okay so this is mobility I call it Mobility because in our school we do it we go by con I think you guys too we do go by Concepts so Mobility must go skeletals the same time and some of this is my site some of it is um from other professors but same concept guys so um you know where you when you do your um clinicals do you guys take care of orthop patients um what kinds of patients you guys care for right now in your clinical well are some examples of the people you take care of I did the rapid go ahead okay detox usually or some people they had a sleep gastro gastric and like uh I had it like U edema last last time oh like a CHF like a CHF patient like a step down youit oh so you're doing like some advanced stuff like people who are studing for M sech too okay I'm just okay and then Rosana what did you say what kind of same thing rapid detox I did one arthroplasty most of your detox they put a lot of effort in that one oh a lot of cardiac stuff huh so you haven't been doing like much like um start from the beginning and do ortho stuff it's just whoever shows up so okay and what kind of floor is it just a like a a free-for-all med search floor or it's pretty small there there wasn't that many patients like my only had four patients and one was rapid detox so she focused on her one was arthoplasty for what the other two were so there's not like a lot um so sometimes like pre um surgical stuff or anything like that I think I know of one had a hernia but she left so not too much going on on my part I don't know if the others have a different experience anybody else I'm just trying to C I'm trying to I'm GNA try to gear this towards your clinical tell me some other kinds of patients you're caring for I had a patient who had bir really bad and then okay um another one was there for a possible a tumor on his liver and then I think the other one was also for a tumor tumor okay so liver stuff yeah you know what's so funny all that liver and G stuff is the part that's what the men search too did they just had to mum and all that stuff so and sometimes I could confus um I I actually know what each of you guys are doing but they have that's what their lecture is on that stuff right now so it's but but I wonder what their is their clinicals different than yours or is it pretty the same you see the other people I don't know because we don't see them where are you are you guys in South coasta no no we're at um Anaheim Global Anaheim Global okay so yeah I have no idea they oh I think one of them one of the groups goes to east east Del doctors I think well no that's the other group ahead of you I don't know anyway okay I'm just trying to figure out what kind of patients are taking care of so you can see this and um live okay anyway well let me do my best I can and if you see this if you have seen this before just say hey I've seen this before and you know but the as far as labs and care of patients it should be um there's there are some themes with this and there's some priorities but um I'll do the best I can and maybe some of you like some some of your lvm that you've taken care of these patients so okay so you know the skeletal system it's like basically the it's like the car has the frame of the car just like the um skeleton has the frame of the body um it allows the body to be weightbearing and upright you know and supports everything our organs our muscles and tendons and you know assists in movement and you know it protects the organs like I said and um and also we talked about in the couple past chapters there's Immunology it does assist you know especially with with proasis creating red blood cells and B narrow development there calcium we talked a lot about calcium and phosphorus and also the role and oh yeah okay yeah when you get into M two we're going to talk more about the thyroid system and this is what they just had a test on um calcitonin vitamin D pth and other hormon hormonal regulation calcium phosphorus so just kind of know this and you'll get more in details next term when you take Med search too so we know we have different kinds of Bones you have the long bones like um you know the the femur um you know ground end and bears weight so and you have the sesmic bone which is like the patella you know it's so round but many people have fractured it at different points and then there um the scapula the shoulder you know like at the you know by the shoulders um and then you have the sh bones like the fanges like the um these um little hand bones and the regular bones in the wrist and for for teeth rate and then they seem so small that when they fracture it is really painful and they could be um you know very um challenging trying to recover especially the the hand bones because you know that a lot of it we do um you know we do um you know we Rite we count on a lot of things so um this is important too so all these bones here so the difference you know we have tendons and ligaments ligaments is bone to bone so from bone to bone is a ligament and then tendons it goes from muscle to Bone there and you could see here um you know like this is like a lot especially anyone plays football or running or just in sports in general um you have um these these ligaments here um this is the the anterior you know people like I don't know if you guys watch a lot basketball or football and they say oh yeah I damaged the anterior crochet ligament and so they're always talking about this liament like a lot of basketball players and volleyball players damage this ligament and you have the posterior one as all as well and then you have the lateral ligaments here and then the meniscus here but you the bones in between so you know as we get older this is when things start to get tricky so but I've been very fortunate um you know I I'm not lately but I I have been a runner I have run over 11 12 marathons I I don't know if you guys watched the marathon the other day in the Olympics that was actually um I don't know if you guys watch the track but the marathon um the women's marathon on Sunday was actually pretty crazy because they were running it um they're probably running like a four or five mile minute miles for 26 miles that which is pretty insane itself and then the the F the winner came down to a Sprint at the end who who would you think about sprinting at the marathon after running 26 miles but um I actually got a little PTSD watching the marathon because I know how much has anybody want marathons here no okay you guys yeah you guys are Saye I'm not sayane I'm crazy because every time I ran a marathon looking why am I doing this why do I do this myself this is mile 17 I should be there watching um TV um drinking hot cocoa and the freezing rain but say I'm just running like half naked shorts running this marathon and I I did this once and and I broke my personal record just because I was so cold I just said I'm just going to run this Marathon really fast and I ran it in 508 that's fast for me I don't know some some of you might run faster than me but that was um 10 years ago I ran or 15 years ago I ran in five hours eight minutes but that's the I don't think I could break five hours I don't think I could ever run that fast anymore I don't know maybe maybe I can someday but anyway it it's a lot on these muscles and ligaments and so um as I get older this is the challenge of trying to protect these okay so the bones you know this you have the par um the different types of b um structures here you have the epithesis the DI um thesis and epip thesis the ends of the bones um here you know you can see how the bones like when you're younger they're they're spongier but over time they get they kind of get you're at risk of getting calcified and we'll talk about osteoporosis later especially how osteoporosis and menopause goes together so but when we're young they're all like fresh like that and then you know that this is the um when Pediatrics when you said Pediatrics we talk about the growth plates and when they talk about the growth plate they're talking about the EP epithesis here because when um kids are younger they have a growth plate where they um this are start to grow more and more here and this all this bone structure is very vascular and we as we covered before the bone Maro um that's where blood cells are created and the whole process is called arthop palasis okay you can see how vascular this whole system is so you know bone remodeling it goes this through this continuous process um there's a lot of Osteo blast activity and reabsorption destruction osteoclast activity and so everything you know this whole process happens till 35 it's like it seems like when 3540 when you turn that age your body starts to change a little bit as far as bones and everything and so after that age you know you have more susceptible gain bone loss and loss of the r of formation leaving um less um density less math that's the official word osteopenia the word penia is like um less of so your bone density is going to um decrease and it's more common in women than in men because of the um menopause okay so this is another little um so yeah I told you to get the bonesy density test when you turn 40 and you know be good you know I honestly I have never done a I should probably consider doing bones andity test but I'm one of those people I'm bar lucky to get an appointment um but it's it's we have to take care better care of ourselves and make a point doing that and here are some other things um this standard deviation this is more um statistics talking about comparing the bones patient's bone mass to that of a healthy um adult this is what they do for bone density and to keep your bones healthy you know a lot of it's most of it actually is nutrition that's why good weightbearing exercises even I'm not asking you to do like heavy weights but we should just do like walking every day um maybe even light weights those will keep our bones and muscles going for a long time and it's never late too late to do like minor um weightlifting I don't know you if you watch um social media that one lady um Ernestine she's an African um black lady she started weightlifting at 50 and then and and she's in her eights and she's still a stud and she does this body building in her 80s so Ernestine I forgot her last name her name's if you goog go Ernestine and weightlifting you'll see her in her 80s she crazy um started 50s and she was able to reverse free diabetes and um Can her heart disease and her risk into not having those risk anymore just from um changing the way she diets and um eats and exercise so anyway okay so I mentioned um the other bones you have the sockets the hinges like the door the elbow hinge joint there and then you have the ribs and vertebrae which is the semi-mobile joints and then you have the vertebrae here which is a like penous joints here and then you have the skull here and you have hip okay and this is important too especially the hip because we do especially if you work in the oan floors there are a lot of patients who when you talk about hip replacement surgery or just hip surgeries you know it's all you know we have to be considered that this area here and um you get some PE and then also the vir but you you are going to get some people with back um back injuries as well okay so joints is when two or more bones come together makes a joint um it provides movement and flexibility and there's three types there's the um one that's not really that's not movable that's called um sarro deal and then the one that's slightly movable is this antheor anthor wor I'm not going to ask these definitions but just to kind understand but this one the diodos novial it's freely movable that's the the elbow and they very common in diseases so you have the sovial joints here um you know the bone the synovium you have the bone plate joint at cavity here that's how it looks okay so the sovial again as we age it becomes more of a challenge there is this little lubrication um and we constantly continues to produce fluid to absorb all that shock and now I I bring up my Marathon my running because I know over time um your bones don't move as much that's why like you hear like like crcket cick and um even in your 30s I start to feel that way because I I ran a lot in those days and now I'm doing more hoola I'm gonna start that up again um but you know over time you produce less and less of this um lubrication um it's like a shock absorption here okay and then you have collagen fiber um here and then over time this becomes less and less and then you have inflammatory arthritis and um breakdown Cartage as well sorry I got to check this I just got a message okay so you have the um the ball and socket joints here um you know the permits to move in any direction and then you have the um the the gliding movement here this is for the wrist so you can see enhanced joints so just to kind of give I'm not going to have you memories just but an understanding you know you have you know the how it pivots how it hinges gliding um ball sockets and saddle okay yeah hold on okay so with the fractures let's talk about fractures this is will be important um for exam purposes we'll talk about the description like the other stuff I'm not going to ask about the exam just more about this stuff okay FR devices use in fracture healing today um you guys mentioned about the fixator and um treat me treatment for fracture healing as well so this is okay so a fracture technically is a break or disruption in the continuity of a bone that often affects mobility and causes impaired comfort and there's two types of fractures you have the complete fracture where it completely breaks that across the with the bone in such a way that it you have a when you say complete break that there like instead of one complete bone is two separate bones separate sections where you have the a complete fracture which you'll probably see a lot in like in the older people in the nursing homes especially those kinds of patients that especially the ones with fall it does not completely divide the vone in two portions because The Brak is only in one part of the bone and you know a lot