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presented by Cheryl Lehman, PhD, RN, CRRN
Financial: Cheryl Lehman receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.
Non-Financial: Cheryl Lehman has no competing non-financial interests or relationships with regard to the content presented in this course.
Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.
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Rehabilitation nurses across the continuum of care will encounter patients with a variety of orthopedic conditions, both medical and surgical in nature. It is important that rehabilitation nurses are knowledgeable about their patients' current orthopedic conditions as well as potential complications that may not immediately be present. The rehabilitation nurse must be able to competently care for and teach these patients in the rehabilitation setting, and be able to prepare their patients to prevent orthopedic complications in the future. This course will review the anatomy and physiology of bones and joints; provide an in-depth look at orthopedic conditions that may be seen in the rehabilitation setting; and review conditions that may await their patients in the future, after rehabilitation. Conditions to be covered include kyphosis and scoliosis, heterotopic ossification, bone infection, and joint pain. Physical assessment skills and parameters will be examined, and "when to report" will be stressed.
Cheryl Lehman, PhD, RN, CRRN
Dr. Cheryl Lehman has been a registered nurse since graduating from the Decatur Memorial Hospital School of Nursing in 1978. Since that time, she earned a BSN from Maryville University-St. Louis in 1990; an MSN in Adult Health Nursing from the University of Texas Medical Branch (UTMB) at Galveston in the Clinical Nurse Specialist role…
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1. The bones and Joints
This chapter reviews anatomy and physiology of the bones and joints. The function of various regions of the skeleton and joints will be reviewed. Key physical and diagnostic assessment techniques specific to the skeletal system and joints will be included.
2. Kyphosis and Scoliosis
Years of wheelchair use can result in alterations in posture related to bony changes such as kyphosis and scoliosis. While they may seem to be benign, kyphosis and scoliosis can limit pulmonary function, and lead to pneumonia and other pulmonary conditions. This chapter will review kyphosis and scoliosis, including anatomical changes, pathological implications, and preventive techniques. The role of the rehabilitation nurse in preparing patients for the future will be stressed.
3. Heterotopic Ossification
Heterotopic ossification (HO) is a serious complication related to abnormal bone growth, often associated with traumatic injury such as spinal cord injury or brain trauma. It is also being found in patients with a blast-associated injury. The rehabilitation nurse should be familiar with HO, and be able to identify its signs and symptoms so that HO can be diagnosed early and promptly treated.
4. Bone Infection
Osteomyelitis, or bone infection, can occur as the result of multiple conditions, including fracture, orthopedic surgery, and pressure ulcers. It can become evident days to months after any of the precipitating events, and can quickly become a critical situation. It is not unusual for osteomyelitis to be diagnosed during the rehabilitation stage of treatment. This chapter will review the causes, signs and symptoms of osteomyelitis, as well as diagnostic tests and treatment. The role of the rehabilitation nurse in assessment, identification of signs and symptoms, and treatment will be included.
5. Joint Pain and Overuse Injuries
Pain in the joints can be complex in nature. This chapter reviews overuse injuries of the joints, an orthopedic condition commonly seen in patients who use wheelchairs for mobility. Overuse injuries related to wheelchair mobility are often seen in the wrists, elbows and shoulders. Risk factors, signs and symptoms, assessment parameters and diagnostics tests for joint pain will be reviewed in this chapter. Treatment will also be reviewed. The rehabilitation nurses’ role in prevention, patient education, and treatment of overuse injuries will be stressed.
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