Ortho Flashcards
S/S of fx
Unnatural movement Deformity possible Shortening of extremity cause by muscle spasm Crepitus Swelling, pain Discoloration
What do you worry about with fx
Compartment Syndrome
Tx of fx
Immobilize bone ends plus the adjacent joints
Support above and below site
Move as little as possible
Splints prevent fat emboli and muscle spasm
What do you do with open fx
Cover with something sterile
Most important thing for fx
Neurovascular checks
- Pulses
- Color
- Movement-neuro
- Sensation-neuro
- Cap refill
- Temp
Complication of fx
Shock (hypovolemic)
Fat embolism
Compartment syndrome
What type of fx do you see fat embolisms with?
Same ones that can lead to shock: long bones (femur), pelvic, crushing injuries
S/S of fat embolism depend on what?
Where the fat embolus goes
- Petechiae or rash over chest
- Conjunctival hemorrhages
- Snow storm on CXR
- Young males
- First 36 hours
Compartment syndrome
Increased pressure within a limited space, fluid accumulates in the tissue and impairs tissue perfusion. The muscle becomes swollen and hard and the client complains of sever pain that isn’t relieved with meds
Pain with compartment syndrome
Unpredictable, disproportionate to injury
If compartment syndrome is undetected, what may result?
Nerve damage and possible amputation
Common areas of compartment syndrome?
Forearm and Quadricep
Prevention of compartment syndrome
Elevate extremity, soft cast then rigid cast
Tx of compartment syndrome
Loosen cast to restore circulation
Be careful picking answer “remove cast”
Cas cutters to remove cast: instruct client that the cast saw doesn’t touch skin, but it does vibrate
Fasciotomy- doc cuts down into tissue to relieve pressure
Before a cast is removed, what must happen?
They must have really bad NV checks
Cast care for plaster and fiberglass casts
Ice packs on the side, not top, for first 24 hours, it’s still wet
No indentations
Use palms of hands for first 24 hours, it’s still wet
Keep uncovered and allow for air drying
Don’t rest cast on hard surface or sharp edge, rest on soft pillow, no plastic bc plastic holds heat
Mark breakthrough bleeding: circle area, date and time site
Cover cast close to groin with plastic once it is dry
NV checks with 5 Ps
What do you do if the client with a cast complains of pain?
NV check
Most pain with cast clients is relieved how?
Elevation, cold packs and analgesics. If they don’t relieve the pain, think complication
Fiberglass cast
More common than plaster
Advantageous bc they’re lightweight, waterproof and stronger than plaster
Provides earlier wight bearing than plaster
Traction info
Decreases muscle spasms, reduces (realigns) and immobilizes
Continuous
Weights should hang freely, don’t touch bed or floor
Keep client pulled up in bed and centered with good alignment
Exercise non-immobilized joints
Ropes should move freely and knots should be secure
Special air filled foam mattress
Skin traction
Used short term to relieve muscle spasms and immobilize until sx
Tape, a boot, splint, or some type of material is stuck to the skin and the weights pull against it
Skin is not penetrated
Do good skin assessments
Can you insert anything into a cast?
NO, not even something soft. To relieve itching, apply cool, cool blowing
Common type of skin traction
Buck’s, used with hip and femoral fx
When can you relieve traction?
Only with a doc order
Skeletal traction
Applied directly to bone with pins and wires
Used when prolonged traction is needed
Must monitor the pin sites and do pin care
Pin care
Sterile
Remove crusts!
Serous drainage is okay
Types of skeletal traction
Steinman, Crutchfield, Gardner-Wells tongs, Halo vest
What do you do if the client is sliding down in bed and the weights are almost touching the floor?
Have a friend come help and lift weights while you pull the client up
Pre op total hip replacement
Buck’s traction is used frequently
Post op total hip replacement
NV checks
Monitor drains, don’t want fluid to accumulate in tissues
Firm mattress, joints need support
Over-bed trapeze to build upper body strength
Position: neutral rotation-toes to ceiling, limit flexion, we want extension of hip, abduction
Isometrics (squeeze muscles)
Trochanter roll to prevent external rotation, document
No weight-bearing until ordered by doc
Avoid crossing legs or being over
Do not sleep on operated side
Hydration
Stresses to new hip joint should be minimal in first 3-6 months
No pain meds in operative hip
How to prevent foot drop
Foot drop boot or high top tennis shoes
Anytime you’ve got somebody with an ortho or joint problem, what type of mattress do they need?
Firm for support
What do you do if one of a clients pins is laying on the floor when you walk in?
Immobilize leg, call doc. You take over the roll of the pin
Complications of total hip replacement
Dislocation
Infection
Avascular Necrosis
Immobility problems
Dislocation with total hip replacement
Circulatory and nerve damage
S/S: shortening of leg, abnormal rotation, can’t move extremity, PAIN
Infection with total hip replacement
Prophylactic ABX, just like with heart valve
Remove foley and drains ASAP
Avascular necrosis
Death of tissue due to poor circulation
Client education follow total hip replacement
Walking and swimming are best exercises
Avoid flexion: low chairs, traveling long distances, sitting more than 30 minutes, lifting heavy objects, excessive vending or twisting, stair climbing
Total Knee Replacement (Arthroplasty)
Continuous passive motion
Keeps knee in motion and prevents formation of scar tissue
PT sets matching to gradually increase flexion and extension of knee
Never hyperextend or hyper flex knee
NV checks
Pain relief
Where are amputations performed?
Most distal point that will heal, surgeon tries to preserve the knee and elbow
Immediate post op care for amputations
Keep tourniquet at bedside
Elevation is controversial bc hip contractures. If ordered, only elevate for short time to reduce swelling
Don’t elevate on pillow, use foot of bed
Prevent hip/knee contractures with extension
Inspect residual limb daily to be sure that it lies completely flat on the bed
Phantom pain: seen more with AKA’s, usually subsides in 3 months
First intervention to decrease phantom pain
Diversional activities
Why is limb shaping important with amputations
For a prosthetic
How do you want the stump shaped at the end of an amputation
Cone
What is worn under the prosthesis for amputations?
Limb sock
Why is it important to strengthen the upper body with amputations
They will be using crutches or a walker to ambulate
Is it okay to massage the stump of an amputation?
Yes, promotes circulation and decreases tenderness
How do you teach a client to toughen the stump with an amputation?
Press into a soft pillow, then a firm pillow, then the bed, then a chair
Walkers
Walk into a walker
Crutches
Should be 1-2 inches below axilla to prevent risk of brachial nerve damage
When ambulating, it’s up with the good leg, down with the bad leg
Use canes on which side of the body?
Strong side