of do you guys take care of a lot of older patients it sounds like you take a lot of of acute care of detox and stuff but anyway but they're more Su especially the patients who are more susceptible to Falls um you know you got to um be careful with this okay so you have the incomplete and the complete okay so with the open fracture is the skin um surface over the the broken bone is disrupted it causes an external wound and then the closed fracture does not extend through the skin and therefore has no visible wound so you could see it with the open fracture like when the um you you'll see some skin breakage it's causing it it's a a fracture and a room where the clothes it kind of contain in that skin area I can't remember in your case it was it was it a closer or open I can't remember what yours was but um send me yeah post your when you have a chance post your Google doc or send it to me so we could share it you know maybe I'll get some questions from there okay you can put in the chat if you can and I'm going to show you this slide um so my friend I have a friend I found we met on Facebook one of our groups and she um she had a she has a son who was in this really major um boating accident and so um he what was it called um speed di well in in a boat and he got his hand jammed into I don't know the motor or something so you can see how bad it was so this is the hand and you could see all the the both plate so it really broke in half so it was pretty messed up and I can't remember it's the right it looks like it's it might be the left I think it's I can't tell any yeah might be the left it's the left hand it's the right hand it's one of them anyway but you can see the bones there it it was pretty pretty extensive and it took several years to kind of get it half normal but when it happens it was pretty messed up um they had to do emergency surgery and they they live in Washington state so um but I think they were they had a I don't think they live close to Seattle but they had to go to Seattle and get these major surgeries done okay so this is how it looks now and it looks a lot better even though this one's curved but can you imagine it looks so much better than that's before and that's after but I think the fact that he's 24 years old and his epithesis here because I think males are still growing technically to the age of 25 26 so if you got your young men here and young women but especially the young man um there's still hope for you you could become come an NBA no okay but if you're 25 but um you're still growing so you can see here thanks to him being 24 he was a and also fantastic surgeons he was able to kind of get it semi-normal but this is due to a lot of reconstruction surgeries it's pretty amazing to go from that to that crazy lots of therapy lots of pain medication yeah another one too you could see you know that I think because the epithesis was so healthy it was able to regenerate and able to kind of work together and they were able to ship it's amazing what orthopedic surgeons could do you know especially hand surgery I think can is pretty amazing and here too okay whatever yeah so let that see that okay yeah so yeah this is from what so this is was like in his um recovery stage I should asked my friend if she has updates of his hand so I could upd this PowerPoint This was um in 2021 20 so this is three years ago so I met her during Co right before Co hit that um yeah this is crazy you see that right yeah but it looks good you can see all the sutures here okay so and I think that was once a open fracture because it did extend beyond the um the skin so this is an example of a um close fracture so that looks like that and I didn't realize it time 24 let me see and this is how it looks like someone else like um gave me the slide from another patient so if you have cool slide share with me I love to share these St slides look really bad that's pretty bad that's um that kick um I don't know if you watch MMA but one of the kickers um Anderson Silva many years ago um he was in this um I don't know if you guys watch UFC anyway he had he he did a front kick to his his um opponent he was doing kicking because he does he's known for his kicking as well as his sparring and everything and jit's grappling and so the guy his opponent kicked him right when he was going for the front kick kick him right there and I think his Breck was similar to this like the the tibula and the um the femur can you m oh and so and you could see the bones kind of going through the skin I was just like cringy and I'm pretty strong but I saw when I saw it happen you could tell it was for someone to kick that strong and break it like that on the KP it's insane look at that okay let me see where I'm at and I think I like you guys are all going to the bathroom I see all your post but um okay yeah so I I'll stop at this slide and then I'll let you guys go so so the national patient safety goals um we did they did um create some goals like CLI to risk with osteoporosis um you have the dexas scans and then um most common fractures you know um is the r and wrist and upper third um so MRI is very accurate and and noting this so this is just some of the safety goals um for The Joint Commission probably because of the risk of Falls we're trying to control um falls in the hospital and this is interesting it's not common uncommon for a patient to to person to with six inches yeah because like I just when I went in for that CAT 5 to urgent care they said that was 53 I 53 I was I used to be 55 and a half maybe I am 53 maybe the way I was standing but that's just part of aging we kind of go you know our shoulders slag like that okay well let me give you a break why don't you guys come back at um it's 7:15 is that good you want to come back at 7:15 okay come back at 7 15 guys thanks thanky say had a lucky for me okay did you see him C I just see what kind of doggy is it a k oh where are you can you okay I can see something happened to my okay hold on oh I can see I can see I L if my con comes on camera oh how cute okay I can't say hi hi say bye look at shake your head that's okay oh you're so cute yeah he my if I see my Kaa I'll bring her online she's kind of she's I have to see where she's she's probably outside somewhere when he get bored he always at this time he likes to go out that's why he just trying to show up to me himself I call this the kaona hour because she had to it's not quite it's only four o' here but at six or seven that's the con hour it's like she's a doodle so she kind of goes nuts oh but I I'll try to bring her I'll try to bring her online when I see her yeah yeah okay okay see you pet it'll be pet sharing day days okay okay okay sure okay mother e K you bottoms and you also French it's take us at least that's why I'm going to fix it for you like just give me some time man forever well I'm trying my best I don't know what you want to I I actually don't have a manager I actually R this do you want the's phone number f no I'll start iils absolutely adorable but I did have a portable I and only a sticker for flooring but it was this is a client point of view back in 2020 and then that's when I found out doing nails was my passion I ended up graduating high school with the scholarship to University until life hit me so hard and I reached the lowest point in my life I completely let myself go until I realized that my personality makes up my personal reality and I had the most wild yet beautiful self-discovery journey I lived on my own worked from home and absolutely loved it before upgrading my space into a nail Suite one year later and m to use FACS the the moment I put them on my nails and now I just want to take them off don't look at me when I say this but usually I RI them off I ripped them off okay I literally and I shouldn't so I got this this is what it looks like looks like making a little so that the liquid go inside I just got new nail polishes I'm trying to upgrade okay so I got D I got a top coat I kind of really want to do basic pink nails I know how boring but this is like the perfect pink look this is in Coral Castle and then I got pearly pink and this is going to be my new Face coat I think it's going to be perfect okay let's see if my nails are ready this might be a game Cher takes a little bit of work comes off this one might need just a little bit more take your time and they I'm actually happy with this now it's time for nails the put on my nails I'm going basic I got this color and I want to dip all 10 of my fingers in it currently it's 11 another day another episode of Gossip Girl the way that I'm ready this emoj I just already feel the energy coming from this color I think this is the most beautiful color ever do I add something to it do I add a little bow there's the bow but I kind of hate it everybody say bye to the bow I'm doing this I love them I love them I feel like a princess right now like hold on let me hold something these are the final nails and I can't wait to send text messages it goes with the Apple watch the mouse imagine you see the vision is for Gra for down you for for e for she my everybody I'm sing back so it's 7:15 guys okay I'm just trying to keep my time it's 4:15 here so okay um any question questions stories from ability broken bone stories if you have any let me know um and we'll keep going I was just looking at the ATI right now um not not for your for my class actually at uh Hilo because they changed a lot of um it's very sophisticated now this atti that's why I get confused at the um the different types of modules you have to do and so I'm trying to finalize my class that I'm gonna this my main my main gig my uh Halo gig so I um going to be teaching OB that's my first love you guys so nothing against Med search this stuff but I I I really love maternity um I didn't when I was a student like you but now um after being a labor delivery nurse and working it for a while and I'm I'm still going to school as psych I actually do like psychic mental health so I think for me mental health and OB is like a perfect marriage for me I I like those Specialties but M are just fun too but um you guys are young so you guys can handle all the emergency room stuff and Med search but um um I do like I do like babies I don't know that's just me and if you guys ever want to work in labor delivery let me know I know all the good I know the good places in Southern California scary places good places I know some um nurses yeah sh sha what's up what's up please keep me in mind do you like yes you please keep me follow yeah and you guys could follow me on LinkedIn after or Facebook or whatever I don't sure thank you yeah because I have to wait after you officially graduated it's like okay you could be my friend now but yeah um I love maternity and that's why I got I get all Goose pump being excited talking about maternity I mean this is okay too but sorry I I do like the babies and the smell of fresh babies is cool so um okay but back to Broken Bones I'm okay with broken bones too because I'm an athlete and watching the Olympics inspired me um not to work out though they're young they do all that stuff but I'm telling you if you could watch on peock that marathon Race you don't even have to watch the whole Marathon just watch like the last two minutes that was crazy and I would love I've been to Paris twice but the sites were beautiful I it was pretty amazing that whole race but I I should off I gotta um find my power again I was doing some stuff before you guys okay here we go let me we go back to our bones which is is good to just not not quite OB but it's okay so anyway we'll talk about the different types of fractures um we have like the fragility fragility fracture and so that's usually like the older people usually get those like the people even if you're not don't fall like it's so fragile and you have all these um comorbidities like kidney disease or osteoporosis it could just happen like you know you see like some people like women especially oh I have a pelvic fracture it's just because their bones are so weak and so it's just spontaneously happen and so that's why it's so important to keep your nut nutrients up keep your diet up and then you have fatigue fracture and this is uh athletes a lot of athletes have this and um I used to get shin splits a lot when was in track and I didn't I was not eating very well in high school so um that was a different time and back then when I was going to high school they didn't have all the the nutrition stuff that they do now um you know all these kids with nail contracts and everything it's very sophisticated but back then it's just like okay you get you get what you eat but that's that's the fatigue fracture you just repet repetitive and you're just using it over and over again and then you have the compression fractures you know um you know just forces on the cancelous bone especially the vertebrae people with osteoporosis and these this could be very debilitating and you are going to see people with um clotting back problems and those kinds of issues with compression fractures it's lifelong and you know you see people you know who needs um pain relief and this is where people become addicted to opioids you know with the compression factors it could become chronic if not controlled um the way should be controlled okay so this is yeah you need to know this for your um quiz or test I know there's questions on this part so stage one is within the first one to three days um after the injury and right away as soon you know you fracture that bone he the hematoma is going to happen and all the healing process start right away so that formation of hematoma is the start of the um you know replenishing that bone and trying to make it the way it was before or even better and then stage two and after that hematoma forms it's going to go to this next stage where it could be for the first two weeks where um right away when the granul tissue begins invades the hematoma like it's just more like this integration of tissue and the that tatoma it's really starts to form and take shape and it per um this thing called fioc Cartage