Orthopaedic Nursing最新文献

Background: Ehlers-Danlos syndrome (EDS) is a group of inherited disorders affecting collagen and extracellular matrix proteins, which can cause skin hyperelasticity, joint hypermobility, atrophic scarring, and blood vessel fragility. Complications include joint dislocation, chronic pain, fatigue, functional gastrointestinal disorders, mast cell hyperactivity, orthostatic intolerance, anxiety disorders, and pelvic and bladder dysfunction, among others. This article discusses the orthopedic concerns and complications, diagnosis, genetic testing, and multidisciplinary approach to management in EDS patients.

Methods: A comprehensive review of the literature in PubMed was performed, focusing on EDS and its orthopedic implications, diagnosis, genetic testing, and management. Search terms included EDS with/without diagnosis, orthopedics, and management. Peer-reviewed journals were prioritized. Each source's credibility, findings, and level of evidence were organized by theme to synthesize the information. Literature within 5 years was prioritized. However, given the little information available about EDS, this was expanded to include landmark and highly relevant sources.

Results: EDS patients often have weak spinal muscles, deformities, and reduced column support leading to joint instability, recurrent dislocations, and chronic pain. Diagnosis is primarily clinical, but identifying the type of EDS by the gene encoding the defect in collagen or other proteins is essential to guide management. Physical therapy, pain management, skin care, and nutrition form the cornerstone of EDS management. Orthopedic surgery to address orthopedic concerns such as joint stability is controversial due to the potential for complications and should be considered only after nonoperative medical treatments have failed.

Conclusion: EDS presents unique considerations that must be addressed, especially when orthopedic intervention is being considered. Due to the unique symptom presentation, goals and care plans should be individualized. The orthopedic nurse plays a vital role throughout all phases of care and should be aware of the special considerations with patients with EDS. The focus of treatment should be on patient safety, symptom management, and the prevention of future injuries.

This study aimed to evaluate the differences in elective total joint replacement (TJR) orthopedic patients receiving discharge instructions from a Virtual Nurse Visit (VNV) compared to a bedside nurse. A descriptive, cross-sectional, and quasi-experimental design with a nonequivalent control group was utilized, using a convenience sample of elective TJR patients. A total of 111 participants were included in the study, with 40% (n=44) receiving discharge instructions from virtual nurses and 60% (n=67) receiving instructions from bedside nurses. The average age of participants was 65 years old, with those receiving discharge instructions from virtual nurses averaging 63 years and receiving instructions from bedside nurses averaging 66 years. Mean satisfaction score for virtual nurses was slightly higher (M = 4.88, SD = 0.41) compared to bedside nurses (M = 4.55, SD = 0.81), with a moderate effect size (Cohen's d = 0.39). No statistically significant differences were found in overall patient satisfaction between virtual nurses and bedside nurses providing discharge instructions (t (49) = 1.28, p = .205) indicating that both modes of instructions provided to patients were sufficient. Less than 1% of patients experienced a post-discharge 30-day ED visit, with no significant differences between groups receiving discharge instructions from virtual nurses or bedside nurses. Virtual nurses are a valuable addition to the healthcare team, enhancing patient satisfaction and optimizing nursing workflows during critical transitions of care. The consistency in satisfaction across demographic groups indicates that virtual nursing may offer an equitable approach to discharge education delivery.

Patients who misuse alcohol daily are at risk for withdrawal if they are admitted to the hospital after same day surgery. Most institutions utilize the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-AR) to assess symptoms of withdrawal. However, there is speculation whether it is suitable for general medicine hospitals as it was created for detoxification centers. As a result, the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) was created because the creators felt the CIWA-AR is too complex and timely for registered nurses (RNs) to complete. The investigators conducted a two-phase evidence-based practice study to assess RN perception of the use of the GMAWS tool. Following positive results of a 6-month pilot study, the hospital adopted the tool for use. After hospital implementation, most RNs found GMAWS quick and easy to use, and they believed it made caring for patients more streamlined.

This study aims to evaluate the incidence of calcaneal spurs in patients presenting with ankle sprains and to determine the association between the presence of spurs and the severity of the trauma sustained. Calcaneal spurs occur in 15-20% of the general population, and when symptomatic, they can have a considerable negative impact on an individual's quality of life. We conducted a retrospective analysis of individuals aged 18 years and above who presented with ankle sprains in the emergency department over the course of 1 year. A total of 3,667 patients with ankle sprains were included in the study, with a mean age of 36.6 ± 14.2 years; 55.3% were male. Calcaneal spurs were detected in 46.3% of patients, and fractures were observed in 15.3%. Surgical intervention was required in 4.6% of the cases. The distribution of trauma severity was as follows: Grade 0 (46.6%), Grade 1 (40.4%), Grade 2 (8.4%), and Grade 3 (4.6%). A significant association was found between the presence of calcaneal spurs and increasing trauma severity grades (p < .001). Patients with calcaneal spurs had significantly higher rates of fractures, splint application, hospitalization, and surgery (p < .001). Receiver operating curve analysis showed that calcaneal spur length significantly predicted trauma severity, with an area under the curve of 0.794 (95% CI: 0.772-0.816). The optimal cut-off value was determined as 0.75 cm, yielding 82.1% sensitivity and 62.6% specificity. The presence of calcaneal spurs is significantly associated with increased trauma severity in patients with ankle sprains, highlighting the importance of early diagnosis and comprehensive management to potentially reduce severe outcomes and improve patient quality of life.