ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

AbstractCharcot joint is the painless, degenerative, progressive neuropathic destruction of the bony architecture of one or more joints of the feet. Diabetes mellitus is the most common cause of Charcot joint in North America, although the exact etiology is uncertain. The classic presenting complaint involves unilateral painless swelling of the lower extremity or foot. Charcot joint is often mistaken for cellulitis or deep vein thrombosis and may result in significant foot or ankle deformities. There are several treatment options for the patient presenting with Charcot joint. Medical management often includes immobilization and maintaining nonweightbearing status. Surgical intervention, often a final attempt at managing Charcot foot, involves careful patient selection and is not recommended for all patients. The postoperative phase can be challenging for both patient, nursing staff, and the surgeon.Charcot joint, or neuropathic osteoarthropathy, is a term denoting a relatively painless, degenerative, progressive neuropathic destruction of the bony architecture of one or more joints. Originally, it was described in patients with tertiary syphilis, but this condition can be caused by a variety of pathologies that create neural deficits. It can occur in the presence of any disorder that reduces pain sensation, including Hansen's disease (leprosy), multiple sclerosis, polio, congenital insensitivity to pain or spinal cord lesions, steroid‐induced osteoporosis, and alcoholism (Reinherz et al., 1995).In North America, diabetes mellitus is the most common cause of Charcot joint (Saltzman et al., 1992). In diabetic patients, this condition usually affects the lower extremity, especially the ankle and metatarsophalangeal joints. It is usually associated with those who have moderate to severe neuropathy, and affects 1 in 700 people with diabetes (Halpin‐Landry & Goldsmith, 1999). It is a condition that may have an acute or gradual onset, and in the most severe form, often results in significant foot or ankle deformities and foot ulcers.

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

AbstractChildren have historically been undertreated for pain. Children with chronic disabilities may face multiple, complex surgeries that cause severe postoperative pain. In addition, underlying problems with increased muscle tone can cause painful postoperative spasms. Gillette Children's Specialty Healthcare treats children with chronic disabilities. Our orthopaedic surgeons have developed a single surgical approach referred to as “multiple lower extremity procedures” (MLEPs) to correct the patient's primary, underlying orthopaedic deformities all under one anesthesia. Because of the intensity of postoperative pain caused by this approach, Gillette Children's uses epidural analgesia or patient‐controlled/nurse‐controlled analgesia to manage postoperative pain.Gillette Children's pain control practices involve preoperative planning, postoperative pain assessment and documentation every 2 hours, interventions to control pain guided by the patient's response (including pharmacologic and nonpharmacologic approaches), and patient/family education about how to manage pain at home.Historically, children across the country have been undertreated for pain (Macfadyen et al., 1999). Myths, such as the long‐held belief that children experience less pain than adults, have contributed to this undertreatment. There is also a persistent fear of cardiorespiratory complications that may be associated with pain relief medications (Deshpaude & Tobias, 1996). However, our experience has shown that well‐managed analgesia dramatically reduces this concern.The nature of a child's illness, injury, or condition is a key factor to consider when developing a pain management plan. Typically, there is a differentiation between pain management for children with acute conditions and those who are being treated for conditions related to chronic disability. Children in an acute‐care hospital are usually treated for urgent or serious illnesses and injuries on a short‐term basis. Either intramuscular or intravenous administration of pain medication is historically the method of choice in such cases and can be highly effective. IM injections, however, while still widely used, are extremely painful and frightening to children (Maikla, 1998).Pain management for patients who have a chronic disability often requires a more aggressive and closely monitored approach. While it is true that patients with disabilities may have relatively short hospital stays following surgery, the chronic nature of their conditions must be considered when developing a pain management plan.For example, more than 40 percent of all children who have surgery at Gillette Children's Specialty Healthcare in St. Paul, Minnesota, have a primary diagnosis of cerebral palsy. Many of them face a series of major surgeries to correct secondary conditions (such as muscle contractures and bony deformities) throughout the period of their growth and development. In addition to the sheer number of surgeries that such children face, the procedures themselves are typically complex, increasing the patient's need for closely managed pain control.Many children with cerebral palsy undergo multiple lower extremity procedures (MLEPs)‐sometimes as many as a dozen ‐ under the same anesthesia. Spinal surgery to correct severe scoliosis may involve the removal of vertebral elements, repositioning of the spine, and/or placement of bone and instrumentation for stability and fusion.Often, these multistage procedures require the surgeon to enter the child's body from more than one side. Other surgical interventions, such as selective dorsal rhizotomy (SDR) to reduce spasticity, involve complex neurologic procedures that leave nerve endings acutely sensitive to pain.Underlying difficulties with muscle tone that complicate postsurgical recovery are found in many children with disabilities. In patients with muscle spasticity, the correction of muscle contractures, disturbance of muscle during a procedure, or neurologic intervention can temporarily increase the level of muscle spasms. Our experience has shown that postsurgical spasms can cause excruciating pain for the patient.A child's cognitive and functional abilities are further factors that must be taken into consideration when managing pain for children with disabilities. Many children with physical disabilities are cognitively impaired and may not understand what is happening to them or why. Separation from their everyday environment and routine may cause them anxiety or fear. It is well recognized that emotions play into a person's perception of pain, which can be exacerbated by fear and anxiety (Price, 1999). In addition, past experience with painful procedures, especially with acute pain that was not well managed, can directly impact the effectiveness of pain control (MacGrath, 1989).

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

AbstractManaging behavioral disorders such as delirium and agitation while simultaneously attending to the acute needs of elderly patients is a challenge that confronts orthopaedic nurses on a daily basis. This will only increase in frequency and complexity as the new century dawns. Delirium and agitation affect morbidity, mortality, length of stay, and costs — in short, outcomes. To manage and care for these patients, orthopaedic nurses must first update their knowledge of acute disorders that can disrupt mental status and behavior, and the effects of systemic events on brain function. With the knowledge of the pathophysiology of delirium and agitation, nurses then need to refine their assessment and intervention skills. This article describes the phenomena of agitation and delirium in the elderly acute orthopaedic patient, outlines current perceptions regarding pathophysiology, and offers guidelines for prevention and intervention. An algorithm has been developed that can assist with the identification of at‐risk individuals, causes of delirium, and early assessments in the acute care setting.

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

AbstractEven more than the general population, orthopaedic patients suffer from multiple consequences of immobility. Fortunately, most of these patients are physically able to participate in some degree of moderately intense exercise. Helping the orthopaedic patient initiate and adhere to a moderately intense exercise routine is a nursing challenge. This challenge is even more difficult because as nurses, we are often expecting our patients to make a lifestyle change that we have been unable or unwilling to make ourselves. Understanding the health‐related benefits that can be derived from participation in moderately intense exercise routines and the recommended guidelines for exercise frequency and intensity is a first step toward initiating a fitness routine. Using information acquired from research, nurses can assess for specific facilitators and barriers to exercise participation. This assessment data can then be used to individualize plans for exercise that meet the fitness needs of our patients and ourselves.

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0744-6020    

出版商:OVID    

年代:2001

数据来源: OVID