and that is the foundation of bone healing fiber Cartage might have interest coming out here we go so this is the first the five stages here the hematoma um forming is the very first stage it happens like instantaneously as soon as the injury happens and then two eventually you have this little like tissue kind of forming around the and inflammation is going to happen when you see inflammation that's just the whole process of trying to um recover and trying to um heal that area there and so you know the inflammations the First Defense and you're just trying to rebuild here rebuild the vessels and the cells everything that's affected and then after two weeks you have the callous formation and that's new osteoblast the the bone building cells and the osteoclast the bone reabsorbing cells so together that's what's needed for the bone remol process especially when you're young um this happens right away and I would I would assume that people with diabetes they this this could take longer just because they don't heal as well as the as the healthy person and then stage four is called consolidation and it's not the permanent bone but there's a softer bone called woven bone so it's like it's like this in between bone to the real bone and so you know the stronger bone comes it's going called place of B it's just like a it's like a a transitional bone that woman bone and finally bone you know the bone remodeling and you know and you have this brand new bone from here and it could take you know months to years like my friend's son took years with that Pan um and I don't know Anderson Silva I should look at that to see how long it took for his leg it was I want to say was like a couple years CU he was out of commission and he was still young enough to fight but he was out for at least a year and a half it was crazy and this happened about 15 years ago I was in Vegas I was at was not fight in Vegas but I was in Vegas when I saw the fight on TV and um it's so funny because his his kids and my kids they're about the same same age I think a little bit older than my son they're their 20 so he he's I think retired um but he is from he's like in the South Bay Area he was living in the Dante Beach area for because I used to see him oh yeah he's at the mall oh oh yeah cool so we all get you know like the celebrity studying him and we see Kendrick Lamar kendri lar oh yeah cool but um we used to see I used to run into my not me but my my son and um husband's ERS so but that's cool that's the five stages of healing and then you know this continues this PowerPoint and then final stage could take year months to years depending on the um the condition in the health of the patient so you know when we're assessing the fracture the new fracture you know you um of course you're going to assess like the condition but you can assess the overall condition of the patient the ABCs you know are they breathing especially if they're in the traumatic um like a car crash or even a plane crash or in a motorcycle most likely happens a lot you know so what caus what caused them to come have this condition and so you want make sure they their breathing stable their heart stable are they getting enough oxygenation you just do this head to toe um do they know um you know orientation times for their name where they're at what time it is you know just all those things and when you become a seasoned nurse this will come easily to you and no matter what specialy you go to whether it's SL delivery or M surge emergency room you're going to be doing the same assessment stuff it's going to be the same no matter what specialty you decide to Branch off on but always check for the airway breathing ABCs and then assess the the condition of the fracture and depending on um the severity of of the patient coming in you can ask them questions too like um you know you have history of other diseases do you have a history of anemia for example and um you know whatever happened you know you can do your SAR you know what is the um why it happened you guys do a lot SAR in clinical you guys do that every week SAR okay good so I just say you guys know what SAR is okay so you're going to do your SAR and then you're going to make sure um if especially they're coming through the emergency room they're going to all get they usually all get IVs because they're probably going to get some um fluid some fluid replacement and electrolyte replacement too and right away to no matter where the broken bone is you're going to do some like type of splint uh you know just to to immobilize it and usually when it's a fracture I would say high probability they're going to go to surgery and try to um put it back together or try to um hold it together they use this um these different surgical methods and we'll talk about that in the later slides here so the fracture management you could have it Theo there a Clos and open method so the Clos method is the most conservative method and you might start this at the very beginning um it's just um just to make sure that something's happening you want to keep it as a mobilized so it could allow for proper healing and so it could be involve a boot or it could be even just something as simple as um really type um bandages or tape um is splints you know cast traction so you you know and then the main thing is this I should proba um highlight this is is the assessment of neurovascular dysfunction or compromise so the care for these patients especially in the very first hours after the surgery you neurovascular assessment is a must so and then we'll go over the neurovascular assessment in the other slides but that's you're going to be U besides doing the other stuff like the AY breathing you're going to be assessing their um the neurovascular assessment and every um floor has their own particular protocol regarding your vascular assessment and before we get into this there's there's this thing called rice this is like when you get into sports injuries um this is one I things they do Rice so you want to like it's a boner ankle and the broken bone even arrest the injur for the 48 Hours you want to ice it for at least 20 minutes the time 4 to eight times per day I mean people I know you hear people oh yeah I did it for 30 minutes but that that's a little too long but if you could tolerate 20 minutes is great if you can you know do it frequently throughout the day it it kind of um decreases the swelling and then it it it helps things along um from getting worse so you want to ice it and you want to compress it with a tight tape or splint to reduce the swelling and sometimes what they do too like um if it's not broken like like for the ankle injuries and my son played a lot of basketball and volleyball um he used to wear like he wore basketball shoes for volleyball and they they try not to take off the basketball shoe especially if it's an ankle injury because once it becomes an ankle you know an ankle injury it just balloons up and you can't put that shoe on again so they just tie that shoe that shoe as tie as possible and try to immobilize it the tape and then you want to elevated with the pillows don't put theill never put it underneath the knees always kind of like from that calf area below is where you put the knees the the pillows and six to 10 inches above the heart this just you're trying to um make sure you get circulation to that injured area so they're um traction too is another way if they don't do surgery it's just a more consider way that they're going to um for the bone ends so they align and traction it could be painful depending what it is especially if it involves the leg bones and they probably would use some sedation and also you know and maybe some monitor the O2 SAS to make sure that they're not in too much discomfort when this happens and they have xray to make sure that they're um that it matches um whatever they're trying to immobilize so it could be like this um a lot of kids um you see this when you work Pediatrics I remember that was one of my my rotation to Children's Hospital I was very fortunate I didn't know then but I was fortunate to go to Children's Hospital for clinical I went to ausa Pacific that's where I went to nursing school and I remember going to Children's and I remember all these little kids with the little hip um their hip congenital diseases and they had all these injuries and I just remember the little [ __ ] the ones with the little kids with their um you know their up in the air like this like ATT traction and then they allow them to go to the bathroom but just to be like that just crazy but um yeah that was one of my memories a Pediatrics that but for traction this is you should know this definition it's the application of pulling a force to aart the body and to provide um you know reduction alignment and rest okay so that's the purpose of ATT traction and it's you reduce muscle spasms with the traction and with the traction it reduce it relieves the pain as well it relieves the pain reduces the muscle spasm it also corrects the deformity and the tissue damage it helps that process the traction very lining up things um level and usually when they're in Trac they usually don't go home like this they're usually in the hospital um when they have this client suppli to them okay so there's different types of tra um traction there the running traction it's kind of like this um pulling forces in One Direction and the body itself is the countertraction of it and then you have the balance suspension and then there's some weights involved so you don't have you never have the weights on the bed but it's providing this countertraction so it's not altered the force when the bed um the patient's moving and with the balance suspension it allows a little bit more um movement and um you know for the patient and then here's another type there a skin traction too you know you have that this little duckle thing and tight a sprp and again you want to prevent the muscle spasms um especially you know accompany the hip and human fractures and then and then the weight is used as a as a pulling Force here so this is a skin traction and then you have the skeletal traction where the screws are surgically inserted in the um bones and so it would be like um like I think this would be skin Camal russle traction and then you have the balance traction it's simple and it aids in bone alignment and moner impair tissu integr it's cool when you get these kinds of patients because you get to do pin care and I I my um I actually my um the very first rotation at our hospital here in Honolulu was or orthop Flor and so we all got to take care of um they got to be experts in um knee Replacements and hip surgeries and it's like oh yeah you guys it's your turn to do the to do the dressing change like okay they get out excited and then they get to okay you get to discontinue the poly Happ there I mean simple things make students happy and that was one of them changing the dressing replacing the dressing and doing pin care so they get to do all those things and that's what I hope for you guys if you ever get some other patients we can do pain care and those things it's it's actually pretty good it's it's actually nursing um place for nursing to start off with or stay forever so the things that you should consider is the provider will write a prescription of how much weights are needed for that you know depending on the patient's body weight and the injury so he calculates the weights out and never allow the weights to rest on the floor they should be freely hanging um if they're on any distractions at least every eight hours they should be assessed for signs of irritation or inflammation so sometimes you may have to remove the belt or boot just to make sure to see what's underneath there you know to give some you know um some circulation and then also if POS they are on a lot of payments these people and so make sure you give them and usually these days like the first couple days it's opioids and then after that then they use the nonopioids and then they use a combination of like the the opioids and then they use sometimes tar cting or they try to get them off the purpose set eventually but some people are just addicted and they they're on it for a long time they also give Gap Hinton a lot um this is the multimodal approach is what they're using these days and sometimes the muscle relaxing as well okay so you know we talked okay so we we mentioned um the boots and we mentioned um you know there is some special shoes you could wear and then upper extremities there's weight bearing devices they don't do like for the arms and stuff they don't do I hardly ever see tractions for the arms it's mainly for the legs and then um so cast you see you probably see cast a lot they cast a lot of kids even if they don't really see the um the broken B right for kids they cast them especially if they can't see because they have a they may see some they might be affected by the growth plate so they want to mobilize by the way and so they use cast to correct deformities we have to look at tissue Integrity especially um for arm cast elevated above the heart be swelling ice is really important the first day or two after cast replacement okay um L Lake cast they may use things along with Walkers and crutches along with the F blockers and cashes should be utilized along the cast The main thing is neuro um neurovascular assessment um every hour so um let me just ask somebody here or anybody maybe can volunteer so just for neurovascular assessment what kinds of things are you going to assess how you going to do in your vasc assessment can you tell me some ways I'm checking if the checking if the um they can move their fingers or their toes okay yeah and you want to compare with the good and the bad so maybe they can wiggle their toes or um you know the range of movement right and they they do they have like a when you take care of these patients they have comparison between the good side and the bad side affective side and how well they could move YES Movement what else do do you want to check balance if if it's nonweightbearing weightbearing yeah