Lesson 16 — Orthopedic Assisting

Half A · HLT420A·Kinn's Ch 20·General Patient Care (18.7%)

Source

All procedural steps, PURPOSE rationales, and topic content below are verbatim from MedCerts HLT420A Storyline modules. Quiz items have been normalized to multiple-choice format with verbatim source rationales. Reference textbook: Niedzwiecki & Pepper, Kinn's The Clinical Medical Assistant, 15th ed., Chapter 20. No outside material added.

Learning Objectives — NHA-aligned
Module L16-01 · Procedural skill

Orthopedic Assisting 1

Goal: To apply a cold compress to a body area to reduce pain, prevent further swelling, and/or reduce inflammation.

Equipment
  • Patient's health record
  • Small ice cubes or ice chips (at home, patient can use frozen bag of peas or corn)
  • Ice bag or closeable disposable plastic kitchen food bag
  • 2-3 Towels
  1. Sanitize your hands.
  2. Greet the patient, introduce yourself and verify the patient's identity by name and date of birth, and explain the procedure. Answer any questions.
  3. Check the ice bag for leaks.
  4. Fill the bag with small cubes or chips of ice until it is about two thirds full.
    Purpose

    Small chips conform more easily to the shape of the body.

  5. Push down on the top of the bag to expel excess air and put on the cap or seal the plastic bag.
    Purpose

    To remove as much air as possible from the bag because air is a poor conductor of cold.

  6. Dry the outside of the bag and cover it with one or two towel layers.
  7. Help the patient position the ice bag on the injured area.
  8. Advise the patient to leave the ice bag in place for about 20 to 30 minutes or until the area feels numb, whichever comes first.
    Purpose

    Leaving the ice in place for longer than 20 to 30 minutes may cause tissue damage.

  9. After removing the ice pack, check the skin for color, feeling, and pain.
    Purpose

    If the treated area becomes very painful, remains numb, or is pale or cyanotic, the ice bag should be removed and the provider notified.

  10. Dispose of ice pack and towels; if supplies are not disposable follow manufacturer recommendations on sanitizing the bag and place towels in facility laundry. Sanitize your hands.
  11. Record the procedure in the patient's health record.
    Purpose

    A procedure is not considered done until it is recorded.

Module L16-02 · Procedural skill

Orthopedic Assisting 2

Goal: To fit crutches accurately and to teach the patient to use the crutches properly in three-point walking.

Equipment
  • Patient's health record
  • Crutches with arm pads and foam handgrips
  1. Greet the patient, introduce yourself, and verify the patient's identity by name and date of birth. Explain the procedure, and answer any questions the patient may have.
  2. Sanitize your hands.
  3. Ask the patient to stand up straight.
  4. Fit the crutches to the patient so that they are 1 to 1 1/2 inches (2 finger widths) below the armpits when they are standing up straight. The handgrips should be even with the top of the hip line.
  5. Make sure all wing nuts are tight.
  6. Make sure the foam pads at the armpits and around the handgrips are comfortable.
  7. Instruct the patient to keep the injured leg as relaxed as possible and slightly bent at the knee.
  8. Adjust the handgrips on the crutches so that the patient's elbow is bent approximately 30 degrees when he or she is holding the handgrip.
  9. Place the crutch tips about 2 inches in front of each foot and approximately 6 inches to the side of each foot before beginning crutch walking.
  10. Ask the patient to push down on the crutches and lift the body slightly, nearly straightening the arms. The patient should hold the top of the crutches tightly to the sides and use the hands to absorb the weight.
  11. Do not let the tops of the crutches press into the armpits.
    Purpose

    To prevent injury to the muscles and nerves of the axillary region.

  12. Have the patient swing the body forward about 12 inches.
    Purpose

    The swing-through gait is one of the fastest crutch gaits that can be used, but it requires a great deal of energy and upper body strength.

  13. Instruct the patient to stand on the good leg, then move the crutches just ahead of the good foot, and repeat.
  14. Document the patient education intervention in the patient's record.
    Purpose

    A procedure is not considered done until it is recorded.

Stairs

Face the steps, hold the handrail with one hand, and tuck both crutches under the armpit on the other side. To go up the steps, start with the uninjured side, keeping the injured side raised behind. If the stairway does not have handrails, keep one crutch under each arm. With the crutches on the step where you are standing, step up with your stronger leg, push down on the crutches, and then step up with the weaker leg. Once both feet are on the same step, bring the crutches up. To go down steps, hold onto the hand rail with 1 hand with both crutches under the opposite arm. If there is no hand rail, keep 1 crutch under each arm, first place crutches on next step down, step down with weaker leg followed by the strong leg. If necessary, the patient can sit on the stairs and move up or down each step.

Three-point crutch gait

Move both crutches and the affected leg forward, then bear weight down through the crutches and move the unaffected leg forward. Repeat. This gait is used if the patient is unable to bear weight on one leg.

Four-point crutch gait

Move the right crutch forward, then the left foot, followed by the left crutch and then the right foot. This gait provides the best stability, but it is slow; however, it can be helpful for patients in whom both legs are weak.

