.
5. How to prevent a personal nerve paralysis.
Equipment for demonstrations:
A. Batch bed with two hair mattresses of such thickness
that the level of the top mattress is above the level
of the foot of the bed.
B. Overhead frame with trapeze.
C. Foot spreader block with pulley incorporated.
D. Double pulley wood endpiece.
E. Two six-inch square wood blocks.
F. Weights from one to five pounds.
0. Traction cart.
H. Bed linen and pillows.
1. Bedpan.
Demonstrations :
A. The initial setup of Russell traction.
B. The application of Russell traction on a student by an
orthopedic surgeon.
C. The bedside care to the student in traction.
D. The tying of a substantial square knot.
E. Return demonstrations by students.
Laboratory procedures:
A. Prepare the initial setup for Russell traction in the
patient’s room.
38
B. Assist the doctor with the application of Russell
traction on the patient.
C. Care for the patient in traction.
Debatable issues:
A. At what angle should the rope leading from the knee to
the overhead pulley be placed? Should the rope point
to the head of the bed, or the foot of the bed?
B. In Russell traction should the pu].l be focused above,
or below the knee?
C. In caring for the traction patient, should the sheets
be changed from the affected side, or from the un
affected side?
D. In Russell traction, should the heel of the patient
rest upon the pillow, or clear the edge of the pillow
upon which the leg rests?
Visual aids;
A. Film on "Fractures in Orthopedic Nursing" by Edgar
Bergen.
B. Slides on traction patients by the Joint Orthopedic
Nursing Advisory Service.
C. X-ray pictures contrasting the femur before and after
traction is applied.
d. Anatomical maps illustrating the origin and the inser
tion of the hamstring and the quadricep muscle groups.
39
E* Blackboard diagrams illustrating the principle of weight
applied in Russell traction.
F. Special types of suspension and traction devices.
1. Buck's extension.
2. Hodgen's traction.
3. Bryant's traction.
4. Head traction.
5. Kirschner wire and Steinmann pin for skeletal
traction.
Sources :
Nursing: Oalderwood 464-9; Day 484-502; Eliason-Ferguson-
Farrand 455-77; Felter-West 293-309; Funsten-Calderwood
336-71; Harmer-Henderson 964-72; Lockwood-Wolfer 307-29;
McBride-Sink 86-103.
Advanced: Dunlop 155-67; Magnuson 26-40, 112-5, 145,
201, 219, 230-71; Russell 291-502, 637-38; Watson-Jones
134-42, 501-21, 566-70.
40
2. HOW TO CARE FOR THE CAST PATIENT
Sub-problems :
A. How to assist in the application of the plaster case.
1. How to prepare the plaster bandage.
2. How to protect the patient’s skin.
3. How to immerse the plaster bandage before applica
tion.
B. How to care for the patient in a newly-applied cast.
1. How to prepare the bed.
a. How to arrange a firm mattress.
b. How to place the pillows.
c. How to protect the pillows and mattress.
2. How to regulate the room temperature.
3. How to handle the patient in a damp cast.
a. How to transfer the patient from the surgery
cart to the bed.
b. How to prevent cracking and splitting of the
oast joints.
c. Hov/ to prevent indentation in the cast.
4. How to provide for good body alignment.
a. How to support the contours of the cast.
5. How to dry the cast.
a. How to provide for adequate air circulation
around the chest.
41
b. How to promote even drying.
c. How to prevent the complications of burning
the skin, heat exhaustion, or chilling.
6. Hqw to check for symptoms of circulatory impairment.
C. How to administer bedside care.
1. How to bathe the patient.
2. How to turn the patient as a unit.
3. How to care for the patient's back.
a. How to insert a Lorenz back-scratcher.
4. How to place the bedpan.
5. How to treat the patient’s skin after the cast is
removed.
D. How to preserve the efficiency of the cast.
1. How to bind the raw edges.
2. How to waterproof the cast.
3. How to clean the cast without weakening its
structure.
E. How to remove the cast.
1. How to soften the plaster cast.
2. How to cut the plaster bandage.
3. How to cut the soft bandages.
Equipment for demonstrations:
A. Rubber gloves and gown.
B. Crinoline and powdered plaster of Paris.
0. Deep pail containing water at 90° to 105° F.
42
D. Instruments for plaster work.
E. Cotton batting and felt pads.
F. Tubular jersey sleeving.
G. Zinc strips.
H. Fracture bed with a Bradford frame attachment.
I. Bed linen and rubber-covered pillows.
J. Bedpan.
ÎC. Heat cradle or cast dryer.
Demonstrations :
A. The preparation of a plaster of Paris bandage.
B. The application of a plaster case on a student by an
orthopedic surgeon.
C. The drying of the cast.
D. The turning of the student in the cast.
E. The placement of the bed linen on the fracture bed with
a Bradford frame attachment.
F. The special arrangement of the pillows under the student
to support the contour of the cast.
G. The manipulation of the fracture bed.
H. The removal of the cast.
I. Return demonstrations by students.
Laboratory procedures:
A. Prepare a plaster of Paris bandage in surgery.
B. Care for the patient in a newly-applied cast.
C. Give bedside care to the patient in a hip spica cast.
43
Debatable issues;
A. Should the patient in a cast be turned on, or away from
the affected side?
B. In cool weather with the anesthetized patient, should
you expose or cover a large damp cast, such as the hip
spica?
G. In case of a pressure area, is it better to cut a hole
in the cast over the pressure point, or to split the
cast longitudinally?
D. Should you cover, or explose the nev/ly-applied cast?
E. Should you administer morphine to the cast patient who
is in severe pain, providing he has a pro re natum
order, or should you notify his doctor?
Visual aids:
A. Film on "Fractures in Orthopedic Nursing" by Edger
Bergen.
B. Slides on cast patients by the Joint Orthopedic Nursing
Advisory Service.
C. Charts illustrating various typesof casts, such as the
single hip spica, double hip spica, leg cast with flexed
knee, hi-valve, and the cast with an incorporated
walking iron.
D. Pictures showing pillow arrangements under the patient
in a hip spica cast in the prone and supine positions.
E. Pictures illustrating methods and techniques used in
turning the patient in a hip spica cast.
44
Sources:
Nursing: Atkins 1-67; Bruck 400-2; Day .474-80;
Eliason-Ferguson-Farrand 450-5; Felter-West 307-
8; Funsten-Calderwood 42-64; Harmer-Henderson 945*
64; Lewin 22-39; McBride-Sink 73-85; Sever 393-8.
Advanced: Luck 23-9; Magnusion 43-6; Watson-Jones
121-9. 153.