okay balance but I'm thinking about other other key things with neurovascular so movements maybe um symmetrical you know one side could move more the other so we got that covered but there's like one or two key things for neurovascular assessment um just think about it anybody like circulation if it's red okay circulation color so you going to check the color and what else color and there's something else like you know you want to make sure it's not pale okay you want to make sure it's not black that's bad because that's necrosis like okay there's something wrong there but you look at the color but more importantly besides the color what else are you going to be checking the cap refill cap refill yes definitely so you can check the cap refill of the toes or the um like if you have a knee injury or hip injury you can do um capit refill at the toes um especially and then also on the fingers that's too especially for arm injury so you check the cap refill and then there's um what other things you going to check besides for neurovascular assessment is it sensation yes if they feel it yeah that's definitely um yeah so sensation you going to compare and there's a couple two key things that is really important that you're not getting yet just think about it which one temperature if it's warm or yeah if it's cold like oh there's something going on so you yeah definitely temperature you you check and compare the Good Foot and the bad foot you injured and the healthy the temperature of it and there's something else you want to check I don't know very very important think about it syndrome Yeah well yeah that's yeah you're getting really sop yeah compartment syndrome there that's one thing but I'm thinking a little bit simpler than that something very simple but very important to check when you're talking about Limbs and um your vascular circulation huh circulation what do you mean Lucas how you check circulation Lucas how do you check it do um just press oh I don't know how to check you got it press what what you going to press press the feet to see yes it bounce back like what bounces back just like you're checking Eda ad okay and Gina what were you saying I can see you before your your pictures before Lucas what are you thinking Gina um the PED pulse that's it thank you thank you okay pules okay can stress enough and yeah you're so close look it's like I go it bounces back I go what bounces back okay and I just want to tell you I want you guys to get it okay pulses I can't stress enough aedo pulses and um especially when you have a cast placement on the Good Foot and the badot you have to check they have to have pulses they don't have pulses the cast can be too tight or something's going on wrong with there okay yes and then discoloration and temperature you're also could be concerned with blood clots too right so all those worries with these patients blood clots um the the pulses I did have a patient um I was very early in my nursing career I I did work a good um good good cican hospital downtown LA I I was in the um ICU program because I thought would be quick care N I hated it it was okay but I didn't hate it I didn't love it but it is not my labor delivery but I just did it just because I wanted to be a rail rounded nurse and I had a very difficult patient um not difficult their their behavior not Behavior but just carewise it was so challenging it was almost like a two to one patient there's just so much going on with that patient and so she I don't um it was either the right or the left leg and I did check the pulses the best I can but and she was just getting these um platelets constantly she was just so bad off but eventually one at one moment I don't know what hour of the night she lost her I could not it went from like um One Plus to very Pap B to Doppler and then I couldn't feel her pulse anymore we had eventually amputate that leg so I would never forget that and now that's why so then that was one of my examples in my career thinking so important to do neurovascular check the pulses of course you're going to check the edema you're going to check the um move symmetrical movement or asymmetrical movement you're going to see um you know all and color you want to make sure that they're warm not cold you don't want to make sure they're black that means that's bad that's necrotic and then you know just all these things together makes up neurovascular assessment you guys did great so a good job so the complications from cast so again you know it could be too tight and also infection could occur underneath the cast and and there could be this pressure part in the um pressure necrosis they report a hot spot and so um with the hot spot um if that's the situation then the they could um you know that's not good so they're going to have to reapply the cast take it out and do a new one and so you teach them how to self possess for circulation uh making sure that um they have to report any nerve damage or if it's too tight um decrease profusion and then some complications after removing cast because you're kind of contracted for a while because you've been like immobilized for so long and sometimes like you lack bone um development meaning that it's compromised you're not um the bones are weak so there is a minor condition of osteoporosis if if you're not in that menopause age of you're um a male or you know not female and but you velop this temporarily because you're in this cast for a while and there's also chances of muscle dis atrophy and osto arthritis as well so you want to teach these um patient okay so that's that's that's cast care okay that's the complications there and then we'll we'll talk more about it in those other slides but um that's it for now so you want to also teach patient and um about anesthesia payments um and I think you guys talked about um a fix your patient have did they have or I can't remember they did have some type of fixator your patient I in your case study but anyway this is one way this is the most common way they use it's called or open reduction internal fixation surgical management it's the most common way to um reduce immobilize the fracture and this is is the surgical proced this is surgical so 95 the majority of patients get this on Ora and so the advantages of this is that the surgeon could they go in and they see the the fracture side and with this in um fixation um they could they could also use metal pins and screws rods plates or prosthesis to immobilize that fracture during the healing and they usually they them a cast or a boot or splint um is maintained to um immobilize during the healing process and when the bone a Chiefs Union the metal they take it off it's a it's a process and I remember my department chair at um my the Comm College I used to work at she broke her ankle bone and again this is what happened when you get old and I wasn't sure about her um she tripped with her backyard was full of stuff and she tripped over something in her backyard just walking through her backyard she TST her ankle and it turned out to be broken I don't know that's just crazy and she um it was like the towards the end of the school year there's a lot going on trying to finish your grades and trying to do this and it was like towards the end actually it was the middle of the OB class I had to take over her lecture it was a lot but um she had this happen and she was bed bound for months yeah she was bed down and so um and it depends on the health of the patient and the the extent of the surgery and so but usually like when they come U I do work in the open floor I used to I'm not going to do it anymore they they keep calling me the hospitals like I I I have so much going on but they they usually go through the ER and it's so much easier they go from ER straight to surgery back to the floor but sometimes they go from the ER and they they go straight to the floor and then they wait um for a time where the doctors could operate they take them to surgery and then back to the room so that's the way that they usually do it but they get admitted and they have surgery within that um less than 24 hours later maybe like less than 12 hours later or less than that depending on the situation and if they have a surgery team so external fixation they have pins and wires through the skin and used for upper lower pelvic fractures and then when you move the the fixator the affected body is placed in the cast boot or splint healing is complete or they they have an internal fixation it's not as um aggressive as the internal fixation and the good thing about the external fixation that you have less blood loss and you do um allow for early ambulation on the affected body and you do M you know it still maintains alignment with the close fractures and but the the disadvantage is that you you still have to do pinside infection there's a chances of infection so you still have to clean the pins and so this is important so our our care for this posttop um or patient again they're going to start start them um opioids the very um couple days and a lot of times too they still send them up with the um PCA pumps a lot of times they're fentel um they put them on fentel and and there the doctors these days are very cautious about continuous but if they do continuous it's very short live it's just like the first like 24 hours is continues then after that it's on demand um for the for the pcas and then eventually they get off the PCA pumps and they could give them IV um to doll and so the key thing is they want them they don't want this to be a chronic pain so they are going to attack the pain pretty aggressive ly with the opioids and at least the first two or three days they're going to Round the Clock treatment with pain and the reason why you want to get the pain under control is so you want to get them reh rehabilitated faster and um for early mo mobility and you know they want to put them on external fixator um for the pin sides and then clear fluid drainage or beeping is expected normal um yeah so know that it's so if you see um get a question with clear food drainage that's a normal finding but if it becomes not clear fluid if it becomes see something like green color or cus color or red that's a sign of infection and that that could be a test question I'm not know if it is but that's just examples of test questions you might see if you want to make sure you um but the early stages clear fluid that is normal but it's when you see different colors other than clear that's not Norm and you want to advise the patient um with the changes in body image and provide um Psy social support and the the key thing with Mobility I you back in the older days like you'd see people kind of up you know well unless unless it's like my my friend who really had a complete break but they do everything they possible um to get them up in physical therapy because they don't want you know because you have a risk of um blood clots right if you're in bed for a long period of time because even if you're um sitting up at the edge of the bed or you're dangling and you can't put weight on it they they're going to try to push you to get up to be some type of Mobility as as early as possible and um I can't stress that enough because you don't want them to be contracted you don't want to lose um your muscles and so it depends on the patient's motivation and willingness to do physical therapy the feel good good physical therapy is key here and occupational therapy too especially if they don't get back to completely normal you might have to bring occupational therapy and um the physical therapy is pretty good because they come in and this is where I I kind of no this um the very first day after surgery they start slowly um what are some things like when they um this is a good test like when they are starting to get back to normal whether are some kinds of nursing considerations just name one or two things um that you're going to be concerned about for this patient trying to get up for the first time since the surgery just name one or two main ones anybody Oro hypo T yes you got it Ortho hypotension orthostatic hypotension okay that's going to be the number one consideration right because um they get up um even sitting in the bed like oh I feel dizzy and that's the most common problem you're going to find in these patients orthostatic hypotension I can't stress them enough um so you're going to monitor that um and you probably have patients like that in the hospital that has her risk for that and then you have to be kind of wary like okay what kinds of um if they're if they have paid medication you don't want to be emulating them um you know till their systolic bre pressure go up sometimes you might have to hold your blood pressure meds if it gets too low there might be some doctors that might hold blood pressure next if the systolic is below 100 um or you never see it like the opposite really high at least we have medications to control high blood pressure but most of the times you're going to be concerned of too low of a blood pressure especially if they're on these pain meds like toll or fenol they tend to have lower blood pressures and you're going to have to watch out for that but orthotic hypotension is the most common thing you're going to watch for these patients yeah okay so I'm going to start talking about the reg generative um a is the first one um um so Al that's very common happens I think when we get older or even if you're athlete and then you eventually get this and so this is like you know time and just constant um pressure on your knees and um joints it's basically the progressive degeneration lots of Cartage and one or more joints so you like especially in this area too this starts to deteriorate this articular Cartage over time and you know I mentioned about the sovial fluid we get lots of fluid here to keep everything all lubricated but over time you produce less of this and so this cartilage is not going to be so like limber strong it's going to be like a little flaky and so what could happen is that this cart could rub off and then it could just be bone on bone which happens to a lot