orthopedics Flashcards
fracture s/s
pain tenderness unnatural movement deformity shortening of extremity (r/t muscle spasms) crepitus swelling discoloration worry about compartment syndrome
fracture treatment
immobilize
support above and below site
little movement
splints help prevent fat emboli and muscle spasms
cover w/ sterile dressing for open fractures
**neurovascular checks (pulse, color, movement, sensation, CRT, temp)
fx complications
hypovolemic shock:
pelvic
crushing
long bone
fat embolism: long bone (femur) pelvic crushing s/s: petechiae rash over chest conjunctival hemorrhages snow storm on CXR
compartment syndrome:
increased pressure within a limited space
fluid accumulates in the tissue and impairs tissue perfusion
swollen muscle and hard with lots of pain
can result in nerve damage and amputation
***don’t need to have fx to have this
treatment:
loosen cast to restore circulation
cast cutters to remove/loosen cast
cast saws (vibrates but does not touch skin)
fasciotomy (cuts into tissue to relieve pressure and restore circulation)
plaster cast care
ice packs on side for first 24hrs because cast is wet
used for complex fx
prevent indentions (no fingertips)
keep cast uncovered and allow for air drying
dont rest on hard surface or sharp edge
rest on soft pillow; no plastic
mark breakthrough bleeding
cover cast close to groin with plastic
neurovascular checks
most pain is relieved by elevation, cold packs, and analgesics (***if this does not relieve pain, think complications)
fiberglass cast care
dry within 30minutes lightweight waterproof stronger *** do not stick anything down-- use blow dryer on cool can bear weight earlier hard to mold and contour (Drys quick) ***simple fx
traction
**never release unless you have prescription because muscles will spasms
uses pulling force to reduce and immobilize fx
goal is to reduce spasms, pain, realign bones, and prevent deformities
continuous
weights hang free
keep them up in bed and centered
exercise non-immbolized joints
ropes should move free and knots should be secure
weights should not rest on floor
prevent foot drop (boot or high top sneakers)
skin traction
short term relieve muscle spans immobilize until surgery tape, boot, or splint is on skin and weights pull against it Buck's skin assessment 3x/day
skeletal traction
directly to the bone with pins and wires prolonged Steinman pins, Crutchfield, Gardner-Wells tongs, Halo vest pin sites assess q8hrs pin care daily ***immobilize leg if pin falls out
total hip replacement
preop:
buck’s traction
postop: neurovascular checks monitor drains firm mattress over bed trapeze to build upper body strength neutral rotation (toes toward the ceiling) limit flexion extension of hip abduction isometric exercises trochanter roll to prevent external rotation **** no weight bearing until prescribed by HCP avoid crossing legs/bending over don't sleep on operated side hydrate no pain meds in hip
total hip replacement complications
dislocation (circulatory and nerve damage) s/s: shortening of leg abnormal rotation can't move extremity ***pain
infection:
prophylactic antibiotics
remove caths and drains asap
avascular necrosis (death of tissue r/t bad circulation) immobility
total hip replacement education
walk
swim
rock
avoid flexion: low chairs traveling long distances sitting more than 30minutes lifting heavy excessive bending/twisting stair climbing
amputations
most distal point
post op:
tourniquet at bedside (hemorrhage)
extension to prevent knee/hip contractures
inspect residual limb daily to be sure that it lies flat
prone position to extend hip/knee joints
phantom pain:
- **diversional activity, pain meds
- ** least invasive first
amputation rehab
limb shaping important for prosthesis
shape stump as a cone
limb sock should be worn under prosthesis
can massage stump to promote circulation and decrease tenderness
toughen the stump: press into soft pillow then firm pillow then bed then a chair ***needs to be tough for prosthesis otherwise it'll hurt
walker
walk into a walker
crutches
1-2inch below axilla to decrease risk of brachial nerve damage
rest body weight on hands
up with the good leg (stairs)
down with the bad leg (stairs)