45
3. HOW TO CARE FOR THE PATIENT
WIPE A SKULL FRACTURE
Sub-problems:
A. How to give general nursing care.
1. How to place the patient in bed.
2. How to turn the patient.
3. How to lift the patient.
4. How to apply restraints.
5. How to maintain a restful atmosphere.
B. How to prevent complications.
1. Hov/ to combat shock.
2. How to check the patient for signs of meningeal
hemmorrhage.
a. How to check for pupillary changes.
b. How to detect changes in limb movements.
c. How to note the early symptoms of coma.
3. Hov/ to treat the patient with escaping blood or
cerebrospinal fluid from the nose, mouth, or ears.
4. How to treat the patient with an increased pressure
in the cerebrospinal fluid.
a. Hov/ to administer the hypertonic solutions.
b. Hov/ to limit the fluid intake.
5. How to check for impending respiratory and pulse
changes.
46
6. How to care for the patient with a sudden rise in
blood pressure and spinal fluid.
7. How to check for changes in the eye grounds.
8. How to manage the patient in coma.
a. How to maintain nutrition.
b. How to prevent later symptoms of headache and
vertigo.
9. How to manage the patient with mental impairment.
G. How to assist the doctor with a spinal puncture treat
ment.
1. How to equip the tray.
S. How to instruct the patient.
3. How to place the patient in the correct position.
4. How to prepare the skin area.
Equipment for demonstrations;
A. Sterile gloves.
B. Spinal puncture tray.
C. Spinal manometer.
Demonstrations :
A. An outline on the blackboard by a student on the man
ifestations of a meningeal hemorrhage.
B. A spinal puncture on Mrs. Chase (the hospital doll)
by a doctor.
C. The technique of applying restraints.
47
Laboratory procedures:
A. Care for the patient with a skull fracture.
B. Assist the doctor with a spinal puncture treatment.
Debatable issues:
A. When blood or cerebrospinal fluid are escaping from the
ears or nose, should you gently-irrigate the aural and
nasal cavities with a sterile solution, or loosely
introduce a piece of sterile cotton into these cavities?
B. In the prevention of dehydration should you give the
patient with a skull fracture a limited, or unlimited
supply of fluid?
G. If the patient with a skull fracture becomes unusually
restless, should you administer morphine, administer
another form of sedative, or apply restraints?
Visual aids;
A. Z-rays showing various types of skull fractures.
B. A diagram of the brain, showing a meningeal hemorrhage.
C. Diagrams illustrating the cerebrospinal fluid pathways.
Sources :
Nursing: Cabot-Giles 221-31; Eliason-Ferguson-Narrand
416-26; FeIter-West 354-60; Lockwood-Wolfer 67-71;
Rothweiler-White 623-6.
Advanced: Everts-Woodhall 145-48; Magnuson 415-39.
48
TRUE-FALSE TEST ON CHAPTER V
Directions; Mark true or false the statements below
by encircling the appropriate letter.
T F 1. If the patient in Russell traction is unable
to sleep, the weights should be lifted for a
short while.
T F 2. The patient in a hip spica cast should be
turned on the affected side.
T F 3. Morphine should be administered at once to
alleviate severe pain in the fracture patient.
T F 4. When blood or cerebrospinal fluid are escaping
from the ears or nose of the patient with a
skull fracture, you should loosely introduce
a piece of sterile cotton into these cavities.
T F 5. The sheets of the patient in traction should
be changed from the affected to the unaffected
side.
T F 6. If the temperature of the fracture patient is
normal after the fourth postoperative day,
it need be taken only tvfice daily.
T F 7. The patient in traction should be turned more
frequently than the patient in a hip spica
oast.
49
T F 8* You should out a window in the.cast in case
of persistent pain over a pressure point.
T F 9. In Russell traction it is best to have the
heel of the patient just clear the pillow
upon which the leg rests.
T F 10. The patient in a damp cast should be covered,
in orderto prevent complications of pneu
monia.
T F 11. The patient with a skull fracture should be
placed in bed with a small felt pillow under
his head.
T F 12. The angle of the rope from the knee sling of
the patient in Russell traction- should point
toward the foot of the bed.
T F 13. When the patient with a skull fracture
becomes unusually restless, morphine should
be administered immediately in order to
prevent further injury to the brain.
T F 14. In the rectal administration of a hypertonic
solution, it is better to introduce distilled
water rather than a saturated solution of
magnesium sulphate, since the latter may be
irritating to the rectal mucosa.
T F 15. In placing a bedpan under the patient in
Russell traction, it should be placed from
50
the unaffected side.
T F 16. After cutting the plaster cast due to a
pressure area, the skin under the cast
should be visible.
CHAPTER VI
HOW TO ADMINISTER NURSING CARE TO THE PATIENT
WITH A JOINT INVOLVEP’ CENT
The importance of a joint involvement, whether it is
due to trauma or to disease, cannot be over-emphasized,
either from an economical or a medical viewpoint. Each
year countless individuals are temporarily or sometimes
permanently disabled by various arthritic conditions.
There is the tendency to minimize them and minor joint
ailments are permitted to go untreated. Perhaps you have
had occasion to hear the child’s complaint of an aching
joint lightly regarded as a "growing pain.” Yet those
migratory joint pains may be the first warning of two
insidious diseases, rheumatic fever and tuberculosis of
the spine.
Because rheumatic fever is the "Number One Killer”
of the .school child, due to present or potential pathology
in the heart; because tuberculosis of the spine is the most
frequently occurring of the skeletal tuberculosis lesions;
and because the sprain in the sacroiliac region is so
prevalent and exquisitely painful, this chapter is organized
to prepare you to proceed intelligently in caring for these
patients.
52
1. HOW TO CARS FOR THE PATIENT
WITH RHEUMATIC FEVER
Sub-problems;
A. How to manage the emotional instability and apprehension
of the child.
1. How to arrange a quiet, , non-stimulating environment.
2. How to be truthful, but tactful, in all approaches.
3... How to display sympathy, but not pity.
B. How to treat the systemic involvement of the child.
1. How to minimize fatigue.
2. How to maintain adequate nutrition.
3. How to reduce the fever.
4. How to administer the specific drug without toxic
effects.
5. How to alleviate the extreme nervousness.
6. How to care for the skin rashes.
0. How to care for the arthritic joints of the child.
1. How to arrange for a comfortable bed position.
2. How to support the inflamed joints.
3. How to wrap the swollen Joints.
4. How to lift and move the painful joints.
5. How to protect the joints from undue weight.
D. How to manage the child with manifec tat ions of a
heart involvement.
1. How to provide complete bed rest.
53
a. How to anticipate every need.
b. How to move and lift the patient.
c. How to limit activity.
S. How to record intake and output.
a. How to apportion the daily fluids.
3. How to alleviate the dyspnea.
4;. How to managethe edematous parts.
5. How to discover serious pulse irregularities.
a. ^ow to examine the apical and the radial pulse
beats.
6. How to note incipient heart failure.
7. How to provide for passive recreational therapy.
a. How to choose short stories.
b. How to arrange mirrors for viewing unseen places.
c. How to select pets.