of people so like a lot of people try to prolong having these knee um knee replacement surgeries because they don't they they feig that oh they don't want to repeat if this happens but then this the downside if you wait too long then it you can develop a um complication later with you know with this and so happened to a good friend of ours he may have waited a little too long it was so bad because my him and my husband were like best friends and they used to go on these walks together and what really hurt him was going down the hill and so what happened is this cartilage it it was like this I kind of probably was destruction the cartilage so I think he got to this point you don't want to get to this point so you kind of want to get to the point where you have some cartilage before you get a knee replacement so this is what happen so you have the the bone here and you have the cartilage and then so these cartilage remnants it kind of like kind of float off into the area here and it destroit itself so yeah it's a it's a pretty sad situation and um So eventually people get knee surgeries and it depends on the a um okay that's other slice talk about other things affects ostearthritis development so inflammation the cartilage could also what happens if this is inflame you could have bone outgrowth spurs to form around the joint so this is like you know around the cart you have these little Spurs forming too like these little bone um H hypertrophy because they're trying to um compensate for the loss of cartilage so when they lose the Cartage the bones here starts to hypertrophy so they're just trying to compensate for the lack of Cartage in that area by kind of gr these outo of Bones things of that so so these are some of the triggers um they're aging you know we get older um genetic factors you might there is some genetic Tendencies obesity causes joint on degeneration in the knees here's that thing smoking again I'm going smoking causes everything so um yeah smoking again um trying to remove the um oxy ruin the whole oxygenation of the blood and everything and excessive use athletes carp layers there there is um risk for this and Trauma as well so like the weightbearing the hips and the knees the vertebral column the hands especially mechanical stress and weight over the years and affects women more than men probably because of the um the menopause and um let's see this more okay so yeah you know the whole weight thing too because like we you know every 10 years we slow down and so even like 10 or 20 pounds in um pressure on the knees that that that's a lot for your body to um to handle and you know working as a like this unall nurse in the earth of Flo um I I see the people are becoming younger and younger I think I uh usually it's just like I'm seeing people in their 50s and even in their 40s getting knee Replacements depending what they they did I see like a lot of like ex football players former football players who become you know especially the ones who play defense they were big to begin with but what happens that they let their weight go and because when you once you stop doing a sport you just tend to get weight because you don't have that metabolism you're not constantly working out anymore as a football player so you kind of build weight and and then as a results um I do see a lot of like ex football players as patience over there and that's the hospital I work at and so yeah and and there's some Runners too but I've been fortunate I haven't not not been so bad but what you see for ostearthritis you see joint pain mild severe and there's this thing called her herid and node here where you see this little inflammation and then people are going to say they know like uh oh it's cold the the joints feel cold or when it's raining like when it's rainy weather cold weather it hurts especially more at their joints and you know with the early stages are it it comes chronic and sometimes nothing helps unless they rest and so they get Siff you know they get joint stiffness as well first 30 minutes in the morning um you know it's slow to rise up and and my husband you know he uses he uses the machine gun he he machine guns his joints every day which is probably not a bad idea I should probably do I mean he does his whole body and I I should probably do that that I I'm so bad at he said that but I should and crepitation meaning like this grating of car cartilage yeah so that's how it looks like that so the healthy knee and then um the not so healthy knee you can see the Cartage is just gone yeah this Cartage is like this and now it's like that and you see the little bone spurs here and then also especially in the hips too especially at the women here you can see all generation of the cartilage the Bing socket area there and then so you could do some diagnostic tests um ctmri to diagnose this they do x-rays as well um to see how the the bone development the osteop formation bone sclerosis um very specific they're good they're good these x-rays sadly ostearthritis is degenerative it's chronic the the key is to manage the pain and inflammation and this is where gets tricky especially when you get older and this is why it's so important including myself to be to take care of ourselves to make sure we do something weightbearing and I proba I was thinking about today and I I kind I had to wake up early for a meeting at 7:15 because it was main that hours and um that's a little early for me 7:15 um but for them was 10:15 um even know they're in in Florida so it's like 1 o'clock their time but I um kind of got off the wrong start today but I I would I intended to do yoga because before I went and took that long trip to California I did every day but I'm gonna get back to my team and um I'll probably do it tomorrow do my yoga and exercise because you got to do something every day because toing vent this from being degenerative because um the pain management um I was celing some patients the other day when you when you rely on on inets like um ibuprofen and um Tylenol they're so bad for your kidneys and your liver because your liver and your kidneys can handle so much so that's why another reason why to try to kind of attack his head on and be active even if it's 30 minutes a day that's all you need is 30 30 minutes a day minimum um you want to prevent disability you want to improve joint function yeah yoga even though it's pretty good because you're moving and balance rest and activity um heat cold um rate reduction lose weight um yeah I don't know you but me I probably this weight uh agents such as um you could use like s strict aspac cream or like the salus or um B type stuff inss but again you know it over time there's a limit of how much in you your body could take um cellid breast is they say is really good for arthritis but again there's there's lot of complications with that in considerations dxic cycline um decreases loss of cartilage you could take that um you can do steroid injections I've had that before for my um not for my knee but for my foot I had um right now I have P um H fasciitis I had to buy shoes when I was in California um because I could I wore slippers a lot and so that kind of messed with my foot but um I know I just got the the email to do coola again um so I just gotta yeah anyway and then um compliment complimentary alternative um medicate medicine you could do like um um like acupuncture glucosamine May decrease inflammation they still are out to the door because like you know you see these U especially when you go to these vitamin stores like lber nutrition for example they say oh yeah use glucas and crond dotin um it can kind of decrease inflammation and I'm not sure if it it helps with the carage formation but some people use it I still I still take that one at Costco this what collagen movement but um for me it seems to work it keeps I I just used the one from Costco that's these big white pills um I'll show you doing break what I take um when then we have another break again probably pretty soon and then um yeah coron helps to the cage I'll I'll show you what I take and then make sure if you do exercise don't go beyond the point of pain don't overdo it and and then with the few things between um glucosamine and crotin glucosamine specifically it's a molecule called um glyos aminoglycan it's used to repair the cartilage and from Droid is the most abundant glycos aminoglycan responsible it's it makes the um partment strong so with these little nutrients that there's a theory saying that or consumption of this may increase the rate of formation of new cartilage and do they help so it has not been shown to alter the availability of these Cartage building but I don't know it kind it kind of helps me with the pain so I guess it depends on each person but I guess there still are not 100% that's working and um n says okay so again um one two three four you can only do like four times a day for the Motrin and um a leave is only one top a day so these are the incets how much how often you could take them but the things with the inets you got to watch out because some people are very sensitive with um the and like especially with the moin that ipren you might have to eat a bit crackers or take it with a snack watch for Disney's and rash heartburn and okay so that's inets I mentioned celebrates this is actually really good a lot if you could get celebr it really helps with the the pain um for a while there they took it out of the market but they brought it back again but the main thing with celebr you have to watch out for um dyspepsia for the stomach stuff um diarrhea abdominal pain um the Uris um peral edema and GI discomfort so this like a lot of GI stuff and it's a Cox 2 inhibitor and so I guess they're kind of cautious about it because it does have a connection with cardiovascular so it does not it's just the good thing about it it does not promote bleeding because it's not involved in that PL aggregation like aspirin is so that's a good thing with cbrats and then this one um e it um loading so loading is good for inflammation and pain it's another insid and so what happens that when you have pain you have increased production of prandin prosting glands are these neurotransmitters it it it's released when you have encounter this increased pain or something and so this release of PR blandin in your body it's that's what's causing the painful um reaction the pain is that release of Prost blandin but this medication is going to counteract the the activity of prandin and so it will stop that um prevent that from H being released or kind of like an inhibitor it's called loading but the thing with this medication you want to watch for um stomach upset nausea venting and diarrhea and um another things that Al when they do if you end up having knee surgery they do they could do arthoscopic where they could go in and look at the instrument and see what's going on without totally completely cutting the knee I mean this is like in the last 30 years but before that they usually do complete knee surgeries all the time and here too with doing arthroscopically you could look at torn ligaments um you know loss of bone cartilage and you can look at the sovial membrane anyway and Tor miniscus doing it operos scopically but you know I can't stress enough about movement and know it's so easy when you become a provider a nurse like okay let's give them a scooter because I remember I used to work as an MP with this um internist and then I have these patients oh I want a a I used to call them death mobiles these little scooters and you see them and sometimes they have at at cost if you don't want to walk and if you have an injury but if you use that all the time those scooters it's just you're just not moving anymore and um I just hate I I wouldn't want to prescribe that to someone unless they really really need it because by not moving by not walking we're killing them basically if they're not able to move so you know you have the search of procedures um and then paint controls no you know they have't the paint control is not working their quality of life is impaired and if they need a new knee replacement um and then arthoscopic could could damage cartilage okay I'm going to stop there stop at here so let's go ahead and take another break so I have to go back 510 let's come back um 8:25 guys so come back at 825 we'll do some more of this thanks Aubrey do you need to take a shower when it's 9 o 8:00 already let's go wash your body wash your body no just shower so you're not stinky so you're not stinky do for for for uh uh uh for I hey stop diamond here relax a t no get why huh why Leo's there I want to go I want to leave that's he's tired of this I'm leaving I'm like bro why don't you just get like a uan take all your [ __ ] already like every time you're here it's the same [ __ ] thing oh it's cuz I'm tired this this and this and that he looks at me and he's like you don't understand my job is harder than yours someone was like your job is harder than mine he's like yeah yours is easy I'm like cuz having people pull guns and knives on you it's easier than [ __ ] pulling wire right and then he didn't anything oh you all was under a building with the earthquake strike okay once in a while you [ __ ] got scared think I don't get scared every [ __ ] day I go to work and I have to deal with [ __ ] I was like well whatever bro since your job's [ __ ] harder than mine I I guess whatever so I was like Mom I ain't got time for this [ __ ] I gotta I got to go I'm like life my life my job's easier when I have to deal with [ __ ] like this and she didn't say anything so she goes ah Leo your job is not easier than you want you want to fight all day want toley bearley bear is showering yes sop sop the the F from the bathroom please thank you the thank you how come you don't want to eat your food today [Music] huh me for for kisses now you to do you like the car huh did you like the car yeah it's pretty nice long though it looks nice hell long long excessively long it looks cool though hi Harley Sophia are you going to eat yeah but I want to I want to man you that making my head part e for