Orthopedics Flashcards
Fractures s/s
Pain / tenderness unnatureal movement deformity shortening of extremity due to muscle spasms crepitus swelling discoloration
*worry compartment
Txt for fractures
- *immobilize bone and adjacent
- support above and below
- move as little ass possible
splints decrease fat emboli and muscle spasms
For open fractures cover with sterile
Assess neurovas
What is neurovas
pulse, color, movement, sensation, cap refill temp
what are complications of fractures
hypovo shock specifically w/
pelvic fractures
crushing injuries
multiple long bone
Fat emboli occurs with
Seen with same fractures
pelvic
crushing injur
long bone
young males
first 36 hrs after injury
S/S of fat emboli
depending where it is but unusual
petchiae on chest
conjuctival hemo
snowball cxr
Compartment symdrome
increased pressure in a small space
fluid accumulates in tissue and impairs perfusion. muscle becomes swollen and does not relieve with pain meds, can lead to nerve damage and amputation
Common areas are arms and quads
Txt of compartment
losen the cast - called bivalving
becareful choosing remove cast cause its like the last resort use saw cutters that dont touch skin explain to client it just vibrates.
Fasciotomy cuts down tissue to relieve pressure and restore circulation
Plaster cast care
Ice packs for first 24hrs ON THE SIDE, prevent indents use pals for first 24-72 hrs. no fingers!
Let it be uncovered, air dry, soft surface, mark bleeding circle time and site, cover cast close to groin with plastic and neurovas checks
What to do if plaster care client reports of pain
Neurocheck, elevate, cold pack pain meds if unrelieved think compartment.
Fiberglass cast
Dries within 30 minutes, lightweight, waterproof and stronger than plaster cast, better on xray, can allow weight bearing but its difficult to contour and so used only with small fractures
Traction
Used to reduce and immobolize fracture, reduce spasms, pain, realign bone and prevent deformity
Weights hang freely not on floor , exercised nonimbolized joints, ropes should be moving freely and knots should be secure, special mattress, prevent foot drop use foot boot
Skeletal traction should be
continous why?
Foot drops are problems with clients who are
immobolize for a long time such as ortho spinal clients
Skin traction
Use to relieve muscle spasms up until surgery, some type of boot or splint in which weight pulls against it. a common type is bucks and requires skin assessment 3x a day
Skeletal Traction
Pins and wires are applied and utilized to prolong traction. must monitor every 8hrs and care begins 48-72 hrs after insertion. requires sterile technique. clear fluid may drain and it is okay
Post op care for total Hip replacement
Buck traction to immbolize fracture
Clients with orthopedic joint problems require what?
Firm matress
Nursing consideration Post op Total Hip
When I assess the patient the patient should be lying on a FIRM mattress. Ill start first with checking my neurochecks, then moving onto their position. They should be neutral (toes up) EXTENSION not FLEXSION, and abduction. and a trochanter roll under to prevent the external document.
When they exercise they should have atrapeze to build upper core strength, isometric exercises. NWB.
What are your complications for hip/traction?
Dislocation which makes circulatory and nerve damage.
s/s shortened leg, abnormal rotation, cant move , and pain
Infection
Give antbiotics and remove indwelling catheters anything foreign in the body act as a portal of infection
avascular necrosis - lack of circulation
immobility problems
Client education for Rehab in total hip replacement
best exercise is walking, swimming, rocking
avoid flexing anything bending the knee too much
Amputations
Performed at the most distal point, and usually perserves knee or elbow.
Post op care amputations
Tourniquet at beside just incase of hemorrhage, prevent contractures how? patient should lie flat, and position should be prone
How to deal with phantom pain with amputees?
Always use diversional activities, then pain meds, usually subsides 3 months after. This is seen more with above knee amputations