8. How to limit the visiting hours.
E. How to care for the convalescent child.
1. How to resume activities.
a. How to plan a daily schedule.
b. How to assign suitable responsibilities.
2. How to increase the diet.
3. How to take the pulse and respiration accurately.
4. How to prevent a relapse.
5. How to arrange for roc cupat ional therapy.
a. How to choose suitable handcrafts.
b. How to select group activities.
54
6* How to provide for school instruction.
a. How to contact the Board of Education.
F. How to prepare the family for the care of the child at
home.
1. How to discover the attitude of the parents.
E. How to explain the symptoms in relation to the
: disease.
3. How to find authentic literature for the parents.
4. How to give encouragement regarding the prognosis,
a. How to overcome the parents’ fear of permanent
invalidism for the child.
5. How to prevent attitudes of over-protectiveness.
a. How to assist parents to enforce disciplinarian
measures.
6. How to demonstrate the physical care needed at home.
7. How to arrange for regular medical checkups.
Equipment for demonstrations;
A. A sphygmomanometer.
B. A stethoscope.
C. Pieces of flannel and a roll of absorbent cotton.
Demonstrations ;
A. The taking and the comparing of the apical and the
radial pulse beats.
B. The wrapping of a student’s joint by the instructor.
55
C. An outline on the blackboard by a student, constructing
a daily activity schedule for the convalescent child
at home.
D. An outline on the blackboard by a student, listing
the symptoms indicative of a relapse.
1. An outline on the blackboard by a student, listing
the symptoms of incipient heart failure.
Laboratory procedures:
A. Give bedside care to the patient with rheumatic fever.
B. Change the wrappings on the affected joints.
C. Count the apical and the radial pulse beats, and make
comparisons.
Debatable issues:
A. In case of a sensitivity in the patient to the drug
specific for rheumatic fever, should the drug be
discontinued, or administered in smaller dosages?
B. During digitalization of the patient, should the
digitalis be administered or discontinued, if the
pulse drops below 80 beats per minute?
G. When the child looks well and there are no apparent
ill effects following the rheumatic fever, should he
ever be permitted to resume activities which were
normal to him prior to the illness?
D. In selecting bed linen and nightwear for the patient,
should the material be cotton, linen, or outing
flannel? Why?
56
E. In case of pregnancy in a young woman with rheumatic
heart, should she be be permitted to go to term, or
should a therapeutic abortion be considered?
Visual aids:
A. Charts illustrating the characteristic heart lesion
in rheumatic fever.
B. Autopsy (whenever possible), demonstrating the Aschoff
bodies on the heart.
C. Electrocardiogram showing signs of delayed conduction
of the impulse between the auricle and the ventricle.
Sources:
Nursing: Emerson-Taylor 674-8; Galvin 255-8; Hartmann
214-5 ; Hull-Wright-Eyl 614; McBride-Sink 195-200;
Sadler-Seibel 170-5; Wilcox 94-9.
Advanced: Cecil 80-98.
57
a. HOW TO CARE FOR THE PATIENT WITH
TUBERCULOSIS OF THE SPINE
Sub-problems :
A. How to improve the patient’s general health.
1. How to sustain the patient’s morale.
a. How to help him adjust to a prolonged period
of bed rest.
b.. How to provide for happy'hours.
S. How to arrange for proper ventilation and sunshine.
3. How;to maintain adequate nutrition.
a. How to select the essential foods.
b. How to choose the in-betweencmeal nourishment.
4. How to make safe the enforced period of bed rest.
a. Hoy/ to select the proper bed.
b. How to prevent kidney complications.
c. How to prevent cardio-vascular disturbances.
d. How to prevent skin irritations.
5. How to treat cold abscesses.
6. How to administer heliotherapy.
B. How to care for the patient immobilized on a Bradford
or on a Stryker frame.
1. How to prevent motion to the tuberculous spine of
the patient.
a. How to keep the frame covers taut.
58
b. How to prevent sagging of the buttocks through
the perineal opening.
c. Hoy/ to remove and replace the bed linen.
d. How to change theiposition of the patient.
e. How to apply restraint jackets.
C. How to care for the patient who has had a spinal fusion.
1. How to care for the patient in a bi-valve body shell.
a. How to bathe the patient.
b. How to turn the patient.
c. Hov/ to arrange a comfortable position.
d. How to dress the incision.
e. How to protect the leg from which the bone for
the graft is taken.
2. How to resume activities.
D. Hov/ to to care for the ambulatory patient.
1. How to select the proper shoes.
2. How to introduce walking.
3. How to check the back brace.
4. How to provide for regular health habits.
5. How to choose recreational acitivities.
Equipment for demonstrations;
A. Portable Bradford frame and four wooden blocks.
B. Stryker frame on a standard having a pivoting device
at each end.
G. Canvas frame covers with straps and buckles.
59
D. Oiled silk and gauze-coveredcelluootton.
S. Small muslin sheets.
Demonstrations ;
A. The covering of a Bradford frame.
B. The bedside care of a student on a Bradford frame.
C. The covering and manipulation of a Stryker frame.
D. The bedside care of a student on a Stryker frame.
Laboratory -procedures:
A. Care for the patient on a portable Bradford frame.
B. Prepare a Stryker frame for the patient.
C. Care for the patient on a Stryker frame.
D. Care for the patient on a bi-valve body shell.
Debatable issues:
A. Following surgery, should the patient with a spinal
fusion be turned more carefully during the first
week, or after the second week.
B. If, after examination, the patient with a tuberculous
joint is found to have the childhood type of tubercu
losis, should you maintain a strict isolation technique,
or merely take precautionary measures to protect him
from recurrent upper respiratory infections and conta
gious diseases?
C. Should you permit the patient with a low back fusion
to return to normal activity earlier than the patient
with a fusion of the thoracic or the upper lumbar vertebrae?
60
D. During the restricted period of activity, is it ever
advisable to recommend swimming as a means of re
creation?
E. In bone surgery with a well-healed external incision,
should you continue to restrict the patient’s activity,
or permit him to resume normal activity?
Visual aids:
A. Z-ray films showing the characteristic changes in
tuberculosis of the vertebrae.
B. Picture of the patient with Pott’s disease.
C. Z-ray films showing the tuberculous spine after fusion.
D. Pictures showing the Stryker frame on its standard.
E. Pictures illustrating the care of the patient on a
Bradford frame, on a Stryker frame, and in a body shell.
F. Taylor back brace.
Sources :
Nursing : Cabot-Giles 208-19; Day 480-3; Felter-West
278-85; Frink 18-24; Funsten-Galderwood 80-3, 174-9,
183-203; Greteman-Miller 1-43; Hibbs 697-9; Lewin 120-
55; Lockv/ood-Woldfer 336-9; McBride-Sink 201-19;
Pitman 728-52; Sever 122-54, 274-7, 404-9; Skinner
288-92; Vincent 116648.