for for sopia it's coming relax I don't understand why Leo just doesn't go what the hell is holding him back then he should stop complaining stop this fool swears okay he has all the money in the world for what he did like [ __ ] dude [ __ ] your mom should have never taken him back bro you C for the same sh day for for for for for okay sorry guys I got caught up I had to do some email and um I'm actually have doing something for Ati but I'm back so um I did mention let me just change my background for a second because I'll show you let's see settings is here confus okay so I'm just gonna take off my background for a second see my messy office yeah okay it's not too messy okay so um the one thing I did I I just Ed it from Costco this thing it's called collagen you theory for women and the reason why I started using it it's mainly for my hair because as you get older it starts to get thinner but it does have this collagen and Biotin and it's for and mainly for skin and hair but I think it's also good for the the collagen like especially I like to run and walk a lot so I I I did try using that um and I'm trying to see how much um it has this much collagen 6,000 milligrams and you take um six tablets per day and I do and um it it has worked for me I've been doing this for a couple years this particular brand I'm sure there's better more expensive Brands out there but this is from Costco and it works so anyway this is what I use for collagen okay anyway let me go back to my um my backround this is yeah go back to that okay anyway um yeah that's this is down the street from my house this little beach it's not usable but it's it's pretty anyway okay any questions okay so it's 5:30 we finish at 7 so um we'll keep going here um I think what I might do let me look at the Powerpoints real quick I will um so we can start I'll talk about hip fractures a right okay so yeah I'll continue talking about a arthritis and hip fractures I'll stop at slce 75 for today and then maybe continue the rest next week and then maybe I'll go through those other PowerPoints with the um yeah I'll stop at slide 75 I think that's what I'll do right now so let me go back to that slide and then we'll practice some questions and kind of change things up here this this is a long lesson which is it's a good lesson though because especially if you working the ER or ICU you um you're going to be taking care of these patients let me go back and find it okay slide 62 okay get fractures so we have different types you know hip fractures again just like any fractures um some of the risk factors includes the age um being female having a genetic or history of osteoporosis also things such as a decrease of estrogen and you have a increased tendency for Falls because maybe you've had a TIA um trans trans um Tia like a stroke um anemia medications cardiovascular diseases and so you could mobilize um this is good to you have to know when we take care of these patients um adduction it's another term that they use go towards the body and abduction is away from the body when you move the patient and then there's we have to worry about shortening especially with the hip fracture and so we use like um trochanter rols or sandbags and um we could use internal fixation so the main care for these patients you know we keep them hydrated unless they have just of heart failure then you have to be really careful how much fluids we give them and then respiratory support making sure that they get enough oxygen if they have COPD then they're not going to get as much it's going to be a little bit less delivery because you don't want to um take away the driving force the COPD um we'll talk more about that in N search three and then circulatory check neurovascular assessments you're going to check the cap refill and the P pulses good pain management and prevention of immobility complications and history of other chronic conditions and medications so the types of hip fractures you have here at the neck that's one common one and here at the um intro um chanic fracture and then the sub subro um CH fracture here as well so you know with this fracture it disrupts blood um supply to the femoral head and then so they have higher incidence of non you know the thing here if they they have a fracture here they have a higher incident of non-un so they it doesn't get quite the oh sorry the connection is more difficult and this this become could become necrotic and this happens and then this just talks about the different risk factors you know just basically it's just the blood supply and um the difference the chances of it trying to get back together again by having these particular injuries and it's commonly seen in patients with osteoporosis and rheumatoid arthritis well we'll talk about rheumatoid arthritis next time next week not today and so you know it's the Bone's very vascular so you have a lot of blood supply to these ends of the bones and you know these bones are very spongy unless we age to become you know more and more fragile and so you could see how the vascularity of the areas here and how like this part is just affected how it could be compromised um especially if this breaks and how the bone can become theed so you know when you have the fractures it could happen one or two inches from the hip joint and again you reduce um you're you're going to be lopsided again relate to osteoporosis and so this the difference with this particular fracture the intra capsular and that is related to osteoporosis and this particular one um which is this intro chanic and subo chanic three to four inches from H joint and does not int both U blood supply so this is easier to fix than this one the one like the small neet so there you go so when we do preauth care um these hips it's usually for perform patient um after the age of 60 and you want to make sure that they understand the instructions and complications you're going to educate them what to expect during surgery and as far as rest you know what's going to happen during surgery what's going to happen after and also to like um how to get back to normal again you know using the incend spirometer all of those things are going to be C discussed in your preal care and they're going to talk about the medications that they're going to be taking and so usually they're in bed like this for the first couple days and usually if they if everything's not complicated they could go home within four days usually or to go to a rehal place and so they're going to have special roles when we position them and they they will be ulating slowly and you have occupational therapy to help them with um you know with a shower chair the handheld shower um safety bars they're going to try to assess your house what kind um what are some things in your house like how many steps does it take to get to the um door um it's amazing like I remember this one patient they had like 30 something stairs to get to the front door it's like well that might be too many steps but um some of these patients come from very challenging situations you don't think about it until you get old right like okay um and you try to transfer to like a one-story house compared to a twostory all of these things you have to take it the fact when you get older and when you have things like hip surgeries and knee surgeries for example and so and then you know they're going to give if you do have a dental visit prct to this they might um give you prophylactic antibiotics so you don't develop infections history and then your clotting problems like if you have a history of blood clotting if you're obese um smoking history and your age also drugs that increase um bleeding climing time so usually they stop all these um like incets and vitamin C one week it's sometimes even like 10 days um some people are more aggressive and go two weeks before surgery they stuff all of these um drugs that have a tendency for bleeding so vitamin C vitamin E hormone replacement therapy that's H and nids and they also you have to discuss within the possibility that they could become anemia depending how much blood loss they have there's always a possibility of blood transfusion so this is where you try to get their um how their feelings are regarding blood transfusions you have those religious considerations such as the Jehovah Witness there there's a lot going on with these um cases it may seem so simple but there are a lot of considerations and thank goodness like when you go to the hospital and trying to figure out what I need to teach every you just click on like pre op teaching for osteoarthritis you just click on it and everything's right there you don't have to reinvent the wheel and and create and do research you just click on whatever you want a lot of these nurses have the lipic Cod manuals integrated in their electronic health records you click on it and then bam it's just there and you teach them and if there's a a nursing skill like my students and sometimes we have to do skills that I haven't seen in a long time I can't think I think one was called um I think it was like pin care for that particular hospital I just kind of like click on their on their page for pen care and what kinds of things do they use so you and I I watched a little they have a little video there you can watch and like okay this is what we're going to do I'll walk you through this and that's what I do for my Pat my students when I um do a new skill with them in the hospital I I I'm very Hands-On and I go on and I I'm one of those I'm pretty OCD I pass M with every single one of my students and I make them tell them tell me everything they need to tell me regarding the midp pass and um I don't let for me I don't let the nurses pass with the student um Mid mid pass I I do all the mid pass and I'm there with all the skills so I'm there in the floor all the time working with them yeah um yeah so but unless is one um yeah teaching I go in there and I help teach too and then also epen this is also to prevent anemia so when you do your pre-op checklist you know again it's all going to be there you just go over them reviews with them again you don't have to memorize this but you know for educational purpose just be familiar and you're going to see some common same preop checklist not just for this particular procedure but for most procedures very similar you know you do your education regarding the procedure you make sure that the informed consent is signed and they usually M for at least 12 hours and um or more you know if if possible and they do a skin prep um they do like this an slope or sometimes they do chlorexidine and you want to make sure that um you have a documentation of the checklist and then they go to the bathroom prior to transfer and what they they do if they have to put a catheter in they in the well usually the orthoped they will always have a catheter um that's one of the things they have for orthal cases and right before they put the epidural in whether it's a um spinal epidural or if they do General they will do the um the catheter in the operating table they won't do it before that's like 90 most of the time and they would give like a preop like pre minutes they would give for surgery you so you could anticipate giving a um sometimes they give antibiotics like they give one dose before the surgery um's it called it's such the SE seha sepha um kepic it's like not Keflex but septin they usually give it um or ANF I'm sorry ANF they give ANF they usually give ANF before they give um an during and they give one or two doses after the procedure so you get to anticipate giving um antibiotics and you're going to be anticipating giving um a like a med for their stomach they usually get something called like a bicitra that kind of settle the stomach down you want to make sure that the side rails is the in know or up and sometime the hospital gown allergy band you and then make sure you take up all the metal pieces you always ask them like if they have like a Pac maker or if they have oh and they have piercing the weirdest places you guys yeah yeah you think it's just the ears it's the nose the tongue down there vagina yeah everywhere you guys you have to check every place for I'm telling you I kid you not I've gone down the vaginal are okay there's two earring there's two Cur down there yeah everything has to be removed okay because you don't want the accidental electricity going to them and get this electric shock that would not be good be electrocuted during surgery so everything has to REM if possible sometimes the Rings are might be too tight or they they're Chinese they have those um jade rings and you might have to take them very well the Jade's not so bad because it doesn't have that that electrical current like the the ring vents does and you want to make sure that they no contact censes no eyeglasses you know sometimes they could they they might let them leave them in place depending on the um the procedure if possible they want to move the the um the nail polish especially because especially if they have to do a pulse oximeter in the toes or the fingers the nail polish could interfere with monitoring the um pulse oximetry that's why we remove the nail polish you're going to do vital sites before the transfer and then um make make sure that they have the CBC especially like the um the platelet count if it's too low below 100 200 then they're going to be very cautious of doing surgery they might need to have blood transfusion if they have low platelets and then also things um the medications they take um anyway a lot of things this is everything that you're going to have to be doing for preop okay so it's a lot so you're going to disc okay ANF I just said by an you get answer one before the initial incision general anesthesia epidos may be used yeah don't do and um the epid the good thing with epid it reduces blood loss and instance of DVT and that picture um also in this picture that they usually use um the the thrombosis like I called the leg squeezers they have these um on the patient already going down because like they're in the holding area they want to make sure that they start using