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45 Cards in this Set

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Encases portions of one or two extremities; consists of a body jacket cast and a long leg cast.
Spica Cast
Cast that encircles trunk.
Body Jacket Cast
6 Complications of Casts
Infection
Neurovascular compromise
Compartment Syndrome
Fat Embolism
Hazards of immobility
Disuse Syndrome (muscle atrophy)
Cast Care & Patient Education
Plaster should not get wet, 24-72hr to completely dry.
Padding should not be removed.
No foreign objects inside cast
Elevate & Ice first 24 hours
Avoid covering for long periods
Active ROM above and below.
Smooth rough edges.
Spica Cast Care
Turn patient q2h to promote drying and distribute pressure.
3 people to turn; never use abductor bar.
Skin assessment every shift.
Prone, twice daily if possible
Elimination
Cast syndrome (partial or complete upper intestinal obstruction)
Cast Syndrome S/s
Abdominal pain & distention, N/V, and decreased bowel sounds.
Cast Syndrome Treatment
Gastric decompression with NG tube.
Cast my need to be bivalved or removed.
Post Cast Removal Care
X-ray to confirm healing
Skin care (re-casting=do not wash; else wash and oil to remove dead skin)
Physical Therapy PRN
Mechanical force (sometimes generated by weights and pulleys) to put tension on a displaced bone or joint, such as a dislocated shoulder, to put it back in position and keep it still
Traction
Two Types of Traction
Skin - 48-72hr, 5-10lbs, Buck's & Russell
Skeletal - pins, screws, wires, through bone. 5 - 45lbs
8 Principles of Traction
Patient in correct alignment
Traction is continuous unless DR ordered
Counter traction is maintained continuously
All ropes must move freely
Rope knots never touch pulley
Ropes clear of linens & other.
Weights hang freely at all times.
Skeletal traction must never be released
9 Traction Complications
Skin breakdown
Muscle Weakness / Atrophy
Constipation / Anorexia
Isolation
Pain / Infection
Neurovascular compromise
Atelectasis / Pneumonia
Urinary stasis
Venous Thromboembolism
Used when internal fixation is contraindicated- often to treat open fractures or when a cast would not allow proper alignment of the fracture
External Fixation
Nursing Care: External Fixation
Pin Care
Never adjust hardware
Never use device to move extremity
Encourage isometric activity
Disturbed body image
May still need cast.
Surgical treatment of fracture using pins, screws, rods, plates or prosthesis to stabilize. Permits early mobilization.
Open Reduction with Internal Fixation
(ORIF)
3 Locations of Hip Fractures
Head, Neck, Trochanter
4 Hip Fracture S/s
Inability to move leg except with severe pain.
Externally rotated
Shortening.
Decreased ROM
3 Treatments for Hip Fractures
Buck's traction until surgery
ORIF
Femur head fracture = prosthesis (total hip replacement)
Pre-Op Care of Hip Fracture
Treat chronic health problems
Treat pain
Education (use of trapeze, exercise chair transfers, discharge plans)
Post-Op Care of Hip Fracture
First 24 - 48h relieve pain and prevent complications.
Coughing and deep breathing
Foot flexion q1-2h
Compression socks
Low dose heparin
IV antibiotics
I&O
Abduction and alignment
Neurovascular checks
3 Indications for Arthroplasty
Relieve pain
Improve or maintain ROM
Correct deformity
Hip Fracture Nutrition
High Protein
High Calorie
Vitamins B & C
Calcium
Iron for anemia
Total Hip Replacement: Monitoring for Dislocation
No adduction 4-6 weeks
Weight bearing status
No flexion > 90 degrees
Chair: slide forward, push up, affect leg forward
Use higher chairs / toilets
Avoid internal & external rotation
Sleeping position
Sex position
Total Hip Replacement: Dislocation S/s
Pain at surgical site, swelling and immobilization
Acute groin pain
Shortening
Abnormal internal or external rotation
Inability to move leg or restricted
Popping sensation
4 Immediate Complication of Fractures
Fat Embolism
Venous Thromboembolism
Compartment Syndrome
Infection
Late Complications of Fractures
Malunion
Delayed union
Non-union
Avascular necrosis
Chronic Osteomyelitis
Occurs when fat is released into the blood from bone marrow and tissue; trapped in lung capillaries; edema & hemorrhage in alveoli impair O2 transport - hypoxia
Fat Embolism (FES)
Fat Embolism: Triad of Symptoms
Acute Respiratory Failure
Neurological Dysfunction (pt becomes confused)
Petechial Rash (conjunctiva, inner cheeks, neck and axilla)
Fat Embolism: Treatment
Prevention
Support Respiratory System
High Fowlers
High concentration O2
Corticosteroids (decrease lung inflammation & cerebral edema)
Emboli originates in venous system or right side of heart; dislodges causing infarction of lung tissue due to decreased blood supply. Most common cause of death immediate post-op. May also occur after pelvis, hip or femur fracture.
Venous Thromboembolism
Venous Thrombosis S/s
Depends on size of thrombi
Labored or rapid breathing
Tachycardia
Pallor / Cyanosis
Chest Pain
Confusion
Impending doom
Venous Thrombosis: Diagnosis
ABGs
ECG
VQ Scan
Venous doppler
Venous Thrombosis: Treatment
Prevention
Hydration
Passive ROM
Ambulation ASAP
Stockings
Compression devices
Anticoagulant
Expected range of compartmental pressure.
0 - 10 mmHg
Compression from surrounding tissue (internal), cast or traction (external). Ischemia can occur 4-8 hours. Limb can become useless 24-48 hours. 30mmHg or higher
Acute Compartmental Syndrome (ACS)
When bone union occurs with the fragments in a deformed or improper position, Usually result of inadequate reduction & immobilization. If severe, may need to manually or surgically manipulate & re-immobilize
Malunion
A fracture slow to heal but does demonstrate some calcification.Caused by infection, inadequate immobilization or reduction, inadequate blood supply, metabolic disturbances.
Delayed Union
Repair of fracture stops & no further union after 9 months. Space between fragments too large, muscle or fascia between fragments, callus torn from activity, inadequate blood supply.
Non-union
Acute Compartment Syndrome: Treatment
Prevention & recognition
Extremity not raised above heart
Ice packs
Bivalve cast
Surgical decompression (fasciotomy
A transplant from one person to another, but not an identical twin.
Allograft
Tissue transplanted from one part of the body to another in the same individual.
Autograft
Common infection with open fractures; most common organism is Staph aureaus, S/s recurrent fevers, pain, poor incision healing, continued wound drainage. Treatment is antibiotics, possible removal of hardware
Osteomyelitis
Develops 3-4 days after injury; anaerobic bacteria; infection breaks down tissue causing gas.
Gas Gangrene
Bone loses blood supply from infection or fracture. common with femoral head / neck fracture; treatment is replacement of dead bone naturally by body or prosthesis
Avascular Necrosis
General Nursing Management of Fracture Complications
Identify complication
Patient education
Treat complications