Ortho Flashcards
Fractures
S/S
D CUPSS
Worry about
Discoloration
Crepitus bones grating together Unnatural movement Pain and tenderness Swelling Shortening of affected extremity
COMPARTMENT SYNDROME
Treatment for Fractures
Immobilize
Support
Little
Splint
Immobolize the bone ends plus adjacent joints
Support fracture above and below site
Move as little as possible
Splint helps prevent FAT EMBOLI and muscle spasms
What to do with open fractures?
Most important assessment in fracture?
Cover with something sterile or something clean
Neurovascular checks: Pulses Capillary refill Color Temperature Movement Sensation
3 Complications of fracture
Shock usually hypovolemic. It depends on type and amount of injury. Examples are pelvic, crushing, and multiple long bone fractures
Fat embolism can be seen with same fractures that can lead to shock like long bone, crushing and pelvic fractures. Symptoms depend on where the embolus goes. Example: 1.Petechiae or rash over chest 2.conjuctival hemorrhages 3.snowstorm on Chest XRAY
Danger time is FIRST 36 hours after injury and young males are at high risk because of risky behavior
Compartment syndrome
Compartment syndrome
If undetected
Increased pressure within a limited space
Fluid accumulates in tissues and impairs tissue perfusion. Muscles then become swollen and hard resulting to pain that is not resolved by pain meds.
May result in nerve damage and amputation if undetected. Common areas are forearms and quadriceps.
Treatment for compartment syndrome
Loosen
Dont remove
Fasciotomy
Cast saws
Loosen the cast to restore circulation. Example is bivalve cast.
Dont remove cast not unless it is really really bad
Fasciotomy is cutting of the tissue to relieve pressure and restore circulation
Cast saws dont touch the skin but it does vibrate
Plaster of paris cast care
Ice packs Indentions Uncovered Hard surface Bleeding Groin Assess for
Place ice packs on side of casts for the first 24 hours because it is still wet
Indentions are prevented because they can cause pressure sores. Use palms for first 24 to 72 hours Not fingertips
Keep casts uncovered and allow for air dry to let heat escape
Dont rest on Hard surface, sharp edge and especially plastic because plastic holds heat. Rest cast on soft pillow.
Mark bleeding site, circle area and write date and time
Cover cast close to groin with plastic until dry
Fiberglass cast care
Dries Advantageous Disadvantage Xray Bear Used for
Dries within 30 mins
Advantageous because it is stronger, lightweight and waterproof. Disadvantage is that finerglass is difficult to mold and contour
Xray imaging is a higher quality with fiberglass casts than plaster
Allow client to bear weight earlier
Primarily used for simlple fractures
Testing strategy
Dont stick anything
Never release
Dont stick anything into a cast. Use blow dryer on cool setting or diversional activity for itching
Never release traction without primary healthcare providers prescription
Traction
Types Goal Skeletal Weights Exercise Prevent Keep Special mattress
Skin and skeletal
Traction uses a pulling force to realign and immobilize fractures
Reduce muscle spasms,pain,realign bones and prevent deformities
Skeletal traction should be continuous
Weights should hang freely, dont touch anything and ropes are free and knots secured
Exercise non-immobilized joints
Prevent foot drop om clients with long immobilization by using boots
Keep client pulled up in bed and centered with good alignment
Special mattresses are used such as air filled or high density foam
If client with cast reports of pain?
If not relieved?
Check neurovascular
Most pain is relieved by elevation, cold packs and analgesics.
Check again and assume worst
Skin traction
Short Applied directly Penetrate Assess Example
This is used short term to relieve muscle spasms and immobilize until surgery
Applied directly to the skin and weight is pulled against it.
It does not pentrate the skin
Assess the skin 3 times a day. May ask another RN to support area
Bucks traction used with hip and femoral fractures
Skeletal traction
Long Applied Monitor Drainage Examples
Used on long term
Applied directly to the bone with pins and wires
Monitor pin sites every 8 hours. Care begins at 48 to 72 hours after insertion. Must be sterile
Serous drainage is normal
Types are steinman pins, crutchfield, gardner-wells tongs and halo vest
Total hip replacement
Pre-op care
Post op care Assess Monitor Firm Trapeze Position Exercise Avoid Hydrate Is it ok to sleep on operative side? Is it ok to give pain meds on operative hip?
Bucks traction is used preop to immobilize the fracture
Neurovascular checks
Monitor for drains. Dont want fluid to accumulate in tissues
Firm mattress is used to support joints
Over bed trapeze is used to build body strength
Position
Neutral rotation, toes pointed to ceiling
Limit flexion, extension of hip is needed
Abduction not adduction. Legs should be apart
Isometric exercises,squeezing
Avoid crossing legs, flexion could dislocate
Hydration is important
No. Wait for physician to prescribe
No.
Purpose of trochanter roll in post op hip replacement?
Is weight bearing ok in post op hop replacement?
To prevent external rotation and must be documented
No. Wait for prescription.
Complications of total hip replacement
- dislocation
- infection
- avascular necrosis
- Immobility problems
1.Dislocation could result to circulatory and nerve damage. S/S: shortening of leg, PAIN, abnormal rotation and cant move extremity
- Prophylactic antibiotics just like a heart valve replacement and remove catheters and drains ASAP cause these will serve as poetal for infection
- death of tissue due to poor circulation
Client education on total hip replacement
Exercise
Avoid
Best exercise is walking, swimming and rocking chair if prescribed
Avoid FLEXION: low chairs Traveling long distances Sitting more than 30 mins Lifting heavy objects Excessive bending or twisting Stair climbing
Amputations
Performed at
Preserve
Immediate post op care: Keep what Avoid Inspect Position
Performed at the most distal point that will heal
Surgeon tries to preserve the knee or elbow
Keep torniquet at bedside for massive hemorrhage
Avoid flexion. Always extension
Inspect residual limb daily and must be flat on bed
Prone position to extend hip or knee joints
Phantom pain
First intervention
Seen
Lasts
Some
Divertional activity and then pain medication
Seen more in AKA’s
Usually subsides in 3 mos
Some people it never goes away
Rehabilitation for amputations
Limb shaping Stump Wear Upper body Massage Toughen
ShapIng limb is important for the PROSTHESIS
Stump should be shaped like a CONE SHAPED
Limb sock is worn under prosthesis
Upper body strength is needed to use crutches to ambulate
Massage stump to promote circulation
Toughen the stump by:
Pressing into a soft pillow then a firm pillow then the bed and then a chair
After amputation surgery patient will have a really tight compression bandage. Why?
To prevent hemorrhage and edema. But after 2 weeks its purpose will be to shape the stump
Walkers
Crutches
Canes
You walk into a walker
Crutches should fit properly. 1 to 2 inches below axilla to decrease risk of brachial nerve damage. Body weight should rest on hands not axilla. Down with the bad, Up with the good
Use strong side of the body