that machine to to prevent blood spots um the sequential thrombotic um stockings and devices that they might have that already going into the surgery so some people would go into surgery like that okay this what's this R for so you know with the hip surgery they could have this little prosthesis they have the aeter andoral components like that is connected already to school this that'll already be on yeah looks like we have you have feel liner I did see um there a couple cases that came through our um floor where they had to do um those manufactured defects and then they they s when they send consense they're aware that there's a possibility that that product could failure the manufacturer so depending um they do give a compensation okay if this happens then we'll do the surgery for free or we'll replace the um this for free but then the surgery I don't think it's free so um they do you have to sign of consent when you get these um replacement type of surgeries like for the knees and the hips and there's the Bal on the that and as far as analgesia versus anesthesia you know you have the epidural but the epidural especially um at the back um it's not quite in the spine it's in that epidural space before the spinal um space you want to monitor for clear liquid um leakage and usually with the F anesthesia this is like the same one that they get for labor you want to monitor for um itchiness um and then urinary retention and again they're going to be coming out with a c um catheter majority of the time and you going to monitor for V science it says pain control and then uh monitor again they they're blood pressures could drop especially if they go beyond the epid space monitor for low um hypotension and also respiratory um status and also you going to check and see when they can move their feet and um their F their toes again also as far as our care we're going to be copy breathing every two um hours and they're going to be they're going to have these compression stockings and um they're going to have these lace freezes you have the machine over here does show here machine is leg squeezers and look at the positioning they have like the special um abductor um this is just pillows but there's like a special little cushion pillow thing that they could kind of there like a velcro to each leg with attaches to this so it's not just pillows but they do have some like a little device that they could kind of keep aligned again you want to um maybe not quite on their hips but then you want to make sure there's pillows on the back then you don't want them to um to move and you want to check the pulses and their um cap refill every two hours um or probably every you know as needed whatever the order says and they they might be on the PCA prump or give medications as ordered but since if they have an epidural usually the first 24 hours first 12 hours they usually have um they don't have um many times they might not have a PCA pump because the medication they receive with the epidural might be enough to F them then after the 24 hours they're going to really start feeling the pain so not everyone has a PCA um but some people do um and then again DPT is a complication um bleeding or swelling in the area skin breakdown that's why we have to turn our patients if they're a little bit in the heavier side you might have to consider getting an air mattress a special mattress um they're going to have urinary retention and most time again they're going to have a catheter at least for the first day or two and after the second day they usually take it out and again if they do have diabetes there there could be complications from healing and you're going to really monit as a nurse your plan of care besides making sure that they're getting enough Airway breathing and their heart's breating you want to monitor the pain is the main issue for these patients and also repositioning is also important and know also too when you when you take care of these patients you can be looking at their Labs especially their CBC um making sure they don't become anemic also too you look at the white blood cell account to make sure they're not developing um infections yeah this okay this this is kind of the complication this slide is actually good so maybe if this is the slide of the goto this has everything so we talk about neurovascular assessment this is neurovascular assessment okay so make sure you take the slide out and memorize the slide um if you have to memorize any slides for this coming quiz this is the slid to do um like for neurovascular again color the temperature the capillary refill the pulses the pulses relate to that injured site edema sensation muscle spasms also you know prevent adduction external rotation of affected foot again you're going to treat the other problems is going on cardiac um Coral diseases neurological again um adductions going out and then also bug scatches with these spasms and then also depending if they're going what kind if they going to use internal fixation or screws again you have position every two hours um out of bed the first post off day cup de cup do breathing and send barometer you going to monitor eyes and O's and then the PT o she's going to get them up and slowly get them up event no slowly again um avoid extreme hip flexion prevent external rotation and you know you want to make sure um they're going to unable to bear weight surgical sides um one light one legs can be shortened um there might be this temporary deformity because it's healing look for ecosis at the at the um site with surgery site some compromise is also um compartment syndrome is probably one of them it's not mentioned here also um delay Union especially if the fracture is at that neckbone that embolism is a complication and um emble and then also when the patients get older again if they can have conest of hard failure you're not going to be giving them a lots of fluids so before the surgery they're going to increase the fluids because they don't want to get hypotension because of the the anesthesia so as the nurse doctors and nurses forget things and if you see that their IV rate is at the pre-operative rate you going have to speak up and call the doctor say hey this patient is um congestive part failure I hear cocal and then you look at their IVs and oh wow they're day 200 per hour I think we should probably go either like 50 MLS per hour or maybe nothing you know depending um these do something like 50 MLS per hour um if they have congestive heart failure for example but 250 150 that's too much for a patient with CHF yeah um that's why you have to listen to their lungs especially their bed down and then watch out for sence of pneumonia and then also their mentation maybe they're getting too much sedation my crazy dog yeah she just Ching over and then also um watch out for fumble fitis make sure the safety R up in the beds in L position if they have those alarms make sure the green light is on and other problems that they're going to have um you guys did a great job by listing your nursing problems they're also going to have fluid electri imbalance and um possible healing issues so this side is very good this this slide has many questions so make sure you know the slide and I'm going to stop here okay and I'm going to go into um St and let's just spend the last couple hours um I'm going to end the show I'm going to spend the last couple the last not couple hours like an hour I scared I scared myself sorry um just talk going over like the um the questions and stuff and then we'll call it day we can finish everything else next week so um I put this I was able to finally upload it on your announcements and I put it on the chat too this PowerPoint I like it because I have a lot of illustrations and stuff but let me go into the ones that for the module which is chapter 44 45 I believe give a second and um while I'm here I'll just go ahead and open up the um discussion question I always forget every week so okay it's open ch um week six is open I click it and then then I yeah it's okay it's open okay um oh yeah so make sure you do your online practice this week through nutrition and next week your A's do this week next week the B's do and then um I'm going just go over some of the questions on 44 45 I'm G to see if there's anything I missed I think I covered a lot but4 ch okay I have 45 open [Music] see and let me just open 44 yeah so for this week is 4445 but I think let's see what they miss and I like going over these questions and you can discuss the answers that's what we'll do for the last hour okay let me just share this with you [Music] sure yeah so I this is this is the book on and I think I cover most of it but I'm going to see um I like I like just going over this real quick because I like the questions at the end of these it makes us think see if I cover um I this oh I guess I didn't cover it um things muscle skeletal changes associated with aging you have osteopenia severe osteoporosis which scking at the curvature of the bath um it's just that your s joint is not mobile okay and you can have muscle tissue apies again diet you know vitamin D calcium walking not smoking some I did already so I'm just gonna kind of GL here oh well this is important okay so um we have flexion and extension um abduction um towards and abductions away and then um this is how the mov of SK to muscles yeah just skip some of this I'll justop drop it just down slow I'm start calling you guys somebody prepared okay so Nikki you're first up on here you go you take this question which I just tried to unmute myself oh okay yeah so you take what do you think one is going to be which identify highest risk for denti 50 years old C you think it's D yes can the answer y it's D Caucasian women tend have the least amount of bone density of any Group which makes it most likely for us press good okay okay Gina you're next which client statement does the nurse identify that reflects understanding of Health interventions to prevent MUSC skeletal problems H well we know it's not B they said they're thinking of implementing one in 2025 yes so understanding right so the you know this another Quest taking technique understanding the right answer so yeah I wouldn't pick d I think I would go c i okay at least five times week I mean it might be a little too much but I think exercise is supposed to be what helps you with yeah yeah yeah definitely okay let's see what we get okay see so yeah see five times a week so that that's good yeah that's actually pretty attainable um yeah so again we need to to move every day or five at least five times a week and regular exercise assistant device may be needed but not as a preventive measure not everybody needs a can or walker and a nut nutrient Rich diet is important soda is bad because it has a lot of phosph it takes it robs you the phosphorus so sodas make things worse so you should not be drinking soda and then so I know everyone who likes diet cook out there sorry P Pepsi it's it does ruin your bones yeah I found that out um and I haven't drink soda in God it's been like 15 years so I've been off soda I did C diet qu now and then but I haven't had okay Regina you're next so I'm gonna pick a can you go somewhere else um all of the above a b c d e okay that sounds good oh everything but c yeah have you complet your exercise for the day so a b d and e that was good at least you got all yeah these are tricky it's easy to say okay let's just select them all but I guess not see [Music] because the nurse does to ask about daily exercise this time so it's just more preop okay yeah that's okay okay that's that one okay then we'll go to the next slides maybe this is pretty fast I'm going to go to um chapter 45 let see there's any slides here sure okay yeah these are the book ones you can see it's not as um small black and white so yeah so they show yeah this this is actually of osteoporosis yeah you can see you know um this is normal ver vertebrae but yeah over time it could be like like like think of a a sponge like you know like those LOF sponges that's what it looks like just LOF sponges a looks like a LOF sponge b that LOF sponge becomes like lot less fors like all these holes so yeah this how it looks like um aoic bone yes it's like carate sponge and yeah so this is normal bone look at this bone yeah missing a lot get that so osteoporosis is um again um bone loss bone density we can use bone density test and then there's some other condition L of bone so this is interesting you know we talk from the tall 56 to to 5T I'm not quite there yet but they said um I guess they say I'm 53 I was like 55 and a half and they say I'm 53 and I don't I don't see myself standing like that but maybe I do but this is pretty severe but anyway this is how they look like as we age um so This Is 40 years old this is 60 years old and this is 70 years old so I'm trying to see um yeah I want to say I'm I'm between 40 and 60 but not quite 40 and I'm not I don't think I'm quite 60 but you can cost 6 in of weight height loss that again there and lifestyle risk also protein deficiency 44 million Americans Baby Boomers I'm like the last of the Baby Boomers I'm the last year baby boomers so when the teach our young women especially good nutrition vitamin D stop smoking lose weight avoid alcohol limit carbonation drinks and exercise weightbearing exercises I didn't try yet okay so you want to do RIS for fosis your body image yeah also you know this is good spice check the serum calcium and vitamin D and you know you look at the um the X-ray lung bones um you can do dead de um this is just a way to squeen the bones it's another yeah method let see what else out that oh here's another one um and I'll talk more about it next week is osteitis and you you're going to see osteitis a lot in the diabetic patients it basically is just a simple infection in the bones and it's pretty nasty it's pretty bad this OST have anyone seen the bad case of osteitis you want to share no nobody okay yeah I actually had one before I stopped um went to California I had this one I I might have told you this man really bad out of control diabetes and his