Chp 27 Flashcards
Amputate
To remove a limb surgically
Continuous passive motion (CPM) machine
A machine designed to gently flex the patient’s knee according to the number of degrees of flexion on the setting and then gently extend the knee
External fixators
The wires, pins, tongs, and rods that may be used in skeletal traction
Fracture
A break in a bone
Joint Replacement (Arthroplasty)
Surgery to remove damaged articular bone surfaces and replace them with metal and plastic surfaces
Osteoarthritis
A disorder that causes degeneration and inflammation of joints over time
Physical Therapist
A health care team member responsible for assessing musculoskeletal deficiencies and developing the plan of care to strengthen muscles and restore motility
Prosthesis
An artificial limb, such as an arm or leg
Skin traction
A type of traction in which the limb is wrapped with an elastic bandage or fitted with a velcro wrap to which the frame is attached
Skeletal traction
A type of traction in which pins, screws, or tongs are surgically inserted into the bone
Spica
A cast that encases the hips and one both legs
Sprain
An injury to a joint that results in damage to muscles and ligaments. Severe sprains may cause ligaments to be completely
Stump
The remaining portion of a limb after amputation
Immobilization Devices
- Abductor pillow
- Cast
- Elastic bandages
- Amputee compression sock
- Immobilizer
- Splint
- Traction
Abductor pillow
Wedge-shaped foam pillow, often with Velcro straps, placed between the legs of patients who have had total hip replacement surgery; keeps hips abducted while patient is in bed; straps keep the pillow in place and prevent shifting
Cast
Hard plaster or fiberglass encasement for a limb; used to immobilize joints, usually to stabilize fractures until they heal; sometimes used to immobilize severely sprained joints until healing can occur; often used after musculoskeletal surgeries to stabilize the joint and surgical sites
Elastic Bandages
Woven bandage containing elastic to stretch as it is wrapped around an injured area; elastic helps compress the area to decrease edema
Amputee Compression Sock
Also called a “shrinker sock”, elastic sock or sleeve that fits snugly over a stump to help decrease edema and help it heal in a shape to fit the prosthesis
Immobilizer
Soft fabric with firm internal stays; opens and closes with Velcro fasteners; used to protect an injured limb and to keep its joints from flexing; often a boot for foot or ankle injuries
Splint
Firm plastic molded form used to keep a joint or joints from flexing; may be applied to a limb and wrapped in place with gauze or an elastic bandage; sometimes “air splints” are used when transporting injured patients; can be slipped beneath the injured limb, wrapped around it, then inflated to immobilize the joint
Traction
Skin traction: Involves the use of ropes, pulleys, and weights to align bone ends after a fracture
Skeletal traction: Uses wires, rods, or tongs that penetrate the skin and subcutaneous tissue and inserted into the bone
Common crutch walking gaits
Two-point gait Three-point gait Four-point gait Swing-to gait Swing-through gait
Two-point gait
For patients who are able to bear partial weight on the affected limb; patient moves one foot and the opposite crutch forward at the same time , and then moves remaining foot and crutch forward
Three-point gait
For patients who are unable to bear weight on the affected limb; patient moves both crutches and the affected foot forward at the same time without touching down or placing weight on it, and then brings the unaffected foot forward
Four-point gait
For patients able to bear weight on the affected limb; patient moves the first crutch forward and then the opposite food forward ; patient then moves the remaining crutch forward and then the remaining affected food forward
Swing-to gait
For patients able to bear weight on the affected limb; patient stands on both feet and moves both crutches forward at the same time; patient then swings both feet forward to the level of the crutches
Swing-through gait
This is the same as the swing-to gait except that the patient swings both feet forward beyond the level of the crutches
Three types of ambulatory devices
- Crutches
- Canes
- Walkers (knee walkers)
Crutches
- Used when a patient is unable to bear full weight on a lower limb
- Patient may be restricted to partial weight bearing or no weight bearing
- 3 finger breadths below the axilla
- Tips 4 to 6 inches to the side of the heel
Canes
- A cane is used when a patient can bear weight on the affected leg but needs extra support while ambulating
- Ensure that the patient holds the cane on the unaffected side
- Ensure patient moves affected leg and the cane forward and then the unaffected leg
- Erect not leaning over the cane
- A single prong cane,Multi prong canes: three pronged tip- tripod, four pronged tip- quad cane
Walkers
-Used by patients who can bear full weight on both legs but need assistance maintaining balance
Knee Walkers
Helpful for patients who can’t bear weight on a foot or an ankle
Nursing interventions related to the care of a client in traction
- Pin site care
- Ensure that the weights hang freely and do not rest on the floor
- Ensure that ropes pull in a straight line without crossing one another
- Assess for skin breakdown beneath the external traction devices
- When turning a patient in traction, have another person lift up on the weights, causing slack in the ropes while the patient is turned. After the patient is supported and aligned , the second person then slowly and gently releases the weights to hang freely
- Ensure that the patient’s body is in proper alignment so that the traction pulls correctly
Applying an elastic bandage
Skill 27.3 (pg 571)
Guidelines for Caring for Patients With Partial and Total Knee Replacements
- Ensure that the patients pain is managed
- Set the degrees of flexion on the CPM machine according to the physicians orders
- Follow orders exactly regarding the length of time the CPM machine is to be in use and advancing the degrees of flexion
- Assist the patient in and out of bed using a walker or other assistive device
- Follow the physicians orders regarding the amount of weight bearing allowed on the operative knee
Guidelines to follow when caring for patients who have had total hip replacements
- Avoid hip flexion beyond 90 degrees
- Keep the abductor pillow in place while patient is in bed
- Avoid turning patient on operative side, according to physician orders
- Assist patient out of bed carefully
- Ensure patient calls for help if any items are dropped and that the patient does not lean forward
- Assist patient to get up from chair or bedside commode without leaning forward
Caring for a patient after amputation
- physical care: rehabilitation
- emotional support
- Observe to make sure it is healing well
Guidelines for Nursing Care of Dry Casts
- Teach the patient to avoid putting anything between the cast and the skin beneath, especially to scratch
- Observe for any drainage staining the cast or any malodorous discharge, which indicates infection.
- Asses circulation to the casted limb
- Place tape “petals” over the edge of the cast if they begin to crack or crumble over time.
- Cast of all materials are being used less, with removable boots and splints favored more by HCP and patient
Guidelines for Nursing Care of a Plaster Cast that is not yet dry
- Support the limb on pillows in such a way that air circulates all around the cast for even drying
- Avoid touching the wet or damp cast with your fingers because they can leave dents in the cast, causing pressure points in the skin beneath
- use palm of hands to touch cast
Plaster casts or splints
- Often applied initially after a fracture or surgery because they mold easier to a precise shape
- Plaster is the material of choice when bone realignment is necessary to keep the bone in place
Fiberglass casting
- Often applied a week or two after injury because it is more durable once the bone starts
- May also be used if the fractured bone is not out of position
- Allows for better air circulation, is lighter in weight, and is penetrated better by x-rays for clearer visualization of the healing bone.
List key factors regarding neurovascular checks for the client with musculoskeletal injuries
P570
Skill 27.1
