d. Immobility, fear of deformity, and a potentially long hospitalization may cause
the patient to become depressed or discouraged. The understanding and
encouragement of nursing personnel can increase morale. Encourage self-reliance, but
give help willingly and cheerfully when the patient needs assistance. Continuous
teaching will help the patient understand his condition and his limitations and enable
him to become more independent as his condition improves and he is rehabilitated.
Section II. ASSESSMENT
Management of orthopedic patients begins with an accurate assessment of the
patient's specific problems. Important information can be obtained from the patient's
history and the physical assessment. An orthopedic nursing assessment should include
the following examinations and observations:
a. Observe the patient's posture and gait.
b. Palpate the skin for indication of tenderness, swelling, or increased
c. Observe for discoloration.
d. Examine the joints, observing for size, shape, alignment, and range of motion.
e. Examine the muscles for strength, movement, and indications of atrophy or
f. Assess vascular function by "blanching" fingers and toes. Check pulses.
g. Assess neurological function by checking reflexes, sensation, and motor
musculoskeletal disorders. X-rays of a joint may show spur formation, changes in joint
structure, or the presence of fluid. X-rays of bone may show bone texture, density, and
erosion or other bone changes. Special X-ray techniques include the following.
(1) Tomography, or body section roentgenography, is the recording of
internal body structures in a specific plane of tissue. Computerized Axial Tomography,
or CAT scan, uses both X-rays and computers to create three-dimensional images that
appear on a screen in cross-sectional view.