um his foot can't I can't remember now I think it's right foot it was just it smelled so bad um I it they say it was Mera but I don't know but anyway some type of really bad bacterial infection it just keep saying and his diabetes is so out of control he did not know how bad his infection was and you could just the smell just it was just not just room but the whole entire flooret and I can't open and so um and he was just it was a mess and this this is why like go be I just didn't want to take care of that patient because it was just so bad like I got him in the middle of er admission part of Week 1 or 2:00 in the morning and you know you have your set patience and they Adit him it was not that hard but just smell this B was just so bad um if I was pregnant at the time it would totally get me but um that's one thing that when you're pregnant working smells that bother you at least I'm pretty good but that particular day I would not handle it very well can you try it so and I'm not sure what happened but I'm guessing that was so bad that if it's not controlled it could it could get amputated and I actually have patients that have like such a bad infection with diabetes out of control and I had this one man he had 10 fingers okay and then he says um and I go you know his osteitis was so bad and he was I think he was on some street drugs too and we told him that he's going to be on this particular antibiotic for a month just because he had really um bad diabetes his diabetes out of control he was on high doses of insulin um several times a day and just everything's control but the thing is that his ostas was not um it was still there it was not healing so and I then you know we met up with them and said okay you're going to have to be on these new antibiotics because you still have the infection so the the guy goes and he's he's like a couple years younger than me is okay you know what forget this I don't want to be an antibio anymore just cut the finger off I'd rather just have so those are the kinds of patients we have in the hospital he didn't want to be in the hospital anymore I want to be home he misses his drugs so instead I go I don't need a 10 fingers I already have nine other fingers so just cut it off so it was his middle finger so he basically he can't flip off anybody anymore so we cut off this this finger it's like okay so no more finger that cures the osteitis but then you still got to you know assess for um the amputation and all that that's a whole another um day but yeah we Pati like just cut it off I don't need that finger I have nine other fingers but that was that was one of my crazy cases and those are the kinds of patients that I do see a lot in Honolulu um and I'm sure in Los same thing in Los Angeles get um especially in inner city you get a lot of interesting people and I'm sure in parts of Orange County where you guys are going um especially in those areas you're going to get some freaking Flyers crazy cases there's a lot of crazy cases out there and you'll see them you probably seen some ready and so with the osteitis they're going to have this bone pain they're going to have this fever and wherever the area is affected it's going to be aemma and PE their white blood cell I think for that day that patients WBC was like in the 20s I mean it was high and the ESR May rais two and um you know n not surgical surgical okay I didn't talk about bone tumors I'll just talk about that real quick so with benign bone tumors um you know we talked about cancer before you have the benign and malignant um I guess benign ones is the osteochondroma and that's the ones with the femur and the tibia and then you have the malignant ones you know just like R um cancer you know it can mapsize you know bone cancer is hard though when it gets to the bones um because you know the Bon is so vascular that um the chances for Recovery I don't know how the recovery for um so I'm not an oncology nurse but when you gets to Bones because the blood it's usually like stage three stage four and it's just so hard to control and they usually don't they they don't do very well as a whole and people with bone cancer you have to go through a lot of aggressive um treatment um I just lost one of my sorority sisters from y Riverside she she died it be about I think it happened this year when she passed she's a young a year younger than me um she still had kids in college it was sad very pretty girl in college I used I remember her when um pretty girl and um yeah I'm so sad about her her death that she had cancer in her um her foot and entered into bone cancer and she was just a fire she UCLA for treatments and stuff but when it gets to that part it's it's very very challenging and so the the cues that you'll see benign versus malignant bone tumors is just the the pain and the where the pain is and you can diagnose this with um routine X-rays and neob biopsies lab studies including that um the c um cancer antigen um if they have a presence of that um then there's a likely if they have cancer and also if you see it in an x-ray then they could biopsy it and then diagnose it there too then they could do chemotherapy radiation or they might have to amputate and again there's another one um I'm not going to ask this one D there's another um drian contracture gangan um I I'll do I don't know this I might have it next week but maybe it's going to come up the carpal tunnel syndrome um and this is one of the fs I have planed of fitis and um that's like the balls through foot okay let's just let's just do a Cas study so here's a patient 65 years old comes to the provider's office for in an annual physical um she was measure um she measured a standing 65 inches tall last year and then she observes she's 64 in and she has mosis okay so John Lee what kinds of questions are you going to ask this patient what kind of assessment you going to do um like did you feel that you your height got short or you can yeah okay um any other things that you want to ask them about anything else you think I'm sorry say that maybe she had like a pain in the back okay pain okay so pain know that she feels shorter the pain has be good right because maybe they're bending yeah so you can ask those questions yeah she got a shorter yeah you're right John good job zie and ask if she has pain in lifting bending or stooping ask if the pain is worse activity in leevi rest okay good good job okay so Kate you're next you take this question is diagnosed with the possible dios test does n anticipate will um everything except sodium okay so yeah that sounds good dcve yep you're exactly right good job okay everything about Sian okay good okay um Christine fog you go next okay uh the client is diagnosed with osteoporosis which intervention by the nurse would be approp prate um I'd say B walk 30 minutes 3 to five times a week okay that sounds good um okay that's and yep B yeah walking so yeah so again walking is good to um and then increase vitamin D along with the CATE diet again no smoking um yeah okay Daniel you're next which client statement indicates uh which client's statement about selfcare indicates a need for further teaching by the nurse why can't I open anything I mean selfcare I mean c doesn't really apply to selfcare okay so that's so four of them are going to be correct answerers so one's going to be the wrong one so you're going to choose c c I'm choose d d bowling D is a boy D is a dog and dog okay bowling yeah that would be my guess too yep bowling because it it could contribute yeah the pulling the bow good job Daniel um contributes to the compression fractures sewing is really good yogurt has calcium and the throw can make you fall trip good job okay okay we keep going um let's see Erica you you take this one just do your best okay oh my God what the hell is on here she she can take the carum right the once once a day like at the one time no it's too much why um so what what's the um why would you need um extra fluids to take the calcium uh because uh it can cause the constipation that's true um okay see and um and then what what did you say what um you can ask number six too why can't you take it um just once a day how would you say that yeah this is a little trick here sorry you got to trick your question usually they don't um let me see think it's okay take your time I'm not so sure yeah yeah it's a okay cuz I'm looking up too so um you know it has to do with absorption of the calcium and I think um it could cause um I think something with the um you know it it takes so much water to to take with the calcium so you want to prevent um de dehydration something with dehydration I um I will find that answer anybody else with that that's a pretty good question it's something with preventing dehydration with the extra calcium and I think once time a day is not enough um is because one time a day might not be enough calcium that's probably the guess for that one because you have to drink so take so much calcium just to have enough for your bones to not break down and this is the challenge especially for people when they get older is not getting enough calcium um you can only do so much in the supplements but we really have to rely on our diet and try to get like green leafy vegetables have calcium um and if you're lactose intolerant so you can do dairy they do have some Alternatives like um you know I think think soy too or chof Fu but you have to watch out too especially your male that there there's there's some issues with prostate and stuff I know there always these little things but the main thing is to to do a lot of um calcium and um orange juice too um raw dairy raw dairy yogurt's good okay that's a tricky one sorry you did great though Erica you did very good okay so increase there you go increase fluid will help prevent calcium based urinary Stones there you go and we're going to talk about that in the kidney Butcher and then third do should be given at bedtime because calcium is yeah is most readily utilized by the body when the pl is fasting immobile that's I forget this so when you're fasting immobile um that's when calcium is um utilized so when you're in that fasting state in that state you're not eating that's when it's best to take calcium and so again it's not really the dehydr yeah you don't want those the kidney most the majority of the kidney stones is made of calcium oxalate and so you don't want you want to prevent kidney stones that was a higher thinking question so that was good okay I have more questions um let's see okay um suong you get that one you can take that question Ro conducting of community health fair which client do the nurse identify at the highest risk for OSIS I'll go with the Asian American team okay Asian yeah okay that's a good guess and I think you're right yeah it is Asian you're lean build European American Asian women especially those who don't exercise regularly yeah older in Lan bu I know I see a lot of these type of women in Hawaii they're all Slender and this but they're at the highest risk you guys yeah um yeah okay um Christine Moran go ahead which assessment data does a nurse anticipate in a client diagnosed with Osteo malysia um Osteo so it would be vitamin D yeah oh no it's yeah D and D I am TI and it's it's earlier here here it's only like some some there like later yeah OST malaia loss of bone relation lack of vitamin D causes bone softening yeah D is needed for calcium absorption so you need D and calcium works together yeah so decrease bone that's good okay sopia you're next Sophia huh client is diagnosed with d d contracture asked about about the condition which statement by the nurse is most appropriate a this condition will improve at time B the cause of this condition is aging C this condition only affects one hand the the fourth and fifth fingers are usually affected uh I'll go with d okay D yeah fingers okay so yeah yes the fingers slowly Progressive thinking of the Palmer fascia but the fourth is the finger uh causes of known older European American men tend family okay good more diabetic okay that's it and so the ones who missed out so sorry I didn't get to you probably like okay no I'm not sorry okay anyway um well I finished a little today I could I think um let's see let me go back and see how much of my um SL before wait I decid to call it a day because um I just miss let me just stick in my um my fire I just miss something all St okay so more hip stuff okay more hip stuff oh drains okay St drains so okay yeah that's that's a lot actually that um okay yeah let's yeah let's um because next week I could talk more um about the gal and carpot tunel syndrome and I'll talk more about hip stuff and um so I'm going to talk medications too or osteoporosis still yeah and then I think we yeah let's just do that and andus we have plenty to talk about next week yeah so I could just wait and then um then we'll do some reviewing yeah we'll do that because um that that presentation is 150 slides and I could talk more um whoever's presenting next week we present their case and then we'll elaborate more this is a lot of stuff just to do in one day so I want you to absorb everything but do you guys have any other questions do you guys are you guys ready to color tonight yes 9:30 yeah I'll stay around um you have questions I know don't be so enthusiastic that's okay you could be enthusiastic and I'll stick around if you have questions and I know hardly ever get up early on the mid search night but I think next week I'll cover the rest since this is over two two weeks and um this is this is a good chapter I I like I like this concept of Mobility mus skeletal it's it's interesting there a lot of stuff involving one well cardiovascular lunology everything in one concept but I'll stick if you have questions otherwise um anybody have clinical in the morning Wednesday morning yeah okay so you got to be to sleep early you got to get up early anyway so okay well I'll let you guys go we'll come back next week at this time and we'll talk more about um more movability stuff guys okay I'll stay around you have questions but have a nice night you guys Aloha bye thank you you're welcome