Two-point crutch gait

Move the left crutch and the right foot together, then the right crutch and the left foot together. Repeat. This gait is used if both legs are weak; it can be a challenge for the patient to learn the pattern.

Practice quiz · verbatim from MedCerts

Knowledge-check items

Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.

L16-01 · Orthopedic Assisting 1

Q1 · L16-01 · normalized from tf
For cold application, fill the ice bag with small cubes or chips of ice until it is about two thirds full. What is the purpose of filling it to this level?
Rationale
"Small chips conform more easily to the shape of the body."

This is the stated purpose in the procedure for filling the ice bag to about two-thirds full with small cubes or chips.

Source: L16-01 Procedural Steps
Q2 · L16-01 · normalized from tf
Why should you push down on the top of the ice bag to expel excess air?
Rationale
"To remove as much air as possible from the bag because air is a poor conductor of cold."

Air does not effectively conduct cold, so removing it improves the heat transfer between the ice and the patient's skin.

Source: L16-01 Procedural Steps
Q3 · L16-01 · normalized from tf
For how long should the patient be advised to leave the ice bag in place?
Rationale
"Advise the patient to leave the ice bag in place for about 20 to 30 minutes or until the area feels numb, whichever comes first."

Leaving ice in place longer than 20 to 30 minutes may cause tissue damage, so this is the appropriate duration.

Source: L16-01 Procedural Steps
Q4 · L16-01 · normalized from tf
If the treated area becomes very painful, remains numb, or is pale or cyanotic after ice application, what should be done?
Rationale
"If the treated area becomes very painful, remains numb, or is pale or cyanotic, the ice bag should be removed and the provider notified."

These signs indicate potential tissue damage or adverse reaction requiring immediate provider assessment.

Source: L16-01 Procedural Steps
Q5 · L16-01
Which three pieces of information are most important to document in the medical record after heat application?
Rationale
"A procedure is not considered done until it is recorded."

The documentation slide shows date, time of entry, directions for home application (instructions for continuation at home), and the medical assistant's name as essential components for complete record documentation.

Source: L16-01 Correct Documentation

L16-02 · Orthopedic Assisting 2

Q1 · L16-02 · normalized from fitb
When educating the patient in proper crutch use, instruct the patient to stand on the good leg and then move the _______ just ahead of the good foot, and repeat.
Rationale
"Instruct the patient to stand on the good leg, then move the crutches just ahead of the good foot, and repeat."

The crutches are moved ahead of the good foot as part of the crutch walking technique.

Source: L16-02 Procedural Steps
Q2 · L16-02 · normalized from fitb
The patient should hold the top of the crutches tightly to the sides and use the hands to absorb the weight, not letting the tops of the crutches press into the _______.
Rationale
"Do not let the tops of the crutches press into the armpits."

Pressure on the armpits can cause injury to the muscles and nerves of the axillary region.

Source: L16-02 Procedural Steps
Q3 · L16-02 · normalized from fitb
Fit the crutches to the patient so that they are _______ inches, or 2 finger widths below the armpits when they are standing up straight.
Rationale
"Fit the crutches to the patient so that they are 1 to 1 1/2 inches (2 finger widths) below the armpits when they are standing up straight."

This measurement ensures proper crutch fit and positioning for safe and effective crutch walking.

Source: L16-02 Procedural Steps
Q4 · L16-02 · normalized from fitb
The handgrips of each crutch should be even with the _______ of the hip line.
Rationale
"The handgrips should be even with the top of the hip line."

Handgrip placement at the hip level ensures proper arm position and reduces strain during crutch use.

Source: L16-02 Procedural Steps
Q5 · L16-02 · normalized from fitb
The _______ gait is one of the fastest crutch gaits that can be used, but it requires a great deal of energy and upper body strength.
Rationale
"The swing-through gait is one of the fastest crutch gaits that can be used, but it requires a great deal of energy and upper body strength."

The swing-through gait is described as the fastest but most demanding crutch gait in terms of physical exertion.

Source: L16-02 Procedural Steps
Q6 · L16-02
Which crutch gait is used if the patient is unable to bear weight on one leg?
Rationale
"This gait is used if the patient is unable to bear weight on one leg."

The three-point gait involves moving both crutches and the affected leg forward together, then moving the unaffected leg, allowing the affected leg to remain unweighted.

Source: L16-02 Topics
Q7 · L16-02
Which crutch gait provides the best stability but is slow?
Rationale
"This gait provides the best stability, but it is slow; however, it can be helpful for patients in whom both legs are weak."

The four-point gait uses an alternating pattern of right crutch, left foot, left crutch, right foot, providing maximum stability.

Source: L16-02 Topics
Q8 · L16-02
Which crutch gait is used if both legs are weak and can be a challenge for the patient to learn?
Rationale
"This gait is used if both legs are weak; it can be a challenge for the patient to learn the pattern."

The two-point gait requires moving the left crutch and right foot together, then the right crutch and left foot together in a coordinated pattern.

Source: L16-02 Topics