Orthopaedic Nursing最新文献

The applicability of the phase angle in assessing nutritional status among older women remains unexamined. This study aimed to evaluate the usefulness of the phase angle for nutritional assessment in older women with hip fractures and determine the cutoff value for malnutrition and the minimal detectable change (MDC). In this study, a combined cross-sectional and longitudinal design was employed. A total of 138 older female inpatients with hip fractures admitted to one of three rehabilitation units were included. At admission, nutritional status was assessed using the Geriatric Nutritional Risk Index, and the phase angle was calculated by bioelectrical impedance analysis. At one of the rehabilitation units, the phase angle was also measured 1 month after admission. Data from 90 participants (mean age: 83.11 ± 6.79 years) were analyzed. The cutoff phase angle for identifying malnutrition was 3.975° (sensitivity: 0.882 and specificity: 0.740). The MDC was 0.768°. The phase angle may be useful as a screening tool for nutritional assessment in older women with hip fractures.

Patients with intensive care unit-acquired weakness often fail to reach preadmission baseline values of functional ability at the time of hospital discharge. Progressive mobilization is the use of mobility early in the inpatient stay with intent to maintain muscle mass and strength. The nurse is uniquely positioned to encourage mobilization as a primary caregiver who can oversee patient mobility outside of scheduled rehabilitation sessions. The adverse effects of immobilization involve several complex mechanisms that contribute to protein imbalance, muscle deterioration, and progressive weakness that impacts body systems. Immobility may lead to functional decline and the development of intensive care unit-acquired weakness that impacts patients for years to months after discharge from the hospital. The multidisciplinary health care team may enable mobility by adopting mobility care bundles, using mobility score tools, embracing mobility assist devices, encouraging time spent outside of patient rooms, using descriptive mobility criteria to identify mobility strategies, and employing mobility coordinators.

Background: Regional anesthesia is preferred over general anesthesia for benefits like hemodynamic stability, opioid-free pain relief, and reduced postoperative nausea. Its short duration may not fully address postoperative pain in orthopedic surgeries.

Objective: To examine the evidence on dexamethasone as an adjunct to extend the duration of peripheral nerve blocks in orthopedic patients.

Method: A systematic review was conducted. The heterogeneity across studies precluded meta-analysis; the SWiM (Synthesis Without Meta-Analysis) method was used to analyze data.

Results: Seven studies included in this review demonstrate that IV dexamethasone prolongs peripheral nerve block duration and reduces opioid use, with improved pain relief within the first 24 hours post-surgery.

Implications: Implementing opioid-sparing strategies can improve pain management and reduce patients' exposure to opioid side effects.

Conclusions: By extending the analgesic effects of peripheral nerve blocks, dexamethasone is a valuable addition to Enhanced Recovery After Surgery protocols, playing a key role in addressing the opioid epidemic.

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.