Advanced: Campbell 275-322; Maguson 399-402.
61
3. HOW TO GARS FOR THE PATIENT
WITH A SACROILIAC SPRAIN
Sub-problems :
A. How to assist the doctor with tests specific to the
condition.
1. How to instruct the patient.
2. How to drape the patient.
3. How;' to question the patient in making the differ
ential diagnosis.
4. How to check the muscle spasm.
B. How to alleviate the local pain.
1. How to strap the back with adhesive tape.
a. How to prepare the skin area.
b. How to measure the adhesive strips.
c. How to apply the tape effectively.
C. How to add to the patient’s comfort.
1. How to select the proper bed.
2. How to maintain a comfortable recumbent position.
3. How to maintain a comfortable prone position.
4. How to arrange for a comfortable sitting position.
5. How to restrict and resume activities.
D. How to instruct the convalescent patient.
1. How to develop a set of corset muscles.
2. How to choose an efficient therapeutic corset.
3. How to adjust and wear the corset correctly.
62
Equipment for demonstrations:
A. Bed with firm mattress.
B. Two hair pillows.
G. Tincture of benzoin and applicators.
D. Adhesive roll and bandage scissors.
Demons tration s:
A. The applications of an adhesive support to the sacro
iliac area of a student by the Instructor.
B. The correct sacroiliac bed position and sitting position
assumed by the student under the direction of the
instructor.
C. The fitting of a therapeutic corset by the precrip-
tion corseteur.
Laboratory procedures:
A. Assist the doctor in applying an adhesive support on
the patient with a sacroiliac sprain.
B. Give bedside care to the patient with a sacroiliac
sprain.
G. Arrange a comfortable sitting positon for the patient
with a sacroiliac sprain.
D. Assist the patient to adjust his therapeutic corset.
Debatable issues:
A. In strapping the back to support a sacroiliac sprain,
is it better to extend the adhesive strips entirely
around the pelvis, or to extend them from in front
65
of the iliac spine, across the hack, to beyond the
iliac spine on the other side?
B. After the pain subsides, should,the patient with a
sacroiliac sprain ever be permitted to resume normal
activities without some form of support to the sacro
iliac area?
C. In the icondition of a low back pain, if the lumbar
muscle creates a curvature of the spine toward the
affected side, rather than away from it, should it
be reported as a possible sacroiliac or possible
sacrolumbar sprain?
Visual aids;
Â. X-ray pictures illustrating changes in the inter-
vertebral discs.
B. Pictures demonstrating the bed position and the sitting
position for the patient with a sacroiliac sprain.
C. A list on the blackboard by a student on the important
points to observe in the application of a therapeutic
corset.
Sources ;
Nursing: Day 469-71; Funsten-Calderwood 508-21;
lewin 196-203; Sever 115-20.
64
TRUE-FALSE TEST ON CHAPTER VI
Directions : Mark true or false the statements below,
by encircling the appropriate letter.
T F 1. You should keep the canvas covers on the
Bradford and the Stryker frames taut at all
times.
T F 2. The patient with a tuberculous joint should
always be placed .on strict aseptic technique.
T F 3. In supporting the back of the patient with
a sacroiliac sprain, you should extend the
adhesive strips from the level of the tro
chanters to above the iliac crests.
T F 4. In the relief of pain the best drug to
administer to the patient with rheumatic
fever is salicylic acid.
T F 5. Heliotherapy should always be included in
the treatment of the patient with a tubercu
lous joint.
T F 6. Since serious pulse irregularities are im
portant findings in the patient with rheu--
matic fever, you should check the radial
pulse frequently.
T F 7. It is a good plan to dress the child on a
Bradford frame each day and to place his
frame on top of the covers.
65
T F 8. It is à desirable plan to have the patient lie in
his posterior body shell on a Bradford frame for
several hours at a time, prior to the day of
operation.
T F 9. During the digitalization of the patient with
rheumatic■fever, you should discontinue the
drug if the pulse rate drops below 80 beats
per minute.
T F 10. It is better to turn the patient with a spinal
fusion more frequently during the first week
following operation than it is several weeks
later.
T F 11. In case of demonstrable toxicity from the
salicyic acid, the drug should be discontinued
at once.
CHAPTER VII
HOW TO ADMINISTER NURSING CARE TO THE PATIENT
WITH AN AFFECTION OF THE SOFT TISSUES
Although poliomyelitis and cerebral palsy rank high
in the incidence of crippling diseases, there is a third
condition involving the soft tissues which should be given
considerable attention. Yet it is startling to observe the
casual manner in which minor hand infections are treated,
particularly when they frequently result in loss of function,
or even in death. The common expression that every pinprick
is a potential death, is far from being an exaggeration.
The purpose of this chapter is to stress the serious
ness of these conditions, and to acquaint you with the
essential measures in caring for them. It presents the
Kenny technique in the treatment of poliomyelitis, although
there is much controversy over .the relative merits of the
Kenny and the traditional methods of treatment; it
emphasizes the psychological and tie physical management
of the cerebral palsy patient. In addition, it demonstrates
the principles involved in the nursing care of lymphangitis
of the upper extremity, which are applicable to all acute
infective processes of a hand infection.
67
1* HOW TO MANAGE THE PATIENT
WITH POLIOMYELITIS
Sub-problems :
A. How to manage the patient psychologically.
1. How to minimize his anxiety and fear.
2. How to reassure him.
B. How to administer general nursing care during the
acute stage.
1. How to prepare the bed.
a. How to make the mattress firm.
b. How to select the bed linen,
e. How to arrange the footboard.
2. How to relieve the muscle spasm.
a. How to bathe the patient.
b. How to turn the patient as a unit.
3. How to keep the patient in a good bed posture,
a. How to counteract the frog-posture tendency,
4. How to prevent skin irritation.
5. How to maintain the water balance.
6. How to check the respiratory depth and rate.
C. How to give the Kenny pack treatment.
1. How to protect the bed.
2. How to prepare the patient.
68
3. Hov/ to prepare the pack.
a. How to select the material.
b. How to shape the material to fit the affected
part.
c. How to heat and sterilize the material.
4. How to apply the pack.
a. How to prevent the skin from burning.
b. How to place the fomentation to the affected
muscle.
c. How to prevent a feeling of weight.
d. How to maintain the desired temperature.
e. How to secure the pack.
f. How to time the duration and the frequency of
the pack.
5. How to remove the pack.
a. How to prevent relaxation of muscles.
b. How to prevent chilling.
D. How to manage the patient with a respiratory involve
ment.
1. How to relieve choking and air hunger in paralysis
of the respiratory muscles.
2. How to clear the pharangeal passage of secretions
in paralysis of the pharangeal and facial muscles.
3. How to care for the patient in a respirator.
a. How to prepare the machine for the patient.
69
b. Uqw to alleviate the patient’s fears.
c. How to place the patient in the respirator.
d. How to give general nursing care.
e. How to provide recreation.
f. How to prevent complications.
g. How to wean the patient from the respirator.
Equipment for demonstrations;
A. The Kenny pack setup.
1. Tub with wringer.
2. Sterilizer
3. Blankets of 60^ to 75^ wool for inner packs.
4. Material of wool and cotton mixture for outer packs.
5. Waterproof material.
6. Scultet.us binder.
B. A respirator.
Demonstrations ;
A. The outlining with a skin pencil by a physical therapist
on a student to show the origin and insertion of the
deltoid and various other muscles which tend to spasm.
B. The application of the Kenny pack on a student by a
physical therapist.
C. A muscle re-education demonstration by a physical
therapist.
D. The preparation, regulation, and manipulation of a
respirator.
70
E. The nursing care of a student in a respirator by the
instructor•
F. An outline on the blackboard by a student, listing the
symptoms of a respirator paralysis.
0. Return demonstrations by students.
Laboratory procedures:
A. Assemble the equipment and materials needed for the
administration of the Kenny pack.
B. Assist the physical therapist in the application of
a Kenny pack on the patient.
C. Prepare a respirator for the patient.
Debatable issues:
A. In the nursing management of the poliomyelitis patient
do you prefer the traditional, or the Kenny concepts of
treatment? State your reasons for the preference.
B. In bathing the patient, should you use sponging or
gentle massaging strokes?
C. In applying the Kenny pack, should you cover the joints
or leave them uncovered.
D. Is it lawful or unlawful for a student nurse to care for
the patient in a respirator.
E. Before applying the hot fomentations, should the skin be
oiled or not oiled, in order to prevent burning?
F. In regulating the respirator for the patient, should
the pressure be positive or negative.
71
Visual aids:
A. Charts showing the origins and insertions of muscles
commonly affected with spasms.
B. Pictures illustrating the frog position.
C. Diagrams shoxving how the respirator simulates breathing.
D. Diagrams illustrating methods of carding for the patient,
in a respirator.
Sources :
Nursing: Calderwood 624-31; Day 508-12; Funsten-Ca^lderwood
419-61; Breteman 929-53; Norcross 1063-8; Rothweiler-
White 630-2; Rounds 717-23; Sever 206-30; Steindler-
Greteman 1-65.
Advanced; Smith 1666-70; Wilson 257-82.
72
2. HOW TO MANAGE THE PATIENT WITH
CEREBRAL PALSY
Sub-problems :
A. How to manage the psychological aspects of the disease.
1. How to adapt your attitude to the child's background,
personal history, and prognosis.
2. How to win the child's trust and confidence.
a. How to assist him in maintaining his feeling of
adequacy.
b. How to manage his periods of rebellion and
frustration disappointments*
c. How to assign tasks within the scope of his
ability.
3. How to select suitable recreation.
B. How to manage the. physiological aspects of the disease.
1. How to provide the proper environment.
2. How to improve the child’s motor ability.
a. How to check for strong, weak, and normal
muscles.
b. How to develop muscle relaxation,
c. How to re-educate the muscles.
3. How to prevent secondary deformities.
4. How to help the child care for his personal needs,
a. How to assist him in eating .
73
b. How to aid him in walking.
c. How to assist him in talking.
C. How to guide the family in adjusting to the child at
home.
1. How to instill in the parents the proper attitude,
toward the disease.
2. How to instruct the parents to improvise equipment
for the child.
3* How to help the parents arrange a daily schedule
in caring fdr the child.
4. How to arrange for regular medical supervision.
5. How to obtain educational facilities.
Equipment for demonstrations:
A. Single standing table.
B. Walking shoes, walkers, and parallel bars.
C. Low practice stairs.
Demonstrations :
A. The checking of the child for strong, weak, and normal
muscles by a physical therapist in the physical therapy
department of the hospital.
B. The instruction of the child in walking by a physical
therapist.
C. The instruction of the child in speech by a qualified
person.
74
D. An outline on the blackboard by a student, listing the
early and the late symptoms of cerebral palsy in the
baby or young child.
E. An outline on the blackboard by a student, listing the
fundamental differences in the nursing care and treat
ment of the athetoid, the spastic, and the ataxic types
of cerebral palsy patients.
Laboratory procedures;
A. Assist the physical therapist in instructing the child
to walk.
B. Help the child to serve himself at mealtime.
C. Assist the occupational therapist in furthering the
child’s self-help.
D. Demonstrate the care and treatment of the child to the
parents.
Debatable issues:
A. In caring for the young child with cerebral palsy,
should you, or should you not, make him aware that he
may be met with curiosity and even repulsion?
B. In preventing careless speech habits, should you correct,
or merely assist the child?
C. If it appears that the child has not understood you,
should you repeat yourrself, or repeat only when lie
asks you to do so?
75
Visual aids:
A. Pictures illustrating monoplegia, hemiplegia, and
quadriplegia in cerebral palsy patients.
B. Illustrations of specially designed eating equipment.
C. Pictures of practice shoes made from wooden boxes.
D. Pictures of a single standing table.
E. Pictures illustrating a Montessori board for lacing
and other training boards, equi;^dwith zippers, hooks,
ties, and fasteners.
Sources ;
Nursing: Abele 1-19; Ball 722-30; Punsten-Calderwood
467-99; Jones 465-8; 469-74; Lewin 69-75; Sever
249-56; __________ 68-80.
Advanced: 1621-5.
76
3. HOW TO CARE FOR THE PATIENT WITH LYMPHANGITIS
OF THE UPPER EZTREE.ŒTY
Sub-problems:
A. How to care fot the patient during the acute stage.
1. How to treat the systemic involvement.
a. How to reduce the fever.
b. How to maintain the water balance.
c. How to maintain nutrition.
2. How to assemble and prepare the equipment to treat
the local involvement.
a. How to make the per cent of solution ordered.
b. How to place the table.
c. How to arrange the pillows.
d. How to set up the heat cradle.
3. How to apply the pack to the affected part.
a. How to care for the place of incision.
b. How to protect contacting skin surfaces.
c. How to bandage the affected extremity.
d. How to check the temperature of the sterile
solution.
e. How to place the stupes.
f. How to retain the heat and moisture.
4. How to change the dressing.
a. How to protect the patient from secondary
infection.
77
b. How to protect the nurse from infection.
5. How to chart on the nurse's note sheet.
a. How to describe the type of drainage.
b. How to explain the condition of the affected
part.
6. How to prevent complications.
a. How to provide adequate drainage.
b. How to maintain the hand in the position of
function.
G. How to prevent burning of the skin.
d. How to dehydrate the hand.
e. How to limit and resume activity.
B. How to care for the patient after the infection
subsides.
1. How to treat the affected part.
a. How to improve the nutrition of the part.
b. How to relax the scar tissue.
c. How to stretch the adhesions.
d. How to improve the muscle tone.
e. How to restore atrophied muscles.
f. How to introduce active movements.
2. How to maintain the hand in the position of
function.
a. How to apply a tension splint.
78
Equipment for demonstrations;
A. Small table the same height as the bed.
B. Heat cradle with two 40 watt light bulbs.
C. Sterile supplies.
1. Rubber gloves.
2. Two 5-yard gauze roller bandages.
3. One dozen 4” x 4” gauze squares.
4. One gallon of solution as ordered.
5. Covered pitcher.
6. Forceps in container of solution.
D. Four stupes in covered basin.
E. One large piece of oiled silk.
F. One rubber sheet and one rubber-covered pillow.
G. Three bath blankets and two regular pilloxvs.
Demonstrations :
A. The initial setup of the equipment.
B. The application of the dressing on a student by the
instructor.
0. The technique of changing the dressing on a student by
the instructor.
Laboratory procedures;
A. Assemble and prepare the equipment for the initial
treatment.
B. Calculate the number of potassium permanganate tablets,
3.6 grains, required to prepare a solution of 1:5000.
79
Prepare the solution,
C. Care for the patient with lymphangitis of the upper
extremity,
D. Assist the doctor in changing the dressing.
Debatable issues :
A. In applying the hot solution to the bandage, should the
patient or the nurse decide if he can stand the tem
perature?
B. In evacuating the pus, should the incision be made at
the area of the greatest swelling, or at the site of
the greatest tenderness?
C. After the red lines of the lymphatic involvement have
disappeared, should the wet dressings be continued,
or discontinued?
D. In a serious hand infection, should the bandage stop
at the elbow, or at the axilla?
E. In case of the patient being so ill as to demand fluids
paraenterally, should they ever be administered sub-
cutaneously?
F. In treating an infection, should a carbolic acid
solution in any strength be used?
Visual aids:
A. Anatomical charts illustrating the lymphatic drainage.
B. Anatomical charts illustrating the anatomy of the hand.
C. X-ray films illustrating bone involvement.
80
Sources ;
Nursing: Hirshfeld-Pilling 967-73; FeIter-West 31-5.
Advanced: Christopher 458-82; Kanavel 93-123, 239-97,
417-90.
81
TRUE-FALSE TEST ON CHAPTER VII
Directions; Mark true or false the statements below, by
encircling the appropriate letter.
T F 1. In a serious infection of an extremity, it
is better to extend the dressing to the re
gional lymph node*
T F 2. The Kenny pack treatment should be started
as soon as the diagnosis of poliomyelitis is
established.
T F 3. Relaxation need not be considered in helping
the spastic type of cerebral palsy patient.
T F 4. The extremity of the patient with lymphangitis
should be elevated.
T F 5. The athetoid type of cerebral palsy patient
should be helped to relax before attempting
any motion.
T F 6. After the application of the initial dressing
on an extremity with a lymphantic involvement,
it is unnecessary to wear rubber gloves in
changing the stupes.
T F 7. In bathing the patient with poliomyelitis in
the acute stage, you should use gentle
massaging strokes.
82
T F 8. You should change the position of the patient
in a respirator every two hours, unless he
complains of muscle tenderness.
T F 9. In the application of a Kenny pack it is better
to place the hot fomentations directly on tbe
skin.
T F 10. You should be guided by the heat tolerance cf
the patient with lymphangitis, in applying the
hot solution to the affected extremity.
T F 11. The Kenny pack treatment should be continued
night and day as long as there is demonstrable
muscle spasm.
T F 12. Because the cerebral palsy patient is seriously
handicapped, you should anticipate his wants.
T F 13. It is a good plan to have the child with
cerebral palsy sit tailor-fashion.
T F 14. The temperature inside the respirator should
be maintained just below the normal room
temperature.
T F 15. In applying the Kenny packs to the patient,
the joints should be covered.
T F 16. In order to relieve the back pain of the
patient with poliomyelitis, you should give
particular attention to the back rub.
83
T F 17. It is best to regulate the respirator at a
negative pressure between 14 and 18.
T F 18. In caring for the patient with the spastic
^ type of cerebral palsy, you should assist
him to repeat his movements with increasing
range and speed.
T F 19. In preparing the heat cradle for an infection
of the upper extremity, two 60-watt light
bulbs should be used.
CHAPTER VIII
HOW ,T0 ADMINISTER NURSING OARE.ÆO THE
PATIENT WITH A SKSIETAL NEOPIAmï
The specialization in the nursing care of the
cancer patient is a new field. The nurse who attempts it
will need to have qualifications of sympathy, understanding,
gentleness, and tact to a considerable degree, particularly
in the management of the incurable patient, in some
instances accurate technical knowledge will be essential,
especially if the patient is receiving radiation therapy.
Whenever there is a manifestation of bone pathology,
the incidence of pathological fractures is high. Obviously,
caring for the patient with either a benign or a malignant
tumor of the bone places you in a most responsible position.
It is imperative that you take every possible measure to
prevent the occurence of a fracture.
The units of this chapter are planned as a guide to
help you meet these unusual responsibilities.
85
1. HOW TO CARE FOR THE. PATIENT WITH
A BENIGN TUMOR OF THE BONE
Sub-problems :
A. How to manage the affected area.
1. How to support the extremity.
2. How to prevent a pathological fracture.
3. How to detect and locate a pathological fracture.
B. How to treat the "radiation” sickness.
1. How to select the diet.
2. How to supply the fluids.
C. How to care for the irradiated area.
1. How to protect the skin.
2. How to cleanse the skin.
3. How to treat the skin that is blistering and peeling.
4. How to apply the dressing.
5. How to remove the dressing.
Demonstrations :
A. A deep X-ray or radium treatment on the patient at the
tumor clinic.
B. The application of a dressing on the irradiated skin of
the patient by a nurse at the tumor clinic.
0. An outline on the blackboard by a student, summarizing
the nursing care of the patient receiving radiation
therapy.
86
D. The preparation of radium seeds, needles, or capsules,
by a qualified person.
E. The technique of handling and sterilizing radium by a
qualified person.
Laboratory procedures:
A. Care for the patient who has a benign tumor of the bone.
B. Assist the doctors with the radiation treatment at the
tumor clinic.
G. Apply the dressing to the irradiated skin area of the
patient who is receiving radiation therapy.
Debatable issues:
A. When there is a deep reddening of the patient’s skin
following radiation therapy, should you refer to the
reaction as a burn or an erythema?
B. If the patient questions you about the possibility of
his tumor degenerating into a malignancy, should you
evade the issue, refer him to his doctor, or express
your opinion?
C. In caring for an area of irradiated skin that is
blistering and peeling, should you cleanse the area
gently with mild soap and warm water, or cleanse it
with hydrogen peroxide?
Visual aids:
A. Doctors’ slides depicting different types of benign
tumors of the bone and the most common sites of predi
lection.
87
B. X-ray films showing benign tumors of the bone, before
and after radiation therapy.
0. X-ray films illustrating pathological fractures.
Sources ;
Nursing; Eliason-Perguson-Farrand 233; Emerson-Taylor
690,-6; Lockwood-Wolfer 339-40; Sever 350-7.
Advanced: Camnbell 765-83; Ewing; Pack-Livingston
2375-97, 2446-57, 2595-6; Watson 162-187.
88
2. HOW TO CARE FOR THE PATIENT WITH
A MALIGNANT TUMOR OF THE BONE
Sub-problems ;
A. How to sustain the morale of the incurable patient.
1. How to inspire his trust.
2. How to encourage him.
3. How to select occupational therapy.
4. How to instruct the family in self-control.
5. How to minimize disagreeable odors.
B. Hov/ to alleviate the symptoms.
1. How to control the pain.
2. How to minimize the cachexia.
3. How to counteract the advancing anemia.
4. How to treat the acidosis.
C. How to detect and treat a metastasis.
1. How to treat a metastasisto the lung.
2. How to manage a metastasis to the brain.
3. How to treat a metastasis to the liver.
Demonstrations ;
A. An outline on the blackboard by a student on the
nurse’s part in the prevention and control of cancer.
B. An outline on the blackboard by a student, listing the
warning signs and symptoms of Ewing’s sarcoma.
89
Laboratory procedures:
A. Care for the incurable cancer patient.
B. Prepare the deodorizing equipment.
Debatable issues:
t
A. In the control of pain, should the nurse or the
patient be the judge of the quantity of analgesic
needed and the interval betweendosages?
B. If the patient approaching death asks you if he is
dying, should you answer "Yes," "No," or "I do not
know"?
C. In the alleviation of severe pain in the patient
with an incurable sarcoma, should you administer
hypnotics, sedatives, and analgesics conservatively,
or freely?
Visual aids:
A. X-ray pictures of Ewing’s sarcoma, showing onionskin
layers.
B. Doctors’ slides, depicting different types of malignant
tumors of the bone and the most common sites of predi
lection.
Sources :
Nurs ing » Eliason-Ferguson-Farrand £34; FeIter-West 274;
Funsten-Calderwood 503-6; Lockwood-Wolfer 340-1.
Advanced: Campbell 783-9; Ewing; Pack-Livingston 2406-
36, 2457-60, 2552-94; Watson-Jones 162-87.
90
THUE^TALSE TEST ON CHAPTER VIII
Directions : Mark true or false the statements below,
by encircling the appropriate letter.
T F 1. In case of severe pain the patient should be
the. Judge of the quantity of the analgesic
needed and of the time interval which should
elapse between doses.
T F 2. Dressings on an irradiated skin area should
be held securely in place with adhesive tape.
T F 3. Hypnotics, sedatives, and analgesics should
be administered freely in the alleviation of
severe pain in the patient with an incurable
sarcoma.
T F 4. The reaction resulting from radium and X-ray
treatments should be referred to as an er
ythema of the skin.
T F 5. In the incurable patient, morphine should be
withheld until all other drugs fail to give
relief.
T F 6. You should wash the irradiated skin gently
with mild soap and warm water.
T F 7. The irradiated area should be protected from
the clothing by a gauze covering.
91
T F 8. While radium is in use on the patient, you
should examine all dressings when changed or
yremoved.
T F 9. If the patient who has not been informed that
he has a malignant tumor of the bone asks you
if he has a cancer, you should evade answering.
T F 10. After cleansing the irradiated skin, you should
apply an oil with a petroleum base.
T F 11. In caring for irradiated skin that blisters
and peels, you should cleanse it with mild
soap and warm water.
T F 12. If the patient who is approaching death asks
you if he is going to live, you should refer
the question to his doctor.
T F 13. Radium always should be handled with forceps.
CHAPTER IX
HOW TO ADMINISTER NURSING CARE TO THE
PATIENT WHO IS LEARNING TO WALK AGAIN
The first day of crutch walking is anticipated
eagerly by. the orthopedic patient. Yet weight-bearing
exercises must precede crutch walking, or the attempt will
end in fatigue and failure. After weeks of immobilizations,
the orthopedic patient must be re-educated in walking.
The weakened muscles must be strengthened through exercises.
It is the nurse’s responsibility to direct the
patient in these weight-bearing exercises prior to crutch
walking, and to instruct him how to use the crutches with
confidence and co-ordination. This chapter is planned to
aid you in meeting those responsibilities.
93
1. HOW TO PREPARE THE PATIENT
FOR ORUTCH WALKING
Sub-problems:
A. How to select the correct shoes.
B. How to direct the weight-bearing exercises.
1. How to exercise the legs and feet.
2. How to stretch rigid muscles and thickened
ligaments.
3. How to rise from the chair.
0. How to select the crutches.
1. How to measure the patient for crutches.
2. How to place the hand bars.
3. How to check the crutch tips.
D. Hovf to instruct the patient to stand and balance with
crutches.
1. How to maintain the triangular position.
Equipment for demonstrations:
A. Pair of regular crutches.
B. Pair of Canadian crutches.
C. Tape measure.
Demonstrations ;
A. The measurement of a student for crutches by the
instructor.
B. The weigh^-bearing exercises by a physical therapist.
C. The correct standing position with crutches.
94
Laboratory procéduresî
A. Measure the patient for crutches.
B. Instruct and assist the patient in weight-bearing
exercises in preparation for crutch walking.
C. Assist the patient with crutches to stand correctly.
Debatable issues;
A. When measuring the patient for crutches in the back-
lying position, should his arms be elevated above his
head, or be straight at his sides?
B. In measuring the patient for crutches, should you
measure the distance from his axilla to the floor,
or should you add two inches to this measurement?
C. In the correct standing position, should the patient
be instructed to place the crutches in front of his
body, or at his sides?
Visual aids:
A. Diagrams illustrating the correct and the incorrect
standing positions with crutches.
B. Pictures of regular crutches and Canadian crutches.
Sources :
Nursing; Funsten-Calderwood 461-6; Stevenson 149-58.
95
2. HOW TO HELP THE PATIENT WHO
WALKS ON CRUTCHES
Sub-problems ;
A. How to select tbe type of crutch for walking.
1. How to select the gait when weight-bearing is
permitted.
2. How to choose the gait when weight-bearing is
contraindicated.
B. How to instruct the patient in handling the crutches.
1. How to place the hands on the crutches.
2. How to maintain balance.
3. How to carry the weight.
a. Hov/ to prevent crutch paralysis.
4. How to move the crutches.
5. How to sit down and get up from a chair.
0,.’ How to instruct the, patient in the various gaits.
1. How to assist him in thelfour-count gait.
2. How to aid him in the swinging gait.
3. How to help him in the advanced swinging gait.
4. How to show him the hiking gait.
D. How to instruct the patient to go up and down steps.
E. How to wean the patient from his crutches.
Equipment for demonstrations:
A. Pair of regular crutches.
B. Pair of Canadian crutches.
C. Full-length mirror.
96
Demonstrations ;
A. An outline on the blackboard by a student, listing the
fundamental principles involved in crutch walking.
B. The various walking gaits on crutches by the instructor.
Laboratory procedures:
A. Instruct the patient in handling the crutches.
B. Instruct the patient in the gait suitable to his
infirmity.
C. Assist the patient who walks on crutches.
Debatable issues;
A. In helping the patient to handle his crutches, should
you instruct him to place his weight under the axilla,
or on the palms of the hands?
B. In assisting the crutch walker, should you instruct him
to flex, or to extend the wrists and the elbows?
G. In the standing position with crutches, should you
instruct the patient to place his weight upon the balls
of his feet, or upon his heels?
D. When weight-bearing is contraindicated, should you
instruct the patient in the four-count gait, or in the
swinging gait?
E. Should you instruct the patient who has arthritis in
the lower extremity in the four-count gait, or in the
swinging gait?
97
Visual aids;
A. Diagram illustrating the four-count gait method of
crutch v;aIking.
B. Eodachrome slides on crutch walking.
C. Film: "Crutch Walking" by the United States Office of
Education.
Sources :
Nursing: lliason-Ferguson-Earrand 483-5; Nelson 1088-93;
Stevenson 158-70.
Advanced: Magnuson 460-5.
98
TRUE-FALSE TEST ON CHAPTER IX
Directions : Mark true or false the statements below,
encircling the appropriate letter.
T F 1. In crutch walking the weight of the body
should be borne on the palms of the hands.
T F S. The axillary bars should be padded in order
to contribute to the comfort of the patient.
T F 3. The wrists of the crutch walker should always
be in extension.
T F 4. In measuring of the patient for crutches, you
should mark the distance from the patient's
axilla to the floor.
T F 5. The patient v/ho has had a fracture of the
femur should be instructed in the four-gait
method of crutch vmIking.
T F 6. You should instruct the patient who is handling
crutches for the first time to keep the crutches
ahead of his feet.
T F 7. Wcien weight bearing is not a factor to be
considered in selecting the type of crutch
walking for the patient, the swinging method
is preferable.
99
T F 8. Instruction in weight-bearing exercises should
always precede instruction in crutch walking.
T F 9. In the correct standing position the patient
should be instructed to form a triangle with
his feet and crutches.
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GENERAL REFERENCES
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a Good School of Nursing. National League of Nursing
Education, New York, 1945.
Olmsted, Lois, R. N.: "Report of the Joiht Orthopedic
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the National League of Nursing Education, pp. 105-8,' 1"^5.
Taylor, Anna, M. A., R. N. : Ward Teaching. J. B. Lippincott
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NURSING REFERENCES
Abele, John, M. D.: Care of the Spastic Paralytic Child in
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Atkins, Edward: Plaster Casts. Lewis Manufacturing Co.,
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Bruck, Helen, R. N.: "The Drying of Plaster Casts,"
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Cabot, Hugh, N. D,, and Giles, M., R. N., A. M.; Surgical
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Felter, Robert,, M. D., and West, P., R. N., B. S.:
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Frink, Avis, R. N.: "The Child on a Bradford Frame,
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tf
103
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Gabel, M. K. : "Skin Preparation for Orthopedic Surgery,"
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Galvin, L. F., M. D. : "The Rheumatic Fever Pcogram in
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Greteman, T. J., M. D., and Miller, A. , R. N. : Home Care
of Bone and Joint Tuberculosis : A Handbook on Nursing
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Greteman, T, J,, M. D.: "Nursing Care of Acute Poliomye
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Harbin, Maxwell, M. D.: "Osteomyelitis," American Journal
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Harmer, Bertha, R. N., A. M., and Henderson, N.,
Ai. M. : Textbook of the Principles and Practice of Nursing.
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Hartmann, A. F., M. D.: "Acute Salicylate Poisoning,"
Journal of Pediatrics, 26: 214-15, March, 1945.
Hibbs, Russell A., M. D.: "Orthopedic Surgery and the
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Hirshfeld, John W., M. D., and Pilling, M., M. D.: "Injuries
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Hull, Edgar, M. D., Wright, G,, R. N., B, S., and Eyl, A.,
B. S.: Medical Nursing. F. A. Davis Co., Philadelphia,
1943.
Jones, Margaret H., R. N.; "The Cerebral Palsy Child,"
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Kerr, Marion, R. N.: "Nursing Responsibilities in Cerebral
Palsy," American Journal of Nursing, 46: 469-74.
Lewin, Philip, M. D.: A Textbook of Orthopedic Surgery for
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Lewin, Philip, M. D.: Orthopedic Surgery for Nurses.
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104
Lockwood, Charles D., M. D., and Wolfer, J., M. D. : The
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Co. , Nev; York, 1955.
McBride, Earl D., M. D., and Sink, W., R. N., A. B.:
Crippled Children. C. V. Mosby Co., St. Louis, 1937.
Nelson, Doris, P. T.: "Crutch Walking," American Journal
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Nightingale, Florence: . Notes on Nursing. D. Appleton Co.,
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Norcross, Mary E., R. N.: "Drinker Respirator," American
Journal of Nursing. 39: 1063-6.
Pitman, Eleanor B., R. N.: "Nursing Care in Spinal Fusion,"
American Journal of Nursing. 39: 728-32.
"Posture Fundamentals Illustrated," American Journal of
Nursing, 46: 20-1.
Rothwe iler, Ella L., R. N., M. A., and White, J., R. N.,
B. S.: The Art and Science of Nursing. F, A. Davis Co.,
Philadelphia, 1944.
Rounds, R. Clayton, M. D.: "The Treatment of Poliomyelitis,"
American Journal of Nursing, 40: 617-23.
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Sever, James W., M. D.: Principles of Orthopedic Surgery.
Macmillan Co., New York, 1940.
Skinner, Geraldine, R. N.: "The Patient on a Stryker Frame."
American J ournal of Nursing. 46: 288-92.
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105
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Campbell, Willis C., M. D.: Operative Orthopedics#
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Cecil, Russell L., M. D., A. B.: A Textbook of Medicine.
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Asset Metadata

Creator Millard, Dorothy Davis (author)

Core Title A course of study in orthopedic nursing

Contributor Digitized by ProQuest (provenance)

Degree Master of Science

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Education,Health and Environmental Sciences,OAI-PMH Harvest

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Permanent Link (DOI) https://doi.org/10.25549/usctheses-c37-232776

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University of Southern California Dissertations